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Laparoscopic procedures during pregnancy for gynecologic and nongynecologic indications
August 1999, Vol. 6, No. 3 Supplement
The Journal of the American Association of Gynecologic Laparoscopists
Conclusion. Endosurgical hysterectomy may replace other hysterectomy techniques, providing that the steep learning curve is respected and addressed.
ment of endometriosis in women thought to have appendicele endometriosis on visual inspection. More than 50% of appendicele specimens revealed significant pathology (endometriosis, scarring, obliteration, etc.). No increased morbidity due to appendectomy occurred. Conclusion. Appendectomy is an appropriate adjunctive therapy with laparoscopic excisional surgery in women being treated for pelvic pain and/or endometriosis.
114. Laparoscopic Procedures during Pregnancy for Gynecologic and Nongynecologic Indications D Luxman, JR Cohen, B Almog, R Kedar, A Szold, JB Lessing, MP David. Lis Maternity Hospital, Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Objective. To evaluate the safety of laparoscopic procedures performed during pregnancy. Measurements and Main Results. Twenty-five pregnant women underwent 27 diagnostic or operative procedures: ovarian cystectomy, adnexal detorsion, diagnostic laparoscopy, salpingectomy, appendectomy, adhesiolysis, hemostasis of ruptured ovarian cyst, myomectomy, drainage of pouch of Douglas abscess, and removal of a laparoscopic-adjustable gastric band. One intraoperative complication was injury to right inferior epigastric vessels. Postoperative complications were one pelvic abscess after appendectomy and one case of dense adhesions 7 weeks after ovarian cystectomy. Two women underwent two laparoscopic procedures during the same pregnancy. Pregnancy follow-up was normal in 18 patients, and 4 patients experienced pregnancy-induced hypertension (1), gestational diabetes (1), and premature uterine contraction requiring tocolysis (2). Twenty-two women delivered 24 healthy, term infants. One woman had a missed abortion, one had an elective termination of pregnancy, and one delivered prematurely at 36 weeks but well after laparoscopy. Long-term follow-up disclosed no developmental or intellectual abnormalities in the children. Conclusion. Our series contributes to encouraging data that lapaxoscopic procedures during pregnancy for a variety of gynecologic and nongynecologic indications appear safe for both mother and fetus.
116. Resultsof Laparoscopic Presacral Neurectomy TL Lyons, WK Winer, K Bajzak. Center for Women's Care and Reproductive Surgery, Atlanta, Georgia.
Objective. To evaluate symptom relief after laparoscopic presacral neurectomy for pelvic pain and associated symptomatology. Measurements andMain Results. Of 50 women, 85% had relief of symptoms of dysmenorrhea and associated irritable bladder and/or bowel. Conclusion. Laparoscopic presacral neurectomy may be an appropriate adjunctive therapy with excisional surgery in patients with primary dysmenorrhea, cyclic irritable bowel, or irritable bladder.
117. Steroid Receptors and Tumor Suppressor Genes in Endometrial Polyps H Maia, Jr, A Maltez, M Rodrigues, LC Calmon, EM Coutinho. CEPARH, Bahia, Brazil.
Objective. To study whether p53 overexpression antedates the appearance of carcinomas in endometrial polyps. Measurements and Main Results. Forty-one postmenopausal patients underwent excision of endometrial polyps with biopsy. Steroid receptors, p53 overexpression, and c-erbB2 amplification were investigated by immunochemistry. Focal p53 overexpression involving 5% of cell nuclei was detected in 60% of polyps with simple hyperplasia. The percentage of positive nuclei increased to 36% when complex hyperplasia with atypia was present. There was decreased expression for progesterone and testosterone receptors in both stroma and glands in endometrial polyps. Membrane c-erbB2 was amplified in polyps with hyperplasia. Conclusion. Decreased expression for progesterone receptors together with p53 and c-erbB2 overexpression
115. Appendicele Endometriosis May Be Associated with Endometriosis of the Abdomen and Pelvis TL Lyons, WK Winer, K Bajzak. Center for Women's Care and Reproductive Surgery, Atlanta, Georgia.
Objective. To evaluate the frequency of pathologic correlation of appendicele endometriosis. Measurements and Main Results. Laparoscopic appendectomy was performed during laparoscopic treat-
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The Journal of the American Association of Gynecologic Laparoscopists
Conclusion. Endosurgical hysterectomy may replace other hysterectomy techniques, providing that the steep learning curve is respected and addressed.
ment of endometriosis in women thought to have appendicele endometriosis on visual inspection. More than 50% of appendicele specimens revealed significant pathology (endometriosis, scarring, obliteration, etc.). No increased morbidity due to appendectomy occurred. Conclusion. Appendectomy is an appropriate adjunctive therapy with laparoscopic excisional surgery in women being treated for pelvic pain and/or endometriosis.
114. Laparoscopic Procedures during Pregnancy for Gynecologic and Nongynecologic Indications D Luxman, JR Cohen, B Almog, R Kedar, A Szold, JB Lessing, MP David. Lis Maternity Hospital, Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Objective. To evaluate the safety of laparoscopic procedures performed during pregnancy. Measurements and Main Results. Twenty-five pregnant women underwent 27 diagnostic or operative procedures: ovarian cystectomy, adnexal detorsion, diagnostic laparoscopy, salpingectomy, appendectomy, adhesiolysis, hemostasis of ruptured ovarian cyst, myomectomy, drainage of pouch of Douglas abscess, and removal of a laparoscopic-adjustable gastric band. One intraoperative complication was injury to right inferior epigastric vessels. Postoperative complications were one pelvic abscess after appendectomy and one case of dense adhesions 7 weeks after ovarian cystectomy. Two women underwent two laparoscopic procedures during the same pregnancy. Pregnancy follow-up was normal in 18 patients, and 4 patients experienced pregnancy-induced hypertension (1), gestational diabetes (1), and premature uterine contraction requiring tocolysis (2). Twenty-two women delivered 24 healthy, term infants. One woman had a missed abortion, one had an elective termination of pregnancy, and one delivered prematurely at 36 weeks but well after laparoscopy. Long-term follow-up disclosed no developmental or intellectual abnormalities in the children. Conclusion. Our series contributes to encouraging data that lapaxoscopic procedures during pregnancy for a variety of gynecologic and nongynecologic indications appear safe for both mother and fetus.
116. Resultsof Laparoscopic Presacral Neurectomy TL Lyons, WK Winer, K Bajzak. Center for Women's Care and Reproductive Surgery, Atlanta, Georgia.
Objective. To evaluate symptom relief after laparoscopic presacral neurectomy for pelvic pain and associated symptomatology. Measurements andMain Results. Of 50 women, 85% had relief of symptoms of dysmenorrhea and associated irritable bladder and/or bowel. Conclusion. Laparoscopic presacral neurectomy may be an appropriate adjunctive therapy with excisional surgery in patients with primary dysmenorrhea, cyclic irritable bowel, or irritable bladder.
117. Steroid Receptors and Tumor Suppressor Genes in Endometrial Polyps H Maia, Jr, A Maltez, M Rodrigues, LC Calmon, EM Coutinho. CEPARH, Bahia, Brazil.
Objective. To study whether p53 overexpression antedates the appearance of carcinomas in endometrial polyps. Measurements and Main Results. Forty-one postmenopausal patients underwent excision of endometrial polyps with biopsy. Steroid receptors, p53 overexpression, and c-erbB2 amplification were investigated by immunochemistry. Focal p53 overexpression involving 5% of cell nuclei was detected in 60% of polyps with simple hyperplasia. The percentage of positive nuclei increased to 36% when complex hyperplasia with atypia was present. There was decreased expression for progesterone and testosterone receptors in both stroma and glands in endometrial polyps. Membrane c-erbB2 was amplified in polyps with hyperplasia. Conclusion. Decreased expression for progesterone receptors together with p53 and c-erbB2 overexpression
115. Appendicele Endometriosis May Be Associated with Endometriosis of the Abdomen and Pelvis TL Lyons, WK Winer, K Bajzak. Center for Women's Care and Reproductive Surgery, Atlanta, Georgia.
Objective. To evaluate the frequency of pathologic correlation of appendicele endometriosis. Measurements and Main Results. Laparoscopic appendectomy was performed during laparoscopic treat-
$33