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1000 Endometrial laser ablation
August t995, Vol. 2, No. 4. Supplement The Journal of the American Association of Gynecologic Laparoscopists
Laparoscopic Management of Benign Cystic Teratomas During Pregnancy
quently had cesarean deliveries. The Pelosi laparoscopic single-puncture furrowing technique is a simple and cost-effective alternative to current laparoscopic ovarian drilling procedures.
WH Parker, M Canis, JM Childers, DR Phillips. UCLA Medical Center, Los Angeles, CA.
We reviewed the records of women who had laparoscopic management of a benign cystic teratoma during pregnancy, and evaluated the outcome of surgery and the effects on the pregnancy and fetus. Between 1987 and 1995, 10 women (age range 21-36 yrs) underwent laparoscopic removal of a benign cystic teratoma during pregnancy. Gestational ages at the time of surgery ranged from 10 to 17 weeks (mean 14 wks). Cyst size ranged from 5 to 13 cm (mean 8.5 cm). Intraoperative rupture of the cyst occurred in seven of eight women undergoing cystectomy and in both women who had an oophorectomy. Estimated blood loss ranged from 5 to 100 ml (mean 52 ml); operating time ranged from 60 to 130 minutes (mean 87 min); hospital stay ranged from 8 to 72 hours (mean 44 hrs). No intraoperative or postoperative complications occurred. Two women underwent elective termination of the pregnancy; one because of a finding of trisomy 13 at amniocentesis, and the other because she was found to have a major cardiac anomaly during a subsequent sonographic examination. The remaining eight women delivered at term without incident, and none required a cesarean section.
Successful Laparoscopic Removal of a 103-Pound Ovarian Tumor MA Pelosi. Pelosi Women's Medical Center, Bayonne, NJ.
A 103-pound mucinous cystadenoma was removed successfully from a 22-year-old woman using only an operative laparoscope and an umbilical incision 2.5 cm in length. The patient was discharged in good condition 48 hours after surgery. This demonstrates that minimally invasive surgery can be performed safely and effectively in carefully selected patients with extremely large, benign ovarian cysts. Moreover, the size of a pelvic mass alone should not contraindicate laparoscopic surgery as an alternative to laparotomy.
Laparoscopic Treatment of Genitofemoral Neuralgia CP Perry, AMI Brookwood, Women's Medical Center, Birmingham, AL.
Genitofemoral neuralgia is marked by pain in the labia, groin, and medial aspect of the thigh; it is often intense and disabling. Onset may occur after appendectomy, with scarfing around the genitofemoral nerve as it emerges onto the anterior surface of the psoas muscle. The traditional surgical approach has been through the flank incision with extraperitoneal dissection and neurolysis. To our knowledge, this is the first report of laparoscopic treatment of genitofemoral neuralgia.
Laparoscopic Treatment of Polycystic Ovaries Using the Pelosi Furrowing Technique MA Pelosi. Pelosi Women's Medical Center, Bayonne, NJ.
A technique for laparoscopic treatment of infertile women with anovulatory polycystic ovarian disease resistant to conventional ovulation agents uses only an operative laparoscope placed intraumbilically. Through the operative channel of the laparoscope a unipolar electrosurgical needle is used to create four to six linear incisions into the ovarian tissue parallel to the long axis of the ovary. The average operating time for each ovary is approximately 5 minutes. Thus far 24 patients have been treated with this method with no technical difficulty. No bleeding problems or intraoperative or postoperative complications occurred. The reduction of androgen levels postoperatively was highly significant. Regular menses and ovulatory function resumed in 83.3% of women. Spontaneous conception occurred in 70.8%. Minimal periovarian adhesions were found in three patients who subse-
1000 Endometrial Laser Ablations AG Phillips, R Garry, M Whittaker. Women's Endoscopic Laser Foundation, South Cleveland Hospital, Middlesbrough, and St. James' Hospital, Leeds, United Kingdom.
Over a 5-year period 1000 consecutive endometrial laser ablations were performed for dysfunctional uterine bleeding or submucous fibroids amenable to laser resection or ablation. The women were pretreated mainly with danazol at the start of the study, and later with goserelin, a luteinizing hormone-releasing hormone analog. All patients were seen ha the clinic at least at 6 months postoperatively, and were subsequently followed with mailed questionnaires. The main outcome measures were amenorrhea (defined as no menstrual loss whatsoever), oligomenorrhea, patient satisfaction,
$41
Selected Scientific Abslracts
and subsequent hysterectomy rates. A response rate of over 90% was achieved during follow-up of 9 to 67 months. No major operative morbidity occurred, and there were no cases of hemorrhage or transfusion, no uterine perforations with the operating instruments, and no immediate laparotomies or hysterectomies. Patient satisfaction rate was over 85% and the subsequent hysterectomy rate remains under 8%. In conclusion, with or without submucous fibroids, endometrial laser ablation was a consistently successful and safe treatment for dysfunctional uterine bleeding.
min) and the mean hospital stay was 1.48 days (range 1-5 days). Ninety-five patients returned to work within 2 weeks. Hysterectomy by the laparoscopic route may be performed safely in private and academic hospitals as long as one surgeon is experienced and has appropriate credentialing and training.
Bipolar Coagulation of Laparoscopic Leiomyomata DR Phillips. Department of Gynecologic Endoscopy and Laser Surgery, South Nassau Communities Hospital, Oceanside, NY, and Department of Obstetrics and Gynecology, School of Medicine, State University of New York at Stony Brook, Stony Brook, New York.
Lateral Heat Spread With Bipolar Diathermy During Laparoscopic Hysterectomy
From February 1992 through March 1995, 167 women (age 22-52 yrs, mean 44.7 yrs) with symptomatic leiomyomas underwent laparoscopic leiomyoma bipolar coagulation (myolysis). Women with chronic menorrhagia had concomitant transcervical endomyometrial resection (TEMR) and resection of any existing submucous leiomyomas. Depot leuprolide acetate was administered for 3 months before surgery to 165 (98.8%) of the women. Mean followup was 26.2 months (range 6-37 mo). The operations were evaluated in terms of number and type of concomitant procedures, whether or not symptoms were controlled, and changes in uterine and leiomyomata volumes. Nineteen participants (11.4%) had elective second-look laparoscopy 6 months postoperatively. Four women (2.4%) later complained of recurring symptoms; three subsequently had hysterectomies that revealed extensive adenomyosis in one uterus and numerous large leiomyomas not previously treated by myolysis in two. Of 52 women with chronic menorrhagia, 33 (63.5%) developed amenorrhea, 17 (32.7%) had hypomenorrhea or eumenorrhea, and 2 (3.8%) required repeat TEMR. Mean total uterine volume decreased from 623 cm 3 (before leuprolide treatment) to 139 cm 3 (77.7% reduction) 7 to 12 months postoperatively (p <0.0001).
AG Phillips. Women's Endoscopic Laser Foundation, South Cleveland Hospital, Middlesbrough, and St. James's Hospital, Leeds, United Kingdom.
Concern has been expressed regarding the potential risks of using bipolar diathermy to desiccate the uterine artery in the region of the ureter during laparoscopic hysterectomy. A study was carried out using thermocouples to assess heat transfer around the uterine and ovarian vessels as they are secured with bipolar diathermy using the ERBE electrosurgical generator with its autostop facility. This detects rising tissue impedance as the tissues are desiccated and automatically shuts offpower. We found that slight rises in temperature do occur adjacent to the ureter, but they are insufficient to cause thermal necrosis of the ureter when correct, safe surgical technique is used.
Laparoscopic Hysterectomy and Its Variations in Private and Academic Hospitals DR Phillips. Department of Gynecologic Endoscopy and Laser Surgery, South Nassau Communities Hospital, Oceanside, NY, and Department of Obstetrics and Gynecology, School of Medicine, State University of New York at Stony Brook, Stony Brook, New York.
From July 1990 to August 1994 1 performed 100 laparoscopic hysterectomies and variations in 17 private and academic institutions. Bipolar coagulation was used exclusively in 22 cases, Endo GIA 30 exclusively in 58, and a combination of the two in 20. Bilateral ureteral catheters were used 49 times. Of the 108 hysterectomies attempted, 8 were converted to laparotomy. Five complications occurred: two transfusions, two transient febrilities, and one Richter hernia. The repair of the hernia was the only delayed laparotomy. Mean operating time was 123 minutes (range 45-235
LaparoscopicManagement of Heterotopic Pregnancies GA Pistofidis, MJ Mastrominas, K Dimitropoulos. Fertility Centre, Mitera Hospital, Athens, Greece.
The frequency of heterotopic pregnancy after in vitro fertilization (IVF) is reportedly as high as 2.9%. Early management is of paramount importance for both the safety of the mother and the continuation of the intrauterine gestation. We reviewed four cases of
$42
Laparoscopic Management of Benign Cystic Teratomas During Pregnancy
quently had cesarean deliveries. The Pelosi laparoscopic single-puncture furrowing technique is a simple and cost-effective alternative to current laparoscopic ovarian drilling procedures.
WH Parker, M Canis, JM Childers, DR Phillips. UCLA Medical Center, Los Angeles, CA.
We reviewed the records of women who had laparoscopic management of a benign cystic teratoma during pregnancy, and evaluated the outcome of surgery and the effects on the pregnancy and fetus. Between 1987 and 1995, 10 women (age range 21-36 yrs) underwent laparoscopic removal of a benign cystic teratoma during pregnancy. Gestational ages at the time of surgery ranged from 10 to 17 weeks (mean 14 wks). Cyst size ranged from 5 to 13 cm (mean 8.5 cm). Intraoperative rupture of the cyst occurred in seven of eight women undergoing cystectomy and in both women who had an oophorectomy. Estimated blood loss ranged from 5 to 100 ml (mean 52 ml); operating time ranged from 60 to 130 minutes (mean 87 min); hospital stay ranged from 8 to 72 hours (mean 44 hrs). No intraoperative or postoperative complications occurred. Two women underwent elective termination of the pregnancy; one because of a finding of trisomy 13 at amniocentesis, and the other because she was found to have a major cardiac anomaly during a subsequent sonographic examination. The remaining eight women delivered at term without incident, and none required a cesarean section.
Successful Laparoscopic Removal of a 103-Pound Ovarian Tumor MA Pelosi. Pelosi Women's Medical Center, Bayonne, NJ.
A 103-pound mucinous cystadenoma was removed successfully from a 22-year-old woman using only an operative laparoscope and an umbilical incision 2.5 cm in length. The patient was discharged in good condition 48 hours after surgery. This demonstrates that minimally invasive surgery can be performed safely and effectively in carefully selected patients with extremely large, benign ovarian cysts. Moreover, the size of a pelvic mass alone should not contraindicate laparoscopic surgery as an alternative to laparotomy.
Laparoscopic Treatment of Genitofemoral Neuralgia CP Perry, AMI Brookwood, Women's Medical Center, Birmingham, AL.
Genitofemoral neuralgia is marked by pain in the labia, groin, and medial aspect of the thigh; it is often intense and disabling. Onset may occur after appendectomy, with scarfing around the genitofemoral nerve as it emerges onto the anterior surface of the psoas muscle. The traditional surgical approach has been through the flank incision with extraperitoneal dissection and neurolysis. To our knowledge, this is the first report of laparoscopic treatment of genitofemoral neuralgia.
Laparoscopic Treatment of Polycystic Ovaries Using the Pelosi Furrowing Technique MA Pelosi. Pelosi Women's Medical Center, Bayonne, NJ.
A technique for laparoscopic treatment of infertile women with anovulatory polycystic ovarian disease resistant to conventional ovulation agents uses only an operative laparoscope placed intraumbilically. Through the operative channel of the laparoscope a unipolar electrosurgical needle is used to create four to six linear incisions into the ovarian tissue parallel to the long axis of the ovary. The average operating time for each ovary is approximately 5 minutes. Thus far 24 patients have been treated with this method with no technical difficulty. No bleeding problems or intraoperative or postoperative complications occurred. The reduction of androgen levels postoperatively was highly significant. Regular menses and ovulatory function resumed in 83.3% of women. Spontaneous conception occurred in 70.8%. Minimal periovarian adhesions were found in three patients who subse-
1000 Endometrial Laser Ablations AG Phillips, R Garry, M Whittaker. Women's Endoscopic Laser Foundation, South Cleveland Hospital, Middlesbrough, and St. James' Hospital, Leeds, United Kingdom.
Over a 5-year period 1000 consecutive endometrial laser ablations were performed for dysfunctional uterine bleeding or submucous fibroids amenable to laser resection or ablation. The women were pretreated mainly with danazol at the start of the study, and later with goserelin, a luteinizing hormone-releasing hormone analog. All patients were seen ha the clinic at least at 6 months postoperatively, and were subsequently followed with mailed questionnaires. The main outcome measures were amenorrhea (defined as no menstrual loss whatsoever), oligomenorrhea, patient satisfaction,
$41
Selected Scientific Abslracts
and subsequent hysterectomy rates. A response rate of over 90% was achieved during follow-up of 9 to 67 months. No major operative morbidity occurred, and there were no cases of hemorrhage or transfusion, no uterine perforations with the operating instruments, and no immediate laparotomies or hysterectomies. Patient satisfaction rate was over 85% and the subsequent hysterectomy rate remains under 8%. In conclusion, with or without submucous fibroids, endometrial laser ablation was a consistently successful and safe treatment for dysfunctional uterine bleeding.
min) and the mean hospital stay was 1.48 days (range 1-5 days). Ninety-five patients returned to work within 2 weeks. Hysterectomy by the laparoscopic route may be performed safely in private and academic hospitals as long as one surgeon is experienced and has appropriate credentialing and training.
Bipolar Coagulation of Laparoscopic Leiomyomata DR Phillips. Department of Gynecologic Endoscopy and Laser Surgery, South Nassau Communities Hospital, Oceanside, NY, and Department of Obstetrics and Gynecology, School of Medicine, State University of New York at Stony Brook, Stony Brook, New York.
Lateral Heat Spread With Bipolar Diathermy During Laparoscopic Hysterectomy
From February 1992 through March 1995, 167 women (age 22-52 yrs, mean 44.7 yrs) with symptomatic leiomyomas underwent laparoscopic leiomyoma bipolar coagulation (myolysis). Women with chronic menorrhagia had concomitant transcervical endomyometrial resection (TEMR) and resection of any existing submucous leiomyomas. Depot leuprolide acetate was administered for 3 months before surgery to 165 (98.8%) of the women. Mean followup was 26.2 months (range 6-37 mo). The operations were evaluated in terms of number and type of concomitant procedures, whether or not symptoms were controlled, and changes in uterine and leiomyomata volumes. Nineteen participants (11.4%) had elective second-look laparoscopy 6 months postoperatively. Four women (2.4%) later complained of recurring symptoms; three subsequently had hysterectomies that revealed extensive adenomyosis in one uterus and numerous large leiomyomas not previously treated by myolysis in two. Of 52 women with chronic menorrhagia, 33 (63.5%) developed amenorrhea, 17 (32.7%) had hypomenorrhea or eumenorrhea, and 2 (3.8%) required repeat TEMR. Mean total uterine volume decreased from 623 cm 3 (before leuprolide treatment) to 139 cm 3 (77.7% reduction) 7 to 12 months postoperatively (p <0.0001).
AG Phillips. Women's Endoscopic Laser Foundation, South Cleveland Hospital, Middlesbrough, and St. James's Hospital, Leeds, United Kingdom.
Concern has been expressed regarding the potential risks of using bipolar diathermy to desiccate the uterine artery in the region of the ureter during laparoscopic hysterectomy. A study was carried out using thermocouples to assess heat transfer around the uterine and ovarian vessels as they are secured with bipolar diathermy using the ERBE electrosurgical generator with its autostop facility. This detects rising tissue impedance as the tissues are desiccated and automatically shuts offpower. We found that slight rises in temperature do occur adjacent to the ureter, but they are insufficient to cause thermal necrosis of the ureter when correct, safe surgical technique is used.
Laparoscopic Hysterectomy and Its Variations in Private and Academic Hospitals DR Phillips. Department of Gynecologic Endoscopy and Laser Surgery, South Nassau Communities Hospital, Oceanside, NY, and Department of Obstetrics and Gynecology, School of Medicine, State University of New York at Stony Brook, Stony Brook, New York.
From July 1990 to August 1994 1 performed 100 laparoscopic hysterectomies and variations in 17 private and academic institutions. Bipolar coagulation was used exclusively in 22 cases, Endo GIA 30 exclusively in 58, and a combination of the two in 20. Bilateral ureteral catheters were used 49 times. Of the 108 hysterectomies attempted, 8 were converted to laparotomy. Five complications occurred: two transfusions, two transient febrilities, and one Richter hernia. The repair of the hernia was the only delayed laparotomy. Mean operating time was 123 minutes (range 45-235
LaparoscopicManagement of Heterotopic Pregnancies GA Pistofidis, MJ Mastrominas, K Dimitropoulos. Fertility Centre, Mitera Hospital, Athens, Greece.
The frequency of heterotopic pregnancy after in vitro fertilization (IVF) is reportedly as high as 2.9%. Early management is of paramount importance for both the safety of the mother and the continuation of the intrauterine gestation. We reviewed four cases of
$42