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Laparoscopic myomectomy: Is there a place for preventive uterine artery occlusion?
Abstracts
48. Laparoscopic Myomectomy: Is there a Place for Preventive Uterine Artery Occlusion?
adhesiolysis, myomectomy, hydrotubation, salpingostomy, and oophorectomy were also performed. Seven cases of incomplete uterine perforation and three of uterine perforation were found by laparoscopy during hysteroscopic procedures and treated laparoscopically. No complications were caused by hysteroscopy combined with laparoscopy. Conclusion. Hysteroscopy combined with laparoscopy can be performed under one anesthesia and manage lesions in both uterine and pelvic cavities that could not be treated previously with single hysteroscopy or laparoscopy. With laparoscopic monitoring, hysteroscopy can identify and treat uterine perforation in timely fashion and reduce complications.
JB Dubuisson, C Chapron. Clinique Universitaire Cochen, Paris, France.
Objective. To report our experience in associating preventive uterine arteries occlusion (PUAO) with laparoscopic myomectomy (LM). Measurements and Main Results. Two groups of 27 patients underwent LM, one with PUAO (group 1) and the other one without PUAO (group 2). Four criteria were established for comparison: number of removed myomas (2 + 1.6 in group 1, 1.9 + 1.2 in group 2, U test 0.89), size (73.6 + 25.4 and 71.1 + 27.6, U test 0.69), and type (p = 0.16) and location (p = 0.56) of the largest myoma. We performed LM with or without PUAO at their origins using titanium clips. Vasoconstrictive agents were not used. LM was successfully completed in all cases. No patient required transfusion. No major complications occurred. Mean preoperative and postoperative hemoglobin decreases were 2.2 + 1.6 and 2.3 + 1.7 g/dl in groups 1 and 2, respectively (U test 0.04); the drop was more than 3 g/dl in four patients in group 1 and in 8 in group 2. Mean operating times were 163.3 + 48.3 and 143.3 + 57.3 minutes, respectively (U test 0.16). Average hospital stay was 3 + 2.3 and 2.9 + 1.2 days, respectively (U test 0.64). Conclusion. We recommend PUAO in women with large vascularized myomas to facilitate myoma enucleation and myometrium suture.
47. Laparoscopic Lateral Suspension of the Vaginal Vault Combined with LAVH in Genital Prolapse 1JB Dubuisson, 1C Chapron, ~SJacob, ~A Fauconnier, 2V Gomel. 1Hopital Baudelocque, Paris, France; 2Vancouver General Hospital, Vancouver, Canada.
Objective. To report our experience with a new vaginal-assisted laparoscopic technique to treat genital prolapse and associated symptoms. Measurements and Main Results. Subjects were 39 women (mean age 55.7 + 10.15 yrs) with stages II and III symptomatic genital prolapse. All candidates for surgical treatment were included except those with contraindications for operative laparoscopy and general anesthesia. Laparoscopic lateral suspension was associated with a Butch procedure in 20 patients or TVT in 1 if GSUI was present, and with posterior colporrhaphy in 17. The procedure was successfully completed in all 39 patients without conversion to laparotomy. One major postoperative complication occurred (2.6%). This patient was readmitted on postoperative day 15 for obstruction of the left ureter and was treated with ureteral reimplantation. Anatomic results were good or excellent in 36 women. Relief of symptoms and improvement in quality of life were reported by 35 patients at the last follow-up. Operating time was the main disadvantage (200.6 + 41.5 min, range 120-300 min), but was shorter in later operations. Conclusion. The main advantage of this technique is the relative ease of its laparoscopic steps, making it accessible to gynecologic surgeons with moderate experience in operative laparoscopy.
49. Comparison of Bipolar Electrothermal Vessel Sealing and Cutting versus Traditional Bipolar Methods in LAVH JF Dulernba. Women's Center, Denton, Texas.
Objective. To compare bipolar electrothermal vessel sealing and cutting with traditional bipolar sealing and cutting in LAVH. Measurements and Main Results. Between June 1999 and March 2002, 50 patients underwent LAVH procedures using the bipolar electrothermal vessel sealer and cutter as the primary instrument for hemostasis (group 1). Estimated blood loss, procedure time, and postoperative complications were compared retrospectively with those measurements in a similar cohort of women who underwent LAVH with traditional bipolar hemostasis (group 2). Mean blood loss in the
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48. Laparoscopic Myomectomy: Is there a Place for Preventive Uterine Artery Occlusion?
adhesiolysis, myomectomy, hydrotubation, salpingostomy, and oophorectomy were also performed. Seven cases of incomplete uterine perforation and three of uterine perforation were found by laparoscopy during hysteroscopic procedures and treated laparoscopically. No complications were caused by hysteroscopy combined with laparoscopy. Conclusion. Hysteroscopy combined with laparoscopy can be performed under one anesthesia and manage lesions in both uterine and pelvic cavities that could not be treated previously with single hysteroscopy or laparoscopy. With laparoscopic monitoring, hysteroscopy can identify and treat uterine perforation in timely fashion and reduce complications.
JB Dubuisson, C Chapron. Clinique Universitaire Cochen, Paris, France.
Objective. To report our experience in associating preventive uterine arteries occlusion (PUAO) with laparoscopic myomectomy (LM). Measurements and Main Results. Two groups of 27 patients underwent LM, one with PUAO (group 1) and the other one without PUAO (group 2). Four criteria were established for comparison: number of removed myomas (2 + 1.6 in group 1, 1.9 + 1.2 in group 2, U test 0.89), size (73.6 + 25.4 and 71.1 + 27.6, U test 0.69), and type (p = 0.16) and location (p = 0.56) of the largest myoma. We performed LM with or without PUAO at their origins using titanium clips. Vasoconstrictive agents were not used. LM was successfully completed in all cases. No patient required transfusion. No major complications occurred. Mean preoperative and postoperative hemoglobin decreases were 2.2 + 1.6 and 2.3 + 1.7 g/dl in groups 1 and 2, respectively (U test 0.04); the drop was more than 3 g/dl in four patients in group 1 and in 8 in group 2. Mean operating times were 163.3 + 48.3 and 143.3 + 57.3 minutes, respectively (U test 0.16). Average hospital stay was 3 + 2.3 and 2.9 + 1.2 days, respectively (U test 0.64). Conclusion. We recommend PUAO in women with large vascularized myomas to facilitate myoma enucleation and myometrium suture.
47. Laparoscopic Lateral Suspension of the Vaginal Vault Combined with LAVH in Genital Prolapse 1JB Dubuisson, 1C Chapron, ~SJacob, ~A Fauconnier, 2V Gomel. 1Hopital Baudelocque, Paris, France; 2Vancouver General Hospital, Vancouver, Canada.
Objective. To report our experience with a new vaginal-assisted laparoscopic technique to treat genital prolapse and associated symptoms. Measurements and Main Results. Subjects were 39 women (mean age 55.7 + 10.15 yrs) with stages II and III symptomatic genital prolapse. All candidates for surgical treatment were included except those with contraindications for operative laparoscopy and general anesthesia. Laparoscopic lateral suspension was associated with a Butch procedure in 20 patients or TVT in 1 if GSUI was present, and with posterior colporrhaphy in 17. The procedure was successfully completed in all 39 patients without conversion to laparotomy. One major postoperative complication occurred (2.6%). This patient was readmitted on postoperative day 15 for obstruction of the left ureter and was treated with ureteral reimplantation. Anatomic results were good or excellent in 36 women. Relief of symptoms and improvement in quality of life were reported by 35 patients at the last follow-up. Operating time was the main disadvantage (200.6 + 41.5 min, range 120-300 min), but was shorter in later operations. Conclusion. The main advantage of this technique is the relative ease of its laparoscopic steps, making it accessible to gynecologic surgeons with moderate experience in operative laparoscopy.
49. Comparison of Bipolar Electrothermal Vessel Sealing and Cutting versus Traditional Bipolar Methods in LAVH JF Dulernba. Women's Center, Denton, Texas.
Objective. To compare bipolar electrothermal vessel sealing and cutting with traditional bipolar sealing and cutting in LAVH. Measurements and Main Results. Between June 1999 and March 2002, 50 patients underwent LAVH procedures using the bipolar electrothermal vessel sealer and cutter as the primary instrument for hemostasis (group 1). Estimated blood loss, procedure time, and postoperative complications were compared retrospectively with those measurements in a similar cohort of women who underwent LAVH with traditional bipolar hemostasis (group 2). Mean blood loss in the
$16