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2289 Supraumbilical Abdominal Fibromatosis Mimicking Exophytic Fibroids in Pregnancy
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
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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