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Laparoscopic uterine artery occlusion for symptomatic leiomyomas
August 2001, Vol. 8, No. 3 Supplement TheJournal of the American Association of Gynecologic Laparoscopists
118. Laparoscopic Uterine Artery Occlusion for Symptomatic Leiomyomas
conjugated equine estrogen 0.625 mg and medroxyprogesterone acetate 2.5 mg/day. Pain scores were assessed every 12 weeks, lipid profile and bone mineral density were measured after 24 hours and 52 weeks, and serum E2 was measured monthly until the level remained within or near the menopausal range. More women in group A (48%) terminated the study due to vasomotor symptom and noncompliance. By week 12, both groups showed significant improvements in pain scores compared with baseline levels but no significant changes in lipid profile. Women in group A experienced more loss in bone density after 52 weeks than those in group B (6.51% vs 2.61%). Conclusion. One-year treatment with goserelin and add-back hormone therapy provided excellent symptomatic improvement of endometriosis-associated pain and protected against bone loss.
M Lichtinger, L Hallson, P Calvo, G Adeboyejo. Holy Cross Hospital, Fort Lauderdale, Florida.
Objective. To report a laparoscopic technique that safely occludes both uterine arteries, overcoming an altered surgical field resulting from scarring aaad/or uterine leiomyomata. Measurements and Main Results. Eight women (age range 3 1 4 9 yrs) with AUB, pelvic pain or pressure, aaad/or anemia had myomas and uteri larger than 13 weeks' gestation. All underwent laparoscopic retroperitoneal bilateral uterine artery occlusion. Occlusion at the initial tract of the uterine artery was performed by laparoscopic-coated ligature in six women. In two obese patients with deep retroperitoneal space, vascular clips were placed endoscopically using same dissecting technique. Patients were discharged within 20 hours after the procedure. The five women with AUB reported satisfactory decrease. No patient reported amenorrhea. Of women with preoperative pain or pressure; seven reported complete relief and one significant relief. Anemia was corrected in all three women 1 month after treatment. Conclusion. Laparoscopic uterine artery occlusion using a lateral retroperitoneal uniform technique is safe in patients with pelvic scarring and altered pelvic anatomy.
117. Laparascopic-Assisted Vaginal Resection
with the Harmonic Scalpel of Cul-de-sac Obliteration Secondary to Retrocervical Deep Endometriosis L Leo, T Gargiulo, L Brokaj, F Arrnellino. Maria Vittoria Hospital, Turin, Italy.
Objective. To describe the technique and results of en bloc resection of deep infiltrating endometriosis with cul-de-sac obliteration secondary to retrocervical nodules. Measurements and Main Results. Twenty-seven consecutive women (age <40 yrs) with cul-de-sac obliteration secondary to retrocervical deep fibrotic endometriosis (20 partial, 7 complete) were treated for infertility (4), CPP (9), and infertility with CPP (14). The procedure was started by vaginally for colpotomy around the involved area and continued with laparoscopy performed with 5-mm laparosonic coagulating shears. Average operating time was 101 minutes and we had no major complications. The viable intrauterine pregnancy rate among patients with infertility was 67% (12) at 4.4 months after surgery; 10 conceived spontaneously and 2 after ovarian stimulation. At 12-month follow-up all women completed a questionnaire on pain symptoms. Deep dyspareunia improved in all 18 patients and CPP in 19 (90.4%). Conclusion. Laparoscopic-assisted en bloc resection of rectovaginal endometriosis increases fertility potential and gives significant relief of symptoms.
119. Ten-Year Evaluation of Hysteroscopic Surgery for Treatment of Gynecologic Disease F Lirnin, X Enlan. Fuxing Hospital, Beijing Tian Tan Hospital, Beijing, China.
Objective. To evaluate results of hysteroscopic surgery for treatment of gynecologic disease. Measurements and Main Results. We followed 505 women after hysteroscopic surgery for an average of 57.1 months (range 13-117 mo). We performed 371 cases ofTCRE, 9 of endometrial ablation, 21 of TCRP, 10 of TCRS, and 6 of TCRF. Satisfaction was excellent in 73.7% of women, satisfactory in 21%, and unsatisfactory in 5.3%. Quality of life was better in 68.5%, the same in 27.3%, and decreased in 3.2%. Sex life improved in 24.2%, was the same in 59%, and was less than usual in 8.9%. For recurrence, 80.8% would have hysteroscopic surgery again and 10.3% would
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118. Laparoscopic Uterine Artery Occlusion for Symptomatic Leiomyomas
conjugated equine estrogen 0.625 mg and medroxyprogesterone acetate 2.5 mg/day. Pain scores were assessed every 12 weeks, lipid profile and bone mineral density were measured after 24 hours and 52 weeks, and serum E2 was measured monthly until the level remained within or near the menopausal range. More women in group A (48%) terminated the study due to vasomotor symptom and noncompliance. By week 12, both groups showed significant improvements in pain scores compared with baseline levels but no significant changes in lipid profile. Women in group A experienced more loss in bone density after 52 weeks than those in group B (6.51% vs 2.61%). Conclusion. One-year treatment with goserelin and add-back hormone therapy provided excellent symptomatic improvement of endometriosis-associated pain and protected against bone loss.
M Lichtinger, L Hallson, P Calvo, G Adeboyejo. Holy Cross Hospital, Fort Lauderdale, Florida.
Objective. To report a laparoscopic technique that safely occludes both uterine arteries, overcoming an altered surgical field resulting from scarring aaad/or uterine leiomyomata. Measurements and Main Results. Eight women (age range 3 1 4 9 yrs) with AUB, pelvic pain or pressure, aaad/or anemia had myomas and uteri larger than 13 weeks' gestation. All underwent laparoscopic retroperitoneal bilateral uterine artery occlusion. Occlusion at the initial tract of the uterine artery was performed by laparoscopic-coated ligature in six women. In two obese patients with deep retroperitoneal space, vascular clips were placed endoscopically using same dissecting technique. Patients were discharged within 20 hours after the procedure. The five women with AUB reported satisfactory decrease. No patient reported amenorrhea. Of women with preoperative pain or pressure; seven reported complete relief and one significant relief. Anemia was corrected in all three women 1 month after treatment. Conclusion. Laparoscopic uterine artery occlusion using a lateral retroperitoneal uniform technique is safe in patients with pelvic scarring and altered pelvic anatomy.
117. Laparascopic-Assisted Vaginal Resection
with the Harmonic Scalpel of Cul-de-sac Obliteration Secondary to Retrocervical Deep Endometriosis L Leo, T Gargiulo, L Brokaj, F Arrnellino. Maria Vittoria Hospital, Turin, Italy.
Objective. To describe the technique and results of en bloc resection of deep infiltrating endometriosis with cul-de-sac obliteration secondary to retrocervical nodules. Measurements and Main Results. Twenty-seven consecutive women (age <40 yrs) with cul-de-sac obliteration secondary to retrocervical deep fibrotic endometriosis (20 partial, 7 complete) were treated for infertility (4), CPP (9), and infertility with CPP (14). The procedure was started by vaginally for colpotomy around the involved area and continued with laparoscopy performed with 5-mm laparosonic coagulating shears. Average operating time was 101 minutes and we had no major complications. The viable intrauterine pregnancy rate among patients with infertility was 67% (12) at 4.4 months after surgery; 10 conceived spontaneously and 2 after ovarian stimulation. At 12-month follow-up all women completed a questionnaire on pain symptoms. Deep dyspareunia improved in all 18 patients and CPP in 19 (90.4%). Conclusion. Laparoscopic-assisted en bloc resection of rectovaginal endometriosis increases fertility potential and gives significant relief of symptoms.
119. Ten-Year Evaluation of Hysteroscopic Surgery for Treatment of Gynecologic Disease F Lirnin, X Enlan. Fuxing Hospital, Beijing Tian Tan Hospital, Beijing, China.
Objective. To evaluate results of hysteroscopic surgery for treatment of gynecologic disease. Measurements and Main Results. We followed 505 women after hysteroscopic surgery for an average of 57.1 months (range 13-117 mo). We performed 371 cases ofTCRE, 9 of endometrial ablation, 21 of TCRP, 10 of TCRS, and 6 of TCRF. Satisfaction was excellent in 73.7% of women, satisfactory in 21%, and unsatisfactory in 5.3%. Quality of life was better in 68.5%, the same in 27.3%, and decreased in 3.2%. Sex life improved in 24.2%, was the same in 59%, and was less than usual in 8.9%. For recurrence, 80.8% would have hysteroscopic surgery again and 10.3% would
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