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237: An Animal Model of Uterine Auto and Allo-transplantation With the Achievement of Pregnancy
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Journal of Minimally Invasive Gynecology, Vol 14, No 6, November/December Supplement 2007
resorbable membrane designed to prevent adhesions and compare it to the liquid barrier Adept. Design: Prospective, randomised, single-blind clinical trial. Setting: University medical center. Patients: Thirty patients with laparoscopic myomectomy. Intervention: Thirty patients admitted for laparoscopic myomectomy were randomised to receive adhesion prophylaxis with either Supraseal (n⫽15), a solid adhesion barrier consisting of D,L-polylactid or Adept (n⫽15), a liquid barrier consisting of icodextrin 4% solution. Measurements and Main Results: Questionnaires given to patients after 14 days and 3 months did not reveal a significant difference in the post-operative outcome. Questionnaires for the surgeons showed that intra-operatively Supraseal was considerably more difficult to use (p⬍0.05) Conclusion: 1.) At equal efficacy, liquid barriers are the better strategy because they are easier to use. 2.) Further clinical trials involving second look are warranted to translate Supraseal into a new option for patients. 236 Adhesion Prophylaxis Using a Novel Resorbable Biomembrane Consisting of D,L-Polylactid (Supraseal) - Experimental Results in the Rat Model 1 Rajab TK, 1Wallwiener D, 2Planck H, 3Kraemer B, 4 Fletcher NM. 1Tuebingen University, Tuebingen, Germany; 2ITV Denkendorf, Tuebingen, Germany; 3 Tuebingen University, University Women’s Hospital, Tuebingen, Germany; 4Wayne State University, Detroit, Michigan Study Objective: Supraseal is a novel, resorbable membrane designed to prevent post-operative adhesions. Obtaining consent for 2nd look laparoscopy in the clinical setting is difficult. Therefore we report data using this new membrane in an objective rat model. Design: Prospective, randomised, controlled, blinded animal study. Setting: University animal research facility. Patients: Forty-five virgin female wistar rats. Intervention: Standardized peritoneal traumatisation and subsequent adhesion prophylaxis with Supraseal (n⫽15), Adept (n⫽15), or no treatment (n⫽15). The resulting adhesions were evaluated in a blinded fashion at 2nd look after 14 days. Measurements and Main Results: The adhesion scores of animals receiving Supraseal or Adept were improved compared to no treatment (p⬍0.01). Supraseal appeared more efficacious than Adept but this difference did not reach significance in the number of animals examined (p⬎0.05). Conclusion: We conclude that Supraseal is an efficacious, new barrier to prevent post-operative adhesions and that further clinical studies are warranted to help translate this agent into a new option for patients.
237 An Animal Model of Uterine Auto and Allotransplantation With the Achievement of Pregnancy Ramirez ER. Pasadena, Texas Study Objective: The purpose of this project is four fold: (1) to investigate an animal model of uterine transplantation after ovarian vessel ligation and uterine vessel reanastomosis (pig, sheep and goats) (2) to determine the rates of successful uterine transplant by assessing histological studies and tissue rejection (3) developing a control group to determine the success rate of pregnancy (sheep) and (4) to evaluate the role of omentopexy as a source of neovascularization for the transplanted uterus (dog). Design: Our research project explores feasibility of uterine transplantation by comparing avascular and vascular uterine transplantations and by exploring the impact of immunosuppressive therapy on fertility. Our endpoint is delivery of a viable live born from the transplanted organ. As we develop surgical methods and techniques, pathological assessment of vascularity and tissue rejection will be quantified. Setting: Texas Tech University Health Science Center, New York Medical College and The Univeristy de La Salle Veterinary School of Medicine. Patients: Seventy-six uterine transplants in four different animal models (dog, pig, sheep and goats). Intervention: The use of the Mobius retractor in uterine transplant surgery. Measurements and Main Results: Our preliminary results demostrates the following, an 80% success rate in dogs (n-11), a 66% mortality rate in pigs (n-9), a 94% success rate in sheep (n-42) and cabra (n-14) models, with a 4% pregnancy rate in our sheep uterine allo-transplant models. The mortality rates in pigs were attributable primarily to the high rate of porcine malignant hyperthermia. Conclusion: In order for uterine transplantation to be successful, surgical technique and teamwork are essential. At this point, we have developed a surgical technique that has allowed us to perform successful uterine transplants. 238 Does Ablation Preference Influence Hysterectomy Rates for Menorrhagia? Reilly GP, Savells A. Seven Hills Center for Minimally Invasive Surgery, Cincinnati, Ohio Study Objective: Compare hysterectomy rates between three gynecologists whose preference is either the HTA System, Novasure, or ThermaChioce for the treatment of menorrhagia. Secondary objectives will compare need for preoperative workup, postoperative treatments and outcomes. Design: Five year (2002-2006); retrospective chart review of patients treated by endometrial ablation or hysterectomy
Journal of Minimally Invasive Gynecology, Vol 14, No 6, November/December Supplement 2007
resorbable membrane designed to prevent adhesions and compare it to the liquid barrier Adept. Design: Prospective, randomised, single-blind clinical trial. Setting: University medical center. Patients: Thirty patients with laparoscopic myomectomy. Intervention: Thirty patients admitted for laparoscopic myomectomy were randomised to receive adhesion prophylaxis with either Supraseal (n⫽15), a solid adhesion barrier consisting of D,L-polylactid or Adept (n⫽15), a liquid barrier consisting of icodextrin 4% solution. Measurements and Main Results: Questionnaires given to patients after 14 days and 3 months did not reveal a significant difference in the post-operative outcome. Questionnaires for the surgeons showed that intra-operatively Supraseal was considerably more difficult to use (p⬍0.05) Conclusion: 1.) At equal efficacy, liquid barriers are the better strategy because they are easier to use. 2.) Further clinical trials involving second look are warranted to translate Supraseal into a new option for patients. 236 Adhesion Prophylaxis Using a Novel Resorbable Biomembrane Consisting of D,L-Polylactid (Supraseal) - Experimental Results in the Rat Model 1 Rajab TK, 1Wallwiener D, 2Planck H, 3Kraemer B, 4 Fletcher NM. 1Tuebingen University, Tuebingen, Germany; 2ITV Denkendorf, Tuebingen, Germany; 3 Tuebingen University, University Women’s Hospital, Tuebingen, Germany; 4Wayne State University, Detroit, Michigan Study Objective: Supraseal is a novel, resorbable membrane designed to prevent post-operative adhesions. Obtaining consent for 2nd look laparoscopy in the clinical setting is difficult. Therefore we report data using this new membrane in an objective rat model. Design: Prospective, randomised, controlled, blinded animal study. Setting: University animal research facility. Patients: Forty-five virgin female wistar rats. Intervention: Standardized peritoneal traumatisation and subsequent adhesion prophylaxis with Supraseal (n⫽15), Adept (n⫽15), or no treatment (n⫽15). The resulting adhesions were evaluated in a blinded fashion at 2nd look after 14 days. Measurements and Main Results: The adhesion scores of animals receiving Supraseal or Adept were improved compared to no treatment (p⬍0.01). Supraseal appeared more efficacious than Adept but this difference did not reach significance in the number of animals examined (p⬎0.05). Conclusion: We conclude that Supraseal is an efficacious, new barrier to prevent post-operative adhesions and that further clinical studies are warranted to help translate this agent into a new option for patients.
237 An Animal Model of Uterine Auto and Allotransplantation With the Achievement of Pregnancy Ramirez ER. Pasadena, Texas Study Objective: The purpose of this project is four fold: (1) to investigate an animal model of uterine transplantation after ovarian vessel ligation and uterine vessel reanastomosis (pig, sheep and goats) (2) to determine the rates of successful uterine transplant by assessing histological studies and tissue rejection (3) developing a control group to determine the success rate of pregnancy (sheep) and (4) to evaluate the role of omentopexy as a source of neovascularization for the transplanted uterus (dog). Design: Our research project explores feasibility of uterine transplantation by comparing avascular and vascular uterine transplantations and by exploring the impact of immunosuppressive therapy on fertility. Our endpoint is delivery of a viable live born from the transplanted organ. As we develop surgical methods and techniques, pathological assessment of vascularity and tissue rejection will be quantified. Setting: Texas Tech University Health Science Center, New York Medical College and The Univeristy de La Salle Veterinary School of Medicine. Patients: Seventy-six uterine transplants in four different animal models (dog, pig, sheep and goats). Intervention: The use of the Mobius retractor in uterine transplant surgery. Measurements and Main Results: Our preliminary results demostrates the following, an 80% success rate in dogs (n-11), a 66% mortality rate in pigs (n-9), a 94% success rate in sheep (n-42) and cabra (n-14) models, with a 4% pregnancy rate in our sheep uterine allo-transplant models. The mortality rates in pigs were attributable primarily to the high rate of porcine malignant hyperthermia. Conclusion: In order for uterine transplantation to be successful, surgical technique and teamwork are essential. At this point, we have developed a surgical technique that has allowed us to perform successful uterine transplants. 238 Does Ablation Preference Influence Hysterectomy Rates for Menorrhagia? Reilly GP, Savells A. Seven Hills Center for Minimally Invasive Surgery, Cincinnati, Ohio Study Objective: Compare hysterectomy rates between three gynecologists whose preference is either the HTA System, Novasure, or ThermaChioce for the treatment of menorrhagia. Secondary objectives will compare need for preoperative workup, postoperative treatments and outcomes. Design: Five year (2002-2006); retrospective chart review of patients treated by endometrial ablation or hysterectomy