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A quality of life comparison between laparoscopic supracervical hysterectomy and uterine myoma embolization
August 2002, Vol. 9, No. 3 Supplement The Journal of the American Association of Gynecologic Laparoscopists
isolated from adhesion tissues have abnormal apoptosis regulation. Measurements and Main Results. Immunohistochemistry techniques were used to determine whether p53 protein is present in normal peritoneal and adhesion fibroblasts. Primary cultures of fibroblasts from these tissues were established from the same three patients. Cultured fibroblasts from all tissues were fixed on slides and stained with p53 monoclonal antibody labeled with immunofluorescence. The p53 protein was absent from normal peritoneal fibroblasts, but present in significantly higher levels in adhesion fibroblasts, as indicated by immunohistochemistry. Conclusion. Adhesion fibroblasts have a specific phenotype (adhesion phenotype) characterized in part by p53 expression; this may indicated a possible response to insults or p53 gene mutations that prevent cell entrance into the apoptotoc process. This is consistent with our previous finding that adhesion fibroblast have a significantly lower rate of apoptosis than normal peritoneal fibroblasts. Intervention in the apoptotic pathways to enhance apoptosis may help reduce postoperative adhesions.
injury. The device allows optimal exposure of vaginal fomices and a wide range of uterine movements.
45. A Quality of Life Comparison Between Laparoscopic Supracervical Hysterectomy and Uterine Myoma Embolization 1AJ DiSciullo, 2M Carson. 1Mt. Auburn Hospital, Cambridge, Massachusetts;2Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Objective. To evaluate seven parameters of quality of life after treatment of symptomatic uterine myomas. Measurements and Main Results. Three interviews were conducted after each procedure and a VAS was administered on postoperative days 1 and 21, and 12 months (1 = negative experience, 10 = highly positive experience for each parameter). The 37 women had finished childbearing, had no special interest in retaining the uterus, had uteri 14 to 18 weeks in size, and had bulk symptoms as well as heavy bleeding. Sixteen women underwent uterine myoma embolization (UME) and 21 laparoscopic supracervical hysterectomy (LSH). After 3 weeks average VAS scores were 7.6 and 3.1, respectively; after 1 year the scores were 8.1 and 7.9, respectively. Conclusion. From patients' perspective LSH is preferred over UME.
44. Uterine Elevator, More than a New Manipulator HJ Dionisi. Dionisi Institute, Cordoba, Argentina.
Objective. To analyze the utility of the uterine elevator. Measurements and Main Results. The uterine elevator allows the surgeon to move the uterus forward, backward, and sideways, which, by means of an intrauterine device, prevents the uterus from rotating around its axis. The uterus can be elevated using the device, imitating the function that clips of the angles have in abdominal hysterectomy. The uterine elevator was used in 1200 TLHs performed for benign uterine pathology. We analyzed the number and causes of conversions, as well as intraoperative and postoperative complications. Surgery was performed successfully in 1189 patients; the 11 remaining procedures were converted to laparotomy because of 9 large uteri that could not mobilized and 2 cases of severe vesicouterine adhesions. The only complications were five bladder injuries and three vesicovaginal fistulas. Conclusion. The device is effective in elevating and defining the cervicovaginal junction, makes it easy to grasp uterine pedicles, creates a distance between ureters and uterine pedicles, and allows lateral parametrium dissection with no hemorrhage or ureter
46. Clinical Study of 235 Cases Performed by Hysteroscopy Combined with Laparoscopy H Duan, E Xia, L Wang. Hysteroscopic Center of Fuxing Hospital, Capital University of Medical Sciences, Beijing, China.
Objective. To evaluate the clinical value of combining hysteroscopy with laparoscopy in treating gynecologic disease. Measurements and Main Results. We performed surgery in both uterine and pelvic cavities at the same time in 235 women with gynecologic pathology. Hysteroscopy was successful in all cases for lesions of the uterine cavity except for one that was converted to laparotomy due to heavy bleeding. Hysteroscopies included complicated operations, such as tra_nscervical resection of septa, tra_nscervical resection of adhesions, tra_nscervical resection of embryo bones and IUD pieces embedded in endometrium, as well as transcervical resection of myomas larger than 4.5 cm or intramural myomas and those with broad pedicles. Other laparoscopic procedures, such as cystectomy,
$15
isolated from adhesion tissues have abnormal apoptosis regulation. Measurements and Main Results. Immunohistochemistry techniques were used to determine whether p53 protein is present in normal peritoneal and adhesion fibroblasts. Primary cultures of fibroblasts from these tissues were established from the same three patients. Cultured fibroblasts from all tissues were fixed on slides and stained with p53 monoclonal antibody labeled with immunofluorescence. The p53 protein was absent from normal peritoneal fibroblasts, but present in significantly higher levels in adhesion fibroblasts, as indicated by immunohistochemistry. Conclusion. Adhesion fibroblasts have a specific phenotype (adhesion phenotype) characterized in part by p53 expression; this may indicated a possible response to insults or p53 gene mutations that prevent cell entrance into the apoptotoc process. This is consistent with our previous finding that adhesion fibroblast have a significantly lower rate of apoptosis than normal peritoneal fibroblasts. Intervention in the apoptotic pathways to enhance apoptosis may help reduce postoperative adhesions.
injury. The device allows optimal exposure of vaginal fomices and a wide range of uterine movements.
45. A Quality of Life Comparison Between Laparoscopic Supracervical Hysterectomy and Uterine Myoma Embolization 1AJ DiSciullo, 2M Carson. 1Mt. Auburn Hospital, Cambridge, Massachusetts;2Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Objective. To evaluate seven parameters of quality of life after treatment of symptomatic uterine myomas. Measurements and Main Results. Three interviews were conducted after each procedure and a VAS was administered on postoperative days 1 and 21, and 12 months (1 = negative experience, 10 = highly positive experience for each parameter). The 37 women had finished childbearing, had no special interest in retaining the uterus, had uteri 14 to 18 weeks in size, and had bulk symptoms as well as heavy bleeding. Sixteen women underwent uterine myoma embolization (UME) and 21 laparoscopic supracervical hysterectomy (LSH). After 3 weeks average VAS scores were 7.6 and 3.1, respectively; after 1 year the scores were 8.1 and 7.9, respectively. Conclusion. From patients' perspective LSH is preferred over UME.
44. Uterine Elevator, More than a New Manipulator HJ Dionisi. Dionisi Institute, Cordoba, Argentina.
Objective. To analyze the utility of the uterine elevator. Measurements and Main Results. The uterine elevator allows the surgeon to move the uterus forward, backward, and sideways, which, by means of an intrauterine device, prevents the uterus from rotating around its axis. The uterus can be elevated using the device, imitating the function that clips of the angles have in abdominal hysterectomy. The uterine elevator was used in 1200 TLHs performed for benign uterine pathology. We analyzed the number and causes of conversions, as well as intraoperative and postoperative complications. Surgery was performed successfully in 1189 patients; the 11 remaining procedures were converted to laparotomy because of 9 large uteri that could not mobilized and 2 cases of severe vesicouterine adhesions. The only complications were five bladder injuries and three vesicovaginal fistulas. Conclusion. The device is effective in elevating and defining the cervicovaginal junction, makes it easy to grasp uterine pedicles, creates a distance between ureters and uterine pedicles, and allows lateral parametrium dissection with no hemorrhage or ureter
46. Clinical Study of 235 Cases Performed by Hysteroscopy Combined with Laparoscopy H Duan, E Xia, L Wang. Hysteroscopic Center of Fuxing Hospital, Capital University of Medical Sciences, Beijing, China.
Objective. To evaluate the clinical value of combining hysteroscopy with laparoscopy in treating gynecologic disease. Measurements and Main Results. We performed surgery in both uterine and pelvic cavities at the same time in 235 women with gynecologic pathology. Hysteroscopy was successful in all cases for lesions of the uterine cavity except for one that was converted to laparotomy due to heavy bleeding. Hysteroscopies included complicated operations, such as tra_nscervical resection of septa, tra_nscervical resection of adhesions, tra_nscervical resection of embryo bones and IUD pieces embedded in endometrium, as well as transcervical resection of myomas larger than 4.5 cm or intramural myomas and those with broad pedicles. Other laparoscopic procedures, such as cystectomy,
$15