Efficacy of transcervical resection for submucous myomas in relation to the degree of intramural extension

August 2004, Vol. 11, No. 3 Supplement TheJournal of the American Association of Gynecologic Laparoscopists

Pivotal trial. Three-year effectiveness rate for Essure is 99.80%. Conclusion. The Essure hysteroscopic sterilization procedure continues to demonstrate a high rate of effectiveness and wearing comfort for patients seeking permanent sterilization without the requirement for incisions or general anesthesia.

226. Efficacy of Transcervical Resection for Submucous Myomas in Relation to the Degree of Intramural Extension O Nishii. University Hospital Mizonokuchi, Kawasaki, Kanagawa, Japan. Study Objective. To evaluate transcervical resection (TCR) for submucous myomas in relation to the degree of intramural extension. Design. Retrospective study. Setting. University hospital. Patients. Thirty patients with submucous myomas. Intervention. Transcervical resection. Measurements and Main Results. We treated 38 patients, with submucous myomas less than 50 mm in length, using TCR between April 1998 and March 2000. We evaluated the degree of intramural extension and instituted a classification system, since adopted by the European Society of Hysteroscopy. Pedunculated submucous myoma without intramural extension was classified as type 0. When the submucous myoma was sessile and the intramural part was less than 50%, the myoma was classified as type 1. With an intramural extension of 50% or more, the myoma was classified as type 2. The follow-up period was 12 months. Outcome measures adopted were symptom control, number of complete resections, and number of recurrences. Results: Based on the above classification, 15 patients had type 0, 13 had type 1, and 10 had type 2. No major complications were observed during or after operations. Complete resection was achieved in all patients with type 0. However, in three patients with type 1 and four patients with type 2, the resection was incomplete. Symptomatic improvement was obtained postoperatively in all patients except in one with type 2. One patient with type 1 had a recurrence. Conclusion. TCR appears to be a useful operation for the treatment of submucous myomas. However, with increased intramural involvement, the possibility of achieving complete resection decreased.

227. Dedicated Skilled EndoscopicTeams~Responsible for a Rise in the Rate of Laparoscopic Management of Ectopic Pregnancy: An Experience from Two Inner London District Hospitals S Noor. Whippscross University Hospital, London, Stratford, United Kingdom. Study Objective. To demonstrate the rise in the rate of laparoscopic management of ectopic pregnancy after the appointment of a dedicated consultant trained in minimal access surgery, setting up appropriate laparoscopic equipment and training theatre staff. Design. A prospective audit of the surgical management of ectopic pregnancy was conducted at Newham General

Hospital, UK from April 2001 through March 2002 and Whippscross University Hospital, UK from January 2003 through April 2004. Setting. Women were admitted through the accident and emergency department or the early pregnancy assessment unit. Patients. A total of 149 patients were diagnosed with ectopic pregnancy during this period. All of them were treated surgically. Interventions. Operative laparoscopy and laparotomy. Measurements and Main Results. Audits previously conducted at both hospitals showed that the laparoscopic management of ectopic pregnancy was 20% in Newham General Hospital and 30% in Whippscross University Hospital, a year before the prospective audit was conducted. Audit performed after setting up skilled endoscopic teams, total of 149 patients were treated. Overall, 131 (87.9%) patients had laparoscopic management, and 18 (20.6%) patients had laparotomies. The laparoscopic ectopic pregnancy rate was 88.7% at Newham General Hospital and 87.3% at Whippscross Hospital. There was no increase in the complication rate. Conclusion. Operative laparoscopy is considered the gold standard for the surgical management of ectopic pregnancy. To offer laparoscopy to all women with ectopic pregnancy, we need to develop skilled endoscopic teams to take on the responsibility of the management of these patients.

228. The Efficacy of Hysteroscopy-Guided Endometrial Ablation for Abnormal Uterine Bleeding in Patients with Renal AIIograft 1KHM Park, 1JH Park, 1BS Lee, 2KA Jeong. 1yonsei Medical Center, Seoul, Korea; 2Ewha Women's University Hospital, Seoul, Korea. Study Objective. To evaluate the effectiveness and safety of hysteroscopy-guided endometrial ablation as the surgical management of abnormal uterine bleeding developed in patients with renal allograft. Design. Retrospective analysis. Setting. Yonsei University Medical College, Severance Hospital. Patients. Sixty-seven women with abnormal uterine bleeding who had previously undergone renal allograft. Intervention. Hysteroscopy-guided endometrial ablation. Measurements and Main Results. The mean duration of follow-up was 18 months. Of 67 patients, 58 (87.0%) who underwent hysteroscopy-guided endometrial ablation experienced a decrease in bleeding: amenorrhea in 26 (44.8 %), vaginal spotting in 20 (34.5%), and eumenorrhea in 12 (20.1%). None of the patients experienced any complications related to the procedure. A levonorgestrel-releasing intrauterine device (LNG-IUD) was inserted into nine patients who experienced continuous bleeding, six of whom showed symptomatic improvement--vaginal spotting in four (6%) and eumenorrhea in two (3 %). Three patients who experienced recurrent vaginal bleeding after LNG-IUD insertion underwent hysterectomy, the pathologic findings of which were adenomyosis in two patients and simple endometrial hyperplasia without atypia in one patient. $83