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Laparoscopic management of suspicious adnexal masses
August 1994, Vol. 1, No. 4, Part 2
The Journal of the American Association of Gynecologic Laparoscopists
ed to limit adhesion formation after laparoscopic and open surgical procedures. We tested the effectiveness of HAL T M gels in a rat sidewall defect model. In 50 adult female rats a 1 cm x 1 cm peritoneal defect was made along the abdominal wall. The defect was enclosed with #3-0 silk suture to induce ischemia. The animals were randomized to gel treatment (0.5 ml placed on defect) or non-treatment control groups. Seven days after surgery the extent (0-4 scale) and severity (0-3 scale) of adhesions were scored.
ing, including the assessment of the upper abdomen, was begun laparoscopicaUy. When a cancer was managed l a p a r o s c o p i c a l l y , an early s e c o n d look laparoscopy was performed routinely. Since m a n y l a p a r o t o m i e s may be a v o i d e d , laparoscopic surgery is promising in the management of suspicious adnexal masses. However, from two cases of tumor dissemination, we conclude that this m a n a g e m e n t should follow strict guidelines and needs to be further evaluated.
Treatment Group
Adenomyosis as a Major Cause for LaparoscopicAssisted Vaginal Hysterectomy for Chronic Pelvic Pain
N Extent
Severity Total Score
No. Of Animals w/No
Adhesions Control 20 2.1_+0.3 1.7_+0.2 3.8_+0.5 4/20(20%) HALTMgel 30 0.5_+0.1a 0.7_+0.2a 1.2_+0.3" 20/30(67%) b
qE Carter, 21Kong. 1Department of Ob/Gyn, University of California College of Medicine, Irvine, CA; 2Women's Health Center of South Orange County, Inc., Mission Viejo, CA.
*Adhesions were scored without knowledge of group assignment; ap<0.001 Mann Whitney test; bp<0.005 Chi Square analysis.
Ninety-three women in whom conservative surgical therapy for chronic pelvic pain failed required hysterectomy for control of their disabling condition. In 22 of these 93 patients (24%), adenomyosis was the major pathologic finding. In 10 of the 22 (45%) women who had adenomyosis and required hysterectomy for control of their pain, tubal ligation had been previously performed. Only 15% (11/71) of patients without adenomyosis had had a tubal ligation. Over 23% of patients requiring hysterectomy for control of chronic severe pelvic pain had adenomyosis, and almost half of these women had had a tubal ligation performed. The possible relationship of adenomyosis to a previous tubal ligation has been explored.
H A L T M gel significantly reduced the extent and severity of sidewall adhesions. Moreover, the number of animals with no a d h e s i o n s was significantly increased c o m p a r e d with n o n - t r e a t m e n t . These results indicate that H A L T M gel, which is easily applied to tissue and organs, may be a useful adjuvant for adhesion prevention in open and laparoscopic surgical procedures. The effectiveness and safety of HAL T M gels will be tested in human clinical studies.
Laparoscopic Management of Suspicious Adnexal Masses M Canis, G Mage, JL Pouly, A Wattiez, E Glowaczower, J Raiga, MA Bruhat. Polyclinique de I'HoteI-Dieu C.H.R.U., Clermont, Ferrand, France.
Laparoscopic Treatment for Chronic Pelvic Pain: Results from Three-Year Follow-up
After our initial experience with 757 patients, we have extended our indications for laparoscopy to suspicious adnexal masses. Twenty of 29 ovarian cancers surgically treated since December 1991 were first evaluated by laparoscopy. In all, 321 patients were evaluated by laparoscopy in 1992 and 1993, including 145 women with an ultrasonographically suspicious mass (45.7%). At laparoscopy, 52 masses were diagnosed as suspicious, including 20 cases of malignant ovarian tumors. Sixteen patients were treated by laparotomy (5%), including 11 women with cancer, 2 with teratomas diagnosed as suspicious, and 3 with benign masses that could not be treated endoscopically (0.9%). In cancer treated by laparotomy, stag-
JE Carter. Department of Ob/Gyn, University of California, Irvine, College of Medicine, Irvine, CA. One hundred patients were treated with laparoscopic techniques for chronic pelvic pain. These procedures included uterosacral nerve vaporization, resection and vaporization of endometriosis, hernia repair, appendectomy, presacral neurectomy, and ovarian surgery. Follow-up over a 3 year period revealed the following results. Women with significant e n d o m e t r i o s i s had a 75% cure rate with a change in quality of life index from a preoperative level of pain of 8 to a postoperative level of pain of 2. A Score of 1 is no pain and 10 is maximum pain.
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The Journal of the American Association of Gynecologic Laparoscopists
ed to limit adhesion formation after laparoscopic and open surgical procedures. We tested the effectiveness of HAL T M gels in a rat sidewall defect model. In 50 adult female rats a 1 cm x 1 cm peritoneal defect was made along the abdominal wall. The defect was enclosed with #3-0 silk suture to induce ischemia. The animals were randomized to gel treatment (0.5 ml placed on defect) or non-treatment control groups. Seven days after surgery the extent (0-4 scale) and severity (0-3 scale) of adhesions were scored.
ing, including the assessment of the upper abdomen, was begun laparoscopicaUy. When a cancer was managed l a p a r o s c o p i c a l l y , an early s e c o n d look laparoscopy was performed routinely. Since m a n y l a p a r o t o m i e s may be a v o i d e d , laparoscopic surgery is promising in the management of suspicious adnexal masses. However, from two cases of tumor dissemination, we conclude that this m a n a g e m e n t should follow strict guidelines and needs to be further evaluated.
Treatment Group
Adenomyosis as a Major Cause for LaparoscopicAssisted Vaginal Hysterectomy for Chronic Pelvic Pain
N Extent
Severity Total Score
No. Of Animals w/No
Adhesions Control 20 2.1_+0.3 1.7_+0.2 3.8_+0.5 4/20(20%) HALTMgel 30 0.5_+0.1a 0.7_+0.2a 1.2_+0.3" 20/30(67%) b
qE Carter, 21Kong. 1Department of Ob/Gyn, University of California College of Medicine, Irvine, CA; 2Women's Health Center of South Orange County, Inc., Mission Viejo, CA.
*Adhesions were scored without knowledge of group assignment; ap<0.001 Mann Whitney test; bp<0.005 Chi Square analysis.
Ninety-three women in whom conservative surgical therapy for chronic pelvic pain failed required hysterectomy for control of their disabling condition. In 22 of these 93 patients (24%), adenomyosis was the major pathologic finding. In 10 of the 22 (45%) women who had adenomyosis and required hysterectomy for control of their pain, tubal ligation had been previously performed. Only 15% (11/71) of patients without adenomyosis had had a tubal ligation. Over 23% of patients requiring hysterectomy for control of chronic severe pelvic pain had adenomyosis, and almost half of these women had had a tubal ligation performed. The possible relationship of adenomyosis to a previous tubal ligation has been explored.
H A L T M gel significantly reduced the extent and severity of sidewall adhesions. Moreover, the number of animals with no a d h e s i o n s was significantly increased c o m p a r e d with n o n - t r e a t m e n t . These results indicate that H A L T M gel, which is easily applied to tissue and organs, may be a useful adjuvant for adhesion prevention in open and laparoscopic surgical procedures. The effectiveness and safety of HAL T M gels will be tested in human clinical studies.
Laparoscopic Management of Suspicious Adnexal Masses M Canis, G Mage, JL Pouly, A Wattiez, E Glowaczower, J Raiga, MA Bruhat. Polyclinique de I'HoteI-Dieu C.H.R.U., Clermont, Ferrand, France.
Laparoscopic Treatment for Chronic Pelvic Pain: Results from Three-Year Follow-up
After our initial experience with 757 patients, we have extended our indications for laparoscopy to suspicious adnexal masses. Twenty of 29 ovarian cancers surgically treated since December 1991 were first evaluated by laparoscopy. In all, 321 patients were evaluated by laparoscopy in 1992 and 1993, including 145 women with an ultrasonographically suspicious mass (45.7%). At laparoscopy, 52 masses were diagnosed as suspicious, including 20 cases of malignant ovarian tumors. Sixteen patients were treated by laparotomy (5%), including 11 women with cancer, 2 with teratomas diagnosed as suspicious, and 3 with benign masses that could not be treated endoscopically (0.9%). In cancer treated by laparotomy, stag-
JE Carter. Department of Ob/Gyn, University of California, Irvine, College of Medicine, Irvine, CA. One hundred patients were treated with laparoscopic techniques for chronic pelvic pain. These procedures included uterosacral nerve vaporization, resection and vaporization of endometriosis, hernia repair, appendectomy, presacral neurectomy, and ovarian surgery. Follow-up over a 3 year period revealed the following results. Women with significant e n d o m e t r i o s i s had a 75% cure rate with a change in quality of life index from a preoperative level of pain of 8 to a postoperative level of pain of 2. A Score of 1 is no pain and 10 is maximum pain.
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