- Email: [email protected]
Hysteroscopy in an outpatient setting–38 months experience
e142
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e128–e193
Oral Presentation 16. Minimally invasive surgery
and is particularly relevant in centers without the possibility of office-based procedures.
Hysteroscopy in an outpatient setting–38 months experience
http://dx.doi.org/10.1016/j.ejogrb.2016.07.359
Rita Simões Carvalho ∗ , J. Abreu-Silva, M.J. Morais, A. Quintas, E. Pinto, J. Gonc¸alves, G. Ramalho
Oral Presentation
Department of Obstetrics and Gynecology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal E-mail address: [email protected] (R.S. Carvalho).
Laparoscopic treatment of deep endometriosis increases pregnancy rate in infertile patients
INTRODUTION: Hysteroscopy is one the main diagnostic and therapeutic tools of modern Gynecology, allowing a direct visualization of the uterine cavity for diagnosis and minimally invasive intervention with sampling or removal of any structural abnormalities. At our unit office-based diagnostic hysteroscopy is not available; as such the pre-operative imaging diagnosis is largely based on transvaginal or pelvic ultrasound, often with hysterosonography. OBJECTIVE: Evaluate de correlation between the pre-operative diagnosis, hysteroscopic findings, and histological analysis, concerning all hysteroscopies performed at our Outpatient Surgery Unit during 38 months of activity. METHODS: The authors performed a retrospective study based on the review of medical files from patients who underwent hysteroscopic procedures at our institution’s Outpatient Surgery Unit from November 1st 2012 to December 31st 2015. RESULTS: During the study period 644 hysteroscopies were performed, all under sedation. The patients’ average age was 55 years (27 to 87), 60% were post-menopausal and 77% presented co-morbidities, 8% having a history of breast cancer with current or previous treatment with tamoxifen. All patients had an ultrasound evaluation, 66% at our ultrasound unit (55% with hysterosonography). The main indications for hysteroscopy were: suspected post-menopausal asymptomatic polyps (34%); suspected pre-menopausal polyps (31%); suspected post-menopausal symptomatic polyps (12%); post-menopausal endometrial thickening (12%); retained trophoblastic products (2%). The main findings were: endometrial polyp(s) (70%); endometrial thickening/irregularities (6%); polypoid/secretory endometrium (2%); submucosal leiomyoma (1,2%); suspicious vegetative formations (0,5%); no abnormalities, normal endometrium (11%). Cervical dilation was used in 14% of the procedures; in 0,8% the endometrial cavity was not accessed due to cervical stenosis. Globally, intra-operative findings were concordant with the presumptive diagnosis by ultrasound in 77% of cases, 82% when hysterosonography was previously used. Bipolar energy was used in 39% of the operative procedures; curettage was performed in 37% of the cases. There was four cases of endometrial adenocarcinoma and two of complex hyperplasia with atypia. The diagnosed complications were: uterine perforation (n = 5); bowel injury (n = 1); moderate uterine bleeding (n = 3). CONCLUSION: The indications and complications rate were similar to other centers described in literature. The previous detailed ultrasound study with hysterosonography resulted in a high rate of agreement between the presumptive diagnosis and intra-operative findings, resulting in a more accurate referral to operative hysteroscopy and obviating a previous diagnostic hysteroscopy. This strategy has been previous advocated by other authors, which reduces the number of hysteroscopies per patient,
6. Endometriosis
Centini Gabriele 1,∗ , Lazzeri Lucia 1 , Antonella Biscione 1,2,3 , Afors Karolina 2 , Wattiez Arnaud 2 , Zupi Errico 3 , Petraglia Felice 1,2,3 1 Department of Molecular and Developmental Medicine, Obstetrics and Gynecology University of Siena, Italy 2 IRCAD, Strasbourg, France 3 Department of Biomedicine and Prevention, Obstetrics and Gynecological Clinic, University of Rome “Tor Vergata,” Rome, Italy E-mail address: [email protected] (C. Gabriele).
Subject and Methods: The aim of this study was to evaluate the impact of surgical treatment for deep endometriosis on pregnancyrate in patients with primary infertility and to determinate the role played by localization and size of endometriotic nodules in causing infertility. From March 2009 to September 2012, we retrospectively selected all patients < 38 years old with primary infertility that underwent to laparoscopic treatment for deep endometriosis (n = 115). Patients were subdivided into different groups according to the use of ART prior the to surgery in order to determine if surgery plays a role in spontaneous conception and in four groups according to localization. Results: The overall pregnancy rate was 54,78% (n = 63) with a live-birth rate of 42,6% (n = 49). Regarding the group with failed IVF prior to surgery (n = 45) a total of 18 patients conceived, 7.5% became pregnant spontaneously whilst awaiting medically assisted reproduction. Among this group the pregnancy rate achieved with IVF was 35.7% (15/43). In the group without failed IVF prior to surgery (n = 70) the overall pregnancy rate was 60% and 38.57% of the women conceived spontaneously. The only factors influencing the pregnancy rate were a treatment for multiple lesion (p = 0.01) (OR 2.74) and previous surgery for endometriosis (p < 0.001; OR 4.18). Conclusions: The present study demonstrates that laparoscopic treatment of deep endometriosis enhances pregnancy-rate and patients affected by multiple localizations have higher chance of conception after surgical treatment. Moreover the pregnancy rate is impaired by repeated surgery for endometriosis. http://dx.doi.org/10.1016/j.ejogrb.2016.07.360
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e128–e193
Oral Presentation 16. Minimally invasive surgery
and is particularly relevant in centers without the possibility of office-based procedures.
Hysteroscopy in an outpatient setting–38 months experience
http://dx.doi.org/10.1016/j.ejogrb.2016.07.359
Rita Simões Carvalho ∗ , J. Abreu-Silva, M.J. Morais, A. Quintas, E. Pinto, J. Gonc¸alves, G. Ramalho
Oral Presentation
Department of Obstetrics and Gynecology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal E-mail address: [email protected] (R.S. Carvalho).
Laparoscopic treatment of deep endometriosis increases pregnancy rate in infertile patients
INTRODUTION: Hysteroscopy is one the main diagnostic and therapeutic tools of modern Gynecology, allowing a direct visualization of the uterine cavity for diagnosis and minimally invasive intervention with sampling or removal of any structural abnormalities. At our unit office-based diagnostic hysteroscopy is not available; as such the pre-operative imaging diagnosis is largely based on transvaginal or pelvic ultrasound, often with hysterosonography. OBJECTIVE: Evaluate de correlation between the pre-operative diagnosis, hysteroscopic findings, and histological analysis, concerning all hysteroscopies performed at our Outpatient Surgery Unit during 38 months of activity. METHODS: The authors performed a retrospective study based on the review of medical files from patients who underwent hysteroscopic procedures at our institution’s Outpatient Surgery Unit from November 1st 2012 to December 31st 2015. RESULTS: During the study period 644 hysteroscopies were performed, all under sedation. The patients’ average age was 55 years (27 to 87), 60% were post-menopausal and 77% presented co-morbidities, 8% having a history of breast cancer with current or previous treatment with tamoxifen. All patients had an ultrasound evaluation, 66% at our ultrasound unit (55% with hysterosonography). The main indications for hysteroscopy were: suspected post-menopausal asymptomatic polyps (34%); suspected pre-menopausal polyps (31%); suspected post-menopausal symptomatic polyps (12%); post-menopausal endometrial thickening (12%); retained trophoblastic products (2%). The main findings were: endometrial polyp(s) (70%); endometrial thickening/irregularities (6%); polypoid/secretory endometrium (2%); submucosal leiomyoma (1,2%); suspicious vegetative formations (0,5%); no abnormalities, normal endometrium (11%). Cervical dilation was used in 14% of the procedures; in 0,8% the endometrial cavity was not accessed due to cervical stenosis. Globally, intra-operative findings were concordant with the presumptive diagnosis by ultrasound in 77% of cases, 82% when hysterosonography was previously used. Bipolar energy was used in 39% of the operative procedures; curettage was performed in 37% of the cases. There was four cases of endometrial adenocarcinoma and two of complex hyperplasia with atypia. The diagnosed complications were: uterine perforation (n = 5); bowel injury (n = 1); moderate uterine bleeding (n = 3). CONCLUSION: The indications and complications rate were similar to other centers described in literature. The previous detailed ultrasound study with hysterosonography resulted in a high rate of agreement between the presumptive diagnosis and intra-operative findings, resulting in a more accurate referral to operative hysteroscopy and obviating a previous diagnostic hysteroscopy. This strategy has been previous advocated by other authors, which reduces the number of hysteroscopies per patient,
6. Endometriosis
Centini Gabriele 1,∗ , Lazzeri Lucia 1 , Antonella Biscione 1,2,3 , Afors Karolina 2 , Wattiez Arnaud 2 , Zupi Errico 3 , Petraglia Felice 1,2,3 1 Department of Molecular and Developmental Medicine, Obstetrics and Gynecology University of Siena, Italy 2 IRCAD, Strasbourg, France 3 Department of Biomedicine and Prevention, Obstetrics and Gynecological Clinic, University of Rome “Tor Vergata,” Rome, Italy E-mail address: [email protected] (C. Gabriele).
Subject and Methods: The aim of this study was to evaluate the impact of surgical treatment for deep endometriosis on pregnancyrate in patients with primary infertility and to determinate the role played by localization and size of endometriotic nodules in causing infertility. From March 2009 to September 2012, we retrospectively selected all patients < 38 years old with primary infertility that underwent to laparoscopic treatment for deep endometriosis (n = 115). Patients were subdivided into different groups according to the use of ART prior the to surgery in order to determine if surgery plays a role in spontaneous conception and in four groups according to localization. Results: The overall pregnancy rate was 54,78% (n = 63) with a live-birth rate of 42,6% (n = 49). Regarding the group with failed IVF prior to surgery (n = 45) a total of 18 patients conceived, 7.5% became pregnant spontaneously whilst awaiting medically assisted reproduction. Among this group the pregnancy rate achieved with IVF was 35.7% (15/43). In the group without failed IVF prior to surgery (n = 70) the overall pregnancy rate was 60% and 38.57% of the women conceived spontaneously. The only factors influencing the pregnancy rate were a treatment for multiple lesion (p = 0.01) (OR 2.74) and previous surgery for endometriosis (p < 0.001; OR 4.18). Conclusions: The present study demonstrates that laparoscopic treatment of deep endometriosis enhances pregnancy-rate and patients affected by multiple localizations have higher chance of conception after surgical treatment. Moreover the pregnancy rate is impaired by repeated surgery for endometriosis. http://dx.doi.org/10.1016/j.ejogrb.2016.07.360