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Journal of Minimally Invasive Gynecology, Vol 12, No 5, September/October Supplement 2005
Intervention: Two-hundred eighty-two women were treated with transcervical resection of submucous myomas without endometrial ablation. In case of incomplete resection a repeat procedure was offered. Measurements and Main Results: Seventeen cases (6%) were lost to follow-up. The median follow-up was 100 months (range 3–177 months); for cases without recurrence median follow-up was 110 months (range 76 –177 months). Seventy-two (25.5%) patients had repeat surgery. An independent prognostic value of uterine size (P ⬍ .001) and number of submucous myomas (P ⬍ .001) for recurrence was noted. Forty-three of 72 patients who had repeat surgery subsequently had a hysterectomy. None of the variables investigated predicted the need for hysterectomy. The surgery-free percentage of 165 patients with normal sized uteri and not more than two myomas was 95.9% (SE 1.5) at 2 years and 90.3% ( 3.0) at 5 years and 79.9%(4.8) at 10 years. Conclusion: Hysteroscopic myomectomy is a safe and effective treatment for patients with a normal sized uterus and not more than two submucous myomas. It is an acceptable alternative for selected other patients. There is no need for a combined endometrial ablation. Hysteroscopic myomectomy will give patients a high chance of averting further surgery and hysterectomy and should modify the way patients are counseled. FRIDAY, NOVEMBER 11, 2005 (4:03 PM– 4:09 PM) Open Communications 5—Operative Hysteroscopy 138 Evaluation of a New Cannula for Fundal Intrauterine Anesthesia Valim CA. Campinas, Sa˜o Paulo, Brazil Study Objective: To evaluate the usefulness of a simple 9 mm cannula and trocar with a semi-spherical tip, to be used for fundal topic anesthesia. Design: New instrument design and prospective clinical evaluation. Setting: Private practice in Campinas, SP, Brazil. Patients: Thirteen patients undergoing operative hysteroscopy. Intervention: The cannula was inserted through the cervical canal after being dilated (under previous para-cervical block), and when the trocar was retrieved, a 13x4.5 needle coupled to a needle extender and a 10 cc syringe loaded with Ropivacain Chloridrate 0.2% was passed through the cannula and 3 to 4 cc of anesthetics were injected in three different sites: midline, right and left cornual areas. Measurements and Main Results: All attempts to perform the technique were successful. Eight patients reported no pain or discomfort, 4 reported mild discomfort and 1 had moderate to intense pain. Conclusion: Due to the simplicity and cost effect ratio of both the technique and tools necessary for the procedure we
believe that this extra care could be added to the paracervical block in order to minimize the pain and also reduce bleeding and fluid absorption taking advantage of the vasoconstrictor effect of the topic anesthetics. FRIDAY, NOVEMBER 11, 2005 (4:09 PM– 4:15 PM) Open Communications 5—Operative Hysteroscopy 139 An Observational Study of a Novel Operative Hysteroscopy System for the Removal of Endometrial Polyps and Submucus Myomas Bradley L, Emanuel M, Istre O, Hucke J, Bresco P, Gimpelson RJ. Cleveland Clinic, Cleveland, Ohio; Haarlem, Netherlands, Oslo, Norway; Wuppertal, Germany; Barcelona, Spain; Chesterfield, Missouri Study Objective: The purpose of this observational study is to assess the performance of the Smith & Nephew Operative Hysteroscopy System to resect intrauterine polyps and myomas. Design: The study design is a voluntary patient registry. Setting: All procedures were performed on an out-patient basis in the hospital setting. Patients: The patients included in this study are adult females with endometrial polyps and/or type 0 or type 1 myomas, less than 4 cm in size. Intervention: The operative hysteroscopy system consists of a mechanical morcellator, a continuous-flow hysteroscope, a fluid pump and a vacuum source. The morcellator is designed to work in a saline environment, potentially reducing the risk of hyponatremia. The hysteroscope includes a working channel through which the morcellator is inserted. Fluid enters the uterus through the working channel and is continuously returned through a series of openings in the outer sheath of the scope. Resected tissue is removed through the morcellator channel by means of suction applied at the handpiece and flows into a tissue trap thereby ensuring tissue for pathology. Measurements and Main Results: A total of 155 lesions were treated in 123 patients with the operative hysteroscopy system, which included 120 polyps and 35 myomas. The mean size of the polyps was 186 mm2 and the mean size of the myomas was 336 mm2 Ninety-six per cent of procedures (118) were successfully completed using the operative hysteroscopy system. Three cases were terminated and 2 cases were converted to another procedure. The operative duration for these procedures was 11.5 minutes, and the mean fluid deficit for these procedures was 346 mL. Five adverse events (4%) were reported during these procedures. Conclusion: This novel technique for the removal of endometrial polyps and submucous myomas may offer a safe and effective alternative to conventional resectoscopy.
Journal of Minimally Invasive Gynecology, Vol 12, No 5, September/October Supplement 2005
Intervention: Two-hundred eighty-two women were treated with transcervical resection of submucous myomas without endometrial ablation. In case of incomplete resection a repeat procedure was offered. Measurements and Main Results: Seventeen cases (6%) were lost to follow-up. The median follow-up was 100 months (range 3–177 months); for cases without recurrence median follow-up was 110 months (range 76 –177 months). Seventy-two (25.5%) patients had repeat surgery. An independent prognostic value of uterine size (P ⬍ .001) and number of submucous myomas (P ⬍ .001) for recurrence was noted. Forty-three of 72 patients who had repeat surgery subsequently had a hysterectomy. None of the variables investigated predicted the need for hysterectomy. The surgery-free percentage of 165 patients with normal sized uteri and not more than two myomas was 95.9% (SE 1.5) at 2 years and 90.3% ( 3.0) at 5 years and 79.9%(4.8) at 10 years. Conclusion: Hysteroscopic myomectomy is a safe and effective treatment for patients with a normal sized uterus and not more than two submucous myomas. It is an acceptable alternative for selected other patients. There is no need for a combined endometrial ablation. Hysteroscopic myomectomy will give patients a high chance of averting further surgery and hysterectomy and should modify the way patients are counseled. FRIDAY, NOVEMBER 11, 2005 (4:03 PM– 4:09 PM) Open Communications 5—Operative Hysteroscopy 138 Evaluation of a New Cannula for Fundal Intrauterine Anesthesia Valim CA. Campinas, Sa˜o Paulo, Brazil Study Objective: To evaluate the usefulness of a simple 9 mm cannula and trocar with a semi-spherical tip, to be used for fundal topic anesthesia. Design: New instrument design and prospective clinical evaluation. Setting: Private practice in Campinas, SP, Brazil. Patients: Thirteen patients undergoing operative hysteroscopy. Intervention: The cannula was inserted through the cervical canal after being dilated (under previous para-cervical block), and when the trocar was retrieved, a 13x4.5 needle coupled to a needle extender and a 10 cc syringe loaded with Ropivacain Chloridrate 0.2% was passed through the cannula and 3 to 4 cc of anesthetics were injected in three different sites: midline, right and left cornual areas. Measurements and Main Results: All attempts to perform the technique were successful. Eight patients reported no pain or discomfort, 4 reported mild discomfort and 1 had moderate to intense pain. Conclusion: Due to the simplicity and cost effect ratio of both the technique and tools necessary for the procedure we
believe that this extra care could be added to the paracervical block in order to minimize the pain and also reduce bleeding and fluid absorption taking advantage of the vasoconstrictor effect of the topic anesthetics. FRIDAY, NOVEMBER 11, 2005 (4:09 PM– 4:15 PM) Open Communications 5—Operative Hysteroscopy 139 An Observational Study of a Novel Operative Hysteroscopy System for the Removal of Endometrial Polyps and Submucus Myomas Bradley L, Emanuel M, Istre O, Hucke J, Bresco P, Gimpelson RJ. Cleveland Clinic, Cleveland, Ohio; Haarlem, Netherlands, Oslo, Norway; Wuppertal, Germany; Barcelona, Spain; Chesterfield, Missouri Study Objective: The purpose of this observational study is to assess the performance of the Smith & Nephew Operative Hysteroscopy System to resect intrauterine polyps and myomas. Design: The study design is a voluntary patient registry. Setting: All procedures were performed on an out-patient basis in the hospital setting. Patients: The patients included in this study are adult females with endometrial polyps and/or type 0 or type 1 myomas, less than 4 cm in size. Intervention: The operative hysteroscopy system consists of a mechanical morcellator, a continuous-flow hysteroscope, a fluid pump and a vacuum source. The morcellator is designed to work in a saline environment, potentially reducing the risk of hyponatremia. The hysteroscope includes a working channel through which the morcellator is inserted. Fluid enters the uterus through the working channel and is continuously returned through a series of openings in the outer sheath of the scope. Resected tissue is removed through the morcellator channel by means of suction applied at the handpiece and flows into a tissue trap thereby ensuring tissue for pathology. Measurements and Main Results: A total of 155 lesions were treated in 123 patients with the operative hysteroscopy system, which included 120 polyps and 35 myomas. The mean size of the polyps was 186 mm2 and the mean size of the myomas was 336 mm2 Ninety-six per cent of procedures (118) were successfully completed using the operative hysteroscopy system. Three cases were terminated and 2 cases were converted to another procedure. The operative duration for these procedures was 11.5 minutes, and the mean fluid deficit for these procedures was 346 mL. Five adverse events (4%) were reported during these procedures. Conclusion: This novel technique for the removal of endometrial polyps and submucous myomas may offer a safe and effective alternative to conventional resectoscopy.