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3018 Long Term Symptomatic Outcomes of Treatment of Uterine Fibroids in a Multidisciplinary Clinic
S102
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Virtual Poster Session 1: Laparoscopy (9:50 AM — 10:00 AM)
improvement in all 4 components of work productivity from baseline to 24 months post-procedure: absenteeism decreased from 2.9% to 1.3%; presenteeism decreased from 50.0% to 13.2%; overall work impairment decreased from 50.9% at baseline to 13.8%; impairment in daily activities decreased from 57.9% at baseline to 13.2% (all p<0.0001). Conclusion: Ultrasound-guided transcervical, intrauterine RF ablation with the Sonata system was shown to significantly increase patient health utility and work productivity during the first 24 months post-treatment.
9:50 AM: STATION M 2094 Single-Port Laparoscopic Hysterectomy without Uterine Manipulator in Early Cervical Cancer Ahn JH,* Hwang H, Lee KH. Gynecologic Oncology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea, Republic of (South) *Corresponding author. Video Objective: To present the advanced single port laparoscopic hysterectomy without a uterine manipulator in early cervical cancer. Setting: A 42-year-old woman(G2P2) undertook surgery diagnosed with cervical cancer in PAP smear and punch biopsy. She had no past medical history. There was neither evidence of definite burging mass in the cervix nor any metastasis in the preoperated abdominal computed tomographic imaging. Two ml (2.5 mg/mL) of ICG solution was prepared in a 10 ml syringe to inject directly into the cervix. We recorded video with 30˚ 10 mm scope equipped with a specific lens and light source emitting both visible and NIR light (Stryker 1588 AIM, Stryker Co., ABK, MI, USA). Interventions: Under general anesthesia, we performed laparoscopic single port hysterectomy and both salpingectomy and sentinel lymph node biopsy. During the surgery, we didn’t inserted both uterine manipulator and foley catheter. we used only the colpotomizer cup just before cutting the uterus. we also used a retrieval bag when removing the uterus from the abdominal cavity. Pathology revealed invasive squamous cell carcinoma and no sentinel lymph node metastasis. Conclusion: We successfully performed the single port laparoscopic hysterectomy not using a uterine manipulator for the early cervical cancer without any complication and that would be helpfull reducing the risk of tumor reccurence. Virtual Poster Session 1: Laparoscopy (9:50 AM — 10:00 AM) 9:50 AM: STATION N 1623 Improvement in 24-Month Health-Related Quality of life and Work Productivity after Ultrasound-Guided Transcervical, Intrauterine Radiofrequency Ablation of Uterine Fibroids in the Sonata Pivotal IDE Trial Makai GE,1,* Brooks E2. 1Obstetrics and Gynecology, Christiana Care Health Systems, Newark, DE; 2TTi Health Research & Economics, Westminster, MD *Corresponding author. Study Objective: To establish the long-term improvement in healthrelated quality of life and work productivity after use of ultrasound-guided transcervical, intrauterine radiofrequency (RF) ablation in the treatment of symptomatic uterine fibroids. Design: Prospective, longitudinal, multicenter, single-arm trial. Setting: 22 clinical sites (21 in the US and 1 in Mexico). Patients or Participants: Premenopausal women between the ages of 25 and 50 with heavy menstrual bleeding secondary to fibroids. Interventions: Ultrasound-guided transcervical RF ablation performed on up to 10 fibroids per subject with the SonataÒ system; fibroids ranged from 1-5 cm in diameter as determined by transvaginal sonography. The EuroQOL EQ-5D-3L (which measures health utility) and Work Productivity and Activity Impairment (WPAI) surveys were administered at baseline, as well as at 24 months post-intervention. Paired t-tests were conducted to evaluate improvement in health utility and work productivity from baseline through 24 months. Measurements and Main Results: One hundred forty-seven (147) patients were enrolled and followed through 24 months. Mean patient health utility significantly increased from 0.72 at baseline to 0.89 (p<0.0001). In addition, the WPAI measured statistically significant
Virtual Poster Session 1: Laparoscopy (9:50 AM — 10:00 AM) 9:50 AM: STATION O 3018 Long Term Symptomatic Outcomes of Treatment of Uterine Fibroids in a Multidisciplinary Clinic Lum D,1,* Shaffer R,1 Fast A,2 Vu K,2 Dobberfuhl A,3 Dababou S,4 Marrocchio C,4 Hovsepian D,2 Chen B,1 Ghanouni P2. 1Ob/gyn, Stanford University, Stanford, CA; 2Radiology, Stanford University, Stanford, CA; 3 Urology, Stanford University, Stanford, CA; 4Radiology, Sapienza University, Rome, Italy *Corresponding author. Study Objective: To determine the utilization of medical, interventional radiologic, and gynecologic surgical treatments at a multidisciplinary fibroid clinic, also to assess pre- and post-intervention changes in fibroid symptoms, pelvic floor symptoms, and quality of life over a multi-year follow-up period. Design: A retrospective survey study from 2013-2017. Setting: Academic University Hospital. Patients or Participants: 516 pre-menopausal women with pelvic MRI evidence of uterine fibroids seen at a multidisciplinary fibroid clinic from 2013-2017. Interventions: Demographic and clinical information were collected including baseline Uterine Fibroid Symptoms − Quality of Life (UFSQOL) and Pelvic Floor Distress Index (PFDI) questionnaires. All patients were sent a follow-up electronic survey at a single time point in 2018 assessing secondary treatments, fertility and re-administering UFS-QOL and PFDI questionnaires. Measurements and Main Results: Our cohort of 516 patients utilized various treatments including hysterectomy (N=73, 17.1%), non-hysteroscopic myomectomy (N=68, 15.9%), and uterine fibroid embolization (N=117, 27.5%). Patients who underwent hysterectomy had worse baseline UFS-QOL and PFDI scores. 25.8% of patients responded to the follow-up survey with a mean follow-up interval of 28.6 months. Significant improvement was seen in UFS (-57.30% § 66.90% vs -22.84% § 55.50%, p=0.003) and PFDI (-61.20% § 42.40% vs -11.82% § 93.21%, p=0.012) scores for patients undergoing any intervention compared to expectant/ medical management. There was no significant difference in UFS or PFDI improvement between interventional groups. Conclusion: Patients undergoing any intervention reported better symptom improvement than patients undergoing expectant management or medical therapy. Symptomatic improvement based on UFS-QOL and PFDI scores were comparable between patients undergoing interventional radiologic procedures, myomectomy, and hysterectomy interventions. Virtual Poster Session 1: Laparoscopy (9:50 AM — 10:00 AM) 9:50 AM: STATION P 1138 Repeat Laparoscopy for Pregnancy of Unknown Location Jennings A, Rosen ER*. Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI *Corresponding author.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Virtual Poster Session 1: Laparoscopy (9:50 AM — 10:00 AM)
improvement in all 4 components of work productivity from baseline to 24 months post-procedure: absenteeism decreased from 2.9% to 1.3%; presenteeism decreased from 50.0% to 13.2%; overall work impairment decreased from 50.9% at baseline to 13.8%; impairment in daily activities decreased from 57.9% at baseline to 13.2% (all p<0.0001). Conclusion: Ultrasound-guided transcervical, intrauterine RF ablation with the Sonata system was shown to significantly increase patient health utility and work productivity during the first 24 months post-treatment.
9:50 AM: STATION M 2094 Single-Port Laparoscopic Hysterectomy without Uterine Manipulator in Early Cervical Cancer Ahn JH,* Hwang H, Lee KH. Gynecologic Oncology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea, Republic of (South) *Corresponding author. Video Objective: To present the advanced single port laparoscopic hysterectomy without a uterine manipulator in early cervical cancer. Setting: A 42-year-old woman(G2P2) undertook surgery diagnosed with cervical cancer in PAP smear and punch biopsy. She had no past medical history. There was neither evidence of definite burging mass in the cervix nor any metastasis in the preoperated abdominal computed tomographic imaging. Two ml (2.5 mg/mL) of ICG solution was prepared in a 10 ml syringe to inject directly into the cervix. We recorded video with 30˚ 10 mm scope equipped with a specific lens and light source emitting both visible and NIR light (Stryker 1588 AIM, Stryker Co., ABK, MI, USA). Interventions: Under general anesthesia, we performed laparoscopic single port hysterectomy and both salpingectomy and sentinel lymph node biopsy. During the surgery, we didn’t inserted both uterine manipulator and foley catheter. we used only the colpotomizer cup just before cutting the uterus. we also used a retrieval bag when removing the uterus from the abdominal cavity. Pathology revealed invasive squamous cell carcinoma and no sentinel lymph node metastasis. Conclusion: We successfully performed the single port laparoscopic hysterectomy not using a uterine manipulator for the early cervical cancer without any complication and that would be helpfull reducing the risk of tumor reccurence. Virtual Poster Session 1: Laparoscopy (9:50 AM — 10:00 AM) 9:50 AM: STATION N 1623 Improvement in 24-Month Health-Related Quality of life and Work Productivity after Ultrasound-Guided Transcervical, Intrauterine Radiofrequency Ablation of Uterine Fibroids in the Sonata Pivotal IDE Trial Makai GE,1,* Brooks E2. 1Obstetrics and Gynecology, Christiana Care Health Systems, Newark, DE; 2TTi Health Research & Economics, Westminster, MD *Corresponding author. Study Objective: To establish the long-term improvement in healthrelated quality of life and work productivity after use of ultrasound-guided transcervical, intrauterine radiofrequency (RF) ablation in the treatment of symptomatic uterine fibroids. Design: Prospective, longitudinal, multicenter, single-arm trial. Setting: 22 clinical sites (21 in the US and 1 in Mexico). Patients or Participants: Premenopausal women between the ages of 25 and 50 with heavy menstrual bleeding secondary to fibroids. Interventions: Ultrasound-guided transcervical RF ablation performed on up to 10 fibroids per subject with the SonataÒ system; fibroids ranged from 1-5 cm in diameter as determined by transvaginal sonography. The EuroQOL EQ-5D-3L (which measures health utility) and Work Productivity and Activity Impairment (WPAI) surveys were administered at baseline, as well as at 24 months post-intervention. Paired t-tests were conducted to evaluate improvement in health utility and work productivity from baseline through 24 months. Measurements and Main Results: One hundred forty-seven (147) patients were enrolled and followed through 24 months. Mean patient health utility significantly increased from 0.72 at baseline to 0.89 (p<0.0001). In addition, the WPAI measured statistically significant
Virtual Poster Session 1: Laparoscopy (9:50 AM — 10:00 AM) 9:50 AM: STATION O 3018 Long Term Symptomatic Outcomes of Treatment of Uterine Fibroids in a Multidisciplinary Clinic Lum D,1,* Shaffer R,1 Fast A,2 Vu K,2 Dobberfuhl A,3 Dababou S,4 Marrocchio C,4 Hovsepian D,2 Chen B,1 Ghanouni P2. 1Ob/gyn, Stanford University, Stanford, CA; 2Radiology, Stanford University, Stanford, CA; 3 Urology, Stanford University, Stanford, CA; 4Radiology, Sapienza University, Rome, Italy *Corresponding author. Study Objective: To determine the utilization of medical, interventional radiologic, and gynecologic surgical treatments at a multidisciplinary fibroid clinic, also to assess pre- and post-intervention changes in fibroid symptoms, pelvic floor symptoms, and quality of life over a multi-year follow-up period. Design: A retrospective survey study from 2013-2017. Setting: Academic University Hospital. Patients or Participants: 516 pre-menopausal women with pelvic MRI evidence of uterine fibroids seen at a multidisciplinary fibroid clinic from 2013-2017. Interventions: Demographic and clinical information were collected including baseline Uterine Fibroid Symptoms − Quality of Life (UFSQOL) and Pelvic Floor Distress Index (PFDI) questionnaires. All patients were sent a follow-up electronic survey at a single time point in 2018 assessing secondary treatments, fertility and re-administering UFS-QOL and PFDI questionnaires. Measurements and Main Results: Our cohort of 516 patients utilized various treatments including hysterectomy (N=73, 17.1%), non-hysteroscopic myomectomy (N=68, 15.9%), and uterine fibroid embolization (N=117, 27.5%). Patients who underwent hysterectomy had worse baseline UFS-QOL and PFDI scores. 25.8% of patients responded to the follow-up survey with a mean follow-up interval of 28.6 months. Significant improvement was seen in UFS (-57.30% § 66.90% vs -22.84% § 55.50%, p=0.003) and PFDI (-61.20% § 42.40% vs -11.82% § 93.21%, p=0.012) scores for patients undergoing any intervention compared to expectant/ medical management. There was no significant difference in UFS or PFDI improvement between interventional groups. Conclusion: Patients undergoing any intervention reported better symptom improvement than patients undergoing expectant management or medical therapy. Symptomatic improvement based on UFS-QOL and PFDI scores were comparable between patients undergoing interventional radiologic procedures, myomectomy, and hysterectomy interventions. Virtual Poster Session 1: Laparoscopy (9:50 AM — 10:00 AM) 9:50 AM: STATION P 1138 Repeat Laparoscopy for Pregnancy of Unknown Location Jennings A, Rosen ER*. Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI *Corresponding author.