- Email: [email protected]
Endometrial ablation using a distensible multielectrode balloon
August 1995, Vol. 2, No. 4. Supplement The Journal of the American Association of Gynecologic Laparoscopists
were related to the clamp. With the instrument oophorectomy is possible at vaginal hysterectomy, and thus vaginal hysterectomy becomes less invasive. Hysterosonography as an Alternative to Office Hysteroscopy JM Shwayder. Eastern Virginia Medical School, Norfolk, VA. Hysteroscopy is established as the standard for evaluating women with abnormal bleeding. When performed in the office, it offers convenience to the patient. Unfortunately, the cost of equipment, particularly in light of decreasing reimbursement, has dampened the enthusiasm of many physicians for performing office hysteroscopy. Hysterosonography, the technique of enhancing routine transvaginal sonography by instilling fluid into the uterine cavity, was investigated as an alternative to office hysteroscopy in 50 women with abnormal bleeding (see table). Hysterosonography had an overall sensitivity of 96% and specificity of 96%. The procedure cost approximately $10 for disposable materials and required 10 minutes to perform. Thus, it is a cost-effective and timely alternative to office hysteroscopy.
Polyps, submucous fibroids Hyperplasia Intramural fibroids Normal Retained products of conception Totals
Hysterosonography
Operative Findings
21 4 8 16
22 3 8 16
1 50
1 50
Visual Preperitoneal Access to the Space of Retzius for Laparoscopic Burch Procedure ML Smith Jr, C Perry. Good Samaritan Medical Center, Phoenix, AZ. The space of Retzius was accessed through the peritoneal cavity for the first laparoscopic urethrocolpopexy. This entailed dissection over the bladder and a more delayed entry into the space. Various laparoscopic techniques have been described in an attempt to enter this space more readily and by a preperitoneal route. Cannulas were recently developed for entering the abdominal cavity under visualization, and it was thought that they also be excellent for entering the space
$77
of Retzius without entering the peritoneal cavity. This technique was developed in an animal model and then performed in 12 patients undergoing laparoscopic urethrocolpopexy. Four of the women had had previous lower abdominal surgeries, and one had had four transverse incisions. The space of Retzius was easily attained in all patients, and the procedure was completed without incident. The women were discharged from the hospital within 24 hours without complications. This operation appears to be quicker, easier, and less costly than the balloon and other types of dissections of the space. It immediately became my procedure of choice despite over 90 earlier laparoscopic Burch procedures using other techniques to enter the space of Retzius. Endometrial Ablation Using a Distensible Multielectrode Balloon 1RM Soderstrom, 2PG Brooks, 3SL Corson, 4JG Garza-Leal, 4jL Iglesias-Benavides, sPD Indman, 6j Liu, rTG Vancaillie. ~University of Washington, Seattle, WA; 2LosAngeles, CA; 3Philadelphia, PA; 4Monterrey, Mexico; 5Los Gatos, CA; 6Cincinnati, OH; ZSanAntonio, TX. Endometrial ablation is a minimally invasive alternative to hysterectomy that is typically performed in the operating room. An important advance that will enable gynecologists to perform the procedure in the office is under development. The objective is to have an outpatient procedure that effectively destroys the endometrium and produces tissue necrosis of adequate depth, without significant risk. The VestaBlate system consists of a distensible balloon containing a surface array of electrodes, each with a temperature sensor. A computerized controller connects to an electrosurgical generator. The electrode balloon is inserted through the dilated cervix and inflated. Using 40 to 45 W, the electrodes maintain surface temperatures of 70 to 75~ for 4 minutes. Prehysterectomy studies were conducted in 30 patients. Uterine specimens were examined using hematoxylin and eosin and nitroblue tetrazolium (NBT) stains. Histology revealed no viable endometrium except for a few small areas in distorted cavities where balloon contact was less than complete. The NBT stain showed necrosis into the myometrium from 2 to 4 mm (range 1-6 mm). No significant serosal temperature increases were detected. Promising early clinical results indicate that office-based endometrial ablation can be performed safely and effectively.
were related to the clamp. With the instrument oophorectomy is possible at vaginal hysterectomy, and thus vaginal hysterectomy becomes less invasive. Hysterosonography as an Alternative to Office Hysteroscopy JM Shwayder. Eastern Virginia Medical School, Norfolk, VA. Hysteroscopy is established as the standard for evaluating women with abnormal bleeding. When performed in the office, it offers convenience to the patient. Unfortunately, the cost of equipment, particularly in light of decreasing reimbursement, has dampened the enthusiasm of many physicians for performing office hysteroscopy. Hysterosonography, the technique of enhancing routine transvaginal sonography by instilling fluid into the uterine cavity, was investigated as an alternative to office hysteroscopy in 50 women with abnormal bleeding (see table). Hysterosonography had an overall sensitivity of 96% and specificity of 96%. The procedure cost approximately $10 for disposable materials and required 10 minutes to perform. Thus, it is a cost-effective and timely alternative to office hysteroscopy.
Polyps, submucous fibroids Hyperplasia Intramural fibroids Normal Retained products of conception Totals
Hysterosonography
Operative Findings
21 4 8 16
22 3 8 16
1 50
1 50
Visual Preperitoneal Access to the Space of Retzius for Laparoscopic Burch Procedure ML Smith Jr, C Perry. Good Samaritan Medical Center, Phoenix, AZ. The space of Retzius was accessed through the peritoneal cavity for the first laparoscopic urethrocolpopexy. This entailed dissection over the bladder and a more delayed entry into the space. Various laparoscopic techniques have been described in an attempt to enter this space more readily and by a preperitoneal route. Cannulas were recently developed for entering the abdominal cavity under visualization, and it was thought that they also be excellent for entering the space
$77
of Retzius without entering the peritoneal cavity. This technique was developed in an animal model and then performed in 12 patients undergoing laparoscopic urethrocolpopexy. Four of the women had had previous lower abdominal surgeries, and one had had four transverse incisions. The space of Retzius was easily attained in all patients, and the procedure was completed without incident. The women were discharged from the hospital within 24 hours without complications. This operation appears to be quicker, easier, and less costly than the balloon and other types of dissections of the space. It immediately became my procedure of choice despite over 90 earlier laparoscopic Burch procedures using other techniques to enter the space of Retzius. Endometrial Ablation Using a Distensible Multielectrode Balloon 1RM Soderstrom, 2PG Brooks, 3SL Corson, 4JG Garza-Leal, 4jL Iglesias-Benavides, sPD Indman, 6j Liu, rTG Vancaillie. ~University of Washington, Seattle, WA; 2LosAngeles, CA; 3Philadelphia, PA; 4Monterrey, Mexico; 5Los Gatos, CA; 6Cincinnati, OH; ZSanAntonio, TX. Endometrial ablation is a minimally invasive alternative to hysterectomy that is typically performed in the operating room. An important advance that will enable gynecologists to perform the procedure in the office is under development. The objective is to have an outpatient procedure that effectively destroys the endometrium and produces tissue necrosis of adequate depth, without significant risk. The VestaBlate system consists of a distensible balloon containing a surface array of electrodes, each with a temperature sensor. A computerized controller connects to an electrosurgical generator. The electrode balloon is inserted through the dilated cervix and inflated. Using 40 to 45 W, the electrodes maintain surface temperatures of 70 to 75~ for 4 minutes. Prehysterectomy studies were conducted in 30 patients. Uterine specimens were examined using hematoxylin and eosin and nitroblue tetrazolium (NBT) stains. Histology revealed no viable endometrium except for a few small areas in distorted cavities where balloon contact was less than complete. The NBT stain showed necrosis into the myometrium from 2 to 4 mm (range 1-6 mm). No significant serosal temperature increases were detected. Promising early clinical results indicate that office-based endometrial ablation can be performed safely and effectively.