321: MR-guided Focused Ultrasound Surgery (MRgFUS) for Adenomyosis: A Preliminary Study

Scientific Posters Design: Case Report and Review of the Literature. Setting: Laparoscopic finding within an ambulatory surgical suite. Patient: A 26 year-old female with pelvic pain, dysmenorrhea and dyspareunia. From 1995 to the present, 6 previous patients with pelvic splenosis were reported in the gynecologic literature. Intervention: Laparoscopic diagnosis and treatment of pelvic splenosis Measurements and Main Results: All patients had a history of trauma with splenectomy. Pelvic pain (71%), dysmenorrheal (57%) and dyspareunia (57%) were the common symptoms. Splenic implants were found in the pelvic culde-sac (100%), ovary (29%) and uterine surface (29%) . Conclusion: Laparoscopic management of pelvic splenosis is feasible. Implants are routinely seen in the pelvic cul-desac. Splenosis behaves similarly to endometriosis and should be considered pre-operatively in women who have undergone previous splenectomy. 321 MR-guided Focused Ultrasound Surgery (MRgFUS) for Adenomyosis: A Preliminary Study Fukunishi H, Funaki K, Sawada K. Shinsuma Hospital, Suma-ku, Kobe, Japan Study Objective: To assess patient response to magnetic resonance-guided focused ultrasound surgery (MRgFUS) using ExAblate 2000 (InSightec, Israel) on adenomyosis (focal and diffuse type). Design: Prospective study of 20 consecutive cases after the local ethics committee approved this procedure. Mean follow up duration was 8.7 ⫾ 3.9 months. Setting: Shinsuma General Hospital, Kobe, Japan. Patients: Twenty women with symptomatic adenomyosis visible on non-contrast MR images (MRIs) and who do not plan future pregnancies. Intervention: MRgFUS ablation of uterine adenomyosis tissue followed by measurement of the non-perfused lesion on MRI post procedure and at 6 month, and the assessment of symptom severity score (SSS) at baseline, 1, 3 and 6 months after treatment. Measurements and Main Results: Contrast MRIs immediately after the treatment revealed various levels of nonperfusion. Seven cases showed non-perfused endometrium after ablation of adenomyosis. One patient conceived 5 months after having the MRgFUS procedure. Mean SSS at base line was of 48.4 ⫾ 12.1 (n⫽20), which decreased to 32.3 ⫾ 15.7 (n⫽20) at 1 month (p⬍.01), and to 21.7 ⫾ 13.6 (n⫽18) at 3 months (p⬍.01) and then 26.8 ⫾ 13.5 (n⫽14) at 6 months (p⬍.01). Adverse events included small amount of bleeding (4 cases), more discharge (4 cases), buttock pain (4 cases) and mild contact dermatitis with gel-pad (1 case) immediately after the treatment. No patient required additional treatment for her symptoms during this period. Conclusion: MRgFUS can safely ablate adenomyosis tissue by employing appropriate MRgFUS parameters, resulting in

S117 symptomatic improvement during 6 months. No serious complications were experienced. Since the endometrium could also be ablated, this indication should be limited, at this stage, to women who have completed childbearing. 322 Different Technical Methods of Treatment of Ovarian Endometriomas: Cystectomy vs Fenestration and Ablation 1 Fulop S, 2Kabdebo O, 1Vereczkey A, 1Bokor A, 1Savay S, 1 Szepesi J, 3Tejerizo A, 3Lorenzo E. 1Nyiro Gyula Hospital, Budapest, Hungary; 2Dr. W. Kruesmann Frauenklinik, Munchen, Germany; 3Hospital 12 Octubre, Madrid, Spain Study Objective: To compare two treatment methods of endometriomas. Design: Retrospective analysis of 104 consecutive cases of stripping and fenestration and ablation of endomteriomas. Setting: Reproductive Centre and Minimal Access Gynecological Surgical Unit of Nyiro Gyula General Hospital Budapest under the guidance of Kruesmann Klinik Munich Germany. Patients: One hundred four patients presenting with symptomatic endometriomas exceeding 3 centimetres. Intervention: Cyst wall stripping and reconstruction with suturing of ovaries vs. fenestration and bipolar ablation. Measurements and Main Results: ifty-four stripping and 50 fenestration patients. Stripping was associated with reduced rate of recurrence [13% vs. 56%], further surgery [9.3% vs. 48%], recurrent dysmenorrhoea [20.4% vs. 48%], dyspareunia [9.3% vs. 54%], pelvic pain [11.1% vs. 38%]. Conclusion: The endometrioma is treated by stripping the cyst wall is better surgical treatment. This procedure is technically more demanding, but it’s associated with prolonged symptomatic improvement and lower recurrence rate of symptoms. 323 Can Laparoscopic Sacral Colpopexy With One Posterior Strip of Mesh Support Prolapsed Uterus? Han CH. Seocho-gu, Seoul, Korea Study Objective: In this study, we aim to see whether laparoscopic sacral colpopexy with one posterior strip of mesh can support prolapsed uterus. Intervention: Fifteen patients with third degree prolapsed uterus underwent laparoscopic sacral colpopexy. A 15 by 2.5 cm sized monofilament soft mesh (Gynemesh, Ethicon) was attached to strenghthen the support between the puborectal fascia and the anterior ligament of the sacral promentory. Clinical outcomes of prolapse were reevaluated. Measurements and Main Results: The mean age of patients was 66 years (range: 46-78) with mean parity of 3 (range: 0-7). The operation took mean 97 minutes and average 41 mL of blood loss was estimated (range: 60-140). Postoper-