1493 Preoperative Uterine Artery Embolization Prior to the Surgical Management of Fibroids: An Institutional Case Series

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Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231

Virtual Poster Session 2: Laparoscopy (1:00 PM − 1:10 PM)

for patients with submucous fibroids more than 4 cm in size and/or with an intrauterine extension of more than 50%. A concomitant control hysteroscopy thereafter is useful to identify if the endometrial cavity remains intact after the procedure.

1:00 PM: STATION A 2138 Nodular Adenomyosis: A Single Center 8-Years Results on the Treatment Of 120 Cases by Radiofrequency Thermal Ablation Roviglione G,1,* Stepniewska AK,1 Clarizia R,1 Scarperi S,2 De Mitri P,1 Bruni F,1 Ceccarello M,1 Manzone M,1 Finelli A,3 Ceccaroni M1. 1 Gynecology and Obstetrics, Gynecologic Oncology, Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VERONA, Italy; 2 Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata, Verona, VERONA, Italy; 3Medicine and Aging Sciences, University “G. D’Annunzio” of Chieti-Pescara, CHIETI, Italy *Corresponding author. Study Objective: to prospectively assess the effectiveness and safety of RadioFrequency Thermal Ablation (RFA) for uterine nodular adenomyosis Design: all patients with nodular adenomyosis who desired to preserve the uterus and who were selected for RFA were included. Setting: third-level Referral Center for Endometriosis Patients or Participants: One hundred twenty women with symptomatic nodular adenomyosis, aged 24-51 years, were collected. Interventions: All the procedures were carried out by laparoscopic access in order to perform a concomitant surgery for endometriosis (75% of the cases), if preoperatively detected. In order to evaluate the impact of the treatment on the intensity symptoms related to the presence of uterine adenomyosis, the intensity of uterine bleeding and pain during the follow-up was compared to the properative symptomatology, and the ten-point visual analog scale (VAS) was used for pain assessment. Patients were asked about any hormonal or surgical treatments performed during the follow-up period and pregnancies occurred after the radiofrequency thermal ablation. Measurements and Main Results: The median number of nodular lesions treated per patient was 1 (range, 1-2). The median reduction in volume was 66%. Follow-up period ranged from 6 to 94 months. A significant progressive improvement in the symptoms score was observed at the follow-up. Conclusion: In this study, laparoscopic RFA reduced uterine adenomyosis-related symptoms and volume, with significant improvement on quality of life in the treated patients. Virtual Poster Session 2: Laparoscopy (1:00 PM − 1:10 PM) 1:00 PM: STATION B 1892 Laparoscopic Removal of Large Submucous Myomas Demirel LC,* T€ ulek F, Ergin T. IVF and Minimally Invasive Surgery, Atasehir Memorial Hospital, Istanbul, Turkey *Corresponding author. Video Objective: This video demonstrates the laparoscopic approach in the management of large submucous myomas and minimal damage on the endometrium. Setting: The patient is a 45 year old, G2 P2 woman with the complaint of heavy menstrual bleeding. Ultrasonography revealed a 5 £ 4 cm submucous myoma with 10-20 % of intramural extension. Interventions: Following serosal incision with bipolar energy instrument and entering the endometrial cavity, submucous myoma is extracted, the endometrial defect is closed submucosally with 2-0 V - lock suture. Myometrial defect is closed in double layer closure. Integrity of the endometrial cavity and the sutured line are assessed by an office hysteroscopy at the end of the procedure. Conclusion: Given the fact that the complication risks increase with size and intramyometrial extension of submucous myomas during hysteroscopic surgery; laparoscopic myomectomy may be a better treatment option especially

Virtual Poster Session 2: Laparoscopy (1:00 PM − 1:10 PM) 1:00 PM: STATION C 1953 Ulipristal Acetate for Adenomyosis: A Multicenter Randomized Trial Fernandez H,1,2,3 Brun JL,4 Legendre G,5 Koskas M,6 Merviel P,7 Capmas P1,8,9,*. 1Paris Sud University, Le Kremlin Bicetre, France; 2 CESP, Le Kremlin Bicetre, France; 3Gynecology, Hopital Bicetre, Le Kremlin Bicetre, France; 4CHU Bordeaux, Bordeaux, France; 5CHU Angers, Angers, France; 6Hopital Bichat, Paris, France; 7CHU Amiens, Amiens, France; 8Hopital Bicetre, Le Kremlin Bicetre, France; 9CESP, Villejuif, France *Corresponding author. Study Objective: To evaluate efficacy of a 3 months course of ulipristal acetate on abnormal uterine bleeding in adenomyosis Design: A multicenter randomized trial with a 3:1 ratio. Setting: In five different teaching hospitals Patients or Participants: Women with adenomyosis confirmed on MRI or sonography and abnormal uterine bleeding with PBAC score more than 100 Interventions: Women were randomly assigned for a 3 months course of either 10mg Ulipristal acetate or a placebo Measurements and Main Results: Main objective was the rate of women with a PBAC score under 75 after 3 months of treatment. The secondary objectives included rate of PBAC score under 75 at 6 months, rate of amenorrhea at 3 and 6 months, evolution of the pain and of the quality of life at 3 and 6 months and finally, tolerance. Forty women were included, 30 in the UPA group and 10 in the placebo group. The two groups were comparable particularly for PBAC score and analgesic consumption before the treatment. At 3 months, a significant difference was observed between UPA group and placebo group for the rate of PBAC score under 75 (0 versus 95.2%), p<0.01). At 6 months, there was not anymore significant difference for rate of PABC score under 75 in the two groups. The rate of amenorrhea was also significantly higher at three months (95% versus 0%, p<0.01). At 3 months, a significant decrease in pain was observed in the UPA group (p<0.01) but not at 6 months. There was no significant difference between groups for quality of life. Tolerance was good, no hepatic disorders were found in this study. Conclusion: Ulipristal acetate seems to stop abnormal uterine bleeding due to adenomyosis but also pain during a three months course but both of these symptoms reappeared at the stop of the medication. Other studies are needed to conclude and to try different doses. Virtual Poster Session 2: Laparoscopy (1:00 PM − 1:10 PM) 1:00 PM: STATION D 1493 Preoperative Uterine Artery Embolization Prior to the Surgical Management of Fibroids: An Institutional Case Series Wu HY,1,* Kaczmarski K,2 Portnoy E,3 Wang KC,1 Simpson K,1 Patzkowsky KE1. 1Division of Minimally Invasive Gynecologic Surgery, Johns Hopkins School of Medicine, Baltimore, MD; 2Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD; 3 Radiology, Johns Hopkins School of Medicine, Baltimore, MD *Corresponding author. Study Objective: Uterine artery embolization (UAE) can be used as a preoperative adjunct for the surgical management of fibroids. Few, small

Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231

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studies have reported that preoperative UAE may reduce blood loss or facilitate a laparoscopic approach for myomectomies. We assessed outcomes at our institution with preoperative UAE prior to surgical management of fibroids from 7/1/2013 through 8/1/2018. Design: Case series Setting: Academic medical center Patients or Participants: Patients who underwent preoperative UAE prior to surgical management of fibroids Interventions: Preoperative UAE followed by myomectomy/ hysterectomy Measurements and Main Results: Eight patients underwent planned UAE immediately prior to surgery: 2 myomectomies and 6 hysterectomies. One myomectomy was laparoscopic; 22 week size uterus, 3 fibroids removed (largest 11 cm), specimen weight 903g, estimated blood loss (EBL) 300cc with intraop vasopressin use. The other myomectomy was abdominal; 22 week size uterus, 23 fibroids removed (largest 11 cm), specimen weight 1723g, EBL 500cc, with intraoperative vasopressin and misoprostol used. Of the hysterectomy cases, 3 were abdominal and 3 were laparoscopic. A notable open case was a supracervical hysterectomy of a 32 week size uterus; EBL 200cc, specimen weight 5150g. Among the laparoscopic hysterectomy cases, the mean uterine size was 19 weeks (range 17-21 weeks; mean specimen weight 1328g), average EBL 350cc (range minimal-500cc). There were no complications from the UAE and no perioperative surgical complications (conversion to laparotomy, blood transfusions, fever/infection, bleeding, reoperations). All minimally invasive cases were discharged on postoperative day 0. Conclusion: Preoperative UAE for surgical management of fibroids appears to be a safe adjunct to myomectomy or hysterectomy with respect to control of EBL, reduced need for transfusions, and maintaining a laparoscopic approach (when applicable). Future larger studies, likely with pooled data from multiple sites, are needed to further evaluate the safety and efficacy of preoperative UAE in this setting.

along with resolution of the patient’s dysmenorrhea, and there was no residual fibroid noted on sonography at 7 months post-ablation. The second attempt at assisted reproduction produced an uncomplicated pregnancy that resulted in the vacuum-assisted vaginal delivery of a liveborn infant at term weighing 3670 gms with Apgar scores of 91/105/1010. Pelvic sonography four months postpartum revealed an unremarkable uterus, again with no evidence of a fibroid remnant. Conclusion: This is the first report of a pregnancy and delivery in an infertile couple who underwent transcervical RF ablation of a uterine fibroid followed by assisted reproduction.

Virtual Poster Session 2: Laparoscopy (1:00 PM − 1:10 PM) 1:00 PM: STATION E 1624 Term Delivery in an Infertile Patient after Transcervical Radiofrequency Fibroid Ablation and Assisted Reproductive Technology Pschadka G,1,* Engelhardt M,1 Niehoff C,2 Toub DB3. 1Josephs-Hospital Warendorf, Warendorf, Germany; 2MVZ Kinderwunsch-und Hormonzentrum M€ unster, M€ unster, Germany; 3Gynesonics, Redwood City, CA *Corresponding author. Study Objective: Transcervical radiofrequency ablation of uterine fibroids is an incisionless procedure to treat nonpedunculated uterine fibroids, including those that are not amenable to operative hysteroscopy. However, its safety and effectiveness regarding fertility and fecundity have not been established, including among women with infertility. This is a report of a pregnancy that occurred in a woman after transcervical radiofrequency (RF) ablation of uterine fibroids and assisted reproduction. Design: Case report. Setting: Community hospital in Warendorf, Germany Patients or Participants: A 38-year-old nullipara with infertility since 2008 and a recent complaint of refractory dysmenorrhea in association with a uterine fibroid Interventions: Transcervical RF ablation with the SonataÒ system to treat the symptomatic myoma. Unsuccessful assisted reproduction (intracytoplasmic sperm injection/embryo transfer; ICSI/ET) as confirmed by negative pregnancy testing had been attempted 1 month pre-ablation, and a second embryo transfer after thawing of the previously cryopreserved pronuclei was carried out 7 months post-ablation. Measurements and Main Results: Transcervical RF ablation resulted in a 68% reduction in fibroid volume by sonography at 2 months post-treatment

Virtual Poster Session 2: Laparoscopy (1:00 PM − 1:10 PM) 1:00 PM: STATION F 2289 Supraumbilical Abdominal Fibromatosis Mimicking Exophytic Fibroids in Pregnancy Mama ST,1,2,* Brown HT2. 1OB/GYN, Cooper Medical School of Rowan University, Camden, NJ; 2Cooper Medical School of Rowan University, Camden, NJ *Corresponding author. Study Objective: N/A Design: Case Report Setting: Cooper University Hospital, inpatient and outpatient clinic setting Patients or Participants: The patient is a 31-year-old female who had right sided fundal pain in the third trimester of her second pregnancy. She had a history of a 6 cm left-sided pedunculated fibroid. Pain continued postpartum. Repeat ultrasound reported a large exophytic fibroid. The concern was torsion of the fibroid as the cause of the pain. During laparoscopic myomectomy, after excision of the fibroid, a separate anterior abdominal wall 10 cm mass emanating from the rectus sheath was discovered. After complete excision, the final pathology was fibromatosis. Interventions: N/A Measurements and Main Results: N/A Conclusion: There have been a few cases reported on pregnancy-associated abdominal fibromatosis. There have been no reported cases of pregnancy-associated abdominal fibromatosis misdiagnosed as an exophytic uterine fibroid. In this case, a uterine myoma and an abdominal desmoid tumor occurred simultaneously, a setting so rare that all the doctors involved in the care of this patient were unaware that the abdominal mass was fibromatosis and not an exophytic fibroid. Fibroids diagnosed by ultrasound may in fact be different pathology and an incomplete diagnosis can occur in the setting of rare tumors. Current research suggests using crosssectional imaging modalities such as MRI or CT scan when ultrasound may be equivocal, may have suspicious features, or if a potential rarer tumor is suspected. Identification of the mass prior to surgery may have offered different treatment options given that expectant management after biopsy confirmation is also acceptable as up to 14% of these tumors spontaneously regress. Virtual Poster Session 2: Laparoscopy (1:00 PM − 1:10 PM) 1:00 PM: STATION G 1655 Laparoscopic Unification of Non Communicating Horn with Hemi-Uterus Saini S*. Gynae Laparoscopy, Jaipur Doorbeen Hospital, Jaipur, India *Corresponding author. Video Objective: To demonstrate new idea of laparoscopic unification of functional non − communicating horn with hemi-uterus instead of removal to improve obstetric outcome in future. Setting: an academic tertiary care hospital. A 14-year-old girl presented with complaints of pain in lower abdomen, on and off for 2 months. Her previous 2 cycles were regular; she had cyclic dysmenorrhoea since her