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2453 Office Hysteroscopic Adhesiolysis in a Patient with Severe Asherman's Syndrome
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231 there was fundal submucous fibroid 3 £ 2.5cm. Patient was counseled for intrauterine morcellation by Truclear 8under general anesthesia. Interventions: Diagnostic Hysteroscopy was performed by vaginoscopic technique using the 2.9mm, 30 degree Betocchi hysteroscope with normal saline as distension medium. Submucous fibroid arising from fundus was confirmed. Injection Vasopressin 4 units in 80ml normal saline(0.05units/ ml) was injected 10cc intracervically at 4o’clock and 8o’clock .Cervical dilatation up to 10 hegar’s was easily done. Truclear 8 with ultraplus blade was introduced and the window was placed on the fibroid and cutting and aspiration was activated. In single insertion the pale looking fibroid was morcellated without damaging the rest of the endometrium. No bleeding was observed. Conclusion: Hysteroscopic myomectomy is the first line treatment for symptomatic submucous fibroid in infertility. Truclear 8 mechanical morcellation is most suitable in infertile patients and vasopressin intracervical injection has dual benefits of smooth cervical dilatation with hemostatic effect on the fibroid. Virtual Poster Session 3: Hysteroscopy (10:30 AM − 10:40 AM) 10:30 AM: STATION S 1433 A 13 Year Review of Uterine Endometrial Ablation Device Events Using Categorization of Reports to the Manufacturer and User Facility Device Experience (Maude) Data Base Woo JJ,1,* Johnson ME,2 Kahn BS1. 1Department of Gynecological Surgery, Scripps Clinic, La Jolla, CA; 2Virginia Commonwealth University School of Medicine, Richmond, VA *Corresponding author. Study Objective: Usefully categorize reports on endometrial ablation device events using the FDA MAUDE database. Design: The FDA MAUDE database was reviewed using brand name searches: Novasure, Genesys HTA, Thermachoice, Minerva, and HerOption. Reported events were categorized as follows: Type I, non-injury equipment malfunction; Type II, an injury event not requiring hospitalization; Type III, an injury requiring hospitalization. Setting: 13-year FDA MAUDE database review (2005-2018). Patients or Participants: N/A. Interventions: N/A. Measurements and Main Results: 1518 MAUDE reports were categorized as follows: Novasure: Type I: 92/550 (16.7%), Type II: 273/550 (49.6%), Type III: 185/550 (33.6%); Genesys HTA: Type I: 140/432 (32.40%), Type II: 259/432 (58.1%), Type III: 42/432 (9.49%); Thermachoice: Type I: 315/466 (67.60%), Type II: 78/466 (16.74%), and Type III: 73/466 (15.67%); Minerva: Type I: 13/56 (23.21%), Type II: 9/56 (16.07%), and Type III: 34/56 (60.71%); Her Option: Type I: 4/14 (28.57%), Type II: 0 (0%), and Type III:10/14 (71.43%). Novasure, Minerva, and Her Option had a greater percent of events due to bowel injury while Genesys HTA and Thermachoice had a greater percent of events due to vaginal/cervical/external thermal injuries. Over 50% of HTA Geneysis events were due to vaginal/cervical/external thermal injuries while greater than 50% of Novasure events were due to uterine perforation. Thermachoice had greater than 60% of events due to balloon rupture device malfunction. Conclusion: The MAUDE database serves as a valuable tool for physicians to evaluate the safety and possible complications from existing and new technologies. Categorizing events as described here may improve clinicians’ ability to interpret MAUDE data. Large differences in report type were noted between brands of endometrial ablation devices. The percentage of Type III events by device were highest for HerOption, Minerva, and Novasure. Caution must be made when interpreting the data from the MAUDE database due to potential subjective and incomplete narrative, lack of outcome details, and erroneous or duplicate submissions.
S197 Virtual Poster Session 3: Hysteroscopy (10:30 AM − 10:40 AM) 10:30 AM: STATION T 2453 Office Hysteroscopic Adhesiolysis in a Patient with Severe Asherman’s Syndrome Robinson JK, III1 Hazen ND2,*. 1MIGS - National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Washington, DC; 2 MIGS - National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Washington, DC *Corresponding author. Video Objective: To demonstrate our technique for adhesiolysis in an office hysteroscopy setting. Setting: Office Hysteroscopy. Our patient is a 40 year old nulliparous female with a history for fibroids and heavy uterine bleeding. She has had three hysteroscopic myomectomies, and a uterine artery embolization. In her evaluation prior to IVF she had a HSG and SIS that demonstrated a shortened uterine cavity and likely uterine adhesions. Interventions: We demonstrate our technique for adhesiolysis of uterine synechiae utilizing a 5mm hysteroscope with a 5 fr. working channel and the semi-rigid scissors. Using internal landmarks, and a combination of blunt and sharp dissection we are able to restore the uterine cavity to its normal contour in the office, in spite of the dense adhesions. The presentation ends with a 2nd look hysteroscopy 3 weeks following the initial procedure. Conclusion: Office hysteroscopy is a viable and effective option for management of severe Asherman’s syndrome. Virtual Poster Session 3: Hysteroscopy (10:40 AM − 10:50 AM) 10:40 AM: STATION A 1973 Sutureless Labiaplasty, is it Possible? Acosta-Osio GI*. Clinical Director of Cosmetic Gynecology, Universidad Metropolitana & Fundaci on Hospital Universitario Metropolitano, Barranquilla, Colombia *Corresponding author. Video Objective: The purpose of this video is to present our surgical experience, the technique by performing the CO2 Laser cut without suture and to evaluate immediate or delayed complications and its safety. Setting: The request for female labiaplasty surgery continues to increase. There are many doubts about which is the best technique and about its security. Interventions: In the operating room, with spinal or epidural anesthesia according to the decision of the anesthesiologist, an evaluation of the shape of the lips is performed again, to be sure of the areas to be resected according to each patient; both lips are carefully and harmonically marked. After linearly marking the area to be resected, we placed bilateral clamps in the marked area so that they serve as a guide and help us with the hemostasia, then infiltrate marcaina with epinefrina, and wait about 2 or 3 minutes and then we proceed to cut over them, achieving a much clear and more continuous cut, adjusting the CO2 laser equipment for cutting, which is done slowly, while we do the adequate homeostasis. We remove the forceps to finish harmonizing the edges of the labia with the laser and, if necessary, complete the hemostasis without suture. We then leave a vaginal dressing with a healing cream, and we discharged the patient after being recovered anesthetically, with oral analgesics, antibiotic therapy and control appointment the following day, week, two weeks and then in a month. Conclusion: The labiaplasty performed correctly by a professional trained in the technique, with the help of the CO2 laser, is a safe procedure with a very low complication rate, and provided very satisfactory aesthetic, functional and emotional results for this patient group, in addition to demonstrating that with the CO2 laser, it can be done sutureless. The labiaplasty is an art.
S197 Virtual Poster Session 3: Hysteroscopy (10:30 AM − 10:40 AM) 10:30 AM: STATION T 2453 Office Hysteroscopic Adhesiolysis in a Patient with Severe Asherman’s Syndrome Robinson JK, III1 Hazen ND2,*. 1MIGS - National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Washington, DC; 2 MIGS - National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Washington, DC *Corresponding author. Video Objective: To demonstrate our technique for adhesiolysis in an office hysteroscopy setting. Setting: Office Hysteroscopy. Our patient is a 40 year old nulliparous female with a history for fibroids and heavy uterine bleeding. She has had three hysteroscopic myomectomies, and a uterine artery embolization. In her evaluation prior to IVF she had a HSG and SIS that demonstrated a shortened uterine cavity and likely uterine adhesions. Interventions: We demonstrate our technique for adhesiolysis of uterine synechiae utilizing a 5mm hysteroscope with a 5 fr. working channel and the semi-rigid scissors. Using internal landmarks, and a combination of blunt and sharp dissection we are able to restore the uterine cavity to its normal contour in the office, in spite of the dense adhesions. The presentation ends with a 2nd look hysteroscopy 3 weeks following the initial procedure. Conclusion: Office hysteroscopy is a viable and effective option for management of severe Asherman’s syndrome. Virtual Poster Session 3: Hysteroscopy (10:40 AM − 10:50 AM) 10:40 AM: STATION A 1973 Sutureless Labiaplasty, is it Possible? Acosta-Osio GI*. Clinical Director of Cosmetic Gynecology, Universidad Metropolitana & Fundaci on Hospital Universitario Metropolitano, Barranquilla, Colombia *Corresponding author. Video Objective: The purpose of this video is to present our surgical experience, the technique by performing the CO2 Laser cut without suture and to evaluate immediate or delayed complications and its safety. Setting: The request for female labiaplasty surgery continues to increase. There are many doubts about which is the best technique and about its security. Interventions: In the operating room, with spinal or epidural anesthesia according to the decision of the anesthesiologist, an evaluation of the shape of the lips is performed again, to be sure of the areas to be resected according to each patient; both lips are carefully and harmonically marked. After linearly marking the area to be resected, we placed bilateral clamps in the marked area so that they serve as a guide and help us with the hemostasia, then infiltrate marcaina with epinefrina, and wait about 2 or 3 minutes and then we proceed to cut over them, achieving a much clear and more continuous cut, adjusting the CO2 laser equipment for cutting, which is done slowly, while we do the adequate homeostasis. We remove the forceps to finish harmonizing the edges of the labia with the laser and, if necessary, complete the hemostasis without suture. We then leave a vaginal dressing with a healing cream, and we discharged the patient after being recovered anesthetically, with oral analgesics, antibiotic therapy and control appointment the following day, week, two weeks and then in a month. Conclusion: The labiaplasty performed correctly by a professional trained in the technique, with the help of the CO2 laser, is a safe procedure with a very low complication rate, and provided very satisfactory aesthetic, functional and emotional results for this patient group, in addition to demonstrating that with the CO2 laser, it can be done sutureless. The labiaplasty is an art.