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Can New Medical Treatments Replace Myomectomy
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 Table 1. Clinical Outcomes
Post treatment observation: group (a) (n = 25) patients, who were operated by myomectomy, continued with normal menstrual bleedings, no metrorrhagias, no more pain and pressure symptoms. They were subjected to post surgical iron medication and revealed normal haemoglobin values after 4 months. In group (b) (n = 23) 17 patients continued with normal menstrual bleedings, no more pain and pressure symptoms, the fibroids had shrunk for about 2 3 cm each. 6 patients had to be subjected to laparoscopic myomectomy. Conclusion: Laparocopic intramural myoma enucleation in symptomatic (pain and pressure symptoms) infertility patients should still be treated primarily surgically, however, indications for ulipristale acetate particularly presurgically include: anemia, big and multiple myomas, difficult localized myomas, shrinking of myomas and to gap time issues.
402
compared to literature reported rates as high as 6.6% and 7.6%, respectively. Power morcellation was not performed in any case. Conversion rate to laparotomy was 0.0%, compared to literature reported rate as high as 8.7%. Conclusion: LRH facilitates identification of vital pelvic structures and control of major blood vessels, thereby reducing injuries and bleeding. A 0.0% laparotomy conversion rate with low operative time and complication rates suggests that LRH is a safe, effective and efficient technique for preventing laparotomy. Given the 2014 FDA safety communication concerning power morcellation, and a recent study highlighting a corresponding increase in abdominal hysterectomies, further discussion and investigation of this technique in a comparative study is warranted.
401
Virtual Posters – Session 2 (12:45 PM – 1:45 PM) 40112:51 PM – STATION G
Can New Medical Treatments Replace Myomectomy Mettler L, Alkatout I. Obstetrics & Gynecology, University Hospitals Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany Study Objective: It is suggested to replace or pretreat patients for laparoscopic myomectomies, Antifibrinolytics, combined oral contraceptives, gestagenes, GnRH-analogues or selective progesterone receptor Modulators. Design: Comparative study of 48 patients with uterine fibroids of conservative and surgical laparoscopic treatment. Setting: University Department of Obstetrics & Gynecology, Myoma Clinic Patients: 48 selected infertility patients: Pain, symptoms of lower abdominal pressure, metrorrhagias and continuos spottings, presenting one to three fibroids, 6 - 10 cm in diameter, locolized intra-murally and subserosally. Treatment: (a) (n = 25) direct laparoscopic myomectomy and (b) (n = 23) 5 mg ulipristalacetate / 3 months. All patients revealed haemoglobin values between 9 and 11 g/dL, presenting slight anemia. After 4 months the outcome concerning regular periods, pain and abdominal pressure as well as haemoglobin was evaluated. Intervention: 25 patients were submitted to laparoscopic myomectomies with post-operative observation. Myoma enucleation was carried out stepwise according to the Kiel School of Gynecological Endoscopy: 23 patients were treated with ulipristale acetate 5 mg daily. Measurements and Main Results: Pre-treatment measurements: Haemoglobin, pain and pressure symptoms in a scale from 1 - 5, metrorrhagias and assesment of menstrual periods.
S137
Virtual Posters – Session 2 (12:45 PM – 1:45 PM) 12:51 PM – STATION H
Cesarean Scar Pregnancy; Treatment via Laparoscopic Hysterectomy Pepin KJ, Salazar C, Morris S. Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts Incidence of cesarean scar defect ectopic pregnancy is rising due to the increasing numbers of cesarean deliveries in the United States. Various management and treatment options exist for patients with c-section scar pregnancies. Patients with suspected placenta accreta in addition to their c-section scar pregnancy are at high risk of hemorrhage and should be counseled extensively about their management options. This video will review cesarean section scar pregnancy epidemiology, management and treatment outcomes as well as the association with abnormal placentation. Additionally, it will review a case of a 45 yo G3P2 with known Stage III endometriosis and 2 prior C-sections diagnosed with a C-section scar ectopic pregnancy via ultrasound at 6 + 0 weeks, who was managed via methotrexate and ultimately hysterectomy.
403
Virtual Posters – Session 2 (12:45 PM – 1:45 PM) 12:57 PM – STATION A
Colpotomy-First Total Laparoscopic Hysterectomy: a Novel Technique and New Approach to Reduce Operative Time and Complications Sandoval A, Zulbaran-Rojas A, Zamudio A. Obstetrics and Gynecology, Memorial Hermann Greater Heights Hospital, Houston, Texas Study Objective: To determine the benefit of using Colpotomy-first technique for total laparoscopic hysterectomy (TLH) by minimizing operative time (OT) and estimate blood loss (EBL), thus reduce rates of complications and hospital length of stay. Design: Retrospective analysis between January 2016 and December 2016. Setting: Tertiary care center. Patients: 15 women with benign pathology who underwent TLH. Intervention: TLH Colpotomy-first technique is a procedure that uses 1 umbilical camera port (5 mm) and only 2 (5 mm) side ports, and initiates with the colpotomy step. Technique description: posterior colpotomy [Figure 1], bladder flap development, anterior colpotomy [Figure 2], dissection of left fallopian tube, left infundibulopelvic ligament, left round ligament, skeletonization and section of uterine vessels and broad ligaments; right side in same fashion, and uterus removal, in that order.
Post treatment observation: group (a) (n = 25) patients, who were operated by myomectomy, continued with normal menstrual bleedings, no metrorrhagias, no more pain and pressure symptoms. They were subjected to post surgical iron medication and revealed normal haemoglobin values after 4 months. In group (b) (n = 23) 17 patients continued with normal menstrual bleedings, no more pain and pressure symptoms, the fibroids had shrunk for about 2 3 cm each. 6 patients had to be subjected to laparoscopic myomectomy. Conclusion: Laparocopic intramural myoma enucleation in symptomatic (pain and pressure symptoms) infertility patients should still be treated primarily surgically, however, indications for ulipristale acetate particularly presurgically include: anemia, big and multiple myomas, difficult localized myomas, shrinking of myomas and to gap time issues.
402
compared to literature reported rates as high as 6.6% and 7.6%, respectively. Power morcellation was not performed in any case. Conversion rate to laparotomy was 0.0%, compared to literature reported rate as high as 8.7%. Conclusion: LRH facilitates identification of vital pelvic structures and control of major blood vessels, thereby reducing injuries and bleeding. A 0.0% laparotomy conversion rate with low operative time and complication rates suggests that LRH is a safe, effective and efficient technique for preventing laparotomy. Given the 2014 FDA safety communication concerning power morcellation, and a recent study highlighting a corresponding increase in abdominal hysterectomies, further discussion and investigation of this technique in a comparative study is warranted.
401
Virtual Posters – Session 2 (12:45 PM – 1:45 PM) 40112:51 PM – STATION G
Can New Medical Treatments Replace Myomectomy Mettler L, Alkatout I. Obstetrics & Gynecology, University Hospitals Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany Study Objective: It is suggested to replace or pretreat patients for laparoscopic myomectomies, Antifibrinolytics, combined oral contraceptives, gestagenes, GnRH-analogues or selective progesterone receptor Modulators. Design: Comparative study of 48 patients with uterine fibroids of conservative and surgical laparoscopic treatment. Setting: University Department of Obstetrics & Gynecology, Myoma Clinic Patients: 48 selected infertility patients: Pain, symptoms of lower abdominal pressure, metrorrhagias and continuos spottings, presenting one to three fibroids, 6 - 10 cm in diameter, locolized intra-murally and subserosally. Treatment: (a) (n = 25) direct laparoscopic myomectomy and (b) (n = 23) 5 mg ulipristalacetate / 3 months. All patients revealed haemoglobin values between 9 and 11 g/dL, presenting slight anemia. After 4 months the outcome concerning regular periods, pain and abdominal pressure as well as haemoglobin was evaluated. Intervention: 25 patients were submitted to laparoscopic myomectomies with post-operative observation. Myoma enucleation was carried out stepwise according to the Kiel School of Gynecological Endoscopy: 23 patients were treated with ulipristale acetate 5 mg daily. Measurements and Main Results: Pre-treatment measurements: Haemoglobin, pain and pressure symptoms in a scale from 1 - 5, metrorrhagias and assesment of menstrual periods.
S137
Virtual Posters – Session 2 (12:45 PM – 1:45 PM) 12:51 PM – STATION H
Cesarean Scar Pregnancy; Treatment via Laparoscopic Hysterectomy Pepin KJ, Salazar C, Morris S. Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts Incidence of cesarean scar defect ectopic pregnancy is rising due to the increasing numbers of cesarean deliveries in the United States. Various management and treatment options exist for patients with c-section scar pregnancies. Patients with suspected placenta accreta in addition to their c-section scar pregnancy are at high risk of hemorrhage and should be counseled extensively about their management options. This video will review cesarean section scar pregnancy epidemiology, management and treatment outcomes as well as the association with abnormal placentation. Additionally, it will review a case of a 45 yo G3P2 with known Stage III endometriosis and 2 prior C-sections diagnosed with a C-section scar ectopic pregnancy via ultrasound at 6 + 0 weeks, who was managed via methotrexate and ultimately hysterectomy.
403
Virtual Posters – Session 2 (12:45 PM – 1:45 PM) 12:57 PM – STATION A
Colpotomy-First Total Laparoscopic Hysterectomy: a Novel Technique and New Approach to Reduce Operative Time and Complications Sandoval A, Zulbaran-Rojas A, Zamudio A. Obstetrics and Gynecology, Memorial Hermann Greater Heights Hospital, Houston, Texas Study Objective: To determine the benefit of using Colpotomy-first technique for total laparoscopic hysterectomy (TLH) by minimizing operative time (OT) and estimate blood loss (EBL), thus reduce rates of complications and hospital length of stay. Design: Retrospective analysis between January 2016 and December 2016. Setting: Tertiary care center. Patients: 15 women with benign pathology who underwent TLH. Intervention: TLH Colpotomy-first technique is a procedure that uses 1 umbilical camera port (5 mm) and only 2 (5 mm) side ports, and initiates with the colpotomy step. Technique description: posterior colpotomy [Figure 1], bladder flap development, anterior colpotomy [Figure 2], dissection of left fallopian tube, left infundibulopelvic ligament, left round ligament, skeletonization and section of uterine vessels and broad ligaments; right side in same fashion, and uterus removal, in that order.