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A new transcervical sterilization procedure: results of a pilot implant study in humans
in either arm. Two patients, one in each arm, received two units of blood for a slowly decreasing hematocrit on postoperative day 3. There was no evidence of collateral tissue injury and no injuries to the urinary or intestinal tract in either arm. Conclusions: LigaSure is a safe and effective alternative to sutures in TAH, resulting in decreased blood loss and significant timesaving.
A New Transcervical Sterilization Procedure: Results of a Pilot Implant Study in Humans Victoria E. Carr-Brendel, PhD Adiana, Inc, Redwood City, CA
Dennis R. Stewart, PhD, Douglas C. Harrington, J. G. Garza Leal, MD, and Thierry Vancaillie, MD
DONALD F. RICHARDSON MEMORIAL PRIZE AWARD PAPER Use of Vasopressin During Abdominal Hysterectomy: A Randomized Control Study Cynthia R. Okin, MD University of Pittsburgh, Magee-Womens Hospital, Pittsburgh, PA
Richard S. Guido, MD, Leslie A. Meyn, MS, and Sivan Ramanathan, MD Objective: This prospective randomized double-masked placebo controlled trial was designed to investigate if the use of vasopressin during abdominal hysterectomy would decrease blood loss. Methods: Fifty-one patients undergoing abdominal hysterectomy with the diagnosis of leiomyomatous uterus were randomized and received either vasopressin 10 U/10 mL of normal saline or 10 mL of normal saline, injected 5 mL bilaterally, 1 cm medial to the uterine vessels into the lower uterine segment. The sample size was determined assuming a one third reduction in total blood loss would be clinically relevant. A power analysis determined that 25 patients would be required in each group to assure a power of 0.80, at the 0.05 significance level. Results: Overall, the two groups were very similar with regard to their demographics, preoperative diagnosis, and relevant findings at the time of surgery. The mean total blood loss in the vasopressin and placebo groups was 445.41 mL and 748.42 mL respectively. Total blood loss was significantly decreased by 40% in the vasopressin group compared with the placebo group (P⬍.001). There was no statistically significant difference between the two groups with respect to possible confounding variables or surgical complications. Conclusion: The injection of vasopressin into the uterus at the time of abdominal hysterectomy significantly reduces blood loss without increasing morbidity. We have shown that it is a useful adjunct during abdominal hysterectomy.
8S Tuesday Papers
Objective: We have developed a novel delivery and occlusion method for the purpose of achieving permanent fallopian tube occlusion. This study was designed to determine how the procedure would be tolerated by patients and what early effects there would be on the fallopian tube. Methods: The Adiana procedure consists of applying radio frequency energy to the fallopian tube to ablate the epithelial lining of the tube and depositing a synthetic matrix. Four patients (seven tubes) were treated with the Adiana procedure 12 weeks before an elective hysterectomy. Hysterosalpingography was performed on each patient immediately before the hysterectomy. Additional evaluation of tubal occlusion was performed by applying dye under pressure (up to 150 mm Hg) to the explanted tube. Tissue was then histologically analyzed. Results: All patients tolerated the procedure very well, reporting zero pain on a VAS scale (defined 0 to 100). Patients experienced no pain associated with wearing the implant for the duration of the study. Hysterosalpingography results indicated complete tubal blockage in all treated tubes (seven out of seven). Retrograde dye application determined that six of the seven tubes were resistant to dye passage (150 mm Hg). One of the tubes allowed dye passage after 1 minute of dye application (100 mm Hg), suggesting at least partial occlusion. All seven tubes exhibited host cellular infiltrate into the pores of the matrix. Immunohistologic stains indicated that a variety of host cells made up the occlusive ingrowth. Conclusions: The results of this study indicate that the Adiana procedure is able to promote cellular ingrowth into a matrix and result in occlusion of the fallopian tube for up to 12 weeks.
Lapar-OSCE: A Laparoscopic Observed Structured Clinical Experience Kristin J. Dobay, MD, CPT, USA San Antonio Uniformed Services Health Education Consortium, San Antonio TX
Sally Nalesnik, MD, Capt, USAF Objective: Laparoscopic surgery is a required skill for all graduating residents in obstetrics and gynecology. We designed a laparoscopic observed structured clinical experience (Lapar-OSCE) to introduce and advance basic laparoscopic surgical skills.
Obstetrics & Gynecology
A New Transcervical Sterilization Procedure: Results of a Pilot Implant Study in Humans Victoria E. Carr-Brendel, PhD Adiana, Inc, Redwood City, CA
Dennis R. Stewart, PhD, Douglas C. Harrington, J. G. Garza Leal, MD, and Thierry Vancaillie, MD
DONALD F. RICHARDSON MEMORIAL PRIZE AWARD PAPER Use of Vasopressin During Abdominal Hysterectomy: A Randomized Control Study Cynthia R. Okin, MD University of Pittsburgh, Magee-Womens Hospital, Pittsburgh, PA
Richard S. Guido, MD, Leslie A. Meyn, MS, and Sivan Ramanathan, MD Objective: This prospective randomized double-masked placebo controlled trial was designed to investigate if the use of vasopressin during abdominal hysterectomy would decrease blood loss. Methods: Fifty-one patients undergoing abdominal hysterectomy with the diagnosis of leiomyomatous uterus were randomized and received either vasopressin 10 U/10 mL of normal saline or 10 mL of normal saline, injected 5 mL bilaterally, 1 cm medial to the uterine vessels into the lower uterine segment. The sample size was determined assuming a one third reduction in total blood loss would be clinically relevant. A power analysis determined that 25 patients would be required in each group to assure a power of 0.80, at the 0.05 significance level. Results: Overall, the two groups were very similar with regard to their demographics, preoperative diagnosis, and relevant findings at the time of surgery. The mean total blood loss in the vasopressin and placebo groups was 445.41 mL and 748.42 mL respectively. Total blood loss was significantly decreased by 40% in the vasopressin group compared with the placebo group (P⬍.001). There was no statistically significant difference between the two groups with respect to possible confounding variables or surgical complications. Conclusion: The injection of vasopressin into the uterus at the time of abdominal hysterectomy significantly reduces blood loss without increasing morbidity. We have shown that it is a useful adjunct during abdominal hysterectomy.
8S Tuesday Papers
Objective: We have developed a novel delivery and occlusion method for the purpose of achieving permanent fallopian tube occlusion. This study was designed to determine how the procedure would be tolerated by patients and what early effects there would be on the fallopian tube. Methods: The Adiana procedure consists of applying radio frequency energy to the fallopian tube to ablate the epithelial lining of the tube and depositing a synthetic matrix. Four patients (seven tubes) were treated with the Adiana procedure 12 weeks before an elective hysterectomy. Hysterosalpingography was performed on each patient immediately before the hysterectomy. Additional evaluation of tubal occlusion was performed by applying dye under pressure (up to 150 mm Hg) to the explanted tube. Tissue was then histologically analyzed. Results: All patients tolerated the procedure very well, reporting zero pain on a VAS scale (defined 0 to 100). Patients experienced no pain associated with wearing the implant for the duration of the study. Hysterosalpingography results indicated complete tubal blockage in all treated tubes (seven out of seven). Retrograde dye application determined that six of the seven tubes were resistant to dye passage (150 mm Hg). One of the tubes allowed dye passage after 1 minute of dye application (100 mm Hg), suggesting at least partial occlusion. All seven tubes exhibited host cellular infiltrate into the pores of the matrix. Immunohistologic stains indicated that a variety of host cells made up the occlusive ingrowth. Conclusions: The results of this study indicate that the Adiana procedure is able to promote cellular ingrowth into a matrix and result in occlusion of the fallopian tube for up to 12 weeks.
Lapar-OSCE: A Laparoscopic Observed Structured Clinical Experience Kristin J. Dobay, MD, CPT, USA San Antonio Uniformed Services Health Education Consortium, San Antonio TX
Sally Nalesnik, MD, Capt, USAF Objective: Laparoscopic surgery is a required skill for all graduating residents in obstetrics and gynecology. We designed a laparoscopic observed structured clinical experience (Lapar-OSCE) to introduce and advance basic laparoscopic surgical skills.
Obstetrics & Gynecology