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Gynelase system for laser endometrial ablation for treatment of menorrhagia
August 2001, Vol. 8, No. 3 Supplement
The Journal of the American Association of Gynecologic Laparoscopists
Measurements and Main Results. Sixty-five women (age range 37-61 yrs) were scheduled for hysterectomy for benign conditions due to relative contraindications to a vaginal approach. In the operating room they were randomized to either LAVH or minilaparotomy hysterectomy (MiniLAP). Mean operating time was 75 minutes (range 45-120 rain) for LAVH versus 64 minutes (range 45-90 rain) for MiniLAP (p <0.05). Intraoperative conversions to TAH were 3% and 12.5%, respectively (NS). Postoperative complications were 15% for LAVH (5 cases of postoperative fever) and 9% for MiniLAP (3 cases of postoperative fever in one patient with associated wound infection) (NS). Postoperative pain was significantly lower for LAVH on postoperative days 1 and 2. Resumption of bowel function and hospital stay, although shorter for LAVH, did not differ significantly between groups. Conclusion. MiniLAP hysterectomy is a safe and effective alternative to LAVH. If strict indications for AH are followed, approximately 12% of cases will be unsuitable for MiniLAP and will be converted to TAH.
histologic diagnosis showed diagnostic sensitivity of 96%, specificity of 92%, positive predictive value of 92%, and negative predictive value of 92%. Conclusion. Hysteroscopy is the most accurate procedure for diagnosing endometrial disease because it provides direct vision of the uterine cavity, reveals focal lesions, and allows eye-directed biopsies. It is an essential means to monitor postmenopausal women with breast cancer treated with tamoxifen.
170. Gynelase System for Laser Endometrial Ablation for Treatment of Menorrhagia M Pansky, I Frankel, O Neeman, R Langer, I Bukovsky, D Sherman. Assaf Harofe Medical Center, Zerifin, Israel.
Objective. To evaluate 1-year success rate of global diode laser ablation for menorrhagia. Measurements and Main Results. Twelve women with menorrhagia underwent laser endometrial ablation using the Gynelase system and were followed for 1 year. There were no complications. One patient developed PID, which cleared with antibiotic therapy. The 1-year amenorrhea rate was 50% and significant improvement rate was 75 %. Two women subsequently underwent hysterectomy for continuous menorrhagia. Conclusion. Global endometrial ablation with the diode laser system is safe, simple, and effective.
169. Comparison of Hysteroscopy and Hysterectomy in Detecting Endometrial Pathology in Tamoxifen-Treated Women V Pansini, MV Pansini, O Ceci, N Pansini, A Pellegrino, R di Venere, S Santamato, S Bettocchi. University of Bari, Bari, Italy.
171. Laparoscopic Bladder Neck Suspension with Bone Fixation and Use of a Free Mayo Needle
Objective. To evaluate the accuracy of office hysteroscopy with eye-directed biopsies in the diagnosis of endometrial abnormalities in postmenopausal women with breast cancer receiving tamoxifen. Measurements and Main Results. We evaluated 110 women (mean age 55.7 yrs, range 41-65 yrs) receiving tamoxifen 20 mg/day for breast cmacer (mean duration of therapy 30 mo, range 6-120 mo). Of these, 26 underwent hysterectomy (adenocarcinoma in 4, atypical hyperplasia in 1, fibroid uterus in 8, recurrent polyps in 11, uterine prolapse in 2). All patients underwent office hysteroscopy and, within 2 months, hysterectomy. Hysteroscopies with eye-directed biopsies were performed with a 5-mm operative continuousflow office hysteroscope in an ambulatory setting, without anesthesia or analgesia. Endometrial biopsies were performed by grasp technique, in which the amount of tissue obtained is always adequate for histologic diagnosis. Hysteroscopic results (panoramic examination and eye-directed biopsies) compared with
C Papasakelariou. Christus St. Joseph Hospital, Houston, Texas.
Objective. To describe a new technique for suture placement through Cooper's ligament and paravaginal tissue during laparoscopic bladder neck suspension. Measurements and Main Results. In six women undergoing laparoscopic bladder neck suspension, the straight-in bone-fixation system and a free Mayo needle were used to place sutures through Cooper's ligament and paravaginal tissue. Patients were assessed postoperatively by physical examination, questionnaire, and office stress test. There were no complications, and preliminary results show the women to be symptom free. Conclusion. This appears to be an efficient way of placing sutures during laparoscopic bladder neck suspension.
$51
The Journal of the American Association of Gynecologic Laparoscopists
Measurements and Main Results. Sixty-five women (age range 37-61 yrs) were scheduled for hysterectomy for benign conditions due to relative contraindications to a vaginal approach. In the operating room they were randomized to either LAVH or minilaparotomy hysterectomy (MiniLAP). Mean operating time was 75 minutes (range 45-120 rain) for LAVH versus 64 minutes (range 45-90 rain) for MiniLAP (p <0.05). Intraoperative conversions to TAH were 3% and 12.5%, respectively (NS). Postoperative complications were 15% for LAVH (5 cases of postoperative fever) and 9% for MiniLAP (3 cases of postoperative fever in one patient with associated wound infection) (NS). Postoperative pain was significantly lower for LAVH on postoperative days 1 and 2. Resumption of bowel function and hospital stay, although shorter for LAVH, did not differ significantly between groups. Conclusion. MiniLAP hysterectomy is a safe and effective alternative to LAVH. If strict indications for AH are followed, approximately 12% of cases will be unsuitable for MiniLAP and will be converted to TAH.
histologic diagnosis showed diagnostic sensitivity of 96%, specificity of 92%, positive predictive value of 92%, and negative predictive value of 92%. Conclusion. Hysteroscopy is the most accurate procedure for diagnosing endometrial disease because it provides direct vision of the uterine cavity, reveals focal lesions, and allows eye-directed biopsies. It is an essential means to monitor postmenopausal women with breast cancer treated with tamoxifen.
170. Gynelase System for Laser Endometrial Ablation for Treatment of Menorrhagia M Pansky, I Frankel, O Neeman, R Langer, I Bukovsky, D Sherman. Assaf Harofe Medical Center, Zerifin, Israel.
Objective. To evaluate 1-year success rate of global diode laser ablation for menorrhagia. Measurements and Main Results. Twelve women with menorrhagia underwent laser endometrial ablation using the Gynelase system and were followed for 1 year. There were no complications. One patient developed PID, which cleared with antibiotic therapy. The 1-year amenorrhea rate was 50% and significant improvement rate was 75 %. Two women subsequently underwent hysterectomy for continuous menorrhagia. Conclusion. Global endometrial ablation with the diode laser system is safe, simple, and effective.
169. Comparison of Hysteroscopy and Hysterectomy in Detecting Endometrial Pathology in Tamoxifen-Treated Women V Pansini, MV Pansini, O Ceci, N Pansini, A Pellegrino, R di Venere, S Santamato, S Bettocchi. University of Bari, Bari, Italy.
171. Laparoscopic Bladder Neck Suspension with Bone Fixation and Use of a Free Mayo Needle
Objective. To evaluate the accuracy of office hysteroscopy with eye-directed biopsies in the diagnosis of endometrial abnormalities in postmenopausal women with breast cancer receiving tamoxifen. Measurements and Main Results. We evaluated 110 women (mean age 55.7 yrs, range 41-65 yrs) receiving tamoxifen 20 mg/day for breast cmacer (mean duration of therapy 30 mo, range 6-120 mo). Of these, 26 underwent hysterectomy (adenocarcinoma in 4, atypical hyperplasia in 1, fibroid uterus in 8, recurrent polyps in 11, uterine prolapse in 2). All patients underwent office hysteroscopy and, within 2 months, hysterectomy. Hysteroscopies with eye-directed biopsies were performed with a 5-mm operative continuousflow office hysteroscope in an ambulatory setting, without anesthesia or analgesia. Endometrial biopsies were performed by grasp technique, in which the amount of tissue obtained is always adequate for histologic diagnosis. Hysteroscopic results (panoramic examination and eye-directed biopsies) compared with
C Papasakelariou. Christus St. Joseph Hospital, Houston, Texas.
Objective. To describe a new technique for suture placement through Cooper's ligament and paravaginal tissue during laparoscopic bladder neck suspension. Measurements and Main Results. In six women undergoing laparoscopic bladder neck suspension, the straight-in bone-fixation system and a free Mayo needle were used to place sutures through Cooper's ligament and paravaginal tissue. Patients were assessed postoperatively by physical examination, questionnaire, and office stress test. There were no complications, and preliminary results show the women to be symptom free. Conclusion. This appears to be an efficient way of placing sutures during laparoscopic bladder neck suspension.
$51