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Institutional impact of laparoscopic hysterectomy
Abstracts
66. Institutional Impact of Laparoscopic Hysterectomy
Conclusion. Although quite rare, ureteral remnant syndrome may be a cause of chronic abdominopelvic pain.
A Hern4ndez-Denis, E Garcia-Lara, J AudifredSalom6n, R Venegas-Flores. Hospital General "Dr. Manuel Gea Gonz~51es,"Mexico City, Mexico.
68. Conscious Pain Mapping for Chronic Pelvic Pain
Objective. To demonstrate benefits to patients and reduction in total costs of laparoscopic hysterectomy. Measurements and Main Results. One hundred fifty women (average age 39.4 yrs) with adnormal uterine bleeding underwent laparoscopic hysterectomy with bipolar coagulation of pedicles. All procedures were done by the same surgical team. The main preoperative diagnosis was uterine myomas (132 women, 88%). Postoperative hospitalization was 2.14 days and convalescence 13.4 days. There was a difference of 20.5 days in comparison with convalescence from open hysterectomy. The total cost of laparoscopic hysterectomy was 28% lower than that of open hysterectomy. Indirect costs decreased significantly because recovery time was shorter and cost of incapacity was lower with laparoscopic hysterectomy. Conclusion. Laparoscopic hysterectomy resulted in patient benefits and reduced costs compared with open hysterectomy.
67. Chronic Abdominopelvic Pain Associated with Ureteral Remnant Syndrome 1FM Howard, 2AM EI-Minawi. ~University of Rochester School of Medicine and Dentistry, Rochester, New York; 2Kaser-EI-Aini School of Medicine, Cairo University, Cairo, Egypt.
1FM Howard, 2AM EI-Minawi. :University of Rochester School of Medicine and Dentistry, Rochester, New York; 2Kaser-EI-Aini School of Medicine, Cairo University, Cairo, Egypt.
Objective. To assess the value of conscious pain mapping in patients with chronic pelvic pain. Measurements and Main Results. Sixteen consecutive patients underwent conscious pain mapping to assess the cause of chronic pelvic pain and were compared with a control group. The procedure was successful in nine patients (56%) and unsuccessful or inadequate in seven (44%), with success meaning a complete unhindered view of the pelvis and cul-de-sac. In 12 women an operative procedure was done immediately, based on diagnostic findings in successful cases, and on operative findings after induction of general anesthesia in the rest. Adhesive disease was diagnosed in 50% and endometriosis in 37.5% of women. Other less common diagnoses were granulomas, neuromas, and interstitial cystitis. Conclusion. Despite much-touted efficacy of conscious pain mapping, in 7 of 16 patients it was inadequate or unsuccessful even in the hands of an experienced surgeon. 69. Experience with 200 Consecutive Cases of
Uterine Artery Embolization for Management of Symptomatic Uterine Fibroids
Objective. To report a patient with a remnant of ureter causing chronic abdominopelvic pain. Measurements and Main Results. A 38-year-old women had more than 10 years of chronic abdominopelvic pain. Her history included hysterectomy and bilateral salpingo-oophorectomy, followed by right nephrectomy several years later. She was referred for presacral neurectomy after three successful superior hypogastric blocks for right-sided abdominopelvic pain (leftsided pain not relieved by blocks). At surgery she had a left ovarian remnant and a right pelvic brim right ureteral remnant. Ureteral remnant showed peristaltic activity. After removal of the ureteral remnant her right-sided pain resolved without recurrence after 18 months of follow-up. Left-sided pain recurred after 12 months.
FL Hutchins Jr, R Worthington-Kirsch. Roxborough Memorial Hospital, Bala Cynwyd, Pennsylvania.
Objective. To review the outcome of patients who underwent uterine artery embolization for treatment of symptomatic fibroids. Measurements and Main Results. Two hundred women (age range 35-52 yrs) with documented symptomatic fibroids underwent selective uterine artery embolization performed by a single interventional radiologist. Average reduction in size of uterine fibroids was approximately 50%. More than 90% of patients experienced improvement in bleeding and 70% experienced reduction in bulk symptoms at 3-, 6-, and 12-month follow-up.
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66. Institutional Impact of Laparoscopic Hysterectomy
Conclusion. Although quite rare, ureteral remnant syndrome may be a cause of chronic abdominopelvic pain.
A Hern4ndez-Denis, E Garcia-Lara, J AudifredSalom6n, R Venegas-Flores. Hospital General "Dr. Manuel Gea Gonz~51es,"Mexico City, Mexico.
68. Conscious Pain Mapping for Chronic Pelvic Pain
Objective. To demonstrate benefits to patients and reduction in total costs of laparoscopic hysterectomy. Measurements and Main Results. One hundred fifty women (average age 39.4 yrs) with adnormal uterine bleeding underwent laparoscopic hysterectomy with bipolar coagulation of pedicles. All procedures were done by the same surgical team. The main preoperative diagnosis was uterine myomas (132 women, 88%). Postoperative hospitalization was 2.14 days and convalescence 13.4 days. There was a difference of 20.5 days in comparison with convalescence from open hysterectomy. The total cost of laparoscopic hysterectomy was 28% lower than that of open hysterectomy. Indirect costs decreased significantly because recovery time was shorter and cost of incapacity was lower with laparoscopic hysterectomy. Conclusion. Laparoscopic hysterectomy resulted in patient benefits and reduced costs compared with open hysterectomy.
67. Chronic Abdominopelvic Pain Associated with Ureteral Remnant Syndrome 1FM Howard, 2AM EI-Minawi. ~University of Rochester School of Medicine and Dentistry, Rochester, New York; 2Kaser-EI-Aini School of Medicine, Cairo University, Cairo, Egypt.
1FM Howard, 2AM EI-Minawi. :University of Rochester School of Medicine and Dentistry, Rochester, New York; 2Kaser-EI-Aini School of Medicine, Cairo University, Cairo, Egypt.
Objective. To assess the value of conscious pain mapping in patients with chronic pelvic pain. Measurements and Main Results. Sixteen consecutive patients underwent conscious pain mapping to assess the cause of chronic pelvic pain and were compared with a control group. The procedure was successful in nine patients (56%) and unsuccessful or inadequate in seven (44%), with success meaning a complete unhindered view of the pelvis and cul-de-sac. In 12 women an operative procedure was done immediately, based on diagnostic findings in successful cases, and on operative findings after induction of general anesthesia in the rest. Adhesive disease was diagnosed in 50% and endometriosis in 37.5% of women. Other less common diagnoses were granulomas, neuromas, and interstitial cystitis. Conclusion. Despite much-touted efficacy of conscious pain mapping, in 7 of 16 patients it was inadequate or unsuccessful even in the hands of an experienced surgeon. 69. Experience with 200 Consecutive Cases of
Uterine Artery Embolization for Management of Symptomatic Uterine Fibroids
Objective. To report a patient with a remnant of ureter causing chronic abdominopelvic pain. Measurements and Main Results. A 38-year-old women had more than 10 years of chronic abdominopelvic pain. Her history included hysterectomy and bilateral salpingo-oophorectomy, followed by right nephrectomy several years later. She was referred for presacral neurectomy after three successful superior hypogastric blocks for right-sided abdominopelvic pain (leftsided pain not relieved by blocks). At surgery she had a left ovarian remnant and a right pelvic brim right ureteral remnant. Ureteral remnant showed peristaltic activity. After removal of the ureteral remnant her right-sided pain resolved without recurrence after 18 months of follow-up. Left-sided pain recurred after 12 months.
FL Hutchins Jr, R Worthington-Kirsch. Roxborough Memorial Hospital, Bala Cynwyd, Pennsylvania.
Objective. To review the outcome of patients who underwent uterine artery embolization for treatment of symptomatic fibroids. Measurements and Main Results. Two hundred women (age range 35-52 yrs) with documented symptomatic fibroids underwent selective uterine artery embolization performed by a single interventional radiologist. Average reduction in size of uterine fibroids was approximately 50%. More than 90% of patients experienced improvement in bleeding and 70% experienced reduction in bulk symptoms at 3-, 6-, and 12-month follow-up.
$20