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Journal of Minimally Invasive Gynecology, Vol 12, No 5, September/October Supplement 2005
autoimmune and genetic groups. The highest mean PI values (2.8⫾0.42) were found in otherwise unexplained RSAs. Conclusion: These data suggest that increased resistances to uterine blood flow may be an important contributing factor to some causes of RSA and the cause of some previously unexplained RSA. In these patients the assessment of uterine perfusion could allow new therapeutic approaches. These data suggest that increased resistances to uterine blood flow may be an important contributing factor to some causes of RSA and the cause of some previously unexplained RSA. In these patients the assessment of uterine perfusion could allow new therapeutic approaches. THURSDAY, NOVEMBER 10, 2005 (4:09 PM– 4:15 PM) Open Communications 4 —Uterine Abnormalities 82 Clinical Outcomes Following Hysteroscopic Treatment of Severe Intrauterine Adhesions Abu-Rafea B, Vilos GA, Hollett-Caines J. The University of Western Ontario, London, Ontario, Canada Study Objective: To evaluate the feasibility and efficacy of hysteroscopic lysis of uterine adhesions in women with moderate to severe Asherman’s syndrome and infertility. Design: Retrospective cohort (II-2). Setting: University affiliated teaching hospital. Patients: From October 1993 to January 2004, twenty women with uterine adhesions and a history of infertility underwent hysteroscopic adhesiolysis. Intervention: Hysteroscopic adhesiolysis using either the Ho:YAG laser fiber (N⫽7), knife resectoscopic electrode with cutting current (N⫽6) or Versapoint bipolar needle device (N⫽7) under concomitant laparoscopy. Measurements and Main Results: Outcomes measured include operative complications, menstrual pattern, clinical pregnancy and live birth rates. There were no operative or post-operative complications. Twelve (60%) women regained normal menstrual pattern. Post-operatively, pregnancy and live birth rates were 55% and 30%, respectively. Conclusion: Hysteroscopic adhesiolysis using either Ho: YAG laser fiber, a knife electrode with cutting current or Versapoint bipolar needle electrode was safe and effective. Approximately 50% of women conceived.
THURSDAY, NOVEMBER 10, 2005 (4:15 PM– 4:21 PM) Open Communications 4 —Uterine Abnormalities 83 Postoperative Therapy for Asherman’s Syndrome Swedarsky L, Robinson JK, Isaacson KB. Brigham and Women’s Hospital, Boston, Massachusetts; NewtonWellesley Hospital, MIGS Center, Newton, Massachusetts; Newton-Wellesley Hospital, MIGS Center, Newton, Massachusetts Study Objective: To evaluate the efficacy of postoperative office hysteroscopic blunt adhesiolysis following sharp hysteroscopic adhesiolysis for the treatment of Asherman’s syndrome. Design: Retrospective analysis of 22 cases of Asherman’s syndrome treated with primary hysteroscopic adhesiolysis followed by high dose hormonal therapy and serial flexible office hysteroscopy. Primary and secondary staging was determined using videos and operative reports. Setting: Eastern suburban reproductive endocrinology and minimally invasive gynecologic surgery center and teaching hospital. Patients: Twenty-two women (ages 29 – 47) presenting with menstrual disorders, pain or infertility resulting from Asherman’s syndrome. Intervention: Hysteroscopic sharp adhesiolysis followed by 20 days of high-dose estrogen and 5 days of combined estrogen/progesterone therapy. Postoperative office hysteroscopies with blunt adhesiolysis of recurrent synechiae were performed to maintain endometrial cavity patency. Measurements and Main Results: Primary outcome measurements are restoration of normal menstrual patterns, relief of pain, and improvement in postoperative reproductive outcomes. The secondary outcome measurement is improvement in the severity/staging of Asherman’s syndrome. Sixty-Four percent (14/22) of patients presented with amenorrhea, 36% (8/22) with infertility, and 18% (4/22) with dysmenorrhea. Fifty-nine percent (13/22) had retained products of conception requiring D&C or manual placental extraction, and 32% (7/22) a 1st trimester D&C prior to developing intrauterine adhesions. Initial staging revealed 64% (14/22) had severe adhesions, 32% (7/22) moderate adhesions, and 4.5 % (1/22) minimal disease. Successful adhesiolysis outcomes resulting in minimal to no disease were observed in 43% (6/14) of patients who initially had severe disease, and 71% (5/7) of patients with moderate disease. Overall there was a 91% (20/22) improvement in disease staging over the treatment interval. The mean and median number of follow up procedures was three. Primary outcome data are pending. Conclusion: This postoperative technique appears to be effective for maintenance of endometrial cavity patency following primary hysteroscopic treatment of Asherman’s syndrome. Primary outcome data will be presented.
Journal of Minimally Invasive Gynecology, Vol 12, No 5, September/October Supplement 2005
autoimmune and genetic groups. The highest mean PI values (2.8⫾0.42) were found in otherwise unexplained RSAs. Conclusion: These data suggest that increased resistances to uterine blood flow may be an important contributing factor to some causes of RSA and the cause of some previously unexplained RSA. In these patients the assessment of uterine perfusion could allow new therapeutic approaches. These data suggest that increased resistances to uterine blood flow may be an important contributing factor to some causes of RSA and the cause of some previously unexplained RSA. In these patients the assessment of uterine perfusion could allow new therapeutic approaches. THURSDAY, NOVEMBER 10, 2005 (4:09 PM– 4:15 PM) Open Communications 4 —Uterine Abnormalities 82 Clinical Outcomes Following Hysteroscopic Treatment of Severe Intrauterine Adhesions Abu-Rafea B, Vilos GA, Hollett-Caines J. The University of Western Ontario, London, Ontario, Canada Study Objective: To evaluate the feasibility and efficacy of hysteroscopic lysis of uterine adhesions in women with moderate to severe Asherman’s syndrome and infertility. Design: Retrospective cohort (II-2). Setting: University affiliated teaching hospital. Patients: From October 1993 to January 2004, twenty women with uterine adhesions and a history of infertility underwent hysteroscopic adhesiolysis. Intervention: Hysteroscopic adhesiolysis using either the Ho:YAG laser fiber (N⫽7), knife resectoscopic electrode with cutting current (N⫽6) or Versapoint bipolar needle device (N⫽7) under concomitant laparoscopy. Measurements and Main Results: Outcomes measured include operative complications, menstrual pattern, clinical pregnancy and live birth rates. There were no operative or post-operative complications. Twelve (60%) women regained normal menstrual pattern. Post-operatively, pregnancy and live birth rates were 55% and 30%, respectively. Conclusion: Hysteroscopic adhesiolysis using either Ho: YAG laser fiber, a knife electrode with cutting current or Versapoint bipolar needle electrode was safe and effective. Approximately 50% of women conceived.
THURSDAY, NOVEMBER 10, 2005 (4:15 PM– 4:21 PM) Open Communications 4 —Uterine Abnormalities 83 Postoperative Therapy for Asherman’s Syndrome Swedarsky L, Robinson JK, Isaacson KB. Brigham and Women’s Hospital, Boston, Massachusetts; NewtonWellesley Hospital, MIGS Center, Newton, Massachusetts; Newton-Wellesley Hospital, MIGS Center, Newton, Massachusetts Study Objective: To evaluate the efficacy of postoperative office hysteroscopic blunt adhesiolysis following sharp hysteroscopic adhesiolysis for the treatment of Asherman’s syndrome. Design: Retrospective analysis of 22 cases of Asherman’s syndrome treated with primary hysteroscopic adhesiolysis followed by high dose hormonal therapy and serial flexible office hysteroscopy. Primary and secondary staging was determined using videos and operative reports. Setting: Eastern suburban reproductive endocrinology and minimally invasive gynecologic surgery center and teaching hospital. Patients: Twenty-two women (ages 29 – 47) presenting with menstrual disorders, pain or infertility resulting from Asherman’s syndrome. Intervention: Hysteroscopic sharp adhesiolysis followed by 20 days of high-dose estrogen and 5 days of combined estrogen/progesterone therapy. Postoperative office hysteroscopies with blunt adhesiolysis of recurrent synechiae were performed to maintain endometrial cavity patency. Measurements and Main Results: Primary outcome measurements are restoration of normal menstrual patterns, relief of pain, and improvement in postoperative reproductive outcomes. The secondary outcome measurement is improvement in the severity/staging of Asherman’s syndrome. Sixty-Four percent (14/22) of patients presented with amenorrhea, 36% (8/22) with infertility, and 18% (4/22) with dysmenorrhea. Fifty-nine percent (13/22) had retained products of conception requiring D&C or manual placental extraction, and 32% (7/22) a 1st trimester D&C prior to developing intrauterine adhesions. Initial staging revealed 64% (14/22) had severe adhesions, 32% (7/22) moderate adhesions, and 4.5 % (1/22) minimal disease. Successful adhesiolysis outcomes resulting in minimal to no disease were observed in 43% (6/14) of patients who initially had severe disease, and 71% (5/7) of patients with moderate disease. Overall there was a 91% (20/22) improvement in disease staging over the treatment interval. The mean and median number of follow up procedures was three. Primary outcome data are pending. Conclusion: This postoperative technique appears to be effective for maintenance of endometrial cavity patency following primary hysteroscopic treatment of Asherman’s syndrome. Primary outcome data will be presented.