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Are We Counselling Patients Correctly Prior to Endometrial Ablations?
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S91–S135 Patients: 44 women undergone hysteroscopic tubal sterilization by Essure microinsert placement. Intervention: Placement of the microinserts was performed in office setting following standard produces’recommendations. Three months after the procedure, all patients underwent 3D-TVS and successively 2D-3D realtime HyFoSy. The device position was evaluated on 3D-TVS coronal section and classified as perfect, proximal and very distal according the classification proposed by Legendre(2010). 2D-3D real-time HyFoSy was then performed to confirm tubal occlusion by the absence of gel Foam passage through the tubes and around the ovaries. Side effects and pain level during and after the procedures were also evaluated. Measurements and Main Results: On 44 patients a total of 87 tubes with Essure device were evaluate. On the coronal view, the position of devices was seen as perfect in 6(6.9%) cases, proximal in 54(62.8%) and very distal in 27(30.2%) cases. During HyFoSy bilateral tubal occlusion was observed in 38 cases. In the 6 cases tubal patency was detected (5 unilateral and 1 bilateral tubal patency). Of the 7 patent tubes the devices had a proximal position in 4 tubes, very distal in one tube and an inadequate position mostly inside the uterine cavity in one case. In case of perfect device position non tubal patency was observed. A pain score >5 on VAS was recorded only in 3 patients during the procedure. Conclusion: 2D-3D-TVS-HyFoSy provides the visualization of Essure microinserts’ tubal position and at the same time an accurate assessment of tubal occlusion. It could be considered a reliable tool for evaluating tubal obliteration status after hysteroscopic sterilization. 351
Open Communications 19 - Advanced Endoscopy (4:08 PM - 4:13 PM)
Are We Counselling Patients Correctly Prior to Endometrial Ablations? Hardcastle R, Guyer C. Gynaecology, Queen Alexandra Hospital, Portsmouth, Hants, United Kingdom Study Objective: To seek out long term satisfaction rates for patients undergoing endometrial ablation To seek out predictors of success for endometrial ablation. Design: A report was produced for patients undergoing an ablation procedure between January 2008 and December 2012 (5 years.) All patients were contacted and asked to complete a survey. Patients: This was a retrospective study for patients undergoing ablation procedures for menorrhagia. Measurements and Main Results: GENERAL RESULTS: Of 682 patients contacted 287 responded = 42% return rate. Of these patients 21 didn’t have a treatment performed, leaving 266 entering the study. 64% of patients were satisfied with the outcome of the procedure. 40% of patients required further treatment. If patients required further treatment - 56% had a hysterectomy. PREDICTOR RESULTS Of patients who had been treated with a mirena coil previously 80% found it did not improve there symptoms. 50% of these patients went on to require further treatment after being unsatisfied with an endometrial ablation (67% had a hysterectomy.) For patients in whom a mirena improved menorrhagia previously 78% had successful treatment with an endometrial ablation and none required a hysterectomy at a later date. There was no correlation between the number of previous treatments and the success of an endometrial ablation. Conclusion: When counselling patients prior to an endometrial ablation it is important to discuss the long term outcomes. In patients who have been successfully treated with a mirena coil previously it would appear they have a much better chance of successful outcome with minimal chance of further treatment over 5 years. However if a mirena coil has not improved their symptoms they seem to stand a 50% chance of further intervention which may be especially important to discuss with younger women. It is important to note that multiple failed treatments seems to not predict success of an endometrial ablation.
352
S107
Open Communications 19 - Advanced Endoscopy (4:14 PM - 4:19 PM)
Hysteroscopic Resection in the UK Office Setting: A Pilot Study into Patient Acceptability Hiscock J, Vindla S, Palser T. Obstetrics & Gynaecology, King’s Mill Hospital, Sutton-in-Ashfield, Nottinghamshire, United Kingdom Study Objective: 1) To evaluate patient experience and acceptability throughout all stages of operative hysteroscopy in the office setting. 2) Examine specific patient and procedural factors that affect pain to allow a more realistic and individualised approach to pre-procedure counselling. Design: Prospective observational pilot study using the MyoSureÒ Hysteroscopic Tissue Removal System (Hologic, Inc, USA). Setting: Office Setting, King’s Mill Hospital, Nottinghamshire, UK. Patients: Forty consecutive women (pre and post-menopausal) with previously identified uterine pathology attending for MyoSureÒ. Intervention: Removal of sub-mucosal fibroids or polyps using MyoSureÒ. Patients received oral pre-medication (Acetaminophen & Tramadol) and 6.6 mls of local anaesthetic (Prilocaine 3% with Felypressin 0.03units/ml) administered as a para-cervical block. Women were asked to score their pain using a Numeric Rating scale; 0 (No pain) to 10 (severe pain) in anticipation of the procedure, during anaesthetic administration, dilatation, resection of uterine pathology, post-procedure and following refreshments. Additionally patients were asked if they would recommend the procedure to a friend. Measurements and Main Results: 37 patients were eligible for analysis. Median age 56 years, 27 were post-menopausal and 10 were nulliparous or had had caesarean sections. Mean pain scores specific to each stage in the procedure are demonstrated below:
Mean Pain Scores at each stage of the Procedure Stage of procedure
Mean Pain Score (0 - 10)
Range (0 - 10)
Previous Office hysteroscopy experience Anticipated pain pr-procedure Local anaesthetic administration Cervical dilatation During MyosureÒ resection Immediately post-procedure After refreshments
5.0 5.9 3.6 3.7 3.0 1.3 0.7
0 - 10 2 - 10 0 - 8.0 0- 9.0 0 - 8.0 0 - 8.0 0 - 5.0
Type of device (Lite, Classic or XL) and nature of uterine pathology (fibroid or polyp) did not appear to influence patients’ interpretation of pain. A trend towards higher scores was observed in patients with a BMI > 40, postmenopausal status and nulliparous but numbers in this pilot study were too small to assess statistical significance. 100% recommended their office procedure. Conclusion: This study indicates office-based hysteroscopic resection is both well tolerated and highly acceptable to a wide range of women. Our clinic now uses a more objective approach, setting realistic expectations for these different groups. Additional work is underway to validate these findings in a larger group of patients.
353
Open Communications 19 - Advanced Endoscopy (4:20 PM - 4:25 PM)
Endometrial Ablation in Women with Abnormal Uterine Bleeding Associated with Ovulatory Dysfunction (AUB-O): A Cohort Study Hokenstad AN, El-Nashar SA, Khan Z, Hopkins MR, LaughlinTommaso SK, Famuyide AO. Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
Open Communications 19 - Advanced Endoscopy (4:08 PM - 4:13 PM)
Are We Counselling Patients Correctly Prior to Endometrial Ablations? Hardcastle R, Guyer C. Gynaecology, Queen Alexandra Hospital, Portsmouth, Hants, United Kingdom Study Objective: To seek out long term satisfaction rates for patients undergoing endometrial ablation To seek out predictors of success for endometrial ablation. Design: A report was produced for patients undergoing an ablation procedure between January 2008 and December 2012 (5 years.) All patients were contacted and asked to complete a survey. Patients: This was a retrospective study for patients undergoing ablation procedures for menorrhagia. Measurements and Main Results: GENERAL RESULTS: Of 682 patients contacted 287 responded = 42% return rate. Of these patients 21 didn’t have a treatment performed, leaving 266 entering the study. 64% of patients were satisfied with the outcome of the procedure. 40% of patients required further treatment. If patients required further treatment - 56% had a hysterectomy. PREDICTOR RESULTS Of patients who had been treated with a mirena coil previously 80% found it did not improve there symptoms. 50% of these patients went on to require further treatment after being unsatisfied with an endometrial ablation (67% had a hysterectomy.) For patients in whom a mirena improved menorrhagia previously 78% had successful treatment with an endometrial ablation and none required a hysterectomy at a later date. There was no correlation between the number of previous treatments and the success of an endometrial ablation. Conclusion: When counselling patients prior to an endometrial ablation it is important to discuss the long term outcomes. In patients who have been successfully treated with a mirena coil previously it would appear they have a much better chance of successful outcome with minimal chance of further treatment over 5 years. However if a mirena coil has not improved their symptoms they seem to stand a 50% chance of further intervention which may be especially important to discuss with younger women. It is important to note that multiple failed treatments seems to not predict success of an endometrial ablation.
352
S107
Open Communications 19 - Advanced Endoscopy (4:14 PM - 4:19 PM)
Hysteroscopic Resection in the UK Office Setting: A Pilot Study into Patient Acceptability Hiscock J, Vindla S, Palser T. Obstetrics & Gynaecology, King’s Mill Hospital, Sutton-in-Ashfield, Nottinghamshire, United Kingdom Study Objective: 1) To evaluate patient experience and acceptability throughout all stages of operative hysteroscopy in the office setting. 2) Examine specific patient and procedural factors that affect pain to allow a more realistic and individualised approach to pre-procedure counselling. Design: Prospective observational pilot study using the MyoSureÒ Hysteroscopic Tissue Removal System (Hologic, Inc, USA). Setting: Office Setting, King’s Mill Hospital, Nottinghamshire, UK. Patients: Forty consecutive women (pre and post-menopausal) with previously identified uterine pathology attending for MyoSureÒ. Intervention: Removal of sub-mucosal fibroids or polyps using MyoSureÒ. Patients received oral pre-medication (Acetaminophen & Tramadol) and 6.6 mls of local anaesthetic (Prilocaine 3% with Felypressin 0.03units/ml) administered as a para-cervical block. Women were asked to score their pain using a Numeric Rating scale; 0 (No pain) to 10 (severe pain) in anticipation of the procedure, during anaesthetic administration, dilatation, resection of uterine pathology, post-procedure and following refreshments. Additionally patients were asked if they would recommend the procedure to a friend. Measurements and Main Results: 37 patients were eligible for analysis. Median age 56 years, 27 were post-menopausal and 10 were nulliparous or had had caesarean sections. Mean pain scores specific to each stage in the procedure are demonstrated below:
Mean Pain Scores at each stage of the Procedure Stage of procedure
Mean Pain Score (0 - 10)
Range (0 - 10)
Previous Office hysteroscopy experience Anticipated pain pr-procedure Local anaesthetic administration Cervical dilatation During MyosureÒ resection Immediately post-procedure After refreshments
5.0 5.9 3.6 3.7 3.0 1.3 0.7
0 - 10 2 - 10 0 - 8.0 0- 9.0 0 - 8.0 0 - 8.0 0 - 5.0
Type of device (Lite, Classic or XL) and nature of uterine pathology (fibroid or polyp) did not appear to influence patients’ interpretation of pain. A trend towards higher scores was observed in patients with a BMI > 40, postmenopausal status and nulliparous but numbers in this pilot study were too small to assess statistical significance. 100% recommended their office procedure. Conclusion: This study indicates office-based hysteroscopic resection is both well tolerated and highly acceptable to a wide range of women. Our clinic now uses a more objective approach, setting realistic expectations for these different groups. Additional work is underway to validate these findings in a larger group of patients.
353
Open Communications 19 - Advanced Endoscopy (4:20 PM - 4:25 PM)
Endometrial Ablation in Women with Abnormal Uterine Bleeding Associated with Ovulatory Dysfunction (AUB-O): A Cohort Study Hokenstad AN, El-Nashar SA, Khan Z, Hopkins MR, LaughlinTommaso SK, Famuyide AO. Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota