- Email: [email protected]
A randomized comparison of 12 mm blunt conical versus the 8 mm pyramidal trocar-cannula
August 2001, Vol. 8, No. 3 Supplement TheJournal of the American Association of Gynecologic Laparoscopists
patient is in the 36th week of pregnancy. To the best of our knowledge, congenital abnormal uterus with both septate and bicornate anomaly has not been reported previously. Conclusion. The classic treatment of bicomate uterus is laparotomic metroplasty, which can be complicated by pelvic adhesions. Thus, in our opinion, it should be reserved for patients in whom hysteroscopic septum resection fails.
midal TC, and to assess whether repetitive operative movements applied to the calmula ports affect wound characteristics. Measurements and Main Results. Wound defects from 12-mm blunt conical TC and 8-mm pyramidal TC were evaluated with and without application of simulated operative movements in white swine. Insertions of TC were randomized for a total of 12 insertions for each of four study arms. After insertion, a uniform set of movements to simulate operative maneuvers was applied to the cannula ports. After cannulas were removed, skin and subcutaneous tissues were dissected to expose fascial wounds. Muscle damage score, maximum incision length, and wound areas were determined. Mean wound area for the 12-mm conical TC and 8-mm pyramidal TC were 4.48 and 3.63 mm2, respectively (p = 0.26). When movement was applied, the values were 4.48 and 5.81 mm2, respectively (p = 0.19). Incision length for the conical TC was 12.0 mm, and with movement 12.55 mm; for the pyramidal TC it was 7.83 mm and with movement 11.22 mm.(p <0.05) Mean muscle injury scores were 2 times higher for the pyramidal TC than for the conical TC. Conclusion. The 12-mm conical TC creates similar fascial defects as the 8-mm pyramidal TC. Movement does not appear to alter incision characteristics. Design differences may reduce the risk of wound dehiscence and hemia.
228. Evaluation of Adhesion Formation after Laparoscopic Myomectomy by Second-Look Laparoscopy H Takeuchi, A Sakurai, Y Nakano, Y Sato, K Kinoshita. Juntendo University, Tokyo, Japan. Objective. To evaluate postoperative adhesion formation after laparoscopic myomectomy (LM) with second-look laparoscopy (SLL) using a microlaparoscope. Measurements and Main Results. Of 153 women undergoing LM, 51 (age range 2/1 /14 yrs) underwent SLL. Fibrin glue spray was used to prevent postoperative adhesion formation in all patients at LM. The mean interval between LM and SLL was 5.1 + 3.0 months (range 2-18 mo). The mean size of enucleated myomas was 59.8 + 15.3 cm (range 30-105 cm), and the mean number of myomas removed/patient was 3.0 + 2.2 (range 1-9 myomas). At SLL, 155 myomectomy sites were assessed. The rate of postoperative adhesion was 29.4%/patient and 11.2%/myomectomy site. The main risk factor for adhesion formation on the myomectomy site was posterior location of the myoma. The organ that was most adherent to myomectomy sites was sigmoid colon. The frequency of adnexal adhesions after LM was 17.6%/patient and 11.8 %/site. Conclusion. The rate of adhesions after LM is low, and routine SLL with a microlaparoscope is useful to evaluate the efficacy of LM.
230. Laparoscopic Sacrocolpopexy MW Taylor, CH Koh, GM Janik, C Templeman. Medical College of Wisconsin, Milwaukee, Wisconsin. Objective. To report outcomes in 20 women (average age 57 yrs, range 34-74 yrs; median parity 3, range 0-5) who underwent laparoscopic sacrocolpopexy for symptomatic prolapse (median number of previous operations for prolapse 0, range 0-2). Measurements and Main Results. Laparoscopic sacrocolpopexy and concomitant laparoscopic Burch (9), site-specific defect repair (15), hysterectomy (3), adhesiolysis (2), laparoscopic abdominal herniorrhaphy (1), and ablation of endometrio sis (1) were performed. Mean operating time was 211 minutes (range 125-358 rain), median hospital stay was 2 days (range 1-5 days), and mean follow-up was 29.4 months (range 4-68 too). No procedure was converted to laparotomy. Operative complications were one case of significant
229. A Randomized Comparison of 12 mm Blunt Conical versus the 8 mm Pyramidal Trocar-Cannula 1,2CM Tarnay, 2MG Munro. 1Kaiser Foundation Hospital, Woodland Hills, California; 2UCLA School of Medicine, Los Angeles, California. Objective. To determine whether fascial defects associated with a 12-mm blunt conical trocar-caamula (TC) will be similar to those associated with a 8-mm pyra-
$69
patient is in the 36th week of pregnancy. To the best of our knowledge, congenital abnormal uterus with both septate and bicornate anomaly has not been reported previously. Conclusion. The classic treatment of bicomate uterus is laparotomic metroplasty, which can be complicated by pelvic adhesions. Thus, in our opinion, it should be reserved for patients in whom hysteroscopic septum resection fails.
midal TC, and to assess whether repetitive operative movements applied to the calmula ports affect wound characteristics. Measurements and Main Results. Wound defects from 12-mm blunt conical TC and 8-mm pyramidal TC were evaluated with and without application of simulated operative movements in white swine. Insertions of TC were randomized for a total of 12 insertions for each of four study arms. After insertion, a uniform set of movements to simulate operative maneuvers was applied to the cannula ports. After cannulas were removed, skin and subcutaneous tissues were dissected to expose fascial wounds. Muscle damage score, maximum incision length, and wound areas were determined. Mean wound area for the 12-mm conical TC and 8-mm pyramidal TC were 4.48 and 3.63 mm2, respectively (p = 0.26). When movement was applied, the values were 4.48 and 5.81 mm2, respectively (p = 0.19). Incision length for the conical TC was 12.0 mm, and with movement 12.55 mm; for the pyramidal TC it was 7.83 mm and with movement 11.22 mm.(p <0.05) Mean muscle injury scores were 2 times higher for the pyramidal TC than for the conical TC. Conclusion. The 12-mm conical TC creates similar fascial defects as the 8-mm pyramidal TC. Movement does not appear to alter incision characteristics. Design differences may reduce the risk of wound dehiscence and hemia.
228. Evaluation of Adhesion Formation after Laparoscopic Myomectomy by Second-Look Laparoscopy H Takeuchi, A Sakurai, Y Nakano, Y Sato, K Kinoshita. Juntendo University, Tokyo, Japan. Objective. To evaluate postoperative adhesion formation after laparoscopic myomectomy (LM) with second-look laparoscopy (SLL) using a microlaparoscope. Measurements and Main Results. Of 153 women undergoing LM, 51 (age range 2/1 /14 yrs) underwent SLL. Fibrin glue spray was used to prevent postoperative adhesion formation in all patients at LM. The mean interval between LM and SLL was 5.1 + 3.0 months (range 2-18 mo). The mean size of enucleated myomas was 59.8 + 15.3 cm (range 30-105 cm), and the mean number of myomas removed/patient was 3.0 + 2.2 (range 1-9 myomas). At SLL, 155 myomectomy sites were assessed. The rate of postoperative adhesion was 29.4%/patient and 11.2%/myomectomy site. The main risk factor for adhesion formation on the myomectomy site was posterior location of the myoma. The organ that was most adherent to myomectomy sites was sigmoid colon. The frequency of adnexal adhesions after LM was 17.6%/patient and 11.8 %/site. Conclusion. The rate of adhesions after LM is low, and routine SLL with a microlaparoscope is useful to evaluate the efficacy of LM.
230. Laparoscopic Sacrocolpopexy MW Taylor, CH Koh, GM Janik, C Templeman. Medical College of Wisconsin, Milwaukee, Wisconsin. Objective. To report outcomes in 20 women (average age 57 yrs, range 34-74 yrs; median parity 3, range 0-5) who underwent laparoscopic sacrocolpopexy for symptomatic prolapse (median number of previous operations for prolapse 0, range 0-2). Measurements and Main Results. Laparoscopic sacrocolpopexy and concomitant laparoscopic Burch (9), site-specific defect repair (15), hysterectomy (3), adhesiolysis (2), laparoscopic abdominal herniorrhaphy (1), and ablation of endometrio sis (1) were performed. Mean operating time was 211 minutes (range 125-358 rain), median hospital stay was 2 days (range 1-5 days), and mean follow-up was 29.4 months (range 4-68 too). No procedure was converted to laparotomy. Operative complications were one case of significant
229. A Randomized Comparison of 12 mm Blunt Conical versus the 8 mm Pyramidal Trocar-Cannula 1,2CM Tarnay, 2MG Munro. 1Kaiser Foundation Hospital, Woodland Hills, California; 2UCLA School of Medicine, Los Angeles, California. Objective. To determine whether fascial defects associated with a 12-mm blunt conical trocar-caamula (TC) will be similar to those associated with a 8-mm pyra-
$69