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Journal of Minimally Invasive Gynecology, Vol 12, No 5, September/October Supplement 2005
pathic menorrhagia with high patient satisfaction. The procedure is simple and does not require additional training or expertise in operative hysteroscopy.
SATURDAY, NOVEMBER 12, 2005 (12:36 PM–12:42 PM) Open Communications 10 —Operative Laparoscopy 194
SATURDAY, NOVEMBER 12, 2005 (12:30 PM–12:36 PM) Open Communications 10 —Operative Laparoscopy 193 Laparoscopic Myomectomy of Very Large Myomas Sinha R, Hedge A. Bombay Endoscopy Academy and Centre for Minimally Invasive Surgery, Mumbai, Maharashtra, India Study Objective: To determine the feasibility, safety, conversion rate and complications of laparoscopic myomectomy for very large myomas. Design: Prospective study from 1998 to 2004. Setting: Private endoscopy center. Patients: 99 healthy non-pregnant women with a myomatous uterus, having at least one myoma in any location with size of at least 9 cm on preoperative ultrasound examination, who underwent laparoscopic myomectomy. Intervention: Laparoscopic myomectomy. Measurements and Main Results: Main indications for surgery were abnormal uterine bleeding (50 patients), infertility (21), abdominal pain (20), and abdominal mass (35). One hundred eighty-two myomas were removed laparoscopically in these 99 patients. Five women had two myomas larger than 9 cm; four had two myomas between 5 and 9 cm (in addition to one greater than 9 cm), and two had three myomas between 5 and 9 cm (in addition to one greater than 9 cm). The mean number of myomas removed in each patient was 1.84 ⫾ 1.30 (range 1–9). Thirty patients had multiple myomectomy. The size of the myomas removed ranged from 2 to 21 cm. Mean weight of the myomas removed from each patient was 591.58 ⫾ 574.52 (range 120 to 3400 g). Mean operating time was 112.45 ⫾ 51.87minutes. Mean blood loss was 417.30 ⫾ 573.09. There was one conversion to laparotomy. Devascularization of the myoma prior to myomectomy was done in four patients. Enucleation of the myoma by direct morcellation while the myoma is still attached to the uterus was done in 34 cases. The mean hospital stay was 38.65 ⫾ 10.45 hours. All the patients who were operated before 2003 were followed up for one year. Two patients developed fever and one patient developed a broad ligament hematoma which healed conservatively. One woman underwent laparotomy subtotal hysterectomy due to postoperative intraabdominal bleeding and dilutional coagulopathy. Conclusion: Laparoscopic myomectomy is feasible and safe irrespective of the size, number or location of the myomas.
Endometrial Cryoablation And Laparoscopy In The Obese Patient With Menorrhagia, Pelvic Pain And Pelvic Mass Weather L. New Orleans, Louisiana Study Objective: To evaluate combining endometrial cryoablation with laparoscopy in treating obese patients who present with menorrhagia, pelvic pain and/or pelvic mass. Design: Retrospective analysis of twenty-one obese patients treated for complaints of menorrhagia, pelvic pain and/or pelvic mass with endometrial cryoablation and laparoscopy. Setting: Southern urban private gynecological practice and private ambulatory surgical center. Patients: Twenty-one obese patients (age 31–51), who presented with menorrhagia, benign endometrial pathology, pelvic pain and/or pelvic mass and no desire for future pregnancy or hysterectomy. Intervention: Endometrial Cryoablation with ultrasound guidance and Operative Laparoscopy. Measurements and Main Results: Endometrial cryoablation with ultrasound guidance was performed successfully in all patients after operative laparoscopy, the patient’s weight ranged from 207 lb to 379 lb. The mean weight was 261 lbs. The BMI ranged from 38 –50.2 kg/M2 and the mean BMI was 43 kg/M2. The findings at laparoscopy were endometriosis, fibroids, pelvic adhesions, salpingitis and ovarian cysts. The procedures included cystectomy, laser adhesiolysis, myolysis, myomectomy and ablation of endometrial implants. There were no complications. The endometrial cryoablation results at six months or greater were 49% amenorrhea and spotting. Conclusion: Endometrial cryoablation via ultrasound guidance and operative laparoscopy can be safely performed at the same time in obese patients via an outpatient setting in patients who do not desire future pregnancy or hysterectomy. SATURDAY, NOVEMBER 12, 2005 (12:42 PM–12:48 PM) Open Communications 10 —Operative Laparoscopy 195 Laparoscopic Repair of Vesical Fistula Kweon I, Hur SY, Kim MJ, Kim SJ, Kim EJ. Holy Family Hospital, College of Medicine, The Catholic University of Korea, Korea Study Objective: Laparoscopic surgery provides patients with the benefits of shortened hospital stay and faster return to normal activity. Even though fewer cases have vesical fistula comes into being because of laparoscopic surgery.
Journal of Minimally Invasive Gynecology, Vol 12, No 5, September/October Supplement 2005
pathic menorrhagia with high patient satisfaction. The procedure is simple and does not require additional training or expertise in operative hysteroscopy.
SATURDAY, NOVEMBER 12, 2005 (12:36 PM–12:42 PM) Open Communications 10 —Operative Laparoscopy 194
SATURDAY, NOVEMBER 12, 2005 (12:30 PM–12:36 PM) Open Communications 10 —Operative Laparoscopy 193 Laparoscopic Myomectomy of Very Large Myomas Sinha R, Hedge A. Bombay Endoscopy Academy and Centre for Minimally Invasive Surgery, Mumbai, Maharashtra, India Study Objective: To determine the feasibility, safety, conversion rate and complications of laparoscopic myomectomy for very large myomas. Design: Prospective study from 1998 to 2004. Setting: Private endoscopy center. Patients: 99 healthy non-pregnant women with a myomatous uterus, having at least one myoma in any location with size of at least 9 cm on preoperative ultrasound examination, who underwent laparoscopic myomectomy. Intervention: Laparoscopic myomectomy. Measurements and Main Results: Main indications for surgery were abnormal uterine bleeding (50 patients), infertility (21), abdominal pain (20), and abdominal mass (35). One hundred eighty-two myomas were removed laparoscopically in these 99 patients. Five women had two myomas larger than 9 cm; four had two myomas between 5 and 9 cm (in addition to one greater than 9 cm), and two had three myomas between 5 and 9 cm (in addition to one greater than 9 cm). The mean number of myomas removed in each patient was 1.84 ⫾ 1.30 (range 1–9). Thirty patients had multiple myomectomy. The size of the myomas removed ranged from 2 to 21 cm. Mean weight of the myomas removed from each patient was 591.58 ⫾ 574.52 (range 120 to 3400 g). Mean operating time was 112.45 ⫾ 51.87minutes. Mean blood loss was 417.30 ⫾ 573.09. There was one conversion to laparotomy. Devascularization of the myoma prior to myomectomy was done in four patients. Enucleation of the myoma by direct morcellation while the myoma is still attached to the uterus was done in 34 cases. The mean hospital stay was 38.65 ⫾ 10.45 hours. All the patients who were operated before 2003 were followed up for one year. Two patients developed fever and one patient developed a broad ligament hematoma which healed conservatively. One woman underwent laparotomy subtotal hysterectomy due to postoperative intraabdominal bleeding and dilutional coagulopathy. Conclusion: Laparoscopic myomectomy is feasible and safe irrespective of the size, number or location of the myomas.
Endometrial Cryoablation And Laparoscopy In The Obese Patient With Menorrhagia, Pelvic Pain And Pelvic Mass Weather L. New Orleans, Louisiana Study Objective: To evaluate combining endometrial cryoablation with laparoscopy in treating obese patients who present with menorrhagia, pelvic pain and/or pelvic mass. Design: Retrospective analysis of twenty-one obese patients treated for complaints of menorrhagia, pelvic pain and/or pelvic mass with endometrial cryoablation and laparoscopy. Setting: Southern urban private gynecological practice and private ambulatory surgical center. Patients: Twenty-one obese patients (age 31–51), who presented with menorrhagia, benign endometrial pathology, pelvic pain and/or pelvic mass and no desire for future pregnancy or hysterectomy. Intervention: Endometrial Cryoablation with ultrasound guidance and Operative Laparoscopy. Measurements and Main Results: Endometrial cryoablation with ultrasound guidance was performed successfully in all patients after operative laparoscopy, the patient’s weight ranged from 207 lb to 379 lb. The mean weight was 261 lbs. The BMI ranged from 38 –50.2 kg/M2 and the mean BMI was 43 kg/M2. The findings at laparoscopy were endometriosis, fibroids, pelvic adhesions, salpingitis and ovarian cysts. The procedures included cystectomy, laser adhesiolysis, myolysis, myomectomy and ablation of endometrial implants. There were no complications. The endometrial cryoablation results at six months or greater were 49% amenorrhea and spotting. Conclusion: Endometrial cryoablation via ultrasound guidance and operative laparoscopy can be safely performed at the same time in obese patients via an outpatient setting in patients who do not desire future pregnancy or hysterectomy. SATURDAY, NOVEMBER 12, 2005 (12:42 PM–12:48 PM) Open Communications 10 —Operative Laparoscopy 195 Laparoscopic Repair of Vesical Fistula Kweon I, Hur SY, Kim MJ, Kim SJ, Kim EJ. Holy Family Hospital, College of Medicine, The Catholic University of Korea, Korea Study Objective: Laparoscopic surgery provides patients with the benefits of shortened hospital stay and faster return to normal activity. Even though fewer cases have vesical fistula comes into being because of laparoscopic surgery.