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A new adhesion barrier for myomectomy: The shelhigh dome pericardial no-react treated patch
August 2002, Vol. 9, No. 3 Supplement TheJournal of the American Association of Gynecologic Laparoscopists
were irregular condensed chromatin, invagination of nuclei, and nucleus fragmentation, in stroma of endometriotic lesions. Conclusion. Numerous apoptoses appear in stromal proliferative lesions of endometriosis, and almost of these apoptotic cells are induced in smooth muscle cells. These results suggest that enhanced apoptosis of smooth muscle cells is induced in endometriotic tissue, and it will be interesting to have clarified this significa33t difference of apoptotic appearance between laparoscopic lesions and normal areas in women with endometriosis. We believe that our findings will be useful for further investigations of pathogenesis and progress of human endometriosis.
appears to be an altemative to the open procedure for women with multiple and/or large leiomyomas.
241. A New Adhesion Barrier for Myomectomy: The Shelhigh Dome Pericardial No-React Treated Patch MA Pelosi II, MA Pelosi III. Pelosi Women's Medical Center, Bayonne, New Jersey.
Objective. To assess the efficacy and safety of a new nonabsorbable adhesion barrier made of bovine or porcine pericardial patch to prevent de novo adhesions after extensive myomectomies. Measurements and Main Results. Twenty patients underwent extensive myomectomies with full-thickness uterine wall reconstruction. After minilaparotomy myomectomy with layered uterine closure, a 12-cm hood-shaped patch (dome) was placed over the uterus, covering myomectomy sites and adnexa. One nonabsorable suture anchored the patch to the uterine fundus; four additional absorable sutures were placed to secure the patch further. The combined weight of uterine myomas/patient ranged from 500 to 2572 g. All surgeries were completed successfully without intraoperative or postoperative complications. No problems related to the patch were encountered and no removal of the patch was required. In all cases the lower omental edge was loosely adhered to the patch, which was easily separated solely by hydrodissection. No further adhesions were found. In all patients second-look lapaioscopy was performed 6 weeks later; three women had a third-look laparoscopy. Conclusion. Findings of this pilot study suggest potential benefits with this new, nonabsorable adhesion barrier.
240. Evaluation of Laparoscopic-Assisted Myomectomy ONO Nishii, AAF Fujimoto, T Fujiwara, MMI Ikeda, Y Osuga, Y Taketani, O Tsutsumi. University of Tokyo, Tokyo, Japan.
Objective. To investigate the feasibility, limits, and complications of laparoscopic-assisted myomectomy. Measurements and Main Results. Subjects were 47 women with leiomyomas larger than 3 cm and/or with at least one uterine lesion larger than 6 6 cm in diameter. Mean operating time was 155.0 + 46.6 minutes, mean blood loss was 344.2 + 343.0 ml, and mean postoperative hospital stay was 5.8 + 1.9 days. The number of uterine leiomyomas was 5.3 + 4.3 (range 1-14), size was 7.5 + 2.5 cm (range 3.0 + 14.0 cm), and weight was 222 _+ 176.0 g (range 40-1080 g). Mean age of women with at least one uterine leiomyoma larger than 6 cm in diameter was 35 years. Average blood loss in those with leiomyomas larger than and smaller than 6 cm was 379.1 _+367.1 ml and 178.2 _+ 104.2 ml, respectively (p >0.05). Average size of leiomyomas in those with blood loss more than and less than 500 ml was 9.2 + 2.8 cm and 7.0 + 2.2 cm, respectively (p >0.01). The only intraoperative complication was a vascular injury; the only postoperative complication was a case of deep vein thrombophlebitis. No patient required blood transfusion. No procedure was converted to laparotomy. The postoperative intrauterine pregnancy rate was 33.3% (12 women). Conclusion. Laparoscopic-assisted myomectomy is safe and effective, has a low risk of complications, and
242. Complications of Diagnostic Hysteroscopy 1L Raio, 2M Buttarelli, 2ACromi, 3E Di Naro, 2M Franchi, 2F Ghezzi. 1Department of Obstetrics and Gynecology, University of Berne, Berne, Switzerland; 2Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy; 3Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
Objective. To evaluate the frequency of complications associated with diagnostic hysteroscopy. Measurements and Main Results. Nationwide data were obtained from the Swiss Gynecologic Study
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were irregular condensed chromatin, invagination of nuclei, and nucleus fragmentation, in stroma of endometriotic lesions. Conclusion. Numerous apoptoses appear in stromal proliferative lesions of endometriosis, and almost of these apoptotic cells are induced in smooth muscle cells. These results suggest that enhanced apoptosis of smooth muscle cells is induced in endometriotic tissue, and it will be interesting to have clarified this significa33t difference of apoptotic appearance between laparoscopic lesions and normal areas in women with endometriosis. We believe that our findings will be useful for further investigations of pathogenesis and progress of human endometriosis.
appears to be an altemative to the open procedure for women with multiple and/or large leiomyomas.
241. A New Adhesion Barrier for Myomectomy: The Shelhigh Dome Pericardial No-React Treated Patch MA Pelosi II, MA Pelosi III. Pelosi Women's Medical Center, Bayonne, New Jersey.
Objective. To assess the efficacy and safety of a new nonabsorbable adhesion barrier made of bovine or porcine pericardial patch to prevent de novo adhesions after extensive myomectomies. Measurements and Main Results. Twenty patients underwent extensive myomectomies with full-thickness uterine wall reconstruction. After minilaparotomy myomectomy with layered uterine closure, a 12-cm hood-shaped patch (dome) was placed over the uterus, covering myomectomy sites and adnexa. One nonabsorable suture anchored the patch to the uterine fundus; four additional absorable sutures were placed to secure the patch further. The combined weight of uterine myomas/patient ranged from 500 to 2572 g. All surgeries were completed successfully without intraoperative or postoperative complications. No problems related to the patch were encountered and no removal of the patch was required. In all cases the lower omental edge was loosely adhered to the patch, which was easily separated solely by hydrodissection. No further adhesions were found. In all patients second-look lapaioscopy was performed 6 weeks later; three women had a third-look laparoscopy. Conclusion. Findings of this pilot study suggest potential benefits with this new, nonabsorable adhesion barrier.
240. Evaluation of Laparoscopic-Assisted Myomectomy ONO Nishii, AAF Fujimoto, T Fujiwara, MMI Ikeda, Y Osuga, Y Taketani, O Tsutsumi. University of Tokyo, Tokyo, Japan.
Objective. To investigate the feasibility, limits, and complications of laparoscopic-assisted myomectomy. Measurements and Main Results. Subjects were 47 women with leiomyomas larger than 3 cm and/or with at least one uterine lesion larger than 6 6 cm in diameter. Mean operating time was 155.0 + 46.6 minutes, mean blood loss was 344.2 + 343.0 ml, and mean postoperative hospital stay was 5.8 + 1.9 days. The number of uterine leiomyomas was 5.3 + 4.3 (range 1-14), size was 7.5 + 2.5 cm (range 3.0 + 14.0 cm), and weight was 222 _+ 176.0 g (range 40-1080 g). Mean age of women with at least one uterine leiomyoma larger than 6 cm in diameter was 35 years. Average blood loss in those with leiomyomas larger than and smaller than 6 cm was 379.1 _+367.1 ml and 178.2 _+ 104.2 ml, respectively (p >0.05). Average size of leiomyomas in those with blood loss more than and less than 500 ml was 9.2 + 2.8 cm and 7.0 + 2.2 cm, respectively (p >0.01). The only intraoperative complication was a vascular injury; the only postoperative complication was a case of deep vein thrombophlebitis. No patient required blood transfusion. No procedure was converted to laparotomy. The postoperative intrauterine pregnancy rate was 33.3% (12 women). Conclusion. Laparoscopic-assisted myomectomy is safe and effective, has a low risk of complications, and
242. Complications of Diagnostic Hysteroscopy 1L Raio, 2M Buttarelli, 2ACromi, 3E Di Naro, 2M Franchi, 2F Ghezzi. 1Department of Obstetrics and Gynecology, University of Berne, Berne, Switzerland; 2Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy; 3Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
Objective. To evaluate the frequency of complications associated with diagnostic hysteroscopy. Measurements and Main Results. Nationwide data were obtained from the Swiss Gynecologic Study
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