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Laparoscopic supracervical hysterectomy versus endometrial ablation
August 1999, Vol. 6, No. 3 Supplement
The Journal of the American Association of Gynecologic Laparoscopists
222. VersaPoint Electrode for Endometrial Polyp Resection as an Office Procedure without Anesthesia
reported clear pain relief, two (14.3%) no change of symptoms, and one (7.1%) worse pain. Conclusion. Although these initial data require additional study, bipolar scissors seem to be safe and effective instruments to remove deeply infiltrating lesions, including those with severe involvement of bowel and ureter.
SA Zulli, S Mariorenzi, M Manzini, U Bellati. G. d'Annunzio University, Chieti, Italy.
Objective. To compare the tolerability of endometrial polyp resection in the office using VersaPoint electrode without anesthesia or premedication with diagnostic hysteroscopy alone. Measurements and Main Results. Endometrial polyp resection with VersaPoint electrode in normal saline was performed in 15 women (age 34-63 yrs). It was performed without anesthesia through a 5.5-mm operative Bettocchi hysteroscope (Karl Storz, Tutlingen, Germany). All women had previously undergone diagnostic hysteroscopy to diagnose the polyps. They were asked to rate pain associated with both procedures on a VAS (0 = no pain, 20 = excruciating pain). Pain during polyp resection with VersaPoint was 10.06 (range 7-20) and not statistically different from that with hysteroscopy (p = 0.336). Conclusion. Endometrial polyp resection with VersaPoint electrode can be performed as a routine procedure in the office without anesthesia or premedication because of its tolerability.
221. Comparison of Endometrial Findings by Hysteroscopy and Endometrial Biopsy in Thickened Endometrium of Asymptomatic, Postmenopausal Women Related to Tamoxifen Therapy and Weight/Height Ratio ~S Zulli, 1S Mariorenzi, 1M Manzini, 1A Rossetti, 2U Bellati. ~G. d'Annunzio University, Chieti, Chieti, Italy; 2UCSC University, Rome, Italy.
Objective. To evaluate the results of diagnostic hysteroscopy and endometrial biopsy in asymptomatic postmenopausal women with thickened endometrium with and without tamoxifen therapy, in relation with weight:height (W:H) ratio. Measurements and Main Results. Asymptomatic postmenopausal women (group A, 51 women receiving tamoxifen, age 45-78 yrs; group B, 51 women without treatment) underwent TVUS scan and diagnostic hysteroscopy with endometrial biopsy. Height and weight for the evaluation of W:H ratio were recorded. Women in group A had mean endometrial thickness of 10.16 +_ 5.14 mm (range 5-22 mm). At hysteroscopy we found endometrial polyps (31.37%), typical endometrial hyperplasia (37.26%), synechiae (17.65 %), atrophic endometruim (11.76%), and endometrial carcinoma (1.96%). The mean W:H ratio was 0.41 __0.02 (range 0.38-0.46). In group B (age 48-69 yrs) mean endometrial thickness was 8.7 + 4.27 mm (range 5-19 ram), and hysteroscopy revealed endometrial polyps (54.91%), typical endometrial hyperplasia (11.76%), subatrophic endometrium (19.61%), cystic atrophy (11.76%), and endometrial carcinoma (1.96%). The W:H ratio was 0.44 _+0.07 (range 0.43 _+0.48). The W:H ratio was highly statistically different in groups A and B (p <0.0001). Group A had higher frequency of endometrial hyperplasia (p <0.01) and lower frequency of endometrial polyps (NS). Endometrial synechiae were found only in group A (p <0.01). Conclusion. Endometrial thickness was not statistically different between groups. The higher W:H ratio in group B could be considered as an estrogen stimulus in endometrial polyp pathogenesis.
223. Laparoscopic Supracervical Hysterectomy versus Endometrial Ablation E Zupi, O Marconi, E Valli, E Solima, B De Vivo, G Sorrenti, C Romanini. University of Rome "Tor Vergata," Rome, Italy.
Objective. To investigate the treatment of choice for AUB, laparoscopic supracervical hysterectomy (LSH) or endometrial ablation (EA). Measurements and Main Results. Consecutive women with AUB were prospectively randomized into two groups: group A, 72 patients, underwent LSH, group B, 69 patients, underwent EA. All women were clinically evaluated at 6, 12, 24, and 36 months postoperatively. No major intraoperative and postoperative complications occurred in either group. After mean follow-up of 29 months, 16% women in group B had symptom recurrence. Satisfaction rates were 81.2% and 97.2% for EA and LSH, respectively. Conclusion. LSH was more effective than EA for symptom resolution and patient satisfaction after 2 years of follow-up. Although endometrial ablation is less
$63
Abstracts
expensive, higher recurrence and lower satisfaction suggest that it should be reserved for selected patients.
224. Preperitoneal Laparoscopic Burch Procedure 1E Zupi, 1G Bellipanni, zO Marconi, 1E Priori, 2E Solima, 1C Romanini. 1University of Rome "Tor Vergata," Rome, Italy; 2CI Madonna delle Grazie, Velletri, Italy.
Objective. To evaluate the efficacy of a modified laparoscopic retropubic colposuspension in patients with GUSI. Measurements and Main Results. A series of 259 women with GUSI were treated by modified laparo-
scopic Burch procedure. The surgical technique consisted of a preperitoneal approach to the space of Retzius and polypropylene mesh to elevate the vaginal vault. This modified technique is easier than the transperitoneal approach and reduces operating time considerably. The cure rate evaluated by clinical and urodynamic investigation 6, 12, and 24 months postoperatively was 82.5%. The 15 complications (5.8%) were 1 bladder injury, 3 lesions of inferior epigastric vessels, and 11 postoperative fevers. Conclusion. Preperitoneal laparoscopic colposuspension is an easy and effective technique for treatment of GUSI.
$64
The Journal of the American Association of Gynecologic Laparoscopists
222. VersaPoint Electrode for Endometrial Polyp Resection as an Office Procedure without Anesthesia
reported clear pain relief, two (14.3%) no change of symptoms, and one (7.1%) worse pain. Conclusion. Although these initial data require additional study, bipolar scissors seem to be safe and effective instruments to remove deeply infiltrating lesions, including those with severe involvement of bowel and ureter.
SA Zulli, S Mariorenzi, M Manzini, U Bellati. G. d'Annunzio University, Chieti, Italy.
Objective. To compare the tolerability of endometrial polyp resection in the office using VersaPoint electrode without anesthesia or premedication with diagnostic hysteroscopy alone. Measurements and Main Results. Endometrial polyp resection with VersaPoint electrode in normal saline was performed in 15 women (age 34-63 yrs). It was performed without anesthesia through a 5.5-mm operative Bettocchi hysteroscope (Karl Storz, Tutlingen, Germany). All women had previously undergone diagnostic hysteroscopy to diagnose the polyps. They were asked to rate pain associated with both procedures on a VAS (0 = no pain, 20 = excruciating pain). Pain during polyp resection with VersaPoint was 10.06 (range 7-20) and not statistically different from that with hysteroscopy (p = 0.336). Conclusion. Endometrial polyp resection with VersaPoint electrode can be performed as a routine procedure in the office without anesthesia or premedication because of its tolerability.
221. Comparison of Endometrial Findings by Hysteroscopy and Endometrial Biopsy in Thickened Endometrium of Asymptomatic, Postmenopausal Women Related to Tamoxifen Therapy and Weight/Height Ratio ~S Zulli, 1S Mariorenzi, 1M Manzini, 1A Rossetti, 2U Bellati. ~G. d'Annunzio University, Chieti, Chieti, Italy; 2UCSC University, Rome, Italy.
Objective. To evaluate the results of diagnostic hysteroscopy and endometrial biopsy in asymptomatic postmenopausal women with thickened endometrium with and without tamoxifen therapy, in relation with weight:height (W:H) ratio. Measurements and Main Results. Asymptomatic postmenopausal women (group A, 51 women receiving tamoxifen, age 45-78 yrs; group B, 51 women without treatment) underwent TVUS scan and diagnostic hysteroscopy with endometrial biopsy. Height and weight for the evaluation of W:H ratio were recorded. Women in group A had mean endometrial thickness of 10.16 +_ 5.14 mm (range 5-22 mm). At hysteroscopy we found endometrial polyps (31.37%), typical endometrial hyperplasia (37.26%), synechiae (17.65 %), atrophic endometruim (11.76%), and endometrial carcinoma (1.96%). The mean W:H ratio was 0.41 __0.02 (range 0.38-0.46). In group B (age 48-69 yrs) mean endometrial thickness was 8.7 + 4.27 mm (range 5-19 ram), and hysteroscopy revealed endometrial polyps (54.91%), typical endometrial hyperplasia (11.76%), subatrophic endometrium (19.61%), cystic atrophy (11.76%), and endometrial carcinoma (1.96%). The W:H ratio was 0.44 _+0.07 (range 0.43 _+0.48). The W:H ratio was highly statistically different in groups A and B (p <0.0001). Group A had higher frequency of endometrial hyperplasia (p <0.01) and lower frequency of endometrial polyps (NS). Endometrial synechiae were found only in group A (p <0.01). Conclusion. Endometrial thickness was not statistically different between groups. The higher W:H ratio in group B could be considered as an estrogen stimulus in endometrial polyp pathogenesis.
223. Laparoscopic Supracervical Hysterectomy versus Endometrial Ablation E Zupi, O Marconi, E Valli, E Solima, B De Vivo, G Sorrenti, C Romanini. University of Rome "Tor Vergata," Rome, Italy.
Objective. To investigate the treatment of choice for AUB, laparoscopic supracervical hysterectomy (LSH) or endometrial ablation (EA). Measurements and Main Results. Consecutive women with AUB were prospectively randomized into two groups: group A, 72 patients, underwent LSH, group B, 69 patients, underwent EA. All women were clinically evaluated at 6, 12, 24, and 36 months postoperatively. No major intraoperative and postoperative complications occurred in either group. After mean follow-up of 29 months, 16% women in group B had symptom recurrence. Satisfaction rates were 81.2% and 97.2% for EA and LSH, respectively. Conclusion. LSH was more effective than EA for symptom resolution and patient satisfaction after 2 years of follow-up. Although endometrial ablation is less
$63
Abstracts
expensive, higher recurrence and lower satisfaction suggest that it should be reserved for selected patients.
224. Preperitoneal Laparoscopic Burch Procedure 1E Zupi, 1G Bellipanni, zO Marconi, 1E Priori, 2E Solima, 1C Romanini. 1University of Rome "Tor Vergata," Rome, Italy; 2CI Madonna delle Grazie, Velletri, Italy.
Objective. To evaluate the efficacy of a modified laparoscopic retropubic colposuspension in patients with GUSI. Measurements and Main Results. A series of 259 women with GUSI were treated by modified laparo-
scopic Burch procedure. The surgical technique consisted of a preperitoneal approach to the space of Retzius and polypropylene mesh to elevate the vaginal vault. This modified technique is easier than the transperitoneal approach and reduces operating time considerably. The cure rate evaluated by clinical and urodynamic investigation 6, 12, and 24 months postoperatively was 82.5%. The 15 complications (5.8%) were 1 bladder injury, 3 lesions of inferior epigastric vessels, and 11 postoperative fevers. Conclusion. Preperitoneal laparoscopic colposuspension is an easy and effective technique for treatment of GUSI.
$64