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2579 Isthmocele in a Patient with Secondary Infertility
S198
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Virtual Poster Session 3: Hysteroscopy (10:40 AM − 10:50 AM)
Conclusion: At our center the laparoscopic management of isthmocele with hysteroscopic assistance has given excellent results in patients of infertility and abnormal uterine bleeding.
10:40 AM: STATION B 1886 Hysterectomy and Adnexal Procedures by Vaginal Natural Orifice Transluminal Endoscopic Surgery (Vnotes): Korean Surgeons’ Initial Reports Kim MS,* Jeong SY, Paik ES, Lee YY, Choi CH, Lee JW, Choi DS, Kim BG, Bae DS, Kim TJ. Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of (South) *Corresponding author. Study Objective: To evaluate feasibility and safety of hysterectomy and adnexal procedures by vNOTES. Design: Prospective observational study. Setting: Prepare the surgery under general anesthesia and allow the patient to take a Trendelenburg posture. Patients or Participants: Most of benign diseases except malignant disease were selected from the surgical candidates. Interventions: There is no intervention other than surgery. Measurements and Main Results: The first 26 patients were treated with vNOTES. Basic patient characteristics were measured, and the time of port installation and each stage of surgery was measured. The learning curve was assessed through the graph according to the number of operations using linear and logarithmic regression curve estimation. The complications of surgery were investigated. The median age of the patients was 47.5 years (38-73). Median BMI was 22.4 (18.2-30.0). Median EBL was measured as 100 ml (20.0-500). The median value of hemoglobin changes before and after surgery was 1.8 (0.2-4.5). The day of hospitalization from the day of surgery was 3 days (3-8). 18 (69.2%) cases had previous vaginal delivery history. 5 cases had previous Cesarean section. Five patients previously underwent a Cesarean section, two of which were Pfannenstiels incision and three of whom were low midline incision. The median portal time was 15 min (435) and the median total time was 85 min (43.1-132.0). From the 5th case in the learning curve, the port installation time was significantly shortened. Complications occurred during surgery in three patients who had undergone previous Cesarean section surgery. Two cases of bladder injury occurred during port installation due to adhesion of Cesarean section site and bladder. One case was a reoperation for intraperitoneal hemorrhage on the 13th postoperative day. There were no other complications. Conclusion: To date, vNOTES does not seem to lag much behind other surgical methods in our institution. vNOTES is currently undergoing a prospective study, including pain and cosmetic aspects. Virtual Poster Session 3: Hysteroscopy (10:40 AM − 10:50 AM) 10:40 AM: STATION C 2579 Isthmocele in a Patient with Secondary Infertility Saxena A,* Arora A, Jaiswal E, Teja GND. Tulip Multispeciality Hospital Pvt. Ltd, Sonepat, India *Corresponding author. Video Objective: The study objective is to evaluate the minimally invasive (Laparoscopic & Hysteroscopic) management of isthmocele in infertile patients and their short term follow up. Setting: Tertiary referral center (Tulip Multispeciality Hospital). Interventions: Seven patients who presented with infertility together with pelvic pain and abnormal uterine bleeding were taken. The diagnosis was made by transvaginal ultrasound, sonosalpingography, hysteroscopy or MRI. Laparoscopic resection of isthmocele was done.
Virtual Poster Session 3: Hysteroscopy (10:40 AM − 10:50 AM) 10:40 AM: STATION D 1942 Transvaginal Natural Orifice Transluminal Endoscopic (Vnotes) Hysterectomy Learning Curve: The Feasibility in the Hands of Skilled Gynecologists Matanes E,1,* Lauterbach R,1 Mor O,2 Lowenstein L1. 1Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; 2 Rambam Health Care Campus, Department of Obstetrics and Gynecology, Haifa, Israel *Corresponding author. Study Objective: During Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) the surgeon operates exclusively through a single vaginal entry point, leaving no external scarring. The aim of this study is to evaluate the learning curve of vNOTES hysterectomy in the hands of experienced gynecologists, based on surgical times and shortterm outcomes. Design: A retrospective study of the first 25 vNOTES hysterectomy surgeries performed between July-December 2018 at the Rambam Health Care Campus by a single surgeon. Setting: A retrospective study. Patients or Participants: Women who underwent hysterectomy for benign indication. Interventions: Hysterectomy. Measurements and Main Results: The primary outcome was hysterectomy time. Secondary outcomes included intra-operative bleeding, length of hospitalization, post-operative pain and need for analgesia. Sociodemographic and clinical data were retrieved from patients’ electronic charts. Patients‘ median age was 64.5 years (range 40-79); Median hysterectomy time was 38 minutes (range 30-49) from first cut to completion of hysterectomy. Comparisons between median hysterectomy time in the first 10 hysterectomies and in the 15 sequential procedures demonstrated a significant decrease in median total hysterectomy time, 45 minutes (range 41-49) vs. 32 minutes (range 30-38) respectively (P=0.024). The median estimated intraoperative blood loss decreased from 100 ml (range 70-200) in the first 10 hysterectomies to 40 ml (range 20-100) in the 15 sequential procedures (P=0.011). Conclusion: vNOTES hysterectomy is a feasible procedure in the hands of an experienced gynecologist with an exponential improvement in surgical performance in a short period as expressed by the improvement in hysterectomy time, low complication rates, negligible blood loss, minimal post-surgical pain, fast recovery, short hospitalization Importantly, vNOTES allows easier and safer access to adnexal removal compared to conventional vaginal surgery. Long-term follow up requires further investigation.
Virtual Poster Session 3: Hysteroscopy (10:40 AM − 10:50 AM) 10:40 AM: STATION E 2484 Clinical Outcomes Among Women with Abnormal Uterine Bleeding Treated with Inpatient or Outpatient Hysterectomy Versus Endometrial Ablation Bonafede M,1,* Tran OV,1 Miller JD,1 Pohlman S,2 Troeger K2. 1Life Sciences, IBM Watson Health, Cambridge, MA; 2Outcomes Research, Hologic Inc, Marlborough, MA *Corresponding author.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Virtual Poster Session 3: Hysteroscopy (10:40 AM − 10:50 AM)
Conclusion: At our center the laparoscopic management of isthmocele with hysteroscopic assistance has given excellent results in patients of infertility and abnormal uterine bleeding.
10:40 AM: STATION B 1886 Hysterectomy and Adnexal Procedures by Vaginal Natural Orifice Transluminal Endoscopic Surgery (Vnotes): Korean Surgeons’ Initial Reports Kim MS,* Jeong SY, Paik ES, Lee YY, Choi CH, Lee JW, Choi DS, Kim BG, Bae DS, Kim TJ. Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of (South) *Corresponding author. Study Objective: To evaluate feasibility and safety of hysterectomy and adnexal procedures by vNOTES. Design: Prospective observational study. Setting: Prepare the surgery under general anesthesia and allow the patient to take a Trendelenburg posture. Patients or Participants: Most of benign diseases except malignant disease were selected from the surgical candidates. Interventions: There is no intervention other than surgery. Measurements and Main Results: The first 26 patients were treated with vNOTES. Basic patient characteristics were measured, and the time of port installation and each stage of surgery was measured. The learning curve was assessed through the graph according to the number of operations using linear and logarithmic regression curve estimation. The complications of surgery were investigated. The median age of the patients was 47.5 years (38-73). Median BMI was 22.4 (18.2-30.0). Median EBL was measured as 100 ml (20.0-500). The median value of hemoglobin changes before and after surgery was 1.8 (0.2-4.5). The day of hospitalization from the day of surgery was 3 days (3-8). 18 (69.2%) cases had previous vaginal delivery history. 5 cases had previous Cesarean section. Five patients previously underwent a Cesarean section, two of which were Pfannenstiels incision and three of whom were low midline incision. The median portal time was 15 min (435) and the median total time was 85 min (43.1-132.0). From the 5th case in the learning curve, the port installation time was significantly shortened. Complications occurred during surgery in three patients who had undergone previous Cesarean section surgery. Two cases of bladder injury occurred during port installation due to adhesion of Cesarean section site and bladder. One case was a reoperation for intraperitoneal hemorrhage on the 13th postoperative day. There were no other complications. Conclusion: To date, vNOTES does not seem to lag much behind other surgical methods in our institution. vNOTES is currently undergoing a prospective study, including pain and cosmetic aspects. Virtual Poster Session 3: Hysteroscopy (10:40 AM − 10:50 AM) 10:40 AM: STATION C 2579 Isthmocele in a Patient with Secondary Infertility Saxena A,* Arora A, Jaiswal E, Teja GND. Tulip Multispeciality Hospital Pvt. Ltd, Sonepat, India *Corresponding author. Video Objective: The study objective is to evaluate the minimally invasive (Laparoscopic & Hysteroscopic) management of isthmocele in infertile patients and their short term follow up. Setting: Tertiary referral center (Tulip Multispeciality Hospital). Interventions: Seven patients who presented with infertility together with pelvic pain and abnormal uterine bleeding were taken. The diagnosis was made by transvaginal ultrasound, sonosalpingography, hysteroscopy or MRI. Laparoscopic resection of isthmocele was done.
Virtual Poster Session 3: Hysteroscopy (10:40 AM − 10:50 AM) 10:40 AM: STATION D 1942 Transvaginal Natural Orifice Transluminal Endoscopic (Vnotes) Hysterectomy Learning Curve: The Feasibility in the Hands of Skilled Gynecologists Matanes E,1,* Lauterbach R,1 Mor O,2 Lowenstein L1. 1Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; 2 Rambam Health Care Campus, Department of Obstetrics and Gynecology, Haifa, Israel *Corresponding author. Study Objective: During Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) the surgeon operates exclusively through a single vaginal entry point, leaving no external scarring. The aim of this study is to evaluate the learning curve of vNOTES hysterectomy in the hands of experienced gynecologists, based on surgical times and shortterm outcomes. Design: A retrospective study of the first 25 vNOTES hysterectomy surgeries performed between July-December 2018 at the Rambam Health Care Campus by a single surgeon. Setting: A retrospective study. Patients or Participants: Women who underwent hysterectomy for benign indication. Interventions: Hysterectomy. Measurements and Main Results: The primary outcome was hysterectomy time. Secondary outcomes included intra-operative bleeding, length of hospitalization, post-operative pain and need for analgesia. Sociodemographic and clinical data were retrieved from patients’ electronic charts. Patients‘ median age was 64.5 years (range 40-79); Median hysterectomy time was 38 minutes (range 30-49) from first cut to completion of hysterectomy. Comparisons between median hysterectomy time in the first 10 hysterectomies and in the 15 sequential procedures demonstrated a significant decrease in median total hysterectomy time, 45 minutes (range 41-49) vs. 32 minutes (range 30-38) respectively (P=0.024). The median estimated intraoperative blood loss decreased from 100 ml (range 70-200) in the first 10 hysterectomies to 40 ml (range 20-100) in the 15 sequential procedures (P=0.011). Conclusion: vNOTES hysterectomy is a feasible procedure in the hands of an experienced gynecologist with an exponential improvement in surgical performance in a short period as expressed by the improvement in hysterectomy time, low complication rates, negligible blood loss, minimal post-surgical pain, fast recovery, short hospitalization Importantly, vNOTES allows easier and safer access to adnexal removal compared to conventional vaginal surgery. Long-term follow up requires further investigation.
Virtual Poster Session 3: Hysteroscopy (10:40 AM − 10:50 AM) 10:40 AM: STATION E 2484 Clinical Outcomes Among Women with Abnormal Uterine Bleeding Treated with Inpatient or Outpatient Hysterectomy Versus Endometrial Ablation Bonafede M,1,* Tran OV,1 Miller JD,1 Pohlman S,2 Troeger K2. 1Life Sciences, IBM Watson Health, Cambridge, MA; 2Outcomes Research, Hologic Inc, Marlborough, MA *Corresponding author.