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2860 Diagnostic Hysteroscopy in Missed Abortion
S194
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Measurements and Main Results: She was reviewed after 6 months when her postmenstrual spotting and dysmenorrhea had completely improved. Ultrasound scan showed improved appearance with minimal defect and myometrial thickness of 5mm. Conclusion: The significance of finding of micro-dehiscence of cesarean scar and the future risk of uterine rupture during pregnancy is not clear due to lack of literature. Symptomatic cesarean scar isthmoceles with myometrial thickness of less than 3mm are best treated with surgical resection and resuturing. Transvaginal route offers safe and minimally invasive technique to improve symptoms and potentially reduce the future risk of uterine rupture during pregnancy.
Hospital, The Catholic University of Korea, Seoul, Korea, Republic of (South) *Corresponding author.
Virtual Poster Session 3: Hysteroscopy (10:30 AM − 10:40 AM) 10:30 AM: STATION I 2860 Diagnostic Hysteroscopy in Missed Abortion Norton T,1,* Chen J,2 Smith RB,3 Mahnert N3. 1Ob/Gyn, University of Arizona College of Medicine Phoenix, Phoenix, AZ; 2Minimally Invasive Gynecology, Banner University Medical Center Phoenix, Phoenix, AZ; 3 Minimally Invasive Gynecologic Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, AZ *Corresponding author. Video Objective: To present two surgical cases of diagnostic hysteroscopy at the time of uterine evacuation for spontaneous abortion and to review the literature on hysteroscopy use in the setting of spontaneous abortion. Setting: One 37-year-old G4P1021 at 9 weeks 1-day gestation with spontaneous abortion and a history of uterine septum status post prior septal resection, who desired surgical management with uterine evacuation. The second case is a 38-year-old G5P2022 at 9 weeks gestation with spontaneous abortion and a history of recurrent pregnancy loss who desired surgical management with uterine evacuation. Both patients underwent uncomplicated diagnostic hysteroscopy and suction curettage at an academic medical center. Interventions: In this surgical video, we present two cases of women with first trimester spontaneous abortion who desired surgical management with uterine evacuation. Both cases had preoperative indications for uterine cavity inspection with hysteroscopy given their histories of a uterine anomaly and recurrent pregnancy loss. Diagnostic hysteroscopy was performed in both cases prior to the suction dilation and curettage procedures to closely inspect the cavities as well as identify the implantation site for site-specific curettage as compared to the traditional global suction curettage. Additionally, we summarize the current literature on hysteroscopy use in the setting of spontaneous abortion. Conclusion: Diagnostic hysteroscopy at the time of uterine evacuation for patients with spontaneous abortion is a feasible alternative to traditional suction curettage alone and can provide additional clinical information regarding implantation site for directed resection as well as uterine cavity inspection for uterine anomalies or alternative pathology. Virtual Poster Session 3: Hysteroscopy (10:30 AM − 10:40 AM) 10:30 AM: STATION J 2053 the Fractional CO2 Laser in Korea: An Effective Treatment Option for Genitourinary Syndrome of Menopause Kang HJ,1 Shim S,2 Han Y,3 Park KM,4,* Hwang H,5 Chung YJ,6 Kim MR,6 Park JY4. 1Obstetrics & Gynecology, Seoul St. Mary’s Hospital, The Catholic university of Korea, Seoul, Korea, Republic of (South); 2 The Catholic University of Korea, Seoul St. Mary’s hospital, Seoul, Korea, Republic of (South); 3Seoul St. Mary’s hospital, Seoul, Korea, Republic of (South); 4Seoul St. Mary’s hospital, Seoul, Korea, Republic of (South); 5Bucheon St. Mary’s hospital, Bucheon, Korea, Republic of (South); 6Department of Obstetrics and Gynecology, Seoul Saint Mary’s
Study Objective: The genitourinary syndrome of menopause (GSM) is associated with bothersome symptoms in menopausal women. The GSM may have a negative impact on the quality of life of postmenopausal women, and it should be treated with an appropriate therapy. This study is aimed to evaluate the efficacy of fractional CO2 laser therapy (Laser therapy) in the treatment of GSM. Design: GSM patients treated with Laser therapy and evaluates the progress before and after treatment using objective and subjective indicators. Setting: We use the fractional CO2 laser (SmartXide2 V2LR, Monalisa Touch, DEKA, Italy). The therapy was applicated every 4 weeks. Patients or Participants: The total of 38 women presenting with GSM were enrolled to Laser therapy. 22 patients are survivors of breast cancer. Interventions: The severity of symptoms was assessed with a visual analog scale(VAS) at the baseline and every visit. We also measured the objective scale using the vaginal health index score (VHIS) at baseline and after completion of laser procedure. At each procedure, patient’s pain in VAS and the physician’s difficulty was recorded at each time. At last visit, the patients evaluate their satisfaction with the laser therapy using a 5 points Likert scale. Measurements and Main Results: In our study, almost all symptoms showed the mean VAS score improvement. But only the relief in vaginal dryness improved significantly(p<0.05). On the other hand, the objective scale, the VHIS was significantly improved in comparison with baseline (p <0.001). Each component of VHIS (elasticity, fluid volume, vaginal pH, epithelial integrity, vaginal moisturization; p <0.001) was also significantly improved. The measurement by perineometer to assess the pelvic floor muscle was significantly improved (p =0.002). Conclusion: This study shows that fractional CO2 laser treatment is effective in patients who suffering from genitourinary syndrome of menopause. Further studies should be performed to confirm the results and to assess the long-term effects of the laser therapy. Virtual Poster Session 3: Hysteroscopy (10:30 AM − 10:40 AM) 10:30 AM: STATION K 1397 Vnotes Hysterectomy for Multiple Fibroid Uterus by Atrium Technique Naval S,1,* Naval R,2 Naval S2. 1Minimally Invasive Surgery, Naval Multi Speciality Hospital, Jalgaon, India; 2Naval Multi Speciality Hospital, Jalgaon, India *Corresponding author. Video Objective: To describe technique of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) of hysterectomy in a case of multiple fibroid uterus with the aid of transcervical instrumental uterine manipulation- ATRIUM technique. Setting: Minimally invasive gynecological surgery department, Naval Multi Speciality Hospital, Jalgaon, India. Interventions: Transvaginal natural orifice transluminal endoscopic surgery of hysterectomy. Conclusion: During vNOTES hysterectomy, using a laparoscopy instrument placed transcervically into the uterus for manipulation gives a leverage that helps in good exposure of all uterine attachments. It prevents unintentional rotation of uterus and its attachments. Therefore, the surgeon is not required to use second hand for retraction of uterus during surgery. This allows surgeon to use second hand for retraction of bowel and adnexa. As the tip of instruments is not completely visible in vNOTES surgery, manipulation helps to deflect the uterus and its attachments away from important structures thus preventing inadvertent thermal damage from the tip of the instrument. This is a feasible and safe technique of vNOTES hysterectomy.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Measurements and Main Results: She was reviewed after 6 months when her postmenstrual spotting and dysmenorrhea had completely improved. Ultrasound scan showed improved appearance with minimal defect and myometrial thickness of 5mm. Conclusion: The significance of finding of micro-dehiscence of cesarean scar and the future risk of uterine rupture during pregnancy is not clear due to lack of literature. Symptomatic cesarean scar isthmoceles with myometrial thickness of less than 3mm are best treated with surgical resection and resuturing. Transvaginal route offers safe and minimally invasive technique to improve symptoms and potentially reduce the future risk of uterine rupture during pregnancy.
Hospital, The Catholic University of Korea, Seoul, Korea, Republic of (South) *Corresponding author.
Virtual Poster Session 3: Hysteroscopy (10:30 AM − 10:40 AM) 10:30 AM: STATION I 2860 Diagnostic Hysteroscopy in Missed Abortion Norton T,1,* Chen J,2 Smith RB,3 Mahnert N3. 1Ob/Gyn, University of Arizona College of Medicine Phoenix, Phoenix, AZ; 2Minimally Invasive Gynecology, Banner University Medical Center Phoenix, Phoenix, AZ; 3 Minimally Invasive Gynecologic Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, AZ *Corresponding author. Video Objective: To present two surgical cases of diagnostic hysteroscopy at the time of uterine evacuation for spontaneous abortion and to review the literature on hysteroscopy use in the setting of spontaneous abortion. Setting: One 37-year-old G4P1021 at 9 weeks 1-day gestation with spontaneous abortion and a history of uterine septum status post prior septal resection, who desired surgical management with uterine evacuation. The second case is a 38-year-old G5P2022 at 9 weeks gestation with spontaneous abortion and a history of recurrent pregnancy loss who desired surgical management with uterine evacuation. Both patients underwent uncomplicated diagnostic hysteroscopy and suction curettage at an academic medical center. Interventions: In this surgical video, we present two cases of women with first trimester spontaneous abortion who desired surgical management with uterine evacuation. Both cases had preoperative indications for uterine cavity inspection with hysteroscopy given their histories of a uterine anomaly and recurrent pregnancy loss. Diagnostic hysteroscopy was performed in both cases prior to the suction dilation and curettage procedures to closely inspect the cavities as well as identify the implantation site for site-specific curettage as compared to the traditional global suction curettage. Additionally, we summarize the current literature on hysteroscopy use in the setting of spontaneous abortion. Conclusion: Diagnostic hysteroscopy at the time of uterine evacuation for patients with spontaneous abortion is a feasible alternative to traditional suction curettage alone and can provide additional clinical information regarding implantation site for directed resection as well as uterine cavity inspection for uterine anomalies or alternative pathology. Virtual Poster Session 3: Hysteroscopy (10:30 AM − 10:40 AM) 10:30 AM: STATION J 2053 the Fractional CO2 Laser in Korea: An Effective Treatment Option for Genitourinary Syndrome of Menopause Kang HJ,1 Shim S,2 Han Y,3 Park KM,4,* Hwang H,5 Chung YJ,6 Kim MR,6 Park JY4. 1Obstetrics & Gynecology, Seoul St. Mary’s Hospital, The Catholic university of Korea, Seoul, Korea, Republic of (South); 2 The Catholic University of Korea, Seoul St. Mary’s hospital, Seoul, Korea, Republic of (South); 3Seoul St. Mary’s hospital, Seoul, Korea, Republic of (South); 4Seoul St. Mary’s hospital, Seoul, Korea, Republic of (South); 5Bucheon St. Mary’s hospital, Bucheon, Korea, Republic of (South); 6Department of Obstetrics and Gynecology, Seoul Saint Mary’s
Study Objective: The genitourinary syndrome of menopause (GSM) is associated with bothersome symptoms in menopausal women. The GSM may have a negative impact on the quality of life of postmenopausal women, and it should be treated with an appropriate therapy. This study is aimed to evaluate the efficacy of fractional CO2 laser therapy (Laser therapy) in the treatment of GSM. Design: GSM patients treated with Laser therapy and evaluates the progress before and after treatment using objective and subjective indicators. Setting: We use the fractional CO2 laser (SmartXide2 V2LR, Monalisa Touch, DEKA, Italy). The therapy was applicated every 4 weeks. Patients or Participants: The total of 38 women presenting with GSM were enrolled to Laser therapy. 22 patients are survivors of breast cancer. Interventions: The severity of symptoms was assessed with a visual analog scale(VAS) at the baseline and every visit. We also measured the objective scale using the vaginal health index score (VHIS) at baseline and after completion of laser procedure. At each procedure, patient’s pain in VAS and the physician’s difficulty was recorded at each time. At last visit, the patients evaluate their satisfaction with the laser therapy using a 5 points Likert scale. Measurements and Main Results: In our study, almost all symptoms showed the mean VAS score improvement. But only the relief in vaginal dryness improved significantly(p<0.05). On the other hand, the objective scale, the VHIS was significantly improved in comparison with baseline (p <0.001). Each component of VHIS (elasticity, fluid volume, vaginal pH, epithelial integrity, vaginal moisturization; p <0.001) was also significantly improved. The measurement by perineometer to assess the pelvic floor muscle was significantly improved (p =0.002). Conclusion: This study shows that fractional CO2 laser treatment is effective in patients who suffering from genitourinary syndrome of menopause. Further studies should be performed to confirm the results and to assess the long-term effects of the laser therapy. Virtual Poster Session 3: Hysteroscopy (10:30 AM − 10:40 AM) 10:30 AM: STATION K 1397 Vnotes Hysterectomy for Multiple Fibroid Uterus by Atrium Technique Naval S,1,* Naval R,2 Naval S2. 1Minimally Invasive Surgery, Naval Multi Speciality Hospital, Jalgaon, India; 2Naval Multi Speciality Hospital, Jalgaon, India *Corresponding author. Video Objective: To describe technique of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) of hysterectomy in a case of multiple fibroid uterus with the aid of transcervical instrumental uterine manipulation- ATRIUM technique. Setting: Minimally invasive gynecological surgery department, Naval Multi Speciality Hospital, Jalgaon, India. Interventions: Transvaginal natural orifice transluminal endoscopic surgery of hysterectomy. Conclusion: During vNOTES hysterectomy, using a laparoscopy instrument placed transcervically into the uterus for manipulation gives a leverage that helps in good exposure of all uterine attachments. It prevents unintentional rotation of uterus and its attachments. Therefore, the surgeon is not required to use second hand for retraction of uterus during surgery. This allows surgeon to use second hand for retraction of bowel and adnexa. As the tip of instruments is not completely visible in vNOTES surgery, manipulation helps to deflect the uterus and its attachments away from important structures thus preventing inadvertent thermal damage from the tip of the instrument. This is a feasible and safe technique of vNOTES hysterectomy.