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Intraoperative autotransfusion in laparoscopic surgery for tubal pregnancy
August 2001, Vol. 8, No. 3 Supplement TheJournal of the American Association of Gynecologic Laparoscopists
800 ml glycine. All 13 patients were alive and tumor free clinically 1 to 8 years later. Conclusion. Hysteroscopic-directed biopsy is the ultimate diagnostic tool for endometrial malignancy. Skillful resection may be an alternative treatment in selected women with early carcinoma.
due to unmptured tubal pregnancy. Approximately 800 ml aspirated blood was injected into the patient. Hemoglobin increased to 9.6 g/dl after operation and she was discharged on postoperative day 5. Conclusion. Autotransfusion was successful in increasing the hemoglobin in a woman with unmptured tubal pregnancy.
248. Hysteroscopic Diagnosis of Adenomyosis 1A Wang, 1F Barrueto, 2JM Cooper, 1M Furlong. 1University of Maryland Medical Systems, Baltimore, Maryland; 2University of Arizona, Tucson, Arizona.
250. Fertiloscopy versus Laparoscopy 1A Watrelot, 2C Racinet. 1CRES,Lyon, France; 2University of Grenogue, France.
Objective. To evaluate the diagnosis of adenomyosis by a characteristic diverticular appearance of the endometrial cavity on hysteroscopy. Measurements and Main Results. Women with menorrhagia who had completed childbearing had hysteroscopic endometrial resection with a 27F operative hysteroscope, followed by rollerball ablation. Patients with a history of menorrhagia were evaluated by hysteroscopy. The presence or absence of a characteristic diverticular appearance was noted. The endometrial cavity was fully resected with loop electrocoagulation, followed by rollerball ablation. All specimens were examined by the same pathologist. The diverticular appearance had sensitivity, specificity, positive predictive value, and negative predictive value for adenomyosis of 87%, 54%, 57%, and 88%, respectively. Conclusion. Diverticular appearance of endometrium visualized by hysteroscopy has a high sensitivity for adenomyosis. Lack of such a finding has a high negative predictive value.
Objective. To evaluate diagnostic fertiloscopy compared with laparoscopy in infertile women. Measurements and Main Results. At 14 university hospitals, 2 surgeons were randomized to perform either fertiloscopy or laparoscopy in a blind method in 108 women. Each procedure was videorecorded and reviewed by two independent coordinators, according to French law to protect patients' rights. It was possible to use 88% of the reports. Fertiloscopy had sensitivity of 90% and specificity of 81%, including 9% where it was more informative than laparoscopy. The prevalence of lesions was of 74%. Concordance rate (including minor differences without clinical importance) was 98.5%. Conclusion. Fertiloscopy appears to be a good alternative to laparoscopy. Moreover, it allows the surgeon to perform salpingoscopy, which was not evaluated in this trial.
251. Should a Very Large Uterus be Considered a Contraindication to Total Laparoscopic Hysterectomy?
249. Intraoperative Autotransfusion in Laparoscopic Surgery for Tubal Pregnancy S Watanabe, M Morita, I Uchiide, M Nakakuma, T Maemura, H Kubo. Toho University School of Medicine, Tokyo,Japan.
1A Wattiez, 2D Soriano, 2SB Cohen, 1A Fiaccavento, 1M Canis, 1R Botchorishvili, 1JL Pouly, 1G Mage, 1MA Bruhat. 1Polyclinic de L'HoteI-Dieu CHU, Clermont-Ferrand, France; 2Sheba Medical Center, Haifa, Israel.
Objective. To describe intraoperative authotransfusion during laparoscopic treatment of tubal pregnancy. Measurements and Main Results. Autotransfusion at laparoscopy for tubal pregnancy is safer than using banked blood because it avoids anxiety regarding immunologic response and sterility of hemoperitoneum. A 28-yeax-old, gravida 2, para 2 woman had low abdominal pain. Heavy hemoperitoneum was seen on TVUS, and hemoglobin was 6.7 g/dl. At laparoscopic surgery about 1500 ml ofhemoperitoneum was present
Objective. To evaluate short-term outcome of TLH in women with a very large uterus compared with women with a smaller uterus. Measurements and Main Results. Subjects were 34 patients with a very large uterus (>500 g) who underwent TLH for benign pathology and 68 women (controls) with a mildly large uterus (<300 g). Matching was based on patients' age + 2 years, surgeons' experience, and additional surgical procedures if they were
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800 ml glycine. All 13 patients were alive and tumor free clinically 1 to 8 years later. Conclusion. Hysteroscopic-directed biopsy is the ultimate diagnostic tool for endometrial malignancy. Skillful resection may be an alternative treatment in selected women with early carcinoma.
due to unmptured tubal pregnancy. Approximately 800 ml aspirated blood was injected into the patient. Hemoglobin increased to 9.6 g/dl after operation and she was discharged on postoperative day 5. Conclusion. Autotransfusion was successful in increasing the hemoglobin in a woman with unmptured tubal pregnancy.
248. Hysteroscopic Diagnosis of Adenomyosis 1A Wang, 1F Barrueto, 2JM Cooper, 1M Furlong. 1University of Maryland Medical Systems, Baltimore, Maryland; 2University of Arizona, Tucson, Arizona.
250. Fertiloscopy versus Laparoscopy 1A Watrelot, 2C Racinet. 1CRES,Lyon, France; 2University of Grenogue, France.
Objective. To evaluate the diagnosis of adenomyosis by a characteristic diverticular appearance of the endometrial cavity on hysteroscopy. Measurements and Main Results. Women with menorrhagia who had completed childbearing had hysteroscopic endometrial resection with a 27F operative hysteroscope, followed by rollerball ablation. Patients with a history of menorrhagia were evaluated by hysteroscopy. The presence or absence of a characteristic diverticular appearance was noted. The endometrial cavity was fully resected with loop electrocoagulation, followed by rollerball ablation. All specimens were examined by the same pathologist. The diverticular appearance had sensitivity, specificity, positive predictive value, and negative predictive value for adenomyosis of 87%, 54%, 57%, and 88%, respectively. Conclusion. Diverticular appearance of endometrium visualized by hysteroscopy has a high sensitivity for adenomyosis. Lack of such a finding has a high negative predictive value.
Objective. To evaluate diagnostic fertiloscopy compared with laparoscopy in infertile women. Measurements and Main Results. At 14 university hospitals, 2 surgeons were randomized to perform either fertiloscopy or laparoscopy in a blind method in 108 women. Each procedure was videorecorded and reviewed by two independent coordinators, according to French law to protect patients' rights. It was possible to use 88% of the reports. Fertiloscopy had sensitivity of 90% and specificity of 81%, including 9% where it was more informative than laparoscopy. The prevalence of lesions was of 74%. Concordance rate (including minor differences without clinical importance) was 98.5%. Conclusion. Fertiloscopy appears to be a good alternative to laparoscopy. Moreover, it allows the surgeon to perform salpingoscopy, which was not evaluated in this trial.
251. Should a Very Large Uterus be Considered a Contraindication to Total Laparoscopic Hysterectomy?
249. Intraoperative Autotransfusion in Laparoscopic Surgery for Tubal Pregnancy S Watanabe, M Morita, I Uchiide, M Nakakuma, T Maemura, H Kubo. Toho University School of Medicine, Tokyo,Japan.
1A Wattiez, 2D Soriano, 2SB Cohen, 1A Fiaccavento, 1M Canis, 1R Botchorishvili, 1JL Pouly, 1G Mage, 1MA Bruhat. 1Polyclinic de L'HoteI-Dieu CHU, Clermont-Ferrand, France; 2Sheba Medical Center, Haifa, Israel.
Objective. To describe intraoperative authotransfusion during laparoscopic treatment of tubal pregnancy. Measurements and Main Results. Autotransfusion at laparoscopy for tubal pregnancy is safer than using banked blood because it avoids anxiety regarding immunologic response and sterility of hemoperitoneum. A 28-yeax-old, gravida 2, para 2 woman had low abdominal pain. Heavy hemoperitoneum was seen on TVUS, and hemoglobin was 6.7 g/dl. At laparoscopic surgery about 1500 ml ofhemoperitoneum was present
Objective. To evaluate short-term outcome of TLH in women with a very large uterus compared with women with a smaller uterus. Measurements and Main Results. Subjects were 34 patients with a very large uterus (>500 g) who underwent TLH for benign pathology and 68 women (controls) with a mildly large uterus (<300 g). Matching was based on patients' age + 2 years, surgeons' experience, and additional surgical procedures if they were
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