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Interaction of Follicle Stimulating Hormone (FSH) and Body Mass Index (BMI) in a Large Cohort
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
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CLT (minutes) was significantly shorter during surgery compared to baseline and postsurgical determinations. PAP and F1+2 were statistically higher during surgery. The multivariate analysis of several thrombosis risk factors (Age, BMI, smoking habit, use of hormonal treatment, length of surgery, parity) showed neither association in PAP nor F1+2 in the three study points. Patients > 35 years and users of hormonal treatments presented with longer baseline CLT; patients > 35 years and smokers had longer CLT during surgery; and patients > 35 years had longer postoperative CLT. Conclusion: Benign adnexal laparoscopy transitionally activates plasma fibrinolysis and coagulation parameters. Older patients, smokers and users of hormonal treatments present with longer CLT and thus, should be considered to have a high thromboembolic risk. 585 Does the Order of Surgical Method of Training Affect Learning and Skill? A Comparison of Laparoscopy and Robotics Galloway ML, Corbett JJ, Hill SD. Obstetrics & Gynecology, Wright State University, Boonshoft SOM, Dayton, Ohio Two years later, her twin sister, AMM-2, an 18-year-old G0, presented with a 7 day history of abdominal pain. Gonorrhea was found and treated. CT scan revealed a complex central pelvic mass, 7 x 13.1 x 10.3 cm, containing fat, soft tissue, fluid and areas of calcification. An IUD was in place, she was obese and had a history of anxiety. She underwent uncomplicated laparoscopic left ovarian cystectomy to remove a 15x10 cm smooth-walled mass anterior to the uterus containing a large volume of hair, scalp, and sebaceous material. The right ovary was enlarged consistent with polycystic ovarian syndrome and the clitoris was enlarged to 4 cm in length. Pathologic review confirmed a mature cystic teratoma. Her recovery was uncomplicated. Conclusion: Teratomas are the most common germ cell tumor of the ovary and are frequently encountered in young women. A familial tendency has been reported rarely. Although both of our patients were successfully treated with minimally invasive surgery, previous knowledge of familial association in this case might have led to earlier identification and treatment in AMM-2.
584 Risk Factors for Changes of Fibrinolysis During Benign Adnexal Laparoscopic Surgery assies D,2 Reverter JC,2 Balasch J,1 Martınez-Zamora M-A,1 T Carmona F.1 1Department of Gynecology. Hospital Clınic of Barcelona, Barcelona, Spain; 2Hemotherapy and Hemostasis Unit. Hospital Clınic of Barcelona, Barcelona, Spain Study Objective: Laparoscopic surgery appears to be less traumatic than open procedures but the risk of thrombosis after laparoscopic surgery is not well known. Several studies have reported changes in coagulation and fibrinolysis with controversial results and no previous studies have analyzed these parameters in gynaecological procedures. We assessed changes of systemic fibrinolysis and coagulation in patients who underwent elective benign adnexal laparoscopic surgery and analyzed its changes according to different cardiovascular risk factors. Design: Observational time series study. Setting: Tertiary care university teaching hospital. Patients: 52 patients who underwent elective benign adnexal laparoscopic surgery (uni or bilateral cystectomy/adnexectomy). Intervention: Blood samples were drawn on admission (baseline), during surgery and on the first postoperative day (24 hours after surgery). Samples were evaluated for clot lysis time (CLT), plasmin-alpha 2-antiplasmin complex (PAP) levels and prothrombin fragment 1+2 (F1+2) antigen levels. Measurements and Main Results: No patient presented with thromboembolic events before or within the six months after surgery.
Study Objective: To evaluate if the order of surgical method training affects the rate at which trainees develop their related surgical skills. Design: We assembled nearly 30 medical students to be ‘‘novice’’ volunteer subjects. Subjects will be asked to fill out a short survey to evaluate their previous experience with laparoscopic and robotic surgery simulators and procedures. Subjects are randomly divided into two groups, A and B. All subjects will then participate practice in the assigned method and testing in both surgical methods. Setting: The Brethen Center for Robotics and Minimally Invasive Surgery is a simulation center that contains both low and high fidelity equipment necessary for this study. Patients: Volunteer subjects are gathered from the Wright State University Boonshoft School of Medicine. Intervention: The groups are randomly assigned to ‘‘practice sessions’’ in robotic or laparoscopic techniques using the DaVinci Si or LapSim simulators, with 1 hour practice requirement each week. Testing is performed in the assigned practice method prior to crossover testing in the unassigned method. Measurements and Main Results: Three FLS validated tasks: Peg transfer, Needle manipulation and Intracorporeal suturing were used to test participants. Individual test scores will be graphed against their own results over the three testing periods. The results for all subjects in group A are averaged for each testing session and surgical method (laparoscopic and robotic), as will all results for subjects in group B. Conclusion: This four week study of surgical novices showed improvement in task performance for both groups. Results have that prior laparoscopic exposure did not improve robotic performance and subjects performing robotic training scored almost equally as well as laparoscopic group. These results contradict current perception that robotic surgeons first need to be good laparoscopic surgeons. 586 Interaction of Follicle Stimulating Hormone (FSH) and Body Mass Index (BMI) in a Large Cohort Harvey LFB, Yunker A, Thomassee MS. Obstetrics and Gynecology, Minimally Invasive Surgery Division, Vanderbilt University Medical Center, Nashville, Tennessee Study Objective: To examine the influence of body mass index (BMI) on follicle stimulating hormone (FSH) in a large cohort. Morbid obesity is an epidemic. This increasingly prevalent condition has effects on the hormonal milieu of patients. FSH is often measured in clinical settings to assess ovarian function. We hypothesize that FSH levels are influenced by an elevated BMI and the associated subsequent increased peripheral aromatization of androgens to estrogens. We use data from a large population to evaluate and quantify this interaction.
S162
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
Design: Retrospective cohort analysis. Setting: Department of Ob/Gyn, Vanderbilt University, Nashville, TN. Patients: Women greater than age 18 with a documented FSH, age, and BMI, all measured within a 24 month range. Data were obtained from synthetic derivative, a multi-source database of de-identified clinical and demographic data created by Vanderbilt University Medical Center. This resource contains information from all electronic clinical applications and includes 2.2 million unique individuals. Intervention: No intervention was necessary for the purpose of this retrospective study. Measurements and Main Results: A total of 17,933 encounters were identified with the required parameters of age, FSH, and BMI. These were categorized according to the National Institutes of Health BMI classification scheme. A scatter plot of FSH versus age for each BMI class was created.
Study Objective: Study of role of the combination genetic polymorphisms rs12444979, rs999460, rs2241423 and rs6732220 in formation of uterine hyperplastic processes. Design: Prospective cohort study. Setting: Perinatal center St. Joasaph Belgorod Regional Clinic Hospital. Patients: The research group consisted of 1873 women between 2010 and 2013, of which 908 uterine hyperplastic processes patients and 965 persons of the control group. Main group and control group included Russian women who were native of Central Region of Russia and who were not relatives to each other. Patients with uterine hyperplastic processes were provided with clinical and gynecological examination, ultrasound investigation if pelvic floor, hysteroscopy with further target diagnostic curettage and scrape hystologic study. Intervention: Typing of single nucleotide polymorphism of the following genes was performed for patients with uterine hyperplastic processes women from control group: rs12444979, rs999460, rs2241423 and rs6732220. Analysis of roles of combinations of genetic variants in occurrence of uterine hyperplastic processes was performed with the help of APSampler software. Measurements and Main Results: It has been discovered that combination of genetic variants C rs12444979 with A rs999460 with G rs2241423 and G rs6732220 occur in 19.65% of sick women, respectively, which is 1.4 times lower than that occur in control group (26.63%, p=0.0002, Pperm=1.6*10-6). When there are these combination of polymorphic markers, pathology risk of uterine hyperplastic processes is significantly lower (OR=0.67, CI 0.54-0.84). Conclusion: Protective meaning at formation of proliferative uterine processes belongs to combination alleles of C rs12444979 with A rs999460 with G rs2241423 and G rs6732220 (OR=0.67).
588 Minimally Invasive Fellowship Training and Effect on Operative Mortality Walsh TM, Guan X. Ob/Gyn, Baylor College of Medicine, Houston, Texas A linear prediction plot was applied over each graph.
Conclusion: There is a tendency for FSH to decrease as BMI increases. This variation may have implications for many clinical entities, including menopause or ovarian remnant syndrome, and make diagnosis more challenging in the obese population. 587 Correlation of Genetic Polymorphisms With Development of Uterus Hyperplastic Processes in Women of Russia’s Central Region Krivoshei I, Churnosov M. Medical Biological Disciplines, Belgorod State University, Belgorod, Belgorod Region, Russian Federation
Study Objective: To examine if there is a relationship between minimally invasive surgical fellowship and surgical mortality. Design: Retrospective cohort study. Setting: Academic tertiary care hospital. Patients: All patients undergoing laparoscopic hysterectomy for benign indications at a single institution between July 1, 2011 until June 30, 2013. Measurements and Main Results: The statistics are currently being performed, so the results are preliminary. A total of 363 benign hysterectomies were identified, of which a fellowship trained minimally invasive surgeon (MIS) performed 213 cases (58.7%) and the OB/Gyn generalist division performed 150 cases (41.3%). The average EBL was 185.4 ml in the MIS group and 263.0 ml in the generalist group. The average hospital stay was 1.3 days in the MIS group and 1.5 days in the generalist group. The surgical time was 173.0 minutes in the MIS group, and 203 minutes in the generalist group. Complications were divided into intraoperative and postoperative complications. There were 53 intraoperative complications in the generalist group including: 26 conversions to open (49%), 10 intraoperative consultations (19%), 5 bladder injuries (9.4%), 4 blood transfusions (7.5%), 3 bowel injuries (5.7%), 3 vaginal lacerations (5.7%), and 2 failed entries (3.8%); there was no episodes of ureteral injury or other organ injuries. In the MIS group there were 32 intraoperative complications including: 12 cases of intraoperative consultations (37.5%), 10 blood transfusions (31.3%), 3 vaginal laceration (9.4%), 3 conversions to open (9.4%), 2 bowel injuries (6.3%), 1 injury to other organs (3.1%), 1 bladder injury (3.1%), there were no episodes of failed entry or ureteral injury. Postoperatively there were similar rates of complications in both groups. There were 16 in the MIS group and 17 in the generalist group; in both groups blood transfusion was the most common complication. Conclusion: While final statistics are pending, we hope to provide preliminary data on the benefits of MIS fellowship training.
S161
CLT (minutes) was significantly shorter during surgery compared to baseline and postsurgical determinations. PAP and F1+2 were statistically higher during surgery. The multivariate analysis of several thrombosis risk factors (Age, BMI, smoking habit, use of hormonal treatment, length of surgery, parity) showed neither association in PAP nor F1+2 in the three study points. Patients > 35 years and users of hormonal treatments presented with longer baseline CLT; patients > 35 years and smokers had longer CLT during surgery; and patients > 35 years had longer postoperative CLT. Conclusion: Benign adnexal laparoscopy transitionally activates plasma fibrinolysis and coagulation parameters. Older patients, smokers and users of hormonal treatments present with longer CLT and thus, should be considered to have a high thromboembolic risk. 585 Does the Order of Surgical Method of Training Affect Learning and Skill? A Comparison of Laparoscopy and Robotics Galloway ML, Corbett JJ, Hill SD. Obstetrics & Gynecology, Wright State University, Boonshoft SOM, Dayton, Ohio Two years later, her twin sister, AMM-2, an 18-year-old G0, presented with a 7 day history of abdominal pain. Gonorrhea was found and treated. CT scan revealed a complex central pelvic mass, 7 x 13.1 x 10.3 cm, containing fat, soft tissue, fluid and areas of calcification. An IUD was in place, she was obese and had a history of anxiety. She underwent uncomplicated laparoscopic left ovarian cystectomy to remove a 15x10 cm smooth-walled mass anterior to the uterus containing a large volume of hair, scalp, and sebaceous material. The right ovary was enlarged consistent with polycystic ovarian syndrome and the clitoris was enlarged to 4 cm in length. Pathologic review confirmed a mature cystic teratoma. Her recovery was uncomplicated. Conclusion: Teratomas are the most common germ cell tumor of the ovary and are frequently encountered in young women. A familial tendency has been reported rarely. Although both of our patients were successfully treated with minimally invasive surgery, previous knowledge of familial association in this case might have led to earlier identification and treatment in AMM-2.
584 Risk Factors for Changes of Fibrinolysis During Benign Adnexal Laparoscopic Surgery assies D,2 Reverter JC,2 Balasch J,1 Martınez-Zamora M-A,1 T Carmona F.1 1Department of Gynecology. Hospital Clınic of Barcelona, Barcelona, Spain; 2Hemotherapy and Hemostasis Unit. Hospital Clınic of Barcelona, Barcelona, Spain Study Objective: Laparoscopic surgery appears to be less traumatic than open procedures but the risk of thrombosis after laparoscopic surgery is not well known. Several studies have reported changes in coagulation and fibrinolysis with controversial results and no previous studies have analyzed these parameters in gynaecological procedures. We assessed changes of systemic fibrinolysis and coagulation in patients who underwent elective benign adnexal laparoscopic surgery and analyzed its changes according to different cardiovascular risk factors. Design: Observational time series study. Setting: Tertiary care university teaching hospital. Patients: 52 patients who underwent elective benign adnexal laparoscopic surgery (uni or bilateral cystectomy/adnexectomy). Intervention: Blood samples were drawn on admission (baseline), during surgery and on the first postoperative day (24 hours after surgery). Samples were evaluated for clot lysis time (CLT), plasmin-alpha 2-antiplasmin complex (PAP) levels and prothrombin fragment 1+2 (F1+2) antigen levels. Measurements and Main Results: No patient presented with thromboembolic events before or within the six months after surgery.
Study Objective: To evaluate if the order of surgical method training affects the rate at which trainees develop their related surgical skills. Design: We assembled nearly 30 medical students to be ‘‘novice’’ volunteer subjects. Subjects will be asked to fill out a short survey to evaluate their previous experience with laparoscopic and robotic surgery simulators and procedures. Subjects are randomly divided into two groups, A and B. All subjects will then participate practice in the assigned method and testing in both surgical methods. Setting: The Brethen Center for Robotics and Minimally Invasive Surgery is a simulation center that contains both low and high fidelity equipment necessary for this study. Patients: Volunteer subjects are gathered from the Wright State University Boonshoft School of Medicine. Intervention: The groups are randomly assigned to ‘‘practice sessions’’ in robotic or laparoscopic techniques using the DaVinci Si or LapSim simulators, with 1 hour practice requirement each week. Testing is performed in the assigned practice method prior to crossover testing in the unassigned method. Measurements and Main Results: Three FLS validated tasks: Peg transfer, Needle manipulation and Intracorporeal suturing were used to test participants. Individual test scores will be graphed against their own results over the three testing periods. The results for all subjects in group A are averaged for each testing session and surgical method (laparoscopic and robotic), as will all results for subjects in group B. Conclusion: This four week study of surgical novices showed improvement in task performance for both groups. Results have that prior laparoscopic exposure did not improve robotic performance and subjects performing robotic training scored almost equally as well as laparoscopic group. These results contradict current perception that robotic surgeons first need to be good laparoscopic surgeons. 586 Interaction of Follicle Stimulating Hormone (FSH) and Body Mass Index (BMI) in a Large Cohort Harvey LFB, Yunker A, Thomassee MS. Obstetrics and Gynecology, Minimally Invasive Surgery Division, Vanderbilt University Medical Center, Nashville, Tennessee Study Objective: To examine the influence of body mass index (BMI) on follicle stimulating hormone (FSH) in a large cohort. Morbid obesity is an epidemic. This increasingly prevalent condition has effects on the hormonal milieu of patients. FSH is often measured in clinical settings to assess ovarian function. We hypothesize that FSH levels are influenced by an elevated BMI and the associated subsequent increased peripheral aromatization of androgens to estrogens. We use data from a large population to evaluate and quantify this interaction.
S162
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
Design: Retrospective cohort analysis. Setting: Department of Ob/Gyn, Vanderbilt University, Nashville, TN. Patients: Women greater than age 18 with a documented FSH, age, and BMI, all measured within a 24 month range. Data were obtained from synthetic derivative, a multi-source database of de-identified clinical and demographic data created by Vanderbilt University Medical Center. This resource contains information from all electronic clinical applications and includes 2.2 million unique individuals. Intervention: No intervention was necessary for the purpose of this retrospective study. Measurements and Main Results: A total of 17,933 encounters were identified with the required parameters of age, FSH, and BMI. These were categorized according to the National Institutes of Health BMI classification scheme. A scatter plot of FSH versus age for each BMI class was created.
Study Objective: Study of role of the combination genetic polymorphisms rs12444979, rs999460, rs2241423 and rs6732220 in formation of uterine hyperplastic processes. Design: Prospective cohort study. Setting: Perinatal center St. Joasaph Belgorod Regional Clinic Hospital. Patients: The research group consisted of 1873 women between 2010 and 2013, of which 908 uterine hyperplastic processes patients and 965 persons of the control group. Main group and control group included Russian women who were native of Central Region of Russia and who were not relatives to each other. Patients with uterine hyperplastic processes were provided with clinical and gynecological examination, ultrasound investigation if pelvic floor, hysteroscopy with further target diagnostic curettage and scrape hystologic study. Intervention: Typing of single nucleotide polymorphism of the following genes was performed for patients with uterine hyperplastic processes women from control group: rs12444979, rs999460, rs2241423 and rs6732220. Analysis of roles of combinations of genetic variants in occurrence of uterine hyperplastic processes was performed with the help of APSampler software. Measurements and Main Results: It has been discovered that combination of genetic variants C rs12444979 with A rs999460 with G rs2241423 and G rs6732220 occur in 19.65% of sick women, respectively, which is 1.4 times lower than that occur in control group (26.63%, p=0.0002, Pperm=1.6*10-6). When there are these combination of polymorphic markers, pathology risk of uterine hyperplastic processes is significantly lower (OR=0.67, CI 0.54-0.84). Conclusion: Protective meaning at formation of proliferative uterine processes belongs to combination alleles of C rs12444979 with A rs999460 with G rs2241423 and G rs6732220 (OR=0.67).
588 Minimally Invasive Fellowship Training and Effect on Operative Mortality Walsh TM, Guan X. Ob/Gyn, Baylor College of Medicine, Houston, Texas A linear prediction plot was applied over each graph.
Conclusion: There is a tendency for FSH to decrease as BMI increases. This variation may have implications for many clinical entities, including menopause or ovarian remnant syndrome, and make diagnosis more challenging in the obese population. 587 Correlation of Genetic Polymorphisms With Development of Uterus Hyperplastic Processes in Women of Russia’s Central Region Krivoshei I, Churnosov M. Medical Biological Disciplines, Belgorod State University, Belgorod, Belgorod Region, Russian Federation
Study Objective: To examine if there is a relationship between minimally invasive surgical fellowship and surgical mortality. Design: Retrospective cohort study. Setting: Academic tertiary care hospital. Patients: All patients undergoing laparoscopic hysterectomy for benign indications at a single institution between July 1, 2011 until June 30, 2013. Measurements and Main Results: The statistics are currently being performed, so the results are preliminary. A total of 363 benign hysterectomies were identified, of which a fellowship trained minimally invasive surgeon (MIS) performed 213 cases (58.7%) and the OB/Gyn generalist division performed 150 cases (41.3%). The average EBL was 185.4 ml in the MIS group and 263.0 ml in the generalist group. The average hospital stay was 1.3 days in the MIS group and 1.5 days in the generalist group. The surgical time was 173.0 minutes in the MIS group, and 203 minutes in the generalist group. Complications were divided into intraoperative and postoperative complications. There were 53 intraoperative complications in the generalist group including: 26 conversions to open (49%), 10 intraoperative consultations (19%), 5 bladder injuries (9.4%), 4 blood transfusions (7.5%), 3 bowel injuries (5.7%), 3 vaginal lacerations (5.7%), and 2 failed entries (3.8%); there was no episodes of ureteral injury or other organ injuries. In the MIS group there were 32 intraoperative complications including: 12 cases of intraoperative consultations (37.5%), 10 blood transfusions (31.3%), 3 vaginal laceration (9.4%), 3 conversions to open (9.4%), 2 bowel injuries (6.3%), 1 injury to other organs (3.1%), 1 bladder injury (3.1%), there were no episodes of failed entry or ureteral injury. Postoperatively there were similar rates of complications in both groups. There were 16 in the MIS group and 17 in the generalist group; in both groups blood transfusion was the most common complication. Conclusion: While final statistics are pending, we hope to provide preliminary data on the benefits of MIS fellowship training.