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2848 Treatment of Adenomyosis by Hysteroscope
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
S193
Our data show that 60% of AVM diagnoses on ultrasound reports were likely an overdiagnosis. 43 (35%) of these patients were treated for retained products of conception either surgically or medically. Conclusion: Overdiagnosis is clinically important not only due to cost implications, but because in the setting of true uterine AVM, surgical treatment for retained products via D&C is contraindicated.
Study Objective: To evaluate the safety and effectiveness of operative hysteroscopy for management of retained products of conception (RPOC) Design: Retrospective chart review. Setting: Operating room of a gynecology endoscopy unit of a large community center. Patients or Participants: Patients who underwent hysteroscopic removal of RPOCs between November 1, 2008 and December 31, 2017 performed by a single physician. Interventions: Hysteroscopic removal of retained products of conception performed in the operating room under general anesthesia. Cases were categorized with RPOC type 0 to 3 according to the vascularity of the retained tissue noted on Doppler vaginal ultrasound as per the Gutenberg classification of RPOC. Measurements and Main Results: Forty-five (n=45) patients met inclusion criteria. The average age was 35.9 years of age (SD: 4.45). The preceding pregnancy resulting in retained POCs was abortion comprising 64.4% (n=29) followed by vaginal deliveries (13.3%, n=6) and cesarean (11.1%, n=5). Groups were divided into low vascularity group (Type 0 and 1 of the Gutenberg classification, NV Group) and moderate to high vascularity group (Type 2 and 3 of the Gutenberg classification, HV Group). 37.9% of patients of the NV Group had previous treatment compared to 62.5% of the HV Group (p<0.01). The timing between the end of a pregnancy and the surgery for RPOCs was 2.62 months in the NV Group and 1.7 months in HV Group. Interestingly, all patients of the HV Group required the use of electrosurgical energy ton achieve hemostasis during the procedure, compared to zero patients of the NV Group. (p<0.000). Conclusion: Hysteroscopic removal of RPOC is a highly effective and safe surgical procedure. The use of electrosurgical energy is frequently needed to obtain hemostasis in the presence of highly vascular RPOC. Physicians should ensure the capacity to use electrosurgical energy to avoid intraoperative complications when performing removal of highly vascular RPOCs.
Virtual Poster Session 3: Hysteroscopy (10:30 AM − 10:40 AM) 10:30 AM: STATION F 2848 Treatment of Adenomyosis by Hysteroscope Zhang J,1,* Yu J,2 Zhang D,3 Xia W3. 1Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; 2 Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; 3Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China *Corresponding author. Video Objective: To demonstrate a novel hysteroscopic surgery for adenomyosis. Setting: The benign gynecology department at a university hospital. Interventions: We performed a hysteroscopic minimally operation to treat symptomatic myometrial adenomyosis. The operations were performed under transabdominal ultrasound-guide. We used a cutting loop to resect the lesions repeatedly and progressively with the standard electroresection. The operation was considered complete when the pink fasciculate structure of the myometrium appeared. This study was approved by the institutional ethics committee of the International Peace Maternity and Child Health Hospital in Shanghai, China, on 19 April 2016. The approval number is GLW (2015) 19.Following-up were performed for 2 times at 3-months interval. The patient menstruated regularly. The postoperative VAS scores of dysmenorrhea and menstrual blood volume declined significantly after operation. 6 months after the operation the uterine volume evaluated by magnetic resonance imaging (MRI) reduced by about 33%. Conclusion: Traditionally, adenomyosis is often an incidental finding in specimens obtained from hysterectomy or uterine biopsies and/or percutaneous ultrasound-based biopsies. The modern diagnostic imaging techniques, such as (MRI), contributing to improving accuracy in the identification of this pathology, results in that the conservative uterinesparing treatments of adenomyosis appear to be feasible and efficacious. Hysteroscopic excision of uterine adenomyosis has the following benefits: the uterine is reserved and the symptoms of adenomyosis get improvement; the minimally invasive operation is short-time taking and the patients recovers quickly. Therefore, hysteroscopic excision provides an effective and optional conservative technique for the treatment of adenomyosis. Virtual Poster Session 3: Hysteroscopy (10:30 AM − 10:40 AM) 10:30 AM: STATION G 1809 Hysteroscopic Management of Retained Products of Conception: The New Gold Standard? Pacheco LA,1 Timmons D,2,* Saad-Naguib M,3 Carugno JA4. 1Obstetrics and Gynecology, Centro Gutenberg, Malaga, Spain; 2Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Miami, FL; 3 Obstetrics, Gynecologic, and Reproductive Services, University of Miami, Miami, FL; 4Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Pembroke Pines, FL *Corresponding author.
Virtual Poster Session 3: Hysteroscopy (10:30 AM − 10:40 AM) 10:30 AM: STATION H 1593 Transvaginal Repair of Cesarean Scar Isthmocele with Micro-Dehiscence Jayaram PM,1,* AlSayed O,2 Abid H,2 Al Ibrahim AA2. 1OBGYN, Sidra Medicine, Weill Cornell Medical College, Doha, Qatar; 2OBGYN, WWRC, Hamad Medical Corporation, Doha, Qatar *Corresponding author. Study Objective: Our objective is to report a case of Cesarean Scar Isthmocele (CSI) with micro-dehiscence with symptoms which was successfully repaired through transvaginal route. Design: NA. Setting: Diagnosis and surgical treatment performed in a large tertiary hospital. Patients or Participants: This was a 28 year old, P1, who had previous 1 cesarean section 3 years back for breech presentation. She presented with very bothersome regular post menstrual brownish spotting and dysmenorrhea for more than 7 months. She had no other significant medical problems. Saline hystero-sonography showed CSI of 1.4 £ 0.8 cms with overlying myometrium of 2.2mm thickness. Saline was seen accumulating in vesico-uterine space through microdefects. She was also noted to have unicornuate uterus with no other associated anomalies. Interventions: She was not suitable for hysteroscopic resection as the myometrial thickness was less than 3mm and there was a micro- dehiscence. After discussion, we performed excision of the scar tissue and repair of the CSI through transvaginal route. Under general anesthesia, bladder was dissected off the cervix and uterus and isthmocele was identified by trans-illumination with hysteroscope. The scar tissue was excised and the defect was closed in two layers.
S193
Our data show that 60% of AVM diagnoses on ultrasound reports were likely an overdiagnosis. 43 (35%) of these patients were treated for retained products of conception either surgically or medically. Conclusion: Overdiagnosis is clinically important not only due to cost implications, but because in the setting of true uterine AVM, surgical treatment for retained products via D&C is contraindicated.
Study Objective: To evaluate the safety and effectiveness of operative hysteroscopy for management of retained products of conception (RPOC) Design: Retrospective chart review. Setting: Operating room of a gynecology endoscopy unit of a large community center. Patients or Participants: Patients who underwent hysteroscopic removal of RPOCs between November 1, 2008 and December 31, 2017 performed by a single physician. Interventions: Hysteroscopic removal of retained products of conception performed in the operating room under general anesthesia. Cases were categorized with RPOC type 0 to 3 according to the vascularity of the retained tissue noted on Doppler vaginal ultrasound as per the Gutenberg classification of RPOC. Measurements and Main Results: Forty-five (n=45) patients met inclusion criteria. The average age was 35.9 years of age (SD: 4.45). The preceding pregnancy resulting in retained POCs was abortion comprising 64.4% (n=29) followed by vaginal deliveries (13.3%, n=6) and cesarean (11.1%, n=5). Groups were divided into low vascularity group (Type 0 and 1 of the Gutenberg classification, NV Group) and moderate to high vascularity group (Type 2 and 3 of the Gutenberg classification, HV Group). 37.9% of patients of the NV Group had previous treatment compared to 62.5% of the HV Group (p<0.01). The timing between the end of a pregnancy and the surgery for RPOCs was 2.62 months in the NV Group and 1.7 months in HV Group. Interestingly, all patients of the HV Group required the use of electrosurgical energy ton achieve hemostasis during the procedure, compared to zero patients of the NV Group. (p<0.000). Conclusion: Hysteroscopic removal of RPOC is a highly effective and safe surgical procedure. The use of electrosurgical energy is frequently needed to obtain hemostasis in the presence of highly vascular RPOC. Physicians should ensure the capacity to use electrosurgical energy to avoid intraoperative complications when performing removal of highly vascular RPOCs.
Virtual Poster Session 3: Hysteroscopy (10:30 AM − 10:40 AM) 10:30 AM: STATION F 2848 Treatment of Adenomyosis by Hysteroscope Zhang J,1,* Yu J,2 Zhang D,3 Xia W3. 1Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; 2 Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; 3Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China *Corresponding author. Video Objective: To demonstrate a novel hysteroscopic surgery for adenomyosis. Setting: The benign gynecology department at a university hospital. Interventions: We performed a hysteroscopic minimally operation to treat symptomatic myometrial adenomyosis. The operations were performed under transabdominal ultrasound-guide. We used a cutting loop to resect the lesions repeatedly and progressively with the standard electroresection. The operation was considered complete when the pink fasciculate structure of the myometrium appeared. This study was approved by the institutional ethics committee of the International Peace Maternity and Child Health Hospital in Shanghai, China, on 19 April 2016. The approval number is GLW (2015) 19.Following-up were performed for 2 times at 3-months interval. The patient menstruated regularly. The postoperative VAS scores of dysmenorrhea and menstrual blood volume declined significantly after operation. 6 months after the operation the uterine volume evaluated by magnetic resonance imaging (MRI) reduced by about 33%. Conclusion: Traditionally, adenomyosis is often an incidental finding in specimens obtained from hysterectomy or uterine biopsies and/or percutaneous ultrasound-based biopsies. The modern diagnostic imaging techniques, such as (MRI), contributing to improving accuracy in the identification of this pathology, results in that the conservative uterinesparing treatments of adenomyosis appear to be feasible and efficacious. Hysteroscopic excision of uterine adenomyosis has the following benefits: the uterine is reserved and the symptoms of adenomyosis get improvement; the minimally invasive operation is short-time taking and the patients recovers quickly. Therefore, hysteroscopic excision provides an effective and optional conservative technique for the treatment of adenomyosis. Virtual Poster Session 3: Hysteroscopy (10:30 AM − 10:40 AM) 10:30 AM: STATION G 1809 Hysteroscopic Management of Retained Products of Conception: The New Gold Standard? Pacheco LA,1 Timmons D,2,* Saad-Naguib M,3 Carugno JA4. 1Obstetrics and Gynecology, Centro Gutenberg, Malaga, Spain; 2Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Miami, FL; 3 Obstetrics, Gynecologic, and Reproductive Services, University of Miami, Miami, FL; 4Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Pembroke Pines, FL *Corresponding author.
Virtual Poster Session 3: Hysteroscopy (10:30 AM − 10:40 AM) 10:30 AM: STATION H 1593 Transvaginal Repair of Cesarean Scar Isthmocele with Micro-Dehiscence Jayaram PM,1,* AlSayed O,2 Abid H,2 Al Ibrahim AA2. 1OBGYN, Sidra Medicine, Weill Cornell Medical College, Doha, Qatar; 2OBGYN, WWRC, Hamad Medical Corporation, Doha, Qatar *Corresponding author. Study Objective: Our objective is to report a case of Cesarean Scar Isthmocele (CSI) with micro-dehiscence with symptoms which was successfully repaired through transvaginal route. Design: NA. Setting: Diagnosis and surgical treatment performed in a large tertiary hospital. Patients or Participants: This was a 28 year old, P1, who had previous 1 cesarean section 3 years back for breech presentation. She presented with very bothersome regular post menstrual brownish spotting and dysmenorrhea for more than 7 months. She had no other significant medical problems. Saline hystero-sonography showed CSI of 1.4 £ 0.8 cms with overlying myometrium of 2.2mm thickness. Saline was seen accumulating in vesico-uterine space through microdefects. She was also noted to have unicornuate uterus with no other associated anomalies. Interventions: She was not suitable for hysteroscopic resection as the myometrial thickness was less than 3mm and there was a micro- dehiscence. After discussion, we performed excision of the scar tissue and repair of the CSI through transvaginal route. Under general anesthesia, bladder was dissected off the cervix and uterus and isthmocele was identified by trans-illumination with hysteroscope. The scar tissue was excised and the defect was closed in two layers.