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Indication for Autotransfusion before Laparoscopic Myomectomy (LM) in Our Hospital
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Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S91–S135 Open Communications 18 - Advanced Endoscopy (3:20 PM - 3:25 PM)
Open Power Morcellation Versus Morcellation within a Contained Pneumoperitoneum: Comparison of Perioperative Outcomes Vargas MV, Fuchs-Weizman N, Cohen SL, Wang KC, Manoucheri E, Einarsson JI. Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts Study Objective: To compare perioperative outcomes, particularly operative time, between open and contained power morcellation of uterine tissue at the time of laparoscopic surgery. Design: Retrospective chart review. Setting: Academic tertiary care hospital. Patients: Women undergoing laparoscopic hysterectomy or myomectomy who required morcellation of tissue for specimen extraction. Intervention: Clinical outcomes among patients who had contained power morcellation were compared to clinical outcomes among patients who had open power morcellation. Measurements and Main Results: The cohort consisted of 36 patients who underwent contained morcellation and 49 patients who had open morcellation of uterine tissue. Baseline demographics were comparable between the two groups, although women who underwent contained morcellation were on average older than the open morcellation group (mean age in years [SD], 49.19 [1.12] versus 44.06 [8.93]; P=0.01). The mean operating room (OR) time was longer in the contained group (mean time in minutes (SD), 119.0 (55.91) versus 93.13 (44.90); P=0.02). The estimated blood loss, specimen weight, hospital length of stay, and perioperative complication rate did not vary between the two groups. Operative times did not vary significantly by surgeon. There were no cases of malignancy or isolation bag disruption. Conclusion: Enclosed morcellation led to similar outcomes to open morcellation and may reduce the risk of tissue dispersion. Mean OR time was prolonged by 26 minutes with enclosed morcellation, but could potentially be reduced with further experience using this technique.
weight of myoma or numbers. No patients had postoperative hematoma or reoperation. And no patients needed additional trocar. Conclusion: Single-port laparoscopic myomectomy using a YS sliding extracorporeal knot is rapid, simple, easy to learn and effective to recover the myoma defect by layer by layer without massive blood loss. Moreover, we could overcome the difficulty of intracorporeal suturing by using YS knots. 329
Indication for Autotransfusion before Laparoscopic Myomectomy (LM) in Our Hospital Mimura T, Ishikawa T, Nagashima M, Hasegawa J, Sekizawa A. Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan Study Objective: To determine indication for autotransfusion before LM about the size of myomas in our hospital. Design: Retrospective clinical study. Setting: Showa University Hospital. Patients: 204 patients undergoing LM in our hospital from 2011 to 2012. Intervention: To investigate the association between the amount of bleeding during LM and the sum of the major axis of myomas. The amount of bleeding to need autotransfusion was defined as more than 500 mL. The ROC curve was determined based on the relationship between the sensitivities and false-positive rates at the sum of diameter of myomas for bleeding during LM of more than 500mL. The best cut-off point was evaluated according to maximum likelihood ratio. Measurements and Main Results: There was a significant correlation between the amount of bleeding during LM and the sum of the major axis of myomas. (r=0.575, p\0.01). The threshold sum of the diameter of myomas associated with bleeding of more than 500mL was 16 cm based on an ROC curve. The odds ratio for bleeding to need autotransfusion (>500mL) in cases with more than 16 cm in sum total was 6.3 (95% confidence interval, 2.4-16.8) in comparison to cases with less than 16 cm. Conclusion: Patients with more than 16 cm in sum total of the major axis of myomas should prepare her autotransfusion before LM. 330
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Open Communications 18 - Advanced Endoscopy (3:26 PM - 3:31 PM)
Open Communications 18 - Advanced Endoscopy (3:32 PM - 3:37 PM)
Open Communications 18 - Advanced Endoscopy (3:38 PM - 3:43 PM)
Single-Port Laparoscopic Myomectomy Using a YS Sliding Extracorporeal Knot Chong GO, Lee YH, Hong DG, Lee YS. Gynecologic Cancer Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
Patients’ Age, Myoma Size, Myoma Location, and Interval Between Myomectomy and Pregnancy May Influence the Pregnancy Rate and Live Birth Rate After Myomectomy Zhang Y, Hua KQ. Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
Study Objective: To evaluate clinical outcomes of single-port laparoscopic myomectomy using a YS sliding extracorporeal knot. Design: Continuing prospective study (Canadian Task Force classification II-3). Setting: University hospital. Patients: Between July 2010 and February 2014, 80 patients who underwent single-port laparoscopic myomectomy with suturing of myoma defect using YS knot (Yoon Soon Knots). Intervention: We used extracorporeal YS knot for suturing the defect of myoma at single-port laparoscopic myomectomy. And we use single port system by OCTOPort. All operations were performed using conventional rigid straight laparoscopic instruments and 30 degree 10mm laparoscope. Measurements and Main Results: Patient mean (SD; range) age was 40.5 years (6.8; 22-58) years, and body mass index was 22.7 kg/m2 (3;17.6-30.5). The numbers of myoma of each patients were 2.7 (4.5; 1-35), and weight of myoma was 141gm (267; 3-2300). Operative time was 91.7 minutes (39.7; 34-297). Postoperative changes in the hemoglobin level were 1.1 g/dL (1.2; -5.6-1.8), and estimated Blood loss was 32.5 ml (31; 2-150). Suturing time was 35.4 minutes (19.7; 3-87). During the operations, no patients required blood transfusion. Suturing times were not correlation to
Study Objective: To investigate which clinical characteristics will influence the pregnancy rate and live birth rate after myomectomy. Measurements and Main Results: Data of clinical characteristics and reproductive outcome from 471 patients who wished to conceive and who underwent abdominal or laparoscopic myomectomy in the Obstetrics and Gynecology. Hospital of Fudan University from January 2008 to June 2012 were retrospectively analyzed. Average age in the pregnancy group (30.03.7 years) and the nonpregnancy group (31.24.1 years) was statistically different (P = .000). The diameter of the biggest myoma had a positive relationship with the pregnancy rate when it was\10 cm (rs = 0.095, P = .039). Abortions before myomectomy, operation type, number,location,and classification of myomas, uterine cavity penetration, and uterine volume seemed not to influence the pregnancy rate (P> .05). The location of the myoma may influence the live birth rate after myomectomy (rs = 0.198, P = .002). Anterior and posterior myomas were associated with higher live birth rates than other locations (P = .001). The average interval between myomectomy and pregnancy was 16.08.7 months, and there was no difference between the abdominal
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S91–S135 Open Communications 18 - Advanced Endoscopy (3:20 PM - 3:25 PM)
Open Power Morcellation Versus Morcellation within a Contained Pneumoperitoneum: Comparison of Perioperative Outcomes Vargas MV, Fuchs-Weizman N, Cohen SL, Wang KC, Manoucheri E, Einarsson JI. Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts Study Objective: To compare perioperative outcomes, particularly operative time, between open and contained power morcellation of uterine tissue at the time of laparoscopic surgery. Design: Retrospective chart review. Setting: Academic tertiary care hospital. Patients: Women undergoing laparoscopic hysterectomy or myomectomy who required morcellation of tissue for specimen extraction. Intervention: Clinical outcomes among patients who had contained power morcellation were compared to clinical outcomes among patients who had open power morcellation. Measurements and Main Results: The cohort consisted of 36 patients who underwent contained morcellation and 49 patients who had open morcellation of uterine tissue. Baseline demographics were comparable between the two groups, although women who underwent contained morcellation were on average older than the open morcellation group (mean age in years [SD], 49.19 [1.12] versus 44.06 [8.93]; P=0.01). The mean operating room (OR) time was longer in the contained group (mean time in minutes (SD), 119.0 (55.91) versus 93.13 (44.90); P=0.02). The estimated blood loss, specimen weight, hospital length of stay, and perioperative complication rate did not vary between the two groups. Operative times did not vary significantly by surgeon. There were no cases of malignancy or isolation bag disruption. Conclusion: Enclosed morcellation led to similar outcomes to open morcellation and may reduce the risk of tissue dispersion. Mean OR time was prolonged by 26 minutes with enclosed morcellation, but could potentially be reduced with further experience using this technique.
weight of myoma or numbers. No patients had postoperative hematoma or reoperation. And no patients needed additional trocar. Conclusion: Single-port laparoscopic myomectomy using a YS sliding extracorporeal knot is rapid, simple, easy to learn and effective to recover the myoma defect by layer by layer without massive blood loss. Moreover, we could overcome the difficulty of intracorporeal suturing by using YS knots. 329
Indication for Autotransfusion before Laparoscopic Myomectomy (LM) in Our Hospital Mimura T, Ishikawa T, Nagashima M, Hasegawa J, Sekizawa A. Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan Study Objective: To determine indication for autotransfusion before LM about the size of myomas in our hospital. Design: Retrospective clinical study. Setting: Showa University Hospital. Patients: 204 patients undergoing LM in our hospital from 2011 to 2012. Intervention: To investigate the association between the amount of bleeding during LM and the sum of the major axis of myomas. The amount of bleeding to need autotransfusion was defined as more than 500 mL. The ROC curve was determined based on the relationship between the sensitivities and false-positive rates at the sum of diameter of myomas for bleeding during LM of more than 500mL. The best cut-off point was evaluated according to maximum likelihood ratio. Measurements and Main Results: There was a significant correlation between the amount of bleeding during LM and the sum of the major axis of myomas. (r=0.575, p\0.01). The threshold sum of the diameter of myomas associated with bleeding of more than 500mL was 16 cm based on an ROC curve. The odds ratio for bleeding to need autotransfusion (>500mL) in cases with more than 16 cm in sum total was 6.3 (95% confidence interval, 2.4-16.8) in comparison to cases with less than 16 cm. Conclusion: Patients with more than 16 cm in sum total of the major axis of myomas should prepare her autotransfusion before LM. 330
328
Open Communications 18 - Advanced Endoscopy (3:26 PM - 3:31 PM)
Open Communications 18 - Advanced Endoscopy (3:32 PM - 3:37 PM)
Open Communications 18 - Advanced Endoscopy (3:38 PM - 3:43 PM)
Single-Port Laparoscopic Myomectomy Using a YS Sliding Extracorporeal Knot Chong GO, Lee YH, Hong DG, Lee YS. Gynecologic Cancer Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
Patients’ Age, Myoma Size, Myoma Location, and Interval Between Myomectomy and Pregnancy May Influence the Pregnancy Rate and Live Birth Rate After Myomectomy Zhang Y, Hua KQ. Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
Study Objective: To evaluate clinical outcomes of single-port laparoscopic myomectomy using a YS sliding extracorporeal knot. Design: Continuing prospective study (Canadian Task Force classification II-3). Setting: University hospital. Patients: Between July 2010 and February 2014, 80 patients who underwent single-port laparoscopic myomectomy with suturing of myoma defect using YS knot (Yoon Soon Knots). Intervention: We used extracorporeal YS knot for suturing the defect of myoma at single-port laparoscopic myomectomy. And we use single port system by OCTOPort. All operations were performed using conventional rigid straight laparoscopic instruments and 30 degree 10mm laparoscope. Measurements and Main Results: Patient mean (SD; range) age was 40.5 years (6.8; 22-58) years, and body mass index was 22.7 kg/m2 (3;17.6-30.5). The numbers of myoma of each patients were 2.7 (4.5; 1-35), and weight of myoma was 141gm (267; 3-2300). Operative time was 91.7 minutes (39.7; 34-297). Postoperative changes in the hemoglobin level were 1.1 g/dL (1.2; -5.6-1.8), and estimated Blood loss was 32.5 ml (31; 2-150). Suturing time was 35.4 minutes (19.7; 3-87). During the operations, no patients required blood transfusion. Suturing times were not correlation to
Study Objective: To investigate which clinical characteristics will influence the pregnancy rate and live birth rate after myomectomy. Measurements and Main Results: Data of clinical characteristics and reproductive outcome from 471 patients who wished to conceive and who underwent abdominal or laparoscopic myomectomy in the Obstetrics and Gynecology. Hospital of Fudan University from January 2008 to June 2012 were retrospectively analyzed. Average age in the pregnancy group (30.03.7 years) and the nonpregnancy group (31.24.1 years) was statistically different (P = .000). The diameter of the biggest myoma had a positive relationship with the pregnancy rate when it was\10 cm (rs = 0.095, P = .039). Abortions before myomectomy, operation type, number,location,and classification of myomas, uterine cavity penetration, and uterine volume seemed not to influence the pregnancy rate (P> .05). The location of the myoma may influence the live birth rate after myomectomy (rs = 0.198, P = .002). Anterior and posterior myomas were associated with higher live birth rates than other locations (P = .001). The average interval between myomectomy and pregnancy was 16.08.7 months, and there was no difference between the abdominal