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Laparoscopic Myomectomy – Our Experience
S142
Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S133–S181
Design: Retrospective study. Setting: Gynecologic Endoscopy Service, Vale do Sapucai University, Pouso Alegre, Brazil. Patients: 859 patients submitted to videolaparoscopy surgery between 1996 and 2013 march. Intervention: Laparoscopy surgery. Measurements and Main Results: Of the 859 laparoscopies realized, 28 (3.2%) were converted to laparotomy. The following factors were associated with laparotomy: history of histerectomy (10/35.7%), presence of adhesions (14/50%), endometriosis (7/25%), greater blood loss (5/17.8%) and bowel injury (5/17.8%). In all the patients with bowel injury were present intraabdominal adhesions and 7/ 25% the patients with adhesions was been submitted to histerectomy. Conclusion: Laparoscopic surgery is the treatment of choice for a number of indications in gynaecology. The advantages of laparoscopy as compared with laparotomy are well known. Intraabdominal adhesions increase the risk of bowel injury during access and conversion to laparotomy. All women undergoing laparoscopy should be counseled that unintended laparotomy is a known risk mainly patients with surgery history in which the incidence of adhesions estimated to be almost 100%. 481 Attitudes of Minimally Invasive Reproductive and Gynecologic Surgeons toward Various Energy Sources Bailey AP, Correia KF, Missmer SA, Gargiulo AR. Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility, Brigham and Women’s Hospital and Harvard School of Medicine, Boston, Massachusetts Study Objective: To identify attitudes toward various energy sources used by laparoscopic gynecologic surgeons post-training and by residents and fellows. Design: Online survey link emailed to all ASRM and AAGL members in June 2012. Setting: Academic medical center. Patients: 561 actively practicing post-training gynecologic laparoscopic surgeons (Surgeon) and 138 residents and fellows (response rate 15%). Intervention: Survey completion. Measurements and Main Results: Preferred Energy Source by Procedure (%) Never Monopolar Bipolar Ultrasonic Laser Other Perform Endometriosis 33/44 Myomectomy 43/41 Colpotomy 35/41
22/12 21/12 17/16
21/18 14/23 19/34
12/17 9/5 2/4 12/7 0/0 10/5
4/4 9/13 18/4
Surgeon Response/Resident and Fellow Response Respondents Somewhat Satisfied or Very Satisfied with Characteristics of Various Energy Sources (%) Cost Patient Outcomes Safety Operating Time/Efficiency For Endometriosis For Myomectomy Overall
Electrosurgery 75/52 90/89 77/90 89 Monopolar 67 Bipolar 72 Monopolar 70 Bipolar 63 87/93
Ultrasonic 37/38 68/73 72/75 63/70 60
Laser 16/15 39/40 34/33 29/35 44
48
13
64/72
30/33
Surgeon Response/Resident and Fellow Response where both groups surveyed; single number represents Surgeon Response only
Table 3 Number of Complications during Laparoscopic Procedures in the Previous 12 Months
Complication Bladder Injury Ureteral Injury Bowel Injury Unanticipated Bleeding Conversion to Laparotomy Associated Instrument Monopolar Bipolar Ultrasonic Laser
Endometriosis (78 complications)
Myomectomy (73 complications)
21 7 21 23 6
2 2 1 52 7
18 19 8 0
25 14 6 0
94% of Surgeons were somewhat satisfied or very satisfied with their current primary instrument for treatment of endometriosis, and 93% of Surgeons were somewhat satisfied or very satisfied with their current primary instrument for myomectomy. 79% of Surgeons had used a CO2 laser; yet the predominant response was ‘‘Not Sure’’ with respect to its cost (34%), patient outcomes (33%), operating time/efficiency (32%), safety (31%), and overall performance (32%). Conclusion: Most actively practicing post-training gynecologic laparoscopic surgeons are satisfied with their current instrument for both treatment of endometriosis and myomectomy with the majority choosing electrosurgery for both and for colpotomy. Not surprisingly, residents’ and fellows’ energy source choices mirror those of the Surgeons. Further research is indicated to determine if the higher proportion of complications with electrosurgery is due to the energy source itself or to its more widespread use. Despite current or former use of the CO2 laser, many Surgeons are unfamiliar with the details of this technology and its usefulness in laparoscopic gynecologic surgery. 482 Laparoscopic Myomectomy – Our Experience Braga AC, Ferreira H, Pereira AT. Gynecology Department, Centro Hospitalar do Porto, Oporto, Porto, Portugal Study Objective: Analyze laparoscopic myomectomy indications, surgical complications, number of fibroids removed, their localization and average diameter of all laparoscopic myomectomies carried out at our centre during 2011 and 2012. Design: Descriptive retrospective study, that included 46 patients who underwent laparoscopic myomectomy during 2011-2012 in our center. Parameters registered: myomectomy indications, surgical complications, number of fibroids removed, their localization and average diameter. Setting: European tertiary and universitary hospital located in Oporto, Portugal. Patients: 46 patients submitted to laparoscopic myomectomy in our centre between 2011 and 2012. Intervention: Laparoscopic myomectomy. Measurements and Main Results: Our study included 46 patients with an average age of 36,5 years (22-55 years). The main indications were abnormal uterine bleeding, lower abdominal pain and infertility. In the majority of cases (83%) only one fibroid was removed (maximum of four), with an avarege size of 5,1cm (maximum of 10cm). In 85% of cases fibroids presented an intramural/subserous component. Mean hospitalization time was 2,4 days. There were no major complications during surgeries nor necessity to convert to laparotomy. Conclusion: Laparoscopic myomectomy is a safe procedure, presenting a shorter hospitalization time, a low complication risk, with good overall results and should therefore be a valid surgical procedure recommended in selected cases.
Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S133–S181
Design: Retrospective study. Setting: Gynecologic Endoscopy Service, Vale do Sapucai University, Pouso Alegre, Brazil. Patients: 859 patients submitted to videolaparoscopy surgery between 1996 and 2013 march. Intervention: Laparoscopy surgery. Measurements and Main Results: Of the 859 laparoscopies realized, 28 (3.2%) were converted to laparotomy. The following factors were associated with laparotomy: history of histerectomy (10/35.7%), presence of adhesions (14/50%), endometriosis (7/25%), greater blood loss (5/17.8%) and bowel injury (5/17.8%). In all the patients with bowel injury were present intraabdominal adhesions and 7/ 25% the patients with adhesions was been submitted to histerectomy. Conclusion: Laparoscopic surgery is the treatment of choice for a number of indications in gynaecology. The advantages of laparoscopy as compared with laparotomy are well known. Intraabdominal adhesions increase the risk of bowel injury during access and conversion to laparotomy. All women undergoing laparoscopy should be counseled that unintended laparotomy is a known risk mainly patients with surgery history in which the incidence of adhesions estimated to be almost 100%. 481 Attitudes of Minimally Invasive Reproductive and Gynecologic Surgeons toward Various Energy Sources Bailey AP, Correia KF, Missmer SA, Gargiulo AR. Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility, Brigham and Women’s Hospital and Harvard School of Medicine, Boston, Massachusetts Study Objective: To identify attitudes toward various energy sources used by laparoscopic gynecologic surgeons post-training and by residents and fellows. Design: Online survey link emailed to all ASRM and AAGL members in June 2012. Setting: Academic medical center. Patients: 561 actively practicing post-training gynecologic laparoscopic surgeons (Surgeon) and 138 residents and fellows (response rate 15%). Intervention: Survey completion. Measurements and Main Results: Preferred Energy Source by Procedure (%) Never Monopolar Bipolar Ultrasonic Laser Other Perform Endometriosis 33/44 Myomectomy 43/41 Colpotomy 35/41
22/12 21/12 17/16
21/18 14/23 19/34
12/17 9/5 2/4 12/7 0/0 10/5
4/4 9/13 18/4
Surgeon Response/Resident and Fellow Response Respondents Somewhat Satisfied or Very Satisfied with Characteristics of Various Energy Sources (%) Cost Patient Outcomes Safety Operating Time/Efficiency For Endometriosis For Myomectomy Overall
Electrosurgery 75/52 90/89 77/90 89 Monopolar 67 Bipolar 72 Monopolar 70 Bipolar 63 87/93
Ultrasonic 37/38 68/73 72/75 63/70 60
Laser 16/15 39/40 34/33 29/35 44
48
13
64/72
30/33
Surgeon Response/Resident and Fellow Response where both groups surveyed; single number represents Surgeon Response only
Table 3 Number of Complications during Laparoscopic Procedures in the Previous 12 Months
Complication Bladder Injury Ureteral Injury Bowel Injury Unanticipated Bleeding Conversion to Laparotomy Associated Instrument Monopolar Bipolar Ultrasonic Laser
Endometriosis (78 complications)
Myomectomy (73 complications)
21 7 21 23 6
2 2 1 52 7
18 19 8 0
25 14 6 0
94% of Surgeons were somewhat satisfied or very satisfied with their current primary instrument for treatment of endometriosis, and 93% of Surgeons were somewhat satisfied or very satisfied with their current primary instrument for myomectomy. 79% of Surgeons had used a CO2 laser; yet the predominant response was ‘‘Not Sure’’ with respect to its cost (34%), patient outcomes (33%), operating time/efficiency (32%), safety (31%), and overall performance (32%). Conclusion: Most actively practicing post-training gynecologic laparoscopic surgeons are satisfied with their current instrument for both treatment of endometriosis and myomectomy with the majority choosing electrosurgery for both and for colpotomy. Not surprisingly, residents’ and fellows’ energy source choices mirror those of the Surgeons. Further research is indicated to determine if the higher proportion of complications with electrosurgery is due to the energy source itself or to its more widespread use. Despite current or former use of the CO2 laser, many Surgeons are unfamiliar with the details of this technology and its usefulness in laparoscopic gynecologic surgery. 482 Laparoscopic Myomectomy – Our Experience Braga AC, Ferreira H, Pereira AT. Gynecology Department, Centro Hospitalar do Porto, Oporto, Porto, Portugal Study Objective: Analyze laparoscopic myomectomy indications, surgical complications, number of fibroids removed, their localization and average diameter of all laparoscopic myomectomies carried out at our centre during 2011 and 2012. Design: Descriptive retrospective study, that included 46 patients who underwent laparoscopic myomectomy during 2011-2012 in our center. Parameters registered: myomectomy indications, surgical complications, number of fibroids removed, their localization and average diameter. Setting: European tertiary and universitary hospital located in Oporto, Portugal. Patients: 46 patients submitted to laparoscopic myomectomy in our centre between 2011 and 2012. Intervention: Laparoscopic myomectomy. Measurements and Main Results: Our study included 46 patients with an average age of 36,5 years (22-55 years). The main indications were abnormal uterine bleeding, lower abdominal pain and infertility. In the majority of cases (83%) only one fibroid was removed (maximum of four), with an avarege size of 5,1cm (maximum of 10cm). In 85% of cases fibroids presented an intramural/subserous component. Mean hospitalization time was 2,4 days. There were no major complications during surgeries nor necessity to convert to laparotomy. Conclusion: Laparoscopic myomectomy is a safe procedure, presenting a shorter hospitalization time, a low complication risk, with good overall results and should therefore be a valid surgical procedure recommended in selected cases.