- Email: [email protected]
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Oral Presentations cally intracorporeally. Two patients developed right sided ureterovaginal fistulas, in one it healed with postoperative stenting and in the other patient, laparoscopic ureteroneocystotomy was performed. Conclusion: Laparoscopic hysterectomy for large myomatous uteri is feasible in experienced hands with competent assistants and a state-of-the- art endoscopic set-up. Urinary tract injuries must be detected in time and treated appropriately to ensure good results. FRIDAY, NOVEMBER 11, 2005 (11:40 AM–11:50 AM) Plenary 14 —Hysterectomy 116 Hysterectomies Performed in Illinois in 2003 Tu FF. Evanston Northwestern Healthcare, Evanston, Illinois Study Objective: Objective: to profile laparoscopic, vaginal, and abdominal hysterectomies done in Illinois in 2003. Background: State-level data on medical procedures is needed to guide health care policy planners. Hysterectomies remain one of the most common procedures performed on U.S. women. With minimally invasive approaches to treat uterine problems available, we were interested in characterizing changes in the performance of hysterectomy within Illinois. Design: Cross-sectional study (Level III). Setting: State level database. Patients: Women undergoing hysterectomy in Illinois hospitals in 2000 and 2003. Intervention: We used the Illinois Hospital Association’s COMPdata database to calculate the number of procedures performed in 2003 and 2000 with a primary ICD-9 procedure code listed as laparoscopic assisted vaginal hysterectomy, laparoscopic supracervical hysterectomy, vaginal hysterectomy, subtotal hysterectomy, or total abdominal hysterectomy. Diagnosis codes (including complications) were identified and tabulated. Procedures were compared across length of stay, age, type of hospital, insurance type, and total charges. Measurements and Main Results: Total number of primary coded hysterectomies declined during the period under observation from 72,537 in 2000 down to 62,549 in 2003. Eighty-one percent were performed by abdominal approach, 15% by vaginal approach, and 4% by laparoscopic approach in both years. Mean age of women undergoing these respective procedures in 2003 was 47.6, 49.1, and 43.4 (similar to 2000). All procedure categories (in both years) had a 2% complication rate for the index surgical hospitalization (including hemorrhage, intestinal injury, urinary tract injury, or unspecified surgical complication), except for vaginal hysterectomy in 2000 (1%). Conclusion: Total reported hysterectomies have markedly declined over three years in Illinois. Despite increased attention to the feasibility of laparoscopic hysterectomy, minimally invasive approaches remain infrequent.
S49 FRIDAY, NOVEMBER 11, 2005 (11:50 AM–12:00 NOON) Plenary 14 —Hysterectomy 117 Changing Hysterectomy Technique: New Trend in Oslo, Norway Istre O, Lieng M, Qvigstad E. Ullevaal University Hospital, Hamar, Norway; Ulleval Hospital, Oslo, Norway Study Objective: To evaluate the operative hysterectomy technique in women treated for symptomatic uterine fibroids. Setting: University tertiary referring center in Oslo, Norway. Patients: Investigation of the hysterectomy technique over a 4 years period in Oslo area with a population of 750 000. Intervention: Patient operative record was investigated in 1279 women treated with hysterectomy. Measurements and Main Results: Investigation of operative patient record; if the surgery was performed with laparotomy or laparoscopy, as well as the indication for surgery. A total of 1279 hysterectomies were performed in the period 2001-2004. In 2001, 45 (13.8%) laparoscopic subtotal hysterectomies and 23 (7%) total laparoscopic hysterectomies were performed, while 258 (79.3%) of the hysterectomies were done with laparotomy. The indication for surgery was fibroids in 79% of the laparotomies, 44% in the endoscopic group. This trend has changed gradually through the years. In 2004, 58% of the surgical procedures were laparoscopic, 155 (44%) subtotal and 49 (14%) total laparoscopic hysterectomy. The indication for surgery in 2004 was fibroids in 88% in the laparotomy group, 69% in the endoscopic group. Conclusion: From 2001 to 2004 a trend shift of the operative technique has been seen in Oslo, increasing the endoscopic hysterectomies from 20.8% to 58%. During the same time, larger fibroid uteri are increasingly converted to laparoscopic subtotal hysterectomy, from 44% to 69%. With modern equipment and trained staff more of the routine hysterectomies can be managed endoscopically. FRIDAY, NOVEMBER 11, 2005 (12:00 NOON–12:10 PM) Plenary 14 —Hysterectomy 118 How Often Do We Need a Laparotomy to Remove the Uterus? Canis MJ, Messina R, Botchorishvili R. Clermont Ferrand, France; CHU Polyclinque, Clermont-Ferrand, France Study Objective: After our learning of laparoscopic hysterectomy (an initial series of 1647 cases), we designed the present study to assess the incidence of laparotomy among patients who underwent a hysterectomy for the treatment of
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a benign uterine condition in a department with a good experience of laparoscopic hysterectomy. Design: A retrospective study. Setting: Large tertiary care hospital with university affiliation. Patients: All the patients who underwent a hysterectomy, between January 2000 and December 2003 were included except patients operated for a cancer or a uterine prolapse. Intervention: Clinical data were reviewed retrospectively. Measurements and Main Results: Six hundred sixty-nine patients were included, 32 were operated by laparotomy, 637 by laparoscopy. In the latter group a conversion to laparotomy was necessary in 14 cases. Overall 46 patients (6.9%) underwent a laparotomy and 623 were treated without laparotomy (93.1%). The procedures were performed by 15 different surgeons including seniors, fellows and residents operating under supervision. Only 1 patient received a blood transfusion. Four bladder lacerations (0.6%) and two ureteral coagulations (0.3%) were managed successfully without laparotomy (uneventful postoperative course). Postoperatively 2 vesico vaginal (0.3%) and ureterovaginal (0.3%) fistulae occurred. Conclusion: In our setting a laparoscopic approach allows to perform 93% of all hysterectomies without laparotomy, with a very low complication rate. FRIDAY, NOVEMBER 11, 2005 (12:10 PM–12:20 PM) Plenary 14 —Hysterectomy 119 Evaluating the Economic Cost of Laparoscopic Supracervical Hysterectomy Nainani SR, Lyons TL, Nainani GS. Medical College of Georgia, Augusta, Georgia; Atlanta, Georgia; Augusta, Georgia Study Objective: To determine the economic cost of laparoscopic supracervical hysterectomy. Design: Retrospective analysis. Canadian Task Force classification II-3. Setting: Private Southern urban practice. Patients: All patients undergoing laparoscopic supracervical hysterectomy (LSH) by a single surgeon at a single outpatient surgery center in a large Southern metropolitan area between October 2000 and February 2004. Intervention: One hundred seventeen patients underwent LSH in the time period. Explicit costs, direct and indirect, were obtained by a detailed costing analysis of each case, including time away from work. Abdominal hysterectomy cost comparison is anticipated. Measurements and Main Results: Preliminary analysis reveals the average procedure time was 187 minutes. The average recovery room stay was 13.7 hours. The cost of LSH supplies, overhead and staff was $9,378. Implicit costs, as measured by lost earnings, were $1,062. Conclusion: A comprehensive approach to health care re-
quires economic and clinical considerations. The benefits of the minimally invasive technique of LSH are established in the literature. This study enhances our understanding of the procedure’s economic impact. FRIDAY, NOVEMBER 11, 2005 (2:45 PM–2:55 PM) Plenary 15—Leiomyomas 120 Effect of Pregnancy on Uterine Myomas Hammoud AO, Asaad R. Wayne State University, Detroit, Michigan Study Objective: To define the changes in uterine fibroid volume during pregnancy. Design: Retrospective review of departmental electronic perinatal data base and medical records. Setting: Obstetrical ultrasound unit in a tertiary care center. Patients: One hundred seven patients diagnosed with uterine fibroids during pregnancy and who had two or more obstetrical ultrasounds in different periods of pregnancy. The mean age of the population was 31 ⫾ 6 years. Intervention: We analyzed the change in volume of uterine fibroid between the first half of pregnancy (up until 19 weeks), third quarter (20⫺30 weeks) and last quarter (31 weeks-term). The volume of largest uterine fibroid was calculated using the formula: Volume (mm3) ⫽ 0.523 x (length mm) x (width mm) x (height mm). Measurements and Main Results: Between the third quarter and the first half, the percentage of fibroids that got smaller was 55.1% with a mean decrease in volume of ⫺35 ⫾ 4%, and the percentage of fibroids that enlarged was 44.9% with a mean increase in volume of 69 ⫾ 11%. Between the last and third trimester, those that got smaller were 75% with a mean decrease in volume of - 30 ⫾ 3%, the percentage of those that enlarged was 25% with a mean increase in volume of 102 ⫾ 62%. Conclusion: Contrary to the common belief, we found that uterine fibroid commonly decrease in volume over the course of pregnancy. When there was in increase in size, it was most marked in the last quarter of pregnancy. FRIDAY, NOVEMBER 11, 2005 (2:55 PM–3:05 PM) Plenary 15—Leiomyomas 121 Natural Progression of Uterine Fibroid Size: A Comparison of Pregnancy and Post-Pregnancy Volumes Johnston EB, Goldberg JB, Bromberg JV, Diamond JJ, Weinstein L. Thomas Jefferson University Hospital, Philadelphia, Pennsylvania Study Objective: To determine the natural progression of the change in size of uterine fibroids in the postpartum period as compared with during pregnancy.
S49 FRIDAY, NOVEMBER 11, 2005 (11:50 AM–12:00 NOON) Plenary 14 —Hysterectomy 117 Changing Hysterectomy Technique: New Trend in Oslo, Norway Istre O, Lieng M, Qvigstad E. Ullevaal University Hospital, Hamar, Norway; Ulleval Hospital, Oslo, Norway Study Objective: To evaluate the operative hysterectomy technique in women treated for symptomatic uterine fibroids. Setting: University tertiary referring center in Oslo, Norway. Patients: Investigation of the hysterectomy technique over a 4 years period in Oslo area with a population of 750 000. Intervention: Patient operative record was investigated in 1279 women treated with hysterectomy. Measurements and Main Results: Investigation of operative patient record; if the surgery was performed with laparotomy or laparoscopy, as well as the indication for surgery. A total of 1279 hysterectomies were performed in the period 2001-2004. In 2001, 45 (13.8%) laparoscopic subtotal hysterectomies and 23 (7%) total laparoscopic hysterectomies were performed, while 258 (79.3%) of the hysterectomies were done with laparotomy. The indication for surgery was fibroids in 79% of the laparotomies, 44% in the endoscopic group. This trend has changed gradually through the years. In 2004, 58% of the surgical procedures were laparoscopic, 155 (44%) subtotal and 49 (14%) total laparoscopic hysterectomy. The indication for surgery in 2004 was fibroids in 88% in the laparotomy group, 69% in the endoscopic group. Conclusion: From 2001 to 2004 a trend shift of the operative technique has been seen in Oslo, increasing the endoscopic hysterectomies from 20.8% to 58%. During the same time, larger fibroid uteri are increasingly converted to laparoscopic subtotal hysterectomy, from 44% to 69%. With modern equipment and trained staff more of the routine hysterectomies can be managed endoscopically. FRIDAY, NOVEMBER 11, 2005 (12:00 NOON–12:10 PM) Plenary 14 —Hysterectomy 118 How Often Do We Need a Laparotomy to Remove the Uterus? Canis MJ, Messina R, Botchorishvili R. Clermont Ferrand, France; CHU Polyclinque, Clermont-Ferrand, France Study Objective: After our learning of laparoscopic hysterectomy (an initial series of 1647 cases), we designed the present study to assess the incidence of laparotomy among patients who underwent a hysterectomy for the treatment of
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a benign uterine condition in a department with a good experience of laparoscopic hysterectomy. Design: A retrospective study. Setting: Large tertiary care hospital with university affiliation. Patients: All the patients who underwent a hysterectomy, between January 2000 and December 2003 were included except patients operated for a cancer or a uterine prolapse. Intervention: Clinical data were reviewed retrospectively. Measurements and Main Results: Six hundred sixty-nine patients were included, 32 were operated by laparotomy, 637 by laparoscopy. In the latter group a conversion to laparotomy was necessary in 14 cases. Overall 46 patients (6.9%) underwent a laparotomy and 623 were treated without laparotomy (93.1%). The procedures were performed by 15 different surgeons including seniors, fellows and residents operating under supervision. Only 1 patient received a blood transfusion. Four bladder lacerations (0.6%) and two ureteral coagulations (0.3%) were managed successfully without laparotomy (uneventful postoperative course). Postoperatively 2 vesico vaginal (0.3%) and ureterovaginal (0.3%) fistulae occurred. Conclusion: In our setting a laparoscopic approach allows to perform 93% of all hysterectomies without laparotomy, with a very low complication rate. FRIDAY, NOVEMBER 11, 2005 (12:10 PM–12:20 PM) Plenary 14 —Hysterectomy 119 Evaluating the Economic Cost of Laparoscopic Supracervical Hysterectomy Nainani SR, Lyons TL, Nainani GS. Medical College of Georgia, Augusta, Georgia; Atlanta, Georgia; Augusta, Georgia Study Objective: To determine the economic cost of laparoscopic supracervical hysterectomy. Design: Retrospective analysis. Canadian Task Force classification II-3. Setting: Private Southern urban practice. Patients: All patients undergoing laparoscopic supracervical hysterectomy (LSH) by a single surgeon at a single outpatient surgery center in a large Southern metropolitan area between October 2000 and February 2004. Intervention: One hundred seventeen patients underwent LSH in the time period. Explicit costs, direct and indirect, were obtained by a detailed costing analysis of each case, including time away from work. Abdominal hysterectomy cost comparison is anticipated. Measurements and Main Results: Preliminary analysis reveals the average procedure time was 187 minutes. The average recovery room stay was 13.7 hours. The cost of LSH supplies, overhead and staff was $9,378. Implicit costs, as measured by lost earnings, were $1,062. Conclusion: A comprehensive approach to health care re-
quires economic and clinical considerations. The benefits of the minimally invasive technique of LSH are established in the literature. This study enhances our understanding of the procedure’s economic impact. FRIDAY, NOVEMBER 11, 2005 (2:45 PM–2:55 PM) Plenary 15—Leiomyomas 120 Effect of Pregnancy on Uterine Myomas Hammoud AO, Asaad R. Wayne State University, Detroit, Michigan Study Objective: To define the changes in uterine fibroid volume during pregnancy. Design: Retrospective review of departmental electronic perinatal data base and medical records. Setting: Obstetrical ultrasound unit in a tertiary care center. Patients: One hundred seven patients diagnosed with uterine fibroids during pregnancy and who had two or more obstetrical ultrasounds in different periods of pregnancy. The mean age of the population was 31 ⫾ 6 years. Intervention: We analyzed the change in volume of uterine fibroid between the first half of pregnancy (up until 19 weeks), third quarter (20⫺30 weeks) and last quarter (31 weeks-term). The volume of largest uterine fibroid was calculated using the formula: Volume (mm3) ⫽ 0.523 x (length mm) x (width mm) x (height mm). Measurements and Main Results: Between the third quarter and the first half, the percentage of fibroids that got smaller was 55.1% with a mean decrease in volume of ⫺35 ⫾ 4%, and the percentage of fibroids that enlarged was 44.9% with a mean increase in volume of 69 ⫾ 11%. Between the last and third trimester, those that got smaller were 75% with a mean decrease in volume of - 30 ⫾ 3%, the percentage of those that enlarged was 25% with a mean increase in volume of 102 ⫾ 62%. Conclusion: Contrary to the common belief, we found that uterine fibroid commonly decrease in volume over the course of pregnancy. When there was in increase in size, it was most marked in the last quarter of pregnancy. FRIDAY, NOVEMBER 11, 2005 (2:55 PM–3:05 PM) Plenary 15—Leiomyomas 121 Natural Progression of Uterine Fibroid Size: A Comparison of Pregnancy and Post-Pregnancy Volumes Johnston EB, Goldberg JB, Bromberg JV, Diamond JJ, Weinstein L. Thomas Jefferson University Hospital, Philadelphia, Pennsylvania Study Objective: To determine the natural progression of the change in size of uterine fibroids in the postpartum period as compared with during pregnancy.