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Feasibility and safety of TLH using bipolar coagulation and scissors
Poster Presentations
Group database regarding intraoperative and postoperative complications in 33,088 women. Bowel perforation, bladder and ureteral injuries, and pelvic vessel lesions were considered major operative complications. Perforation of the uterine cavity occurred in 378 patients (1.14%). Of these, major complications occurred in 6.6% (25): 10 bowel perforations, 6 bladder injuries, 6 ureteral injuries, 5 pelvic vessel lesions. Overall, PID occurred in eight women (0.024%). The proportion of patients with PID was significantly higher among women in whom the uterine cavity was perforated than those with an uncomplicated procedure (0.53% vs 0.01%, OR 29.0, 95% CI 5.8;144.2, p <0.001). The proportion of patients with a blood loss greater than 1000 ml was higher when uterine perforation occurred than when it did not (1.1% vs 0.1%, OR 9.7, 95% CI 3.4;27.4, p <0.001). Conclusion. The overall frequency of uterine perforation and major complications related to diagnostic hysteroscopy is low. Uterine cavity perforation should be viewed with caution since the risk of major complications is not negligible.
diagnosis of deep endometriosis. It allows complete preoperative work-up and improves surgical approach.
244. Feasibility and Safety of TLH Using Bipolar Coagulation and Scissors R Seracchioli, M Cantarelli, F Govoni, B Gualerzi, S Missiroli, F Vianello, S Venturoli. Center of Reconstructive Pelvic Endosurgery, Reproductive Medicine Unit, University of Bologna, Bologna, Italy.
Objective. To evaluate retrospectively whether TLH is feasible and safe using scissors and bipolar coagulation for uterine and infundibulopelvic vessels. Measurements and Main Results. Subjects were 140 women undergoing TLH. Uterine weight and volume, mean operating time, blood loss, intraoperative and postoperative complications, and hospital stay were recorded. All surgical procedures were performed by the same surgeon (RS) and the same technique, using scissors and bipolar coagulation for uterine and infundibulopelvic vessels. All instruments were reusable. Round ligaments, fallopian tubes, and utero-ovariaxl ligaments (or infundibulopelvic ligaments if the ovaties were not to be preserved) were sectioned after bipolar coagulation. The uterine vessels were well delineated and divided with scissors after bipolar coagulation. Four cases were converted to laparotomy because of large uterus (2), difficult hemostasis (1), and large abdominal swelling (1). No patients required blood transfusion. One cystotomy was immediately repaired. One ureteral injury occurred during bipolar coagulation. No anesthesiologic or other complications occurred. Conclusion. TLH performed with scissors and bipolar coagulation of uterine and infundibulopelvic vessels is safe, feasible, and inexpensive.
243. The Echo-Logic for Deep Pelvic Endometriosis 1PAG Ribeiro, 2RAAhneida-Prado, 2T Aoki, 2N Donadio, 2TAFerreira, 3AMM Gagliardi, 31PA Kehdi, 2L Rossini. 1Santa Casa Medical School and Skopia Unidade; 2Santa Casa Medical School; 3Skopia Unidade de Endoscopia Ginecologica, S~o Paulo, Brazil.
Objective. To describe and evaluate the effectiveness of an endoscopic and echographic logic classification (echo-logic) for deep pelvic endometriosis. Measurements and Main Results. Twenty women with infertility and or CPP with deep pelvic endometriosis underwent pelvic tra_nsvaginal ultrasound, endoscopic ultrasound, and MRI, followed by laparoscopic and histologic confirmation of endometriosis. Patients were analyzed for the presence of endoscopic and ecographic signs suggestive of endometriosis according to two parameters: depth of infiltration (T; extraintestinal 1, serosal 2, muscularis 3, submucosal 4, mucosa 5), and localization (L; precervical 1, paracervical 2, retrocervical 3, rectovaginal pouch 4, rectovaginal septum 5). Conclusion. The echo-logic is an easy classification system that has high sensibility and specificity in the
245. Laparoscopic Tubal Partial Resection and End-to-End Anastomosis for Tubal Ectopic Pregnancy H Shimizu. Chiba Tokusyukai Hospital, Sakura, Chiba, Japan.
Objective. To describe our successful experience of laparoscopic tubal partial resection and end-to-end anastomosis for tubal ectopic pregnancy. Measurements and Main Results. We routinely performed this simple method using 5-ram instruments and 3-0 polyglactinwithout microsurgery. The tubes
$74
Group database regarding intraoperative and postoperative complications in 33,088 women. Bowel perforation, bladder and ureteral injuries, and pelvic vessel lesions were considered major operative complications. Perforation of the uterine cavity occurred in 378 patients (1.14%). Of these, major complications occurred in 6.6% (25): 10 bowel perforations, 6 bladder injuries, 6 ureteral injuries, 5 pelvic vessel lesions. Overall, PID occurred in eight women (0.024%). The proportion of patients with PID was significantly higher among women in whom the uterine cavity was perforated than those with an uncomplicated procedure (0.53% vs 0.01%, OR 29.0, 95% CI 5.8;144.2, p <0.001). The proportion of patients with a blood loss greater than 1000 ml was higher when uterine perforation occurred than when it did not (1.1% vs 0.1%, OR 9.7, 95% CI 3.4;27.4, p <0.001). Conclusion. The overall frequency of uterine perforation and major complications related to diagnostic hysteroscopy is low. Uterine cavity perforation should be viewed with caution since the risk of major complications is not negligible.
diagnosis of deep endometriosis. It allows complete preoperative work-up and improves surgical approach.
244. Feasibility and Safety of TLH Using Bipolar Coagulation and Scissors R Seracchioli, M Cantarelli, F Govoni, B Gualerzi, S Missiroli, F Vianello, S Venturoli. Center of Reconstructive Pelvic Endosurgery, Reproductive Medicine Unit, University of Bologna, Bologna, Italy.
Objective. To evaluate retrospectively whether TLH is feasible and safe using scissors and bipolar coagulation for uterine and infundibulopelvic vessels. Measurements and Main Results. Subjects were 140 women undergoing TLH. Uterine weight and volume, mean operating time, blood loss, intraoperative and postoperative complications, and hospital stay were recorded. All surgical procedures were performed by the same surgeon (RS) and the same technique, using scissors and bipolar coagulation for uterine and infundibulopelvic vessels. All instruments were reusable. Round ligaments, fallopian tubes, and utero-ovariaxl ligaments (or infundibulopelvic ligaments if the ovaties were not to be preserved) were sectioned after bipolar coagulation. The uterine vessels were well delineated and divided with scissors after bipolar coagulation. Four cases were converted to laparotomy because of large uterus (2), difficult hemostasis (1), and large abdominal swelling (1). No patients required blood transfusion. One cystotomy was immediately repaired. One ureteral injury occurred during bipolar coagulation. No anesthesiologic or other complications occurred. Conclusion. TLH performed with scissors and bipolar coagulation of uterine and infundibulopelvic vessels is safe, feasible, and inexpensive.
243. The Echo-Logic for Deep Pelvic Endometriosis 1PAG Ribeiro, 2RAAhneida-Prado, 2T Aoki, 2N Donadio, 2TAFerreira, 3AMM Gagliardi, 31PA Kehdi, 2L Rossini. 1Santa Casa Medical School and Skopia Unidade; 2Santa Casa Medical School; 3Skopia Unidade de Endoscopia Ginecologica, S~o Paulo, Brazil.
Objective. To describe and evaluate the effectiveness of an endoscopic and echographic logic classification (echo-logic) for deep pelvic endometriosis. Measurements and Main Results. Twenty women with infertility and or CPP with deep pelvic endometriosis underwent pelvic tra_nsvaginal ultrasound, endoscopic ultrasound, and MRI, followed by laparoscopic and histologic confirmation of endometriosis. Patients were analyzed for the presence of endoscopic and ecographic signs suggestive of endometriosis according to two parameters: depth of infiltration (T; extraintestinal 1, serosal 2, muscularis 3, submucosal 4, mucosa 5), and localization (L; precervical 1, paracervical 2, retrocervical 3, rectovaginal pouch 4, rectovaginal septum 5). Conclusion. The echo-logic is an easy classification system that has high sensibility and specificity in the
245. Laparoscopic Tubal Partial Resection and End-to-End Anastomosis for Tubal Ectopic Pregnancy H Shimizu. Chiba Tokusyukai Hospital, Sakura, Chiba, Japan.
Objective. To describe our successful experience of laparoscopic tubal partial resection and end-to-end anastomosis for tubal ectopic pregnancy. Measurements and Main Results. We routinely performed this simple method using 5-ram instruments and 3-0 polyglactinwithout microsurgery. The tubes
$74