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Haemostasis during laparoscopic surgery: A comparative study
WEDNESDAY,
SEPTEMBER
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FC3.07.02 SUCCESSFUL TREATMENT OF UTERINE FIBROIDS WITH INTERSTITIAL LASER PHOTOCOAGULATION Rowan .I Connell, National Medical Laser Centre & Department of Obstetrics and Gynaecology, University College London, UK Alasdair Gordon, Department of Obstetrics and Gynaecology, University College London, UK. Alfred Cutner, Department of Obstetrics and Gynaecology, University College London, UK Stephen G Bown, National Medical Laser Centre, Department of Surgery, University College London, UK Objective: Interstitial laser photocoagulation (ILP) is a technique for destroying lesions in solid organs, using low power laser energy to gently coagulate the target tissue with no surface effects, and therefore no collateral damage. Our aim was to assess ILP as a minimal access technique of treating symptomatic uterine fibroids. Study Methods: This study was carried out at a London teaching Hospital. Twelve women with symptomatic uterine fibroids (3-12 cm diameter) were recruited. Under laparoscopic control, l-4 pre-charred, bare tipped 400pm laser fibres from a semiconductor laser (805nm) were inserted into fibroids through Tuohey needles and activated simultaneously, each delivering 3.5W for 300 seconds. Fibroid volume was measured preoperatively and during follow up with MRI. This treatment is in contrast to laser myolysis (which uses powers up to 5OW). Results: We have MRI follow-up of 17 treated fibroids, with diameters ranging from 4.5 cm to 11.5 cm (volumes 41 mls to 668 mls), in 12 women with a mean age of 41 years (range 33-48 years). There were no complications and recovery was comparable to that after laparoscopy. Fibroid volume as a percentage of the untreated volume was a mean of 175% (81.276%) 1 week after ILP, 93% (range 40.144%) at 4 weeks; 41% (range 15.58%) at 20 weeks; 23% (range 18.32%) at 32 weeks; and 28% (range 20.36%) at 52 weeks, and 18% at 80 months. ILP is safe, it successfully shrinks fibroids and the shrinkage appears to be sustained. Conclusion: ILP is a successful minimal access technique, which can be used to safely treat uterine fibroids.
FC3.07.03 HAEMOSTASIS DURING LAPAROSCOPIC SURGERY: A COMPARATIVE STUDY A.M. BadawL A. L. Magos’, Departement of OBIGYN, Mansoura University, Egypt. ‘Consultant Obstetrician and Gynaecologist, The Royal Free Hospital, London, UK. The objective of this study is to determine the proper haemostatic method to be adopted during laparoscopic surgery. This study comprised 213 patients undergoing laparoscopic hysterectomy, oophorectomy and salpingectomy for various indications whom were randomly allocated to bipolar electrosurgery, Endo GIA 30 stapler or pre-tied sutures as primary methods of haemostasis. The three study groups were compared in regard to many details such as operative time, blood loss, postoperative discomfort, bowel function, medications, hospitalisation, resumption of activity and return to work. The study showed that bipolar electrodesiccation is an effective, rapid, cheap and relatively safe haemostatic technique for almost all laparoscopic procedures. It was effective in securing large pedicles such as infundibulo-pelvic ligament and uterine vessels. Bipolar coagulation was also useful for ablation of endometriosis, for “bloodless” adhesiolysis and opening the peritoneal pouches. Bipolar electrodesiccation was of comparable speed to staples and significantly more rapid than sutures in most of the procedures. Bipolar coagulators have the versatility to be used in various situations especially in emergency conditions and have the capacity to cope with the developing challenges of endoscopic surgery. We have not had major complications from electrosurgery. We can confidently recommend bipolar electrosurgery as the primary method of haemostasis for most of laparoscopic procedures. Bipolar electrosurgery should be an essential part of the armamentarium of any endoscopist.
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FC3.07.04 MINIMALLY INVASIVE PERCUTANEOUS LASER ABLATION OF UTERINE LEIOMYOMAS. Law.P. Dept. Obstetrics & GynaecologyiInterventional MR, [email protected]’s, London, UK. Gedroyc. W, Dept. Interventional MR, St.Mary’s Hospital, London, UK Regan. L, Academic Dept. Obstetrics & Gynaecology, [email protected]’s, London, UK. Objectives: To develop an effective and accurate method for thermal ablation of uterine fibroids using an open interventional magnetic resonance (MR) scanner to guide percutaneous insertion of laser fibres and to monitor the extent of uterine fibroid coagulative necrosis during treatment. Study methods: Thirty women with symptomatic fibroids and completed families were recruited from the gynaecology clinic at St. Mary’s Hospital, London, to undergo percutaneous laser ablation. Four MR compatible needles were placed percutaneously under MR guidance through the anterior abdominal wall into the centre of the targeted leiomyoma. Four bare laser fibres were then inserted into the leiomyoma via the outer needle sheaths. A diode laser heat source of five watts per fibre was used with a four-way splitter.Tissue effects of thermal ablation were monitored throughout the procedure with realtime image processing software. (RTIP) Results: Three months after laser ablation, targeted leiomyoma volume had decreased by 37.5%, which was maintained at six months. Total menstrual blood loss was measured before and after laser ablation in five women with a mean decrease of 39.2%. Women reported symptomatic improvement after laser ablation using a validated gynaecological outcomes questionnaire. Conclusions: Preliminary work with percutaneous laser ablation suggests that this minimally invasive day case procedure may offer an alternative to traditional surgical treatment for symptomatic uterine fibroids.
FC3.07.05 MYOMETRIAL RESECTIONS: PRELIMINARY REPORT OF A UTERINE-CONSERVING PROCEDURE FOR MYOHYPERPLASIA I. M. Oladokun, I. Adewole, Dept. OBIGYN, University of Ibadan, Ibadan, Nigeria. Introduction: Myohyperplasia in our limited experience, occurs discretely, or in association with uterine fibroids or adenomyosis. The definite treatment for myohyperplasia is hysterectomy, but the option is not acceptable to women desirous of continuing childbearing or menstrual function. Study Method: We evolved this technique following the occasional need to restore uterine form following enuclation of huge myomas. A midline anterior uterine incision was the only approach. No tourniquet was applied or vasopressin used. The myometrium was carefully resected, short of the endometrium and reconstituted with scrosal closure all using vicryl sutures. Results: Eight women had the procedure over 3 years. Five patients had myohyperplastic uteri, three in association with fibroids. Menstrual function was unaltered in 5, one patient had hypomenorrhea and another had irregular cycles. One patient got pregnant and was delivered by an elective cesarean section. Conclusion: Myometrial resection is an easily learnt procedure, acceptable to patients and worth considering in settings where hysterectomy for myohyperplasia has hitherto been the practice.
FC3.07.06 EXPERIENCE WITH MYOMECTOMY M. H.Sammour, Dept. OBIGYN, Ain-Shams Medicine, Cairo, Egypt.
Faculty of
During the years 1991.1998, 582 myomectomies were carried in a Private Institute. The mean age was 32.6 years and the mean parity 2.4. The operation was carried n 26 unmarried females. Cervical myomas constituted 8.5% broad ligament myomas 2.8%, 3 cases of peritoneal myomeas and the rest were corporeal. Submucous leiomyomas were present in 22.6% of the cases while the interstitial myomas were present in 74.2% and the subserous in 36.5%. Single myoma in 32.5% of cases while 2-5 myomas accounted to 47.5% of cases while multiple myomas above 5, were seen in 20% of our series. During myomectomy the cavity
SEPTEMBER
6
FC3.07.02 SUCCESSFUL TREATMENT OF UTERINE FIBROIDS WITH INTERSTITIAL LASER PHOTOCOAGULATION Rowan .I Connell, National Medical Laser Centre & Department of Obstetrics and Gynaecology, University College London, UK Alasdair Gordon, Department of Obstetrics and Gynaecology, University College London, UK. Alfred Cutner, Department of Obstetrics and Gynaecology, University College London, UK Stephen G Bown, National Medical Laser Centre, Department of Surgery, University College London, UK Objective: Interstitial laser photocoagulation (ILP) is a technique for destroying lesions in solid organs, using low power laser energy to gently coagulate the target tissue with no surface effects, and therefore no collateral damage. Our aim was to assess ILP as a minimal access technique of treating symptomatic uterine fibroids. Study Methods: This study was carried out at a London teaching Hospital. Twelve women with symptomatic uterine fibroids (3-12 cm diameter) were recruited. Under laparoscopic control, l-4 pre-charred, bare tipped 400pm laser fibres from a semiconductor laser (805nm) were inserted into fibroids through Tuohey needles and activated simultaneously, each delivering 3.5W for 300 seconds. Fibroid volume was measured preoperatively and during follow up with MRI. This treatment is in contrast to laser myolysis (which uses powers up to 5OW). Results: We have MRI follow-up of 17 treated fibroids, with diameters ranging from 4.5 cm to 11.5 cm (volumes 41 mls to 668 mls), in 12 women with a mean age of 41 years (range 33-48 years). There were no complications and recovery was comparable to that after laparoscopy. Fibroid volume as a percentage of the untreated volume was a mean of 175% (81.276%) 1 week after ILP, 93% (range 40.144%) at 4 weeks; 41% (range 15.58%) at 20 weeks; 23% (range 18.32%) at 32 weeks; and 28% (range 20.36%) at 52 weeks, and 18% at 80 months. ILP is safe, it successfully shrinks fibroids and the shrinkage appears to be sustained. Conclusion: ILP is a successful minimal access technique, which can be used to safely treat uterine fibroids.
FC3.07.03 HAEMOSTASIS DURING LAPAROSCOPIC SURGERY: A COMPARATIVE STUDY A.M. BadawL A. L. Magos’, Departement of OBIGYN, Mansoura University, Egypt. ‘Consultant Obstetrician and Gynaecologist, The Royal Free Hospital, London, UK. The objective of this study is to determine the proper haemostatic method to be adopted during laparoscopic surgery. This study comprised 213 patients undergoing laparoscopic hysterectomy, oophorectomy and salpingectomy for various indications whom were randomly allocated to bipolar electrosurgery, Endo GIA 30 stapler or pre-tied sutures as primary methods of haemostasis. The three study groups were compared in regard to many details such as operative time, blood loss, postoperative discomfort, bowel function, medications, hospitalisation, resumption of activity and return to work. The study showed that bipolar electrodesiccation is an effective, rapid, cheap and relatively safe haemostatic technique for almost all laparoscopic procedures. It was effective in securing large pedicles such as infundibulo-pelvic ligament and uterine vessels. Bipolar coagulation was also useful for ablation of endometriosis, for “bloodless” adhesiolysis and opening the peritoneal pouches. Bipolar electrodesiccation was of comparable speed to staples and significantly more rapid than sutures in most of the procedures. Bipolar coagulators have the versatility to be used in various situations especially in emergency conditions and have the capacity to cope with the developing challenges of endoscopic surgery. We have not had major complications from electrosurgery. We can confidently recommend bipolar electrosurgery as the primary method of haemostasis for most of laparoscopic procedures. Bipolar electrosurgery should be an essential part of the armamentarium of any endoscopist.
27
FC3.07.04 MINIMALLY INVASIVE PERCUTANEOUS LASER ABLATION OF UTERINE LEIOMYOMAS. Law.P. Dept. Obstetrics & GynaecologyiInterventional MR, [email protected]’s, London, UK. Gedroyc. W, Dept. Interventional MR, St.Mary’s Hospital, London, UK Regan. L, Academic Dept. Obstetrics & Gynaecology, [email protected]’s, London, UK. Objectives: To develop an effective and accurate method for thermal ablation of uterine fibroids using an open interventional magnetic resonance (MR) scanner to guide percutaneous insertion of laser fibres and to monitor the extent of uterine fibroid coagulative necrosis during treatment. Study methods: Thirty women with symptomatic fibroids and completed families were recruited from the gynaecology clinic at St. Mary’s Hospital, London, to undergo percutaneous laser ablation. Four MR compatible needles were placed percutaneously under MR guidance through the anterior abdominal wall into the centre of the targeted leiomyoma. Four bare laser fibres were then inserted into the leiomyoma via the outer needle sheaths. A diode laser heat source of five watts per fibre was used with a four-way splitter.Tissue effects of thermal ablation were monitored throughout the procedure with realtime image processing software. (RTIP) Results: Three months after laser ablation, targeted leiomyoma volume had decreased by 37.5%, which was maintained at six months. Total menstrual blood loss was measured before and after laser ablation in five women with a mean decrease of 39.2%. Women reported symptomatic improvement after laser ablation using a validated gynaecological outcomes questionnaire. Conclusions: Preliminary work with percutaneous laser ablation suggests that this minimally invasive day case procedure may offer an alternative to traditional surgical treatment for symptomatic uterine fibroids.
FC3.07.05 MYOMETRIAL RESECTIONS: PRELIMINARY REPORT OF A UTERINE-CONSERVING PROCEDURE FOR MYOHYPERPLASIA I. M. Oladokun, I. Adewole, Dept. OBIGYN, University of Ibadan, Ibadan, Nigeria. Introduction: Myohyperplasia in our limited experience, occurs discretely, or in association with uterine fibroids or adenomyosis. The definite treatment for myohyperplasia is hysterectomy, but the option is not acceptable to women desirous of continuing childbearing or menstrual function. Study Method: We evolved this technique following the occasional need to restore uterine form following enuclation of huge myomas. A midline anterior uterine incision was the only approach. No tourniquet was applied or vasopressin used. The myometrium was carefully resected, short of the endometrium and reconstituted with scrosal closure all using vicryl sutures. Results: Eight women had the procedure over 3 years. Five patients had myohyperplastic uteri, three in association with fibroids. Menstrual function was unaltered in 5, one patient had hypomenorrhea and another had irregular cycles. One patient got pregnant and was delivered by an elective cesarean section. Conclusion: Myometrial resection is an easily learnt procedure, acceptable to patients and worth considering in settings where hysterectomy for myohyperplasia has hitherto been the practice.
FC3.07.06 EXPERIENCE WITH MYOMECTOMY M. H.Sammour, Dept. OBIGYN, Ain-Shams Medicine, Cairo, Egypt.
Faculty of
During the years 1991.1998, 582 myomectomies were carried in a Private Institute. The mean age was 32.6 years and the mean parity 2.4. The operation was carried n 26 unmarried females. Cervical myomas constituted 8.5% broad ligament myomas 2.8%, 3 cases of peritoneal myomeas and the rest were corporeal. Submucous leiomyomas were present in 22.6% of the cases while the interstitial myomas were present in 74.2% and the subserous in 36.5%. Single myoma in 32.5% of cases while 2-5 myomas accounted to 47.5% of cases while multiple myomas above 5, were seen in 20% of our series. During myomectomy the cavity