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Endometrial ablation with a distensible multielectrode balloon
Abstracts
Conclusion. Retziusscopy is an alternative to other techniques.
pathology. Transcervical falloposcopy was performed with a linear everting catheter and 0.5-mm fiberoptic falloposcope. Intramural, isthmic, ampullary, and timbrial segments were separately scored, captured, digitized, and measured. Chlamydial serology was obtained in all subjects. Women with surgery or pelvic infections since their last childbirth had highest abnormal scores. Falloposcopy was more predictive of fertility than serology. Normal anatomic measurements of tubal diameters were established. Conclusion. The value of falloposcopy for assessing tubal anatomy was validated. Chlamydial serology is of less value than falloposcopy.
13. The Role of Leiomyomas in Infertility C Bulletti, V Polli, A Cavallo, L Diotallevi, L Fabro, C Flamigni. Rimini's Hospital and University of Bologna, Bologna, Italy.
Objective. To assess the role of leiomyomas and their surgical removal on human infertility (prospective, randomized, case control study). Measurements and Main Results. Two hundred twelve infertile women (age range 26-37 yrs) underwent laparoscopic removal of leiomyomas; 162 patients had three or more myomas (at least one >6 cm) and 50 had one or more myomas (none >6 cm). In all, 128 (60%) women conceived within the first 6 months of followup and delivered viable infants. Those who underwent surgery had higher delivery rates (29%) than those who did not (16%, p <0.001); 15% miscarried (3% and 12%, respectively). Conclusion. Leiomyomas may cause spontaneous abortion, and their surgical removal improves pregnancy rates.
11. Endometrial Ablation with a Distensible Multielectrode Balloon J Bouquet de Joliniere, D Silbon, M Levardon. Hopital Beaujon, Clichy, France.
Objective. To evaluate the Vestablate system for endometriat ablation and to avoid hysteroscopic endometrectomy or hysterectomy in women with menorrhagia. Measurements and Main Results. 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. We used 45 W of pure cutting power with surface temperatures (75 ~ C) during 4 minutes. Satisfaction in 25 patients with 6-month follow-up was over 95%. Conclusion. The Vestablate is an effective instrument for endometrial ablation.
14. Tumor Growth and Dissemination after
Laparotomy and CO2 Pneumoperitoneum in a Rat Ovarian Cancer Model M Canis, R Botchorishvili, A Wattiez, G Mage, JL Pouly, MA Bruhat. Polyclinique de L'HoteI-Dieu, CHRU Clermont-Ferrand, France.
Objective. To compare tumor growth, intraperitoneal implantation, and abdominal wall metastasis after laparotomy and CO2 pneumoperitoneum in a rat ovarian cancer model. Measurements and Main Results. To mimic intraoperative rupture of an ovarian tumor in a syngenic rat ovarian carcinoma model, 105 malignant cells were injected intraperitoneally after a 5-cm vertical midline laparotomy, or after insuffiation of CO2 pneumoperitoneum with 4 or 10 mm Hg intraabdominal pressure. Two weeks later, intraperitoneal tumor growth and dissemination were evaluated semiquantitatively with a scoring system. Scores attributed to each organ were added to calculate a dissemination score for each animal. Animal dissemination scores were 83.4 + 12 in the laparotomy group and 67.3 + 16 and 71.9 + 17 in the 4 and 10 mm Hg CO2 pneumoperitoneum groups (p <0.01). Scores for peritoneum were 21.8 + 3.8 in
12. Minimally Invasive Burch Procedure by Microincision Assisted by Retziusscopy J Bouquet de Joliniere, D Silbon, N Aflak, N Levardon. Hopital Beaujon, Clichy, France.
Objective. To assess the efficacy and safety of traditional Burch procedure for genuine urinary incontinence (isolated) through a suprapubic microincision (<5 cm), assisted by Retziusscopy. Measurements and Main Results. Ninety patients were included. Mean operating time was 20 minutes (range 15-20 min). All women were discharged 1 day after surgery. One complication occurred. During 8 years since our first procedure, follow-up showed good functional results.
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Conclusion. Retziusscopy is an alternative to other techniques.
pathology. Transcervical falloposcopy was performed with a linear everting catheter and 0.5-mm fiberoptic falloposcope. Intramural, isthmic, ampullary, and timbrial segments were separately scored, captured, digitized, and measured. Chlamydial serology was obtained in all subjects. Women with surgery or pelvic infections since their last childbirth had highest abnormal scores. Falloposcopy was more predictive of fertility than serology. Normal anatomic measurements of tubal diameters were established. Conclusion. The value of falloposcopy for assessing tubal anatomy was validated. Chlamydial serology is of less value than falloposcopy.
13. The Role of Leiomyomas in Infertility C Bulletti, V Polli, A Cavallo, L Diotallevi, L Fabro, C Flamigni. Rimini's Hospital and University of Bologna, Bologna, Italy.
Objective. To assess the role of leiomyomas and their surgical removal on human infertility (prospective, randomized, case control study). Measurements and Main Results. Two hundred twelve infertile women (age range 26-37 yrs) underwent laparoscopic removal of leiomyomas; 162 patients had three or more myomas (at least one >6 cm) and 50 had one or more myomas (none >6 cm). In all, 128 (60%) women conceived within the first 6 months of followup and delivered viable infants. Those who underwent surgery had higher delivery rates (29%) than those who did not (16%, p <0.001); 15% miscarried (3% and 12%, respectively). Conclusion. Leiomyomas may cause spontaneous abortion, and their surgical removal improves pregnancy rates.
11. Endometrial Ablation with a Distensible Multielectrode Balloon J Bouquet de Joliniere, D Silbon, M Levardon. Hopital Beaujon, Clichy, France.
Objective. To evaluate the Vestablate system for endometriat ablation and to avoid hysteroscopic endometrectomy or hysterectomy in women with menorrhagia. Measurements and Main Results. 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. We used 45 W of pure cutting power with surface temperatures (75 ~ C) during 4 minutes. Satisfaction in 25 patients with 6-month follow-up was over 95%. Conclusion. The Vestablate is an effective instrument for endometrial ablation.
14. Tumor Growth and Dissemination after
Laparotomy and CO2 Pneumoperitoneum in a Rat Ovarian Cancer Model M Canis, R Botchorishvili, A Wattiez, G Mage, JL Pouly, MA Bruhat. Polyclinique de L'HoteI-Dieu, CHRU Clermont-Ferrand, France.
Objective. To compare tumor growth, intraperitoneal implantation, and abdominal wall metastasis after laparotomy and CO2 pneumoperitoneum in a rat ovarian cancer model. Measurements and Main Results. To mimic intraoperative rupture of an ovarian tumor in a syngenic rat ovarian carcinoma model, 105 malignant cells were injected intraperitoneally after a 5-cm vertical midline laparotomy, or after insuffiation of CO2 pneumoperitoneum with 4 or 10 mm Hg intraabdominal pressure. Two weeks later, intraperitoneal tumor growth and dissemination were evaluated semiquantitatively with a scoring system. Scores attributed to each organ were added to calculate a dissemination score for each animal. Animal dissemination scores were 83.4 + 12 in the laparotomy group and 67.3 + 16 and 71.9 + 17 in the 4 and 10 mm Hg CO2 pneumoperitoneum groups (p <0.01). Scores for peritoneum were 21.8 + 3.8 in
12. Minimally Invasive Burch Procedure by Microincision Assisted by Retziusscopy J Bouquet de Joliniere, D Silbon, N Aflak, N Levardon. Hopital Beaujon, Clichy, France.
Objective. To assess the efficacy and safety of traditional Burch procedure for genuine urinary incontinence (isolated) through a suprapubic microincision (<5 cm), assisted by Retziusscopy. Measurements and Main Results. Ninety patients were included. Mean operating time was 20 minutes (range 15-20 min). All women were discharged 1 day after surgery. One complication occurred. During 8 years since our first procedure, follow-up showed good functional results.
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