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Comparison of a Novel Device and Traditional Uterine Sound to Determine Uterine Cavity Measurements
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Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S50–S94 Open Communications 12dNew Instrumentation (12:47 PMd12:52 PM)
Comparison of a Novel Device and Traditional Uterine Sound to Determine Uterine Cavity Measurements Dimitriadis I, Thieu H-T. Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, Massachusetts Study Objective: To evaluate inter-observer variability of uterine cavity measurements on extirpated uteri using traditional sound methods versus the next generation SureSoundÒ device. Design: Randomized, 2 x 2 comparative bench study. Setting: Laboratory. Patients: Sixteen extirpated uteri consisting of cervix, uterine corpus and fallopian tubes. The specimens were thawed the day prior to the study and assessed for viability. Intervention: Two gynecologists with extensive experience with uterine cavity measurement were trained in the use of the next generation SureSound device. A PGY1 resident was also trained. Specimens were randomized, the order of measuring devices was randomized and each physician was blinded to the other measurements. Measurements and Main Results: Each physician performed two cavity length measurements on each specimen: one using a traditional uterine sound and 7 mm Hegar dilator, and another measurement with the next generation SureSound device. The difference in measurement between the two experienced observers was calculated and t-test was performed to compare differences between the observers. One specimen was deemed unevaluable, and was excluded; 15 specimens were included in the final analysis. Inter-observer variability was slightly less with the SureSound device (mean absolute difference between observers = 0.4 cm) than with the traditional sound (mean absolute difference = 0.5 cm), but this difference was not statistically significant (p = 0.82). The standard deviation of the observer differences was statistically significantly less (p \ 0.05) with the SureSound device (SD = 0.24 cm) than with traditional sound technique (SD = 0.45 cm). Additionally, the PGY1 observations were similar to the experienced users. Conclusion: Consistent intrauterine measurement is an important component of perioperative evaluation for radiofrequency endometrial ablation. Results from this study indicate that the next generation SureSound device performs similarly between experienced and inexperienced users, with little variation compared to the traditional sounding method for uterine cavity measurement.
220
Open Communications 12dNew Instrumentation (12:53 PMd12:58 PM)
Single Port Pelvic Surgery (SiPPS) Feasibility and Outcome Study from a Single Institution Anwah I, Uppal S, Kushner DM, Al-Niaimi AN. Obestetrics and Gynecology-Division of Gynecologic Oncology, University of Wisconsin, Madison, Wisconsin Study Objective: To present our experience with single port pelvic surgery and assess the feasibility and safety of this technique for a number of different gynecologic oncology indications. Design: Retrospective analysis of consequence 39 SiPPs cases over the course of 12 months since adoption. Setting: The University of Wisconsin Hospital, Madison, Wisconsin. Department of Obstetrics and Gynecology. Division of Gynecologic Oncology. Patients: Thirty-nine consecutive patients (ages 35 - 83) requiring surgery for a variety of gynecologic oncology indications. Intervention: Single port laparoscopy, hysterectomy, salpingoopherectomy, lymph node dissection, omentectomy, appendectomy, and hernia repair, and cancer staging. Measurements and Main Results: Thirty-nine consecutive patients with mean age of 55 years and BMI of 32.3. A sum of 27/39 (69.2%) patients
have had had undergone at least one previous abdominal surgery. Ovarian pathology constituted 28/39 (72.2%), while uterine pathology was 8/39 (20.5%), and 2/39 (5.2%) for cervical pathology. Conversion to laparotomy was seen in 6/39(15.4%), 4 (10.2%) cases because of technical difficulty, 1 (2.5%) for advanced pathology, and 1(2.5%) for vascular injury. Cases completed without conversion to laparotomy (33) had a mean length of procedure of 133 minutes (SD=69); length of hospital stay of 1 day (SD=0.79), and EBL of 51 ml (SD=95). For cases complicated by conversion to laparotomy (6), a mean length of procedure was 297 minutes (SD=80), length of hospital stay was 6.3 days (SD=2.9), and means EBL of 1400 ml (SD=996). Adoption of SiPPs was progressive from 7/30 (18%) in the first quarter of the year to 16/39(41%) in the last quarter. Most 6/8(75%) of full uterine cancer staging was in the last two quarters of the year. Conclusion: Single Port Pelvic Surgery can be performed feasibly and safely for a wide variety of Gynecologic Oncology indications. Surgical outcome are comparable to those of the traditional laparoscopic technique.
221
Open Communications 12dNew Instrumentation (12:59 PMd1:05 PM)
Long Term Follow Up after Combined Embolization and Selective Minimally Invasive Myomectomy after MRI (CESAM) Fazel A, Fargeaudou Y, Le Dref O, Pelage JP, Barranger E, Jacob D, Soyer P. Obstetrics and Gynecology, Hopital Lariboisiere, Paris, France Study Objective: To evaluate the long term results of Combined Embolization and Selective minimally invasive myomectomy After MRI. (CESAM). Design: Prospective study (Canadian Task Force classification II-3). Setting: University Hospital, Tertiary Center. Patients: 25 patients aged 37, 5 (23-48), with at least one large (>10 cm), subserosal, submucosal, and/or multiple (>10) symptomatic fibroids. Intervention: After describing in our department the first uterine artery embolization (UAE)for fibroids in 1997, and the first case of combined embolization and selective myomectomy by laparotomy in 2002, we performed UAE and selective myomectomy by laparoscopy or hysteroscopy and followed our patients operated between 2005 and 2011. Measurements and Main Results: Clinical examination and MRI were performed at day 3 and 6 months after CESAM. Complications and symptoms were assessed, up to 8 years. No transfusion was needed during the procedure. One patient was reoperated at day 3 by laparoscopy for hematoma at the site of laparoscopic myomectomy. Heavy bleeding resumed after 6 months when the MRI at day 3 was showing a total devascularization of the remaining fibroids. In one case devascularization was not total at 6 months, although the patient was not symptomatic at that time. Pelvic pain resumed or markedly improved after 6 months. The volume of the remaining fibroids shrunk 60% in average. Transient amenorrhea was noticed with two patients. No major complication was noticed in the long term follow up. No patient needed a hysterectomy during the follow up period. Pregnancy rates are discussed. Conclusion: CESAM is a safe and effective new approach to treat large uteri with multiple fibroids after long term follow up. When embolization is dangerous due to potential necrosis, or ineffective, due to the localization of some fibroids, and when a limited number of myomectomies can be performed by minimally invasive surgery, the CESAM technique is an alternative to hysterectomy, especially in women of child bearing age.
222
Open Communications 13dUrogynecology (12:05 PMd12:10 PM)
Robotic Sacral Colpopexy for the Treatment of Symptomatic Pelvic Organ Prolapse in the Elderly Population Dizon M, Brock C, Elder R, Zite N, Klein F, White W. The University of Tennessee Medical Center, Knoxville, Tennessee
Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S50–S94 Open Communications 12dNew Instrumentation (12:47 PMd12:52 PM)
Comparison of a Novel Device and Traditional Uterine Sound to Determine Uterine Cavity Measurements Dimitriadis I, Thieu H-T. Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, Massachusetts Study Objective: To evaluate inter-observer variability of uterine cavity measurements on extirpated uteri using traditional sound methods versus the next generation SureSoundÒ device. Design: Randomized, 2 x 2 comparative bench study. Setting: Laboratory. Patients: Sixteen extirpated uteri consisting of cervix, uterine corpus and fallopian tubes. The specimens were thawed the day prior to the study and assessed for viability. Intervention: Two gynecologists with extensive experience with uterine cavity measurement were trained in the use of the next generation SureSound device. A PGY1 resident was also trained. Specimens were randomized, the order of measuring devices was randomized and each physician was blinded to the other measurements. Measurements and Main Results: Each physician performed two cavity length measurements on each specimen: one using a traditional uterine sound and 7 mm Hegar dilator, and another measurement with the next generation SureSound device. The difference in measurement between the two experienced observers was calculated and t-test was performed to compare differences between the observers. One specimen was deemed unevaluable, and was excluded; 15 specimens were included in the final analysis. Inter-observer variability was slightly less with the SureSound device (mean absolute difference between observers = 0.4 cm) than with the traditional sound (mean absolute difference = 0.5 cm), but this difference was not statistically significant (p = 0.82). The standard deviation of the observer differences was statistically significantly less (p \ 0.05) with the SureSound device (SD = 0.24 cm) than with traditional sound technique (SD = 0.45 cm). Additionally, the PGY1 observations were similar to the experienced users. Conclusion: Consistent intrauterine measurement is an important component of perioperative evaluation for radiofrequency endometrial ablation. Results from this study indicate that the next generation SureSound device performs similarly between experienced and inexperienced users, with little variation compared to the traditional sounding method for uterine cavity measurement.
220
Open Communications 12dNew Instrumentation (12:53 PMd12:58 PM)
Single Port Pelvic Surgery (SiPPS) Feasibility and Outcome Study from a Single Institution Anwah I, Uppal S, Kushner DM, Al-Niaimi AN. Obestetrics and Gynecology-Division of Gynecologic Oncology, University of Wisconsin, Madison, Wisconsin Study Objective: To present our experience with single port pelvic surgery and assess the feasibility and safety of this technique for a number of different gynecologic oncology indications. Design: Retrospective analysis of consequence 39 SiPPs cases over the course of 12 months since adoption. Setting: The University of Wisconsin Hospital, Madison, Wisconsin. Department of Obstetrics and Gynecology. Division of Gynecologic Oncology. Patients: Thirty-nine consecutive patients (ages 35 - 83) requiring surgery for a variety of gynecologic oncology indications. Intervention: Single port laparoscopy, hysterectomy, salpingoopherectomy, lymph node dissection, omentectomy, appendectomy, and hernia repair, and cancer staging. Measurements and Main Results: Thirty-nine consecutive patients with mean age of 55 years and BMI of 32.3. A sum of 27/39 (69.2%) patients
have had had undergone at least one previous abdominal surgery. Ovarian pathology constituted 28/39 (72.2%), while uterine pathology was 8/39 (20.5%), and 2/39 (5.2%) for cervical pathology. Conversion to laparotomy was seen in 6/39(15.4%), 4 (10.2%) cases because of technical difficulty, 1 (2.5%) for advanced pathology, and 1(2.5%) for vascular injury. Cases completed without conversion to laparotomy (33) had a mean length of procedure of 133 minutes (SD=69); length of hospital stay of 1 day (SD=0.79), and EBL of 51 ml (SD=95). For cases complicated by conversion to laparotomy (6), a mean length of procedure was 297 minutes (SD=80), length of hospital stay was 6.3 days (SD=2.9), and means EBL of 1400 ml (SD=996). Adoption of SiPPs was progressive from 7/30 (18%) in the first quarter of the year to 16/39(41%) in the last quarter. Most 6/8(75%) of full uterine cancer staging was in the last two quarters of the year. Conclusion: Single Port Pelvic Surgery can be performed feasibly and safely for a wide variety of Gynecologic Oncology indications. Surgical outcome are comparable to those of the traditional laparoscopic technique.
221
Open Communications 12dNew Instrumentation (12:59 PMd1:05 PM)
Long Term Follow Up after Combined Embolization and Selective Minimally Invasive Myomectomy after MRI (CESAM) Fazel A, Fargeaudou Y, Le Dref O, Pelage JP, Barranger E, Jacob D, Soyer P. Obstetrics and Gynecology, Hopital Lariboisiere, Paris, France Study Objective: To evaluate the long term results of Combined Embolization and Selective minimally invasive myomectomy After MRI. (CESAM). Design: Prospective study (Canadian Task Force classification II-3). Setting: University Hospital, Tertiary Center. Patients: 25 patients aged 37, 5 (23-48), with at least one large (>10 cm), subserosal, submucosal, and/or multiple (>10) symptomatic fibroids. Intervention: After describing in our department the first uterine artery embolization (UAE)for fibroids in 1997, and the first case of combined embolization and selective myomectomy by laparotomy in 2002, we performed UAE and selective myomectomy by laparoscopy or hysteroscopy and followed our patients operated between 2005 and 2011. Measurements and Main Results: Clinical examination and MRI were performed at day 3 and 6 months after CESAM. Complications and symptoms were assessed, up to 8 years. No transfusion was needed during the procedure. One patient was reoperated at day 3 by laparoscopy for hematoma at the site of laparoscopic myomectomy. Heavy bleeding resumed after 6 months when the MRI at day 3 was showing a total devascularization of the remaining fibroids. In one case devascularization was not total at 6 months, although the patient was not symptomatic at that time. Pelvic pain resumed or markedly improved after 6 months. The volume of the remaining fibroids shrunk 60% in average. Transient amenorrhea was noticed with two patients. No major complication was noticed in the long term follow up. No patient needed a hysterectomy during the follow up period. Pregnancy rates are discussed. Conclusion: CESAM is a safe and effective new approach to treat large uteri with multiple fibroids after long term follow up. When embolization is dangerous due to potential necrosis, or ineffective, due to the localization of some fibroids, and when a limited number of myomectomies can be performed by minimally invasive surgery, the CESAM technique is an alternative to hysterectomy, especially in women of child bearing age.
222
Open Communications 13dUrogynecology (12:05 PMd12:10 PM)
Robotic Sacral Colpopexy for the Treatment of Symptomatic Pelvic Organ Prolapse in the Elderly Population Dizon M, Brock C, Elder R, Zite N, Klein F, White W. The University of Tennessee Medical Center, Knoxville, Tennessee