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Is There an Indication for Laparoscopic Trans Abdominal Cerclage?
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S1eS51
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respectively (p ! .001). Reproductive outcomes were analyzed for 45 patients, after excluding non-relevant cases (N 5 54), patients who did not wish to conceive (N 5 41), and cases without follow up (N 5 42). The rates of either spontaneous/ovulation induced pregnancies were similar for both groups (82.7% and 100%, respectively, p 5 0.08). Five patients (all of the non-intraoperative spillage group) were infertile or conceived by in-vitro fertilization. Conclusion: Intraoperative rupture of benign cystic teratoma is not associated with long term infertility. However, attempt to remove the cysts without spillage is recommended. 168
Open Communications 9dLaparoscopic Surgeries (12:17 PM d 12:22 PM)
Is There an Indication for Laparoscopic Trans Abdominal Cerclage? Charles L.1,2,3,4 1Palms West Surgicenter, Loxahatchee, FL; 2Gynecology, Wellington Regional Medical Center, Wellington, FL; 3Ob/Gyn, Palms West Hospital, Loxahatchee, FL; 4OB/GYN, St Mary’s Medical Center, West Palm Beach, FL uterus in 13 patients. Ten of the 13 patients had prior abdominal surgery. Eight patients had prior morcellation procedures; six performed laparoscopically, two performed by laparotomy. Three patients had multiple parasitic myomas, all of whom had a history of laparoscopic myomectomy with morcellation. The majority (13/17) of myomas were found in the pelvis including two retroperitoneal myomas, and one embedded in the bladder. 8/17 myomas were found along the gastrointestinal tract, and 3/17 were found in the upper abdomen. Conclusion: Parasitic myomas may occur spontaneously as pedunculated subserosal myomas lose their uterine blood supply and parasitize to other organs. However, this series supports what the literature has suggested; more parasitic myomas may be iatrogenically created after prior surgery, particularly surgery using morcellation techniques. With increasing rates of laparoscopic procedures, surgeons should be aware of the potential for iatrogenic parasitic myoma formation, their likely increasing frequency, and intraoperative precautions to minimize occurrence. 167
Open Communications 9dLaparoscopic Surgeries (12:11 PM d 12:16 PM)
Intraoperative Rupture of Benign Cystic Teratoma Is Not Associated with Long Term Infertility Smorgick N, Moskovitch M, Shade D, Ben Ami I, Halperin R, Pansky M. Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Israel Study Objective: Benign cystic teratoma is the most common benign ovarian germ cell tumor. Intraoperative rupture with spillage of the cyst’s irritative content was previously believed to cause a peritoneal inflammatory reaction, possibly leading to chemical peritonitis and mechanical infertility. However, long term data on reproductive outcome following the operation is lacking. The aim of this study was to compare long term reproductive outcomes of women who underwent laparoscopic removal of benign cystic teratoma with and without intraoperative spillage. Design: Retrospective review of cases of benign cystic teratoma removed by laparoscopy in our institution from 1997 to 2007. Occurrence of intraoperative spillage was recorded in the operative report. Copious lavage of the peritoneal cavity was used in cases of spillage. Long term reproductive outcomes of relevant cases (i.e. !40 years at time of surgery, without tubal sterilization) were obtained by telephone interview and by review of patients’ medical records. Setting: Gynecologic endoscopic unit in a university hospital. Patients: One-hundred eighty two patients. Intervention: Laparoscopic removal of benign cystic teratoma and evaluation for subsequent reproductive outcomes. Measurements and Main Results: 182 patients underwent removal of benign cystic teratoma by cystectomy (N 5 125, 68.7%) or adnexectomy (N 5 57, 31.3%). Intraoperative spillage rates were 36% and 7%,
Study Objective: Assess the limitations and benefits of Laparoscopic Cervico Ismique Cerclage in the treatment of Incompetent Cervical Os. Design: Thirty one (31) patients underwent Laparoscopic Trans Abdominal Cerclage during and before pregnancy. The patients were selected after multiple pregnancy loss (3e4) and failed Transvaginal Cerclage (1e3).One Tevdek #9 was used mdian to the uterine vessels at the level of the cervico ismique segment of the uterus in all patients. Setting: Patients were admitted for outpatient surgery in the hospital setting. However, based on special circumstances many were performed in the surgical center setting. Patients: Twenty six (26) patients underwent Laparoscopic Trans Abdominal Cerclage before pregnancy. Five were performed during pregnancy (12e14 weeks gestation). Surgical time went from 25 to 75 minutes. Blood loss averaged 10e25 cc. All patients were followed with serial ultrasounds for cervical length that remained constant between 3.5 and 5.7 cm. Four patients are still contimplating pregnancy. Five patients could not be reached for further followup. One patient had a miscarriage at 10 weeks gestation. Intervention: Of special interest three patients are to be noted with their successful outcomes. 1) surgery performed at 14 weeks with some variation of the technique. 2) Patient delivered at term twin gestation after prepregnancy cerclage and IVF. 3) Patient underwent trachelectomy at 17 years of age due to endocervical Mullerian Sarcoma. Measurements and Main Results: All patients carried their pregnancy to term and delivered by cesarean section. Conclusion: Laparoscopic TransAbdominal Cerclage during pregnancy and the Interval Cerclage are proven successfull when all hope of pregnancy vanishes with failed Trans Vaginal Cerclage. The procedure is safe with minimal blood loss when considering open Abdominal Cerclage. 169
Open Communications 9dLaparoscopic Surgeries (12:23 PM d 12:28 PM)
Myomectomies Performed by Open, Laparoscopic and Hysteroscopic Methods: Perioperative Predictors of Intraoperative Blood Loss Petrozza JC,1 Lukasova T,1 Meeker J.2 1Obstetrics and Gynecology; Division of Reproductive Medicine & IVF, Massachusetts General Hospital, Boston, MA; 2University of Michigan School of Public Health Study Objective: To determine what variables are associated with an increase in intraoperative blood loss during open, laparoscopic, or hysteroscopic myomectomy. Design: Retrospective chart review. Setting: Tertiary hospital in an urban setting. Patients: The medical records of 167 patients referred to the Division of Reproductive Medicine & IVF bewteen 2001 and 2006 were evaluated. The age range was 20e50 years of age and indications for the surgery included menorrhagia, pain, infertility, and recurrent pregnancy loss. Intervention: For open cases, a pfannensteil or vertical incision was made. For laparoscopic cases a total of 3e4 trocar sites were placed. In both of
S49
respectively (p ! .001). Reproductive outcomes were analyzed for 45 patients, after excluding non-relevant cases (N 5 54), patients who did not wish to conceive (N 5 41), and cases without follow up (N 5 42). The rates of either spontaneous/ovulation induced pregnancies were similar for both groups (82.7% and 100%, respectively, p 5 0.08). Five patients (all of the non-intraoperative spillage group) were infertile or conceived by in-vitro fertilization. Conclusion: Intraoperative rupture of benign cystic teratoma is not associated with long term infertility. However, attempt to remove the cysts without spillage is recommended. 168
Open Communications 9dLaparoscopic Surgeries (12:17 PM d 12:22 PM)
Is There an Indication for Laparoscopic Trans Abdominal Cerclage? Charles L.1,2,3,4 1Palms West Surgicenter, Loxahatchee, FL; 2Gynecology, Wellington Regional Medical Center, Wellington, FL; 3Ob/Gyn, Palms West Hospital, Loxahatchee, FL; 4OB/GYN, St Mary’s Medical Center, West Palm Beach, FL uterus in 13 patients. Ten of the 13 patients had prior abdominal surgery. Eight patients had prior morcellation procedures; six performed laparoscopically, two performed by laparotomy. Three patients had multiple parasitic myomas, all of whom had a history of laparoscopic myomectomy with morcellation. The majority (13/17) of myomas were found in the pelvis including two retroperitoneal myomas, and one embedded in the bladder. 8/17 myomas were found along the gastrointestinal tract, and 3/17 were found in the upper abdomen. Conclusion: Parasitic myomas may occur spontaneously as pedunculated subserosal myomas lose their uterine blood supply and parasitize to other organs. However, this series supports what the literature has suggested; more parasitic myomas may be iatrogenically created after prior surgery, particularly surgery using morcellation techniques. With increasing rates of laparoscopic procedures, surgeons should be aware of the potential for iatrogenic parasitic myoma formation, their likely increasing frequency, and intraoperative precautions to minimize occurrence. 167
Open Communications 9dLaparoscopic Surgeries (12:11 PM d 12:16 PM)
Intraoperative Rupture of Benign Cystic Teratoma Is Not Associated with Long Term Infertility Smorgick N, Moskovitch M, Shade D, Ben Ami I, Halperin R, Pansky M. Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Israel Study Objective: Benign cystic teratoma is the most common benign ovarian germ cell tumor. Intraoperative rupture with spillage of the cyst’s irritative content was previously believed to cause a peritoneal inflammatory reaction, possibly leading to chemical peritonitis and mechanical infertility. However, long term data on reproductive outcome following the operation is lacking. The aim of this study was to compare long term reproductive outcomes of women who underwent laparoscopic removal of benign cystic teratoma with and without intraoperative spillage. Design: Retrospective review of cases of benign cystic teratoma removed by laparoscopy in our institution from 1997 to 2007. Occurrence of intraoperative spillage was recorded in the operative report. Copious lavage of the peritoneal cavity was used in cases of spillage. Long term reproductive outcomes of relevant cases (i.e. !40 years at time of surgery, without tubal sterilization) were obtained by telephone interview and by review of patients’ medical records. Setting: Gynecologic endoscopic unit in a university hospital. Patients: One-hundred eighty two patients. Intervention: Laparoscopic removal of benign cystic teratoma and evaluation for subsequent reproductive outcomes. Measurements and Main Results: 182 patients underwent removal of benign cystic teratoma by cystectomy (N 5 125, 68.7%) or adnexectomy (N 5 57, 31.3%). Intraoperative spillage rates were 36% and 7%,
Study Objective: Assess the limitations and benefits of Laparoscopic Cervico Ismique Cerclage in the treatment of Incompetent Cervical Os. Design: Thirty one (31) patients underwent Laparoscopic Trans Abdominal Cerclage during and before pregnancy. The patients were selected after multiple pregnancy loss (3e4) and failed Transvaginal Cerclage (1e3).One Tevdek #9 was used mdian to the uterine vessels at the level of the cervico ismique segment of the uterus in all patients. Setting: Patients were admitted for outpatient surgery in the hospital setting. However, based on special circumstances many were performed in the surgical center setting. Patients: Twenty six (26) patients underwent Laparoscopic Trans Abdominal Cerclage before pregnancy. Five were performed during pregnancy (12e14 weeks gestation). Surgical time went from 25 to 75 minutes. Blood loss averaged 10e25 cc. All patients were followed with serial ultrasounds for cervical length that remained constant between 3.5 and 5.7 cm. Four patients are still contimplating pregnancy. Five patients could not be reached for further followup. One patient had a miscarriage at 10 weeks gestation. Intervention: Of special interest three patients are to be noted with their successful outcomes. 1) surgery performed at 14 weeks with some variation of the technique. 2) Patient delivered at term twin gestation after prepregnancy cerclage and IVF. 3) Patient underwent trachelectomy at 17 years of age due to endocervical Mullerian Sarcoma. Measurements and Main Results: All patients carried their pregnancy to term and delivered by cesarean section. Conclusion: Laparoscopic TransAbdominal Cerclage during pregnancy and the Interval Cerclage are proven successfull when all hope of pregnancy vanishes with failed Trans Vaginal Cerclage. The procedure is safe with minimal blood loss when considering open Abdominal Cerclage. 169
Open Communications 9dLaparoscopic Surgeries (12:23 PM d 12:28 PM)
Myomectomies Performed by Open, Laparoscopic and Hysteroscopic Methods: Perioperative Predictors of Intraoperative Blood Loss Petrozza JC,1 Lukasova T,1 Meeker J.2 1Obstetrics and Gynecology; Division of Reproductive Medicine & IVF, Massachusetts General Hospital, Boston, MA; 2University of Michigan School of Public Health Study Objective: To determine what variables are associated with an increase in intraoperative blood loss during open, laparoscopic, or hysteroscopic myomectomy. Design: Retrospective chart review. Setting: Tertiary hospital in an urban setting. Patients: The medical records of 167 patients referred to the Division of Reproductive Medicine & IVF bewteen 2001 and 2006 were evaluated. The age range was 20e50 years of age and indications for the surgery included menorrhagia, pain, infertility, and recurrent pregnancy loss. Intervention: For open cases, a pfannensteil or vertical incision was made. For laparoscopic cases a total of 3e4 trocar sites were placed. In both of