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Comparison of 5-, 10-, and 15-Point laparoscopic ovarian coagulation in women with PCOS
August 2002, Vol. 9, No. 3 Supplement
The Journal of the American Association of Gynecologic Laparoscopists
Essure System (Conceptus, San Carlos, CA) for submission to the FDA for approval to market the device in the United States. Measurements and Main Results. The guidewirecatheter of the Essure sterilization device is delivered through the hysteroscopic working chalmel into the fallopian tube. Once correctly placed, a microinsert is released. The expandable outer coil of the microinsert holds the device in the tubal lumen. Dacron-like fibers of the inner coil of the microinsert elicit a benign, local tissue response that over time occludes the tube. Eleven of 518 women with proved fertility did not have visible tubal ostia so treatment with the Essure System was contraindicated. Of the remaining 507 women, 464 (92%) had successful bilateral placement. Fifteen women (3%) who did not have placement had preexisting tubal occlusion, and less than 1% had both patent tubes and failure to place. Over 92% of procedures were performed with only intravenous sedation or paracervical block; general anesthesia was used in only 0.2% of procedures. Twenty-five women did not appear for the 3-month HSG. Of those who did, 99% reported good to excellent comfort wearing the device. As of April 2002, over 8400 woman-months of use as a contraceptive have been recorded without a reported pregnancy. The projected 1-year contraceptive effectiveness rate is 99.7%. Conclusion. Essure appears to be a viable altemative to tubal ligation.
and 15.2%, respectively (p = 0.263). Live birth rates were 20.9% in the 5-point and 47.6% in the 15-point groups (p = 0.004). Conclusion. We recommend 15-point laparoscopic ovarian coagulation in women with PCOS.
38. Complications of Operative Hysteroscopy C De Angelis, A Casa, S Campo, L Montevecchi, L Muzii, S Pace, E Zupi. Roman Group of Gynecological Endoscopy, Rome, Italy.
Objective. To report experience of seven Roman endoscopy units with an average of 6.4 years/operator, for a total of 7440 excisions. Measurements and Main Results. Procedures were 3748 endometrial polypectomies (50.3%), 1664 myomectomies (22.3%), 1015 endometrial ablations (13.6%), 689 partial or total uterine septum resections (9.3%), 238 adhesiolyses (3.2%), and 86 cases of removal of foreign bodies (1.1%, lost IUDs, bone metaplasia). The intraoperative complication rate for all interventions was 0.4% (32 cases). The most frequent complication was uterine perforation (0.26%) after either cervical dilatation (0.24%) or resection (0.02%). Nine cases of heavy bleeding (0.12%) and three of fluid overload (0.04%) occurred. No embolism or lesions of the large retroperitoneal vessels, intestine, or urinary tract were reported. Long-term complications after the intervention occurred in 19 women (0.25%): pelvic inflammation and endometrites (0.09%), bleeding (0.08%), and synechiae (0.08%). In women who conceived, no uterine rapture occurred as a consequence of endoscopic metroplasty or myomectomy. Conclusion. Hysteroscopy is safe, reliable, and successful if carried out by expert hysteroscopic surgeons, with very good results and low complication rate.
37. Comparison of 5-, 10-, and 15-Point Laparoscopic Ovarian Coagulation in Women with PCOS H Dabirashrafi, K Mohamad, NM Tabrizi, K Zandinejad, FI Nia, N Sanjari. Tehran University Medical Science and Health, Dabirashrafi Fertility and Endoscopy Research, Tehran, Iran.
Objective. To compare 5-, 10-, and 15-point laparoscopic ovarian electrocoagulation in 187 women with PCOS. Measurements and Main Results. In 67 patients the ovaries were coagulated by 5 points, in 57 by 10 points, and in 63 by 15 points. Age, BMI, and kind and duration of infertility were not statistically different among the groups. Pregnancy rates were 29.9% in 5-point, 31.6% in 10-point, and 52.4% in 15-point groups (p = 0.016). Abortion rates were 30%, 11.1%,
39. Complications of Laparoscopic Use of 0.5% Ferric Hyaluronate Gel CR Della Badia. MCP Hahnemann University, Voorhees, New Jersey.
Objective. To assess the safety of viscous 0.5% ferric hyaluronate gel in patients undergoing laparoscopic gynecologic surgery.
S13
The Journal of the American Association of Gynecologic Laparoscopists
Essure System (Conceptus, San Carlos, CA) for submission to the FDA for approval to market the device in the United States. Measurements and Main Results. The guidewirecatheter of the Essure sterilization device is delivered through the hysteroscopic working chalmel into the fallopian tube. Once correctly placed, a microinsert is released. The expandable outer coil of the microinsert holds the device in the tubal lumen. Dacron-like fibers of the inner coil of the microinsert elicit a benign, local tissue response that over time occludes the tube. Eleven of 518 women with proved fertility did not have visible tubal ostia so treatment with the Essure System was contraindicated. Of the remaining 507 women, 464 (92%) had successful bilateral placement. Fifteen women (3%) who did not have placement had preexisting tubal occlusion, and less than 1% had both patent tubes and failure to place. Over 92% of procedures were performed with only intravenous sedation or paracervical block; general anesthesia was used in only 0.2% of procedures. Twenty-five women did not appear for the 3-month HSG. Of those who did, 99% reported good to excellent comfort wearing the device. As of April 2002, over 8400 woman-months of use as a contraceptive have been recorded without a reported pregnancy. The projected 1-year contraceptive effectiveness rate is 99.7%. Conclusion. Essure appears to be a viable altemative to tubal ligation.
and 15.2%, respectively (p = 0.263). Live birth rates were 20.9% in the 5-point and 47.6% in the 15-point groups (p = 0.004). Conclusion. We recommend 15-point laparoscopic ovarian coagulation in women with PCOS.
38. Complications of Operative Hysteroscopy C De Angelis, A Casa, S Campo, L Montevecchi, L Muzii, S Pace, E Zupi. Roman Group of Gynecological Endoscopy, Rome, Italy.
Objective. To report experience of seven Roman endoscopy units with an average of 6.4 years/operator, for a total of 7440 excisions. Measurements and Main Results. Procedures were 3748 endometrial polypectomies (50.3%), 1664 myomectomies (22.3%), 1015 endometrial ablations (13.6%), 689 partial or total uterine septum resections (9.3%), 238 adhesiolyses (3.2%), and 86 cases of removal of foreign bodies (1.1%, lost IUDs, bone metaplasia). The intraoperative complication rate for all interventions was 0.4% (32 cases). The most frequent complication was uterine perforation (0.26%) after either cervical dilatation (0.24%) or resection (0.02%). Nine cases of heavy bleeding (0.12%) and three of fluid overload (0.04%) occurred. No embolism or lesions of the large retroperitoneal vessels, intestine, or urinary tract were reported. Long-term complications after the intervention occurred in 19 women (0.25%): pelvic inflammation and endometrites (0.09%), bleeding (0.08%), and synechiae (0.08%). In women who conceived, no uterine rapture occurred as a consequence of endoscopic metroplasty or myomectomy. Conclusion. Hysteroscopy is safe, reliable, and successful if carried out by expert hysteroscopic surgeons, with very good results and low complication rate.
37. Comparison of 5-, 10-, and 15-Point Laparoscopic Ovarian Coagulation in Women with PCOS H Dabirashrafi, K Mohamad, NM Tabrizi, K Zandinejad, FI Nia, N Sanjari. Tehran University Medical Science and Health, Dabirashrafi Fertility and Endoscopy Research, Tehran, Iran.
Objective. To compare 5-, 10-, and 15-point laparoscopic ovarian electrocoagulation in 187 women with PCOS. Measurements and Main Results. In 67 patients the ovaries were coagulated by 5 points, in 57 by 10 points, and in 63 by 15 points. Age, BMI, and kind and duration of infertility were not statistically different among the groups. Pregnancy rates were 29.9% in 5-point, 31.6% in 10-point, and 52.4% in 15-point groups (p = 0.016). Abortion rates were 30%, 11.1%,
39. Complications of Laparoscopic Use of 0.5% Ferric Hyaluronate Gel CR Della Badia. MCP Hahnemann University, Voorhees, New Jersey.
Objective. To assess the safety of viscous 0.5% ferric hyaluronate gel in patients undergoing laparoscopic gynecologic surgery.
S13