Comparison of different diagnostic techniques at the level of the cervix and the uterine cavity

August 2002, Vol. 9, No. 3 Supplement TheJournal of the American Association of Gynecologic Laparoscopists

Measurements and Main Results. With some 20,000 cases with which one may directly compare sharp caamulas with the radial expanding-access system, the methods differ by a factor of 60. Conclusion. Retrospective data collected over 4 years show the frequencies of abdominal wall bleeders, vascular injuries, visceral injuries, and hernias, compared with complications with sharp trocars.

and office hysteroscopy, and their accuracy was matched with findings at operative hysteroscopy. Anomalies were found in 34% to 62% of infertility patients, and caused serious reproductive problems in 20% to 45% (high risk of miscarriage 2 0 ~ 5 %, abnormal presentations at delivery 20-50%, retained placenta 10-20%, postpartum hemorrhage 10-32%). Vaginoscopic hysteroscopy has sensitivity of 92% and specificity of 95%. HSG has sensitivity of 75.21%, positive predictive value of 47%, and negative predictive value of 70.60%. TVS has sensitivity of 95.6%, positive predictive value of 100%, negative predictive value of 100%. SIS has sensitivity of 96%, specificity of 91%, and positive and negative predictive values the same as TVS. Conclusion. The decision tree could be clinical examination with colposcopy, followed by TVS if problems arise, and vaginoscopic hysteroscopy. SIS gives the same results as TVS but is more time consuming and more related to the experience of the operator. MRI is a superb diagnostic tool but not cost effective in routine investigations.

189. Hysteroscopic Uterine Septa Resection Increases Gestational Outcome in Women with Recurrent Spontaneous Abortion E Valli, C de Carolis, B De Vivo, N Lazzarin, E Vaquero, E Zupi. Department of Obstetrics and Gynecology, Hospital San Giovanni Calibita, Rome, Italy. Objective. To evaluate the efficacy of hysteroscopic uterine septa resection in increasing gestational outcome after recurrent spontaneous abortion. Measurements and Main Results. Forty-three women had uterine septa and recurrent spontaneous abortions (88.7%, 134 spontaneous abortions). Of these, 28 underwent hysteroscopic metroplasty by resectoscope under minilaparoscopic control of the extemal uterine profile. The only complication was a uterine perforation managed by laparoscopy. The control group consisted of 15 patients who did not have surgery. Four patients were excluded from the study. The remaining 22 patients conceived (25 pregnancies): 19 (76%) term pregnancies, 1 (4%) preterm, and 5 (20%) abortions. In the control group 14 women had 20 pregnancies: 15 (75%) abortions, 1(5%) preterm, and 4 (20%) term pregnancies (p <0.001). Conclusion. Hysteroscopic metroplasty with minilaparoscopic control increased gestational outcomes in patients with uterine septa and recurrent spontaneous abortions.

191. Laparoscopic Colposuspension with Mesh Under the Parietal Peritoneum as an Alternative to Sacrosuspension 1BJ van Herendael, 2B De Vree, 2M Francx. 1Universita del Insubria, Varese Italy, ACZA Campus Stuivenberg OCMW Antwerp, Department of Gynaecological Endoscopy, Antwerp, Belgium; 2AZ Middelheim Department of ObstetricsGynaecology-Fertility, Wilrijk, Belgium. Objective. To describe a new method of colposuspension. Measurements and Main Results. In some patients (elderly, those with chronic bowel dysfunction, anesthesia risks) classic colposuspension with mesh and sacropexy is not feasible. We changed the approach and brought in mesh under the parietal peritoneum from the sidewalls under direct vision. In seven women with vault prolapse, 25-cm mesh was introduced and firmly grasped with forceps with a rounded end. The forceps with the mesh was brought in through a small incision in the lower lateral quadrant under the incision of the 5-mm ancillary port. The forceps was visualized under the peritoneum and guided toward the prepared vagina top. It dissected its way toward the objective without too much pressure and without opening the peritoneum. The mesh was attached to the

190. Comparison of Different Diagnostic Techniques at the Level of the Cervix and the Uterine Cavity BJ van Herendael. Universita del Insubria, Varese Italy, ACZA Campus Stuivenberg OCMW Antwerp, Department of Gynaecological Endoscopy, Antwerp, Belgium. Objective. To compare different diagnostic techniques as to establish a decision tree for infertility evaluation. Measurements and Main Results. Compared were HSG, TVUS, saline-infusion sonohysterography (SIS),

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