- Email: [email protected]
Essure® Tubal Sterilization Combined with Subsequent NovaSure® Endometrial Ablation: A Retrospective Analysis
S62
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S52eS102
from the outpatient group described no discomfort compared with only 17 (56.7%) women from the inpatient group. After 6 months of follow-up no recurrence/persistence of the pathologies occurred. Conclusion: The combination of a new generation small-diameter hysteroscope and a new bipolar electrosurgical system allow the hysteroscopist to perform successfully and safely endometrial polypectomy in the office-based setting, without any analgesia or anaesthesia, with minimal discomfort for the patient. Furthermore, there is suggestion that outpatient hysteroscopic procedures offer significant cost advantages and are preferred by women when compared with the inpatient approach. 212
Open Communications 12dHysteroscopy (3:03 PM d 3:08 PM)
Prognostic Factors of Submucous Myoma Hysteroscopic Resection and New Pre-Operative Classification Assessment Perricard B. Obstetric and Gynecology, University Hospital, Strasbourg, France Study Objective: To study prognostic factors of submucous myomas hysteroscopic resection and to assess a new pre-operative classification (STEP-W classification) in comparison with the ESGE reference one. Design: Retrospective analysis of 481 hysteroscopic resections of symptomatic submucous myomas. Setting: Two north east french university obstetric and gynecology hospital departments. Patients: Four hundred thirty women who suffer from uterine bleeding or infertility. Intervention: Submucous myomas hysteroscopic resection. Measurements and Main Results: Two groups were separated: group A (n 5 332) when the procedure went in one step and group B (n 5 28) in several steps. The main assessment was a complete resection or not. For each classification, the resection level (complete or not), the fluid balance and the rate of complication were compared by means of predictive positive values (PPV). In univarious analysis, age and menopaused women’s rate are significatively higher in group A. Infertile women and myomectomy in past history are more frequent in group B. In group A, the mean size of fibroids is smaller and the intracavity proportion is higher. In group B, type 2 myomas (ESGE) are more numerous and their extension in myometrial thickness are higher. In multivarious analysis, only three characteristics remain: age (p 5 0.023), size of myoma (p 5 0.019) and myometrial extension (p 5 0.005). Twenty one complications were occured (4.4%). Three were consideres like major: 2 mechanical perforations, one bronchospam’s one. When the myoma is risk-classificated (type 2 ESGE or stage III STEP-W), PPV seem to be better if STEP-W classification is used: incomplete resection (57% vs 33%), Conclusion: Young people, size of myoma and the myometrial extension represent significant values for a hysteroscopic resection in several steps. STEP-W classification seems to be superior than ESGE classification to predict an incomplete resection, an unbalanced fluid or complication occurrences.
213
Open Communications 12dHysteroscopy (3:09 PM d 3:14 PM)
EssureÒ Tubal Sterilization Combined with Subsequent NovaSureÒ Endometrial Ablation: A Retrospective Analysis Basinski CM,1 Price P.2 1Basinski LLC, Newburgh, IN; 2Conceptus, Inc., Mountainview, CA Study Objective: To evaluate the safety and outcome of combining the EssureÒ tubal sterilization system followed by NovaSureÒ Endometrial Ablation prior to the 3-month Essure Confirmation Test(CoT) . Design: Retrospective cohort study of women who underwent Essure hysteroscopic sterilization followed by NovaSure EA between July 1, 2008 and April 15, 2009. All participants had menorrhagia and desired permanent sterilization. Demographic information, anesthesia type, bilateral placement rate, ablation treatment time, intra-operative and postprocedure complications, Essure confirmation results, and follow-up data were collected and reviewed.
Setting: Private gynecologic practice in Indiana. Patients: 59 patients (ages 25-50) were identified who underwent Essure hysteroscopic sterilization followed by NovaSure EA in two in-office sessions separated by an average of 25 days. Intervention: All patients underwent Essure micro-insert placement followed by Novasure EA and had/are scheduled to have a(CoT). Measurements and Main Results: 25/59 patients completed the 3-month CoT. 24/25 patients underwent successful 3-month CoTs. At the 3-month CoT, 22 patients were noted to have bilateral occlusion, 2 patients had unilateral occlusion, and one patient could not tolerate the test. 34 patients are still in the 3-month waiting period prior to CoT. No adverse events have been reported in this cohort. Patients will be followed for the next 12 months for contraceptive and EA effectiveness. Conclusion: To date, in this retrospective medical chart review, Essure hysteroscopic sterilization followed by NovaSure EA, in women who desire permanent birth control and reduction of menorrhagia, appears to be safe and effective. In addition, the present data supports that a majority of 3-month CoTs can be obtained and evaluated post-NovaSure EA.
214
Video Session 7dUrogynecology (2:15 PM d 2:23 PM)
Laparoscopic Supracervical Hysterectomy with Sacrocervicopexy with Transcervical Trocar Access Rosenblatt PL, DiSciullo T, Hanaway K. Division of Urogynecology, Mount Auburn Hospital, Cambridge, MA Study Objective: This video demonstrates a novel approach to sacrocervicopexy for uterovaginal prolapse, in which only 5 mm laparoscopic trocars are used in the abdomen. A standard laparoscopic supracervical hysterectomy is performed using a bipolar cutting instrument to obtain vascular control, and a bipolar spatula is used to amputate the fundus. Next, a 15 mm CISH instrument is used to core out the cervix from a vaginal approach. Once the core is removed, the morcellator is placed transcervically and morcellation of the fundus is performed. Once complete, the transcervical trocar is used as an access port to deliver mesh and introduce and remove suture needles. A Y-shaped polypropylene mesh is then secured to the anterior and posterior endopelvic fascia and then to the sacrum. Finally, reperitonealization is performed over the mesh. We have performed this procedure on 12 women with excellent results.
215
Video Session 7dUrogynecology (2:24 PM d 2:32 PM)
da Vinci Sacrocolpopexy with Retroperitoneal Tunneling Levine DJ. Gyn, St Lukes Hospital, Chesterfield, MO Study Objective: This video demonstrates the retroperitoneal tunneling technique utilized for attachment of the mesh from the vaginal apex to the sacrral promintory.The advantage of the tunnel rather than opening the entire retroperitonael space allows for placement of the mesh along the lateral pelvic side wall. This appears to promote a more natural curvature for the placement of the mesh and may allow for less tension.
216
Video Session 7dUrogynecology (2:33 PM d 2:41 PM)
Laparoscopic Sacrocolpoperineopexy for the Treatment of Vaginal Vault Prolapse and Perineal Descent Rosenblatt PL, Dramitinos P. Division of Urogynecology, Mount Auburn Hospital, Cambridge, MA Study Objective: This video demonstrates the approach to a patient with vaginal vault prolapse along with severe perineal descent. The patient presented with vaginal bulging, pelvic pressure and defecatory dysfunction. The goal of the procedure is to not only support the anterior and posterior endopelvic fascia to the sacral promontory, but to attach the mesh posteriorly in the rectovaginal space to the perineal body. This
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S52eS102
from the outpatient group described no discomfort compared with only 17 (56.7%) women from the inpatient group. After 6 months of follow-up no recurrence/persistence of the pathologies occurred. Conclusion: The combination of a new generation small-diameter hysteroscope and a new bipolar electrosurgical system allow the hysteroscopist to perform successfully and safely endometrial polypectomy in the office-based setting, without any analgesia or anaesthesia, with minimal discomfort for the patient. Furthermore, there is suggestion that outpatient hysteroscopic procedures offer significant cost advantages and are preferred by women when compared with the inpatient approach. 212
Open Communications 12dHysteroscopy (3:03 PM d 3:08 PM)
Prognostic Factors of Submucous Myoma Hysteroscopic Resection and New Pre-Operative Classification Assessment Perricard B. Obstetric and Gynecology, University Hospital, Strasbourg, France Study Objective: To study prognostic factors of submucous myomas hysteroscopic resection and to assess a new pre-operative classification (STEP-W classification) in comparison with the ESGE reference one. Design: Retrospective analysis of 481 hysteroscopic resections of symptomatic submucous myomas. Setting: Two north east french university obstetric and gynecology hospital departments. Patients: Four hundred thirty women who suffer from uterine bleeding or infertility. Intervention: Submucous myomas hysteroscopic resection. Measurements and Main Results: Two groups were separated: group A (n 5 332) when the procedure went in one step and group B (n 5 28) in several steps. The main assessment was a complete resection or not. For each classification, the resection level (complete or not), the fluid balance and the rate of complication were compared by means of predictive positive values (PPV). In univarious analysis, age and menopaused women’s rate are significatively higher in group A. Infertile women and myomectomy in past history are more frequent in group B. In group A, the mean size of fibroids is smaller and the intracavity proportion is higher. In group B, type 2 myomas (ESGE) are more numerous and their extension in myometrial thickness are higher. In multivarious analysis, only three characteristics remain: age (p 5 0.023), size of myoma (p 5 0.019) and myometrial extension (p 5 0.005). Twenty one complications were occured (4.4%). Three were consideres like major: 2 mechanical perforations, one bronchospam’s one. When the myoma is risk-classificated (type 2 ESGE or stage III STEP-W), PPV seem to be better if STEP-W classification is used: incomplete resection (57% vs 33%), Conclusion: Young people, size of myoma and the myometrial extension represent significant values for a hysteroscopic resection in several steps. STEP-W classification seems to be superior than ESGE classification to predict an incomplete resection, an unbalanced fluid or complication occurrences.
213
Open Communications 12dHysteroscopy (3:09 PM d 3:14 PM)
EssureÒ Tubal Sterilization Combined with Subsequent NovaSureÒ Endometrial Ablation: A Retrospective Analysis Basinski CM,1 Price P.2 1Basinski LLC, Newburgh, IN; 2Conceptus, Inc., Mountainview, CA Study Objective: To evaluate the safety and outcome of combining the EssureÒ tubal sterilization system followed by NovaSureÒ Endometrial Ablation prior to the 3-month Essure Confirmation Test(CoT) . Design: Retrospective cohort study of women who underwent Essure hysteroscopic sterilization followed by NovaSure EA between July 1, 2008 and April 15, 2009. All participants had menorrhagia and desired permanent sterilization. Demographic information, anesthesia type, bilateral placement rate, ablation treatment time, intra-operative and postprocedure complications, Essure confirmation results, and follow-up data were collected and reviewed.
Setting: Private gynecologic practice in Indiana. Patients: 59 patients (ages 25-50) were identified who underwent Essure hysteroscopic sterilization followed by NovaSure EA in two in-office sessions separated by an average of 25 days. Intervention: All patients underwent Essure micro-insert placement followed by Novasure EA and had/are scheduled to have a(CoT). Measurements and Main Results: 25/59 patients completed the 3-month CoT. 24/25 patients underwent successful 3-month CoTs. At the 3-month CoT, 22 patients were noted to have bilateral occlusion, 2 patients had unilateral occlusion, and one patient could not tolerate the test. 34 patients are still in the 3-month waiting period prior to CoT. No adverse events have been reported in this cohort. Patients will be followed for the next 12 months for contraceptive and EA effectiveness. Conclusion: To date, in this retrospective medical chart review, Essure hysteroscopic sterilization followed by NovaSure EA, in women who desire permanent birth control and reduction of menorrhagia, appears to be safe and effective. In addition, the present data supports that a majority of 3-month CoTs can be obtained and evaluated post-NovaSure EA.
214
Video Session 7dUrogynecology (2:15 PM d 2:23 PM)
Laparoscopic Supracervical Hysterectomy with Sacrocervicopexy with Transcervical Trocar Access Rosenblatt PL, DiSciullo T, Hanaway K. Division of Urogynecology, Mount Auburn Hospital, Cambridge, MA Study Objective: This video demonstrates a novel approach to sacrocervicopexy for uterovaginal prolapse, in which only 5 mm laparoscopic trocars are used in the abdomen. A standard laparoscopic supracervical hysterectomy is performed using a bipolar cutting instrument to obtain vascular control, and a bipolar spatula is used to amputate the fundus. Next, a 15 mm CISH instrument is used to core out the cervix from a vaginal approach. Once the core is removed, the morcellator is placed transcervically and morcellation of the fundus is performed. Once complete, the transcervical trocar is used as an access port to deliver mesh and introduce and remove suture needles. A Y-shaped polypropylene mesh is then secured to the anterior and posterior endopelvic fascia and then to the sacrum. Finally, reperitonealization is performed over the mesh. We have performed this procedure on 12 women with excellent results.
215
Video Session 7dUrogynecology (2:24 PM d 2:32 PM)
da Vinci Sacrocolpopexy with Retroperitoneal Tunneling Levine DJ. Gyn, St Lukes Hospital, Chesterfield, MO Study Objective: This video demonstrates the retroperitoneal tunneling technique utilized for attachment of the mesh from the vaginal apex to the sacrral promintory.The advantage of the tunnel rather than opening the entire retroperitonael space allows for placement of the mesh along the lateral pelvic side wall. This appears to promote a more natural curvature for the placement of the mesh and may allow for less tension.
216
Video Session 7dUrogynecology (2:33 PM d 2:41 PM)
Laparoscopic Sacrocolpoperineopexy for the Treatment of Vaginal Vault Prolapse and Perineal Descent Rosenblatt PL, Dramitinos P. Division of Urogynecology, Mount Auburn Hospital, Cambridge, MA Study Objective: This video demonstrates the approach to a patient with vaginal vault prolapse along with severe perineal descent. The patient presented with vaginal bulging, pelvic pressure and defecatory dysfunction. The goal of the procedure is to not only support the anterior and posterior endopelvic fascia to the sacral promontory, but to attach the mesh posteriorly in the rectovaginal space to the perineal body. This