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A randomized trial to evaluate the prevention of de novo adhesion formation after laparoscopic myomectomy using oxidized regenerated cellulose (interceed) barrier
August 1995, Vol. 2, No. 4. Supplement The Journal of the American Association of Gynecologic Laparoscopists
97-328 lbs), and mean quetelet index was 27.9 (range 19-57), which did not vary significantly from quarter to quarter. Metastatic disease was discovered in 13 (27.6%) of 46 patients with grade II or III lesions. This did not vary significantly from quarter to quarter. Operative times for staging without lymphadenectomy continued to drop from a mean of 163 minutes in the fn'st quarter to 103 minutes in the last 25 patients, whereas operative times for staging with lymphadenectomy plateaued after the first 25 patients to a mean of 163.4 minutes. The hospital stay continued to decrease from a mean of 3.2 days in the first quarter to 1.7 days in the final quarter. The overall major complication rate of 5% (2 enterotomies, 2 cystotomies, 1 transected ureter) did not vary significantly from quarter to quarter. However, the rate of conversion to laparotomy dropped significantly after the first quarter from 8% (2/25) to 0%. We conclude that operative times for staging with lymphadenectomy level off after 25 women and continue to drop for staging with hysterectomy. The ability to detect metastatic disease appears unrelated to operator experience. The major complications rate appears stable at 5%, but the conversion rate to laparotomy drops significantly with experience. The hospital stay continues to be reduced and may not have plateaued after 100 patients.
as to treatment group. In the control group only 12% (3) of women were adhesion free, compared with 60% (15) of those treated with Interceed (p <0.05, Fisher's exact test). The intraoperative and postoperative courses were uneventful in all patients. Interceed significantly reduced de novo adhesion formation after laparoscopic myomectomy.
Evaluation of 850 Cases of Pelviscopic Ovarian Cyst Enucleations, 1990-1994 L Mettler, K Semm. Department of Obstetrics and Gynecology, University of Kiel, Kiel, Germany.
Statistics repeatedly show that prescreening of ovarian tumors allows laparoscopic removal to be performed safely. From 1990 to 1994 we operated laparoscopically on more than 800 ovarian cysts, Women with suspected ovarian cancer were primarily treated by laparotomy. The enucleated ovarian cysts were endometriomas and mucinous cystomas, dermoid cysts, polycystic ovarian syndrome, and a few functional cysts. In no case was ovarian cancer reported on biopsy. All cancers were detected by endoscopic staging, which is the last step before laparoscopic surgery. Surface rupture and membrane infiltration have no correlation to 5-year survival rate of patients with ovarian cancer, as proved by an extensive statistical evaluation in our department. Rupture of an ovarian cyst membrane can be avoided in most cases with careful preoperative and intraoperative screening.
A Randomized Trial to Evaluate the Prevention of de Novo Adhesion Formation after Laparoscopic Myomectomy Using Oxidized Regenerated Cellulose (Interceed) Barrier
A Comprehensive Approach to Resident Training in Advanced Endoscopic Techniques
GB Melis, S Ajossa, B Piras, S Guerriero, D Maraongiu, V Mais. Department of Obstetrics and Gynecology, University of Cagliari, Italy.
1MP Milad, 2Z Szabo. 1Northwestern University Medical School, Chicago, IL; 2Microsurgery and Operative Endoscopy Training Institute, San Francisco, CA.
The formation of adhesions after abdominal myomectomy often negates the effect of the original surgery. Although laparoscopic surgery reduces the formation of de novo adhesions after adhesiolysis or surgery for ectopic pregnancy, this is still a significant problem after laparoscopic myomectomy. Therefore, we evaluated the effect of Interceed barrier on the frequency of de novo adhesion formation after laparoscopic myomectomy. Fifty premenopausal, nonpregnant women who underwent laparoscopic myomectomy were randomized to the control group (25) with surgery alone, or to the treatment group (25) including Interceed barrier. The frequency of adhesionfree patients was assessed at second-look laparoscopy 12 to 14 weeks later by an investigator not informed
Gynecologic resident training has not kept pace with a rapidly developing field of operative endoscopy. Many established gynecologists who are responsible for resident teaching are not themselves formally trained in advanced endoscopy. A comprehensive, four-point endoscopy training program was implemented to provide well rounded experience to obstetrics and gynecology residents at N o r t h w e s t e r n Memorial Hospital. First, weekly endoscopy rounds were instituted to discuss didactic and clinical issues. Also, an annual animal laboratory was provided for second- and fourth-year residents to develop familiarity with equipment and procedures. The first day involved use of a pelvic trainer for laparoscopic suturing and
$31
97-328 lbs), and mean quetelet index was 27.9 (range 19-57), which did not vary significantly from quarter to quarter. Metastatic disease was discovered in 13 (27.6%) of 46 patients with grade II or III lesions. This did not vary significantly from quarter to quarter. Operative times for staging without lymphadenectomy continued to drop from a mean of 163 minutes in the fn'st quarter to 103 minutes in the last 25 patients, whereas operative times for staging with lymphadenectomy plateaued after the first 25 patients to a mean of 163.4 minutes. The hospital stay continued to decrease from a mean of 3.2 days in the first quarter to 1.7 days in the final quarter. The overall major complication rate of 5% (2 enterotomies, 2 cystotomies, 1 transected ureter) did not vary significantly from quarter to quarter. However, the rate of conversion to laparotomy dropped significantly after the first quarter from 8% (2/25) to 0%. We conclude that operative times for staging with lymphadenectomy level off after 25 women and continue to drop for staging with hysterectomy. The ability to detect metastatic disease appears unrelated to operator experience. The major complications rate appears stable at 5%, but the conversion rate to laparotomy drops significantly with experience. The hospital stay continues to be reduced and may not have plateaued after 100 patients.
as to treatment group. In the control group only 12% (3) of women were adhesion free, compared with 60% (15) of those treated with Interceed (p <0.05, Fisher's exact test). The intraoperative and postoperative courses were uneventful in all patients. Interceed significantly reduced de novo adhesion formation after laparoscopic myomectomy.
Evaluation of 850 Cases of Pelviscopic Ovarian Cyst Enucleations, 1990-1994 L Mettler, K Semm. Department of Obstetrics and Gynecology, University of Kiel, Kiel, Germany.
Statistics repeatedly show that prescreening of ovarian tumors allows laparoscopic removal to be performed safely. From 1990 to 1994 we operated laparoscopically on more than 800 ovarian cysts, Women with suspected ovarian cancer were primarily treated by laparotomy. The enucleated ovarian cysts were endometriomas and mucinous cystomas, dermoid cysts, polycystic ovarian syndrome, and a few functional cysts. In no case was ovarian cancer reported on biopsy. All cancers were detected by endoscopic staging, which is the last step before laparoscopic surgery. Surface rupture and membrane infiltration have no correlation to 5-year survival rate of patients with ovarian cancer, as proved by an extensive statistical evaluation in our department. Rupture of an ovarian cyst membrane can be avoided in most cases with careful preoperative and intraoperative screening.
A Randomized Trial to Evaluate the Prevention of de Novo Adhesion Formation after Laparoscopic Myomectomy Using Oxidized Regenerated Cellulose (Interceed) Barrier
A Comprehensive Approach to Resident Training in Advanced Endoscopic Techniques
GB Melis, S Ajossa, B Piras, S Guerriero, D Maraongiu, V Mais. Department of Obstetrics and Gynecology, University of Cagliari, Italy.
1MP Milad, 2Z Szabo. 1Northwestern University Medical School, Chicago, IL; 2Microsurgery and Operative Endoscopy Training Institute, San Francisco, CA.
The formation of adhesions after abdominal myomectomy often negates the effect of the original surgery. Although laparoscopic surgery reduces the formation of de novo adhesions after adhesiolysis or surgery for ectopic pregnancy, this is still a significant problem after laparoscopic myomectomy. Therefore, we evaluated the effect of Interceed barrier on the frequency of de novo adhesion formation after laparoscopic myomectomy. Fifty premenopausal, nonpregnant women who underwent laparoscopic myomectomy were randomized to the control group (25) with surgery alone, or to the treatment group (25) including Interceed barrier. The frequency of adhesionfree patients was assessed at second-look laparoscopy 12 to 14 weeks later by an investigator not informed
Gynecologic resident training has not kept pace with a rapidly developing field of operative endoscopy. Many established gynecologists who are responsible for resident teaching are not themselves formally trained in advanced endoscopy. A comprehensive, four-point endoscopy training program was implemented to provide well rounded experience to obstetrics and gynecology residents at N o r t h w e s t e r n Memorial Hospital. First, weekly endoscopy rounds were instituted to discuss didactic and clinical issues. Also, an annual animal laboratory was provided for second- and fourth-year residents to develop familiarity with equipment and procedures. The first day involved use of a pelvic trainer for laparoscopic suturing and
$31