- Email: [email protected]
Management of Unintentional Fetoscopy
S6
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S1eS51
Analysis of single surgeon’s experience:MIRCS made 62.5% of all the cervical surgeries: 37% in 2002-2003, 60% in 2004e2005, 66.6% in 2006e2007, and 100% in 2008. The change of the surgical technique pattern by a single surgeon with time Surgical Technique Open Radical Hysterectomy MIRCS Total
2002e 2003
2004e 2005
2006e 2007
5
6
7
3 8
9 15
14 21
2008e July-2008
Total
17
18 4 4
30 48
MIRCS (Minimally Invasive Radical Cancer Surgery). Patients with ORH compared to MIRCS had higher BMI (29.7 vs. 24.8; p 5 .01),higher EBL (1044 vs. 199 ml; p 5 .0006),and an insignificant shorter total surgical time (300 vs. 328 minutes; p 5 .07). MIRCS had a total immediate surgical complication rate of 16% compared to 5.5% in the ORH. Surgical time and EBL for MIRCS have not significantly changed with the integration of MIRCS. Conclusion: A dedicated surgeon can virtually eliminate need for ORH with the adoption of MIRCS. The many MIRCS options allow individualized care while providing known fertility and post-operative advantages for the patient. MIRCS takes longer to perform, with a higher rate of urinary tract injury and significantly less EBL.
15
Study Objective: The purpose of this video is to demonstrate a technique for extracorporeal knot tying. The video explains instrumentation and techniques for extracorporeal knot tying using a pelvic trainer. The first segment reviews the required instrumentation. This is followed by a stepby-step explanation of technique for extracorporeal knot tying. The final section offers refinements on technique and trouble shooting.
Plenary Session 3dOncology (11:44 AM d 11:54 AM)
Video Session 1dEducation (11:09 AM d 11:14 AM)
Use of the Mid-Sagittal Hemi-Pelvis To Demonstrate Surgical Anatomy for Vaginal Surgery Miller D,1 Giles D.2 1Wheaton Franciscan Healthcare, Wauwatosa, WI; 2 Reproductive Specialty Center, Milwaukee, WI Study Objective: To demonstrate the adaptation of the mid-sagittally cut hemi-pelvis as a teaching aid for surgical anatomy and to visually enhance the demonstration of transvaginal procedures with a low cost portable setup. Instruction in vaginal surgery is often limited to viewing the back of the primary surgeons hand while they attempt to relay relevant anatomy. Even when whole pelvis cadaveric specimens are employed the observers view is restricted. We demonstrate the use of a hemi-pelvis for surgical instruction. This allows for the simultaneous abdominal and vaginal point-of-view. Observers can watch the appropriate placement of clamps and surgical devices, confirm their understanding of the described technique, and measure the distance to neurovascular structures that could be injured. In an era of new anatomically challenging vaginal surgeries, there is a critical need for more detailed anatomic instruction.
Laparoscopic Staging of Endometrial Cancer. Is Further Evidence Needed? Zullo F, Mocciaro R, Annununziata G, Palomba S. Department of Obstetrics and Gynecology, University Magna Graecia of Catanzaro, Catanzaro, Italy
18
Study Objective: To define, if any, type I clinical evidence regarding the safety and efficacy of the laparoscopic approach to endometrial cancer. Design: Meta-analysis of randomized control trial (RCTs). Setting: Department of Gynecology and Obstetrics, University ‘‘Magna Graecia’’ Catanzaro, Italy. Patients: Patients with early stage endometrial cancer surgically treated. Intervention: We searched randomized control trials (RCTs) that compare laparoscopic and laparotomic approach about efficacy and safety data, to treat patients with early stage endometrial cancer. Measurements and Main Results: Five RCTs were identified and included in the final analysis. Significantly longer operative time (OR 5 53.48, 95%CI 37.28 to 69.68, P 5 0.0002), lower intraoperative blood loss (OR 5 266.86, 95%CI 454.82 to 78.90, P 5 0.005) and postoperative complications (OR 5 0.40, 95%CI 0.23 to 0.70, P 5 0.007) were associated to laparoscopy. No effect of laparoscopy on pelvic (OR 5 0.62, 95%CI 1.47 to 2.71, P 5 0.560) and para-aortic (OR 5 1.49, 95%CI 2.49 to 5.60, P 5 0.477) nodes yield, and intraoperative complications (OR 5 1.60, 95%CI 0.49 to 5.22, P5 0.390) was observed. No significant difference between laparoscopic and laparotomic approaches to endometrial cancer in overall survival (OR50.96, 95% CI 0.51 to 1.81, P 5 0.976), disease-free survival (OR 5 0.95, 95% CI 0.51 to 1.80, P 5 0.986), and cancer-related survival (OR 5 0.91, 95% CI 0.27 to 573.06, P 5 0.883) was observed. Conclusion: Our data suggest that laparoscopic approach should be considered an effective and safe procedure for patients with early stage endometrial cancer as well as laparotomic one.
Study Objective: The objective of this video is to review the avascular planes of the pelvis. Understanding the avascular planes of the pelvis is essential in performing advanced gynecologic surgery. The anatomy of the anterior and posterior cul-de-sacs, paravesical and pararectal spaces, vesicovaginal and rectovaginal spaces are reviewed in this video. The clinical relevance of these spaces is demonstrated in various gynecologic procedures such as abdominal and vaginal hysterectomies, laparoscopic excision of endometriosis, abdominal sacral colpopexy, and radical trachelectomy. Familiarity with the avascular planes of the pelvis is important in performing a variety of advanced gynecologic procedures.
16
20
Video Session 1dEducation (11:00 AM d 11:08 AM)
Extracorporeal Knot Tying Mercer J, Bajzak K. Obstetrics and Gynecology, Memorial University of Newfoundland, St. John’s, NL, Canada
Video Session 1dEducation (11:15 AM d 11:20 AM)
A Vascular Planes of the Pelvis Park AJ, Falcone T, Barber MD. Obstetrics & Gynecology, Cleveland Clinic, Cleveland, OH
19
Video Session 1dEducation (11:21 AM d 11:26 AM)
Anatomy of the Uterus and Its Surgical Removal Park AJ, Falcone T, Barber MD. Obstetrics & Gynecology, Cleveland Clinic, Cleveland, OH Study Objective: The objective of this video is to review the anatomy of the uterus and adnexa and to highlight surgically relevant anatomic relationships. The anatomy of the uterus and adnexa are reviewed in this video, including the basic pelvic anatomy and relationships to the urinary tract. The levels of uterine and vaginal support are also demonstrated. A thorough understanding of the anatomy of the uterus and its adnexa is important for the appropriate surgical planning. Video Session 1dEducation (11:27 AM d 11:35 AM)
Management of Unintentional Fetoscopy Kho KA, Nezhat C. Atlanta Center for Special Minimally Invasive Surgery and Reproductive Medicine, Atlanta, GA
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S1eS51 Study Objective: Approximately 1 in 500 women will require non-obstetric surgery during pregnancy and minimally invasive approaches are being more widely used in this setting. This video presents a never previously reported case of injury to a gravid uterus resulting in a full thickness hysterotomy and unintentional fetoscopy. In a thought provoking manner, the video highlights key steps in conceptualization and management of this complication.
21
Video Session 1dEducation (11:36 AM d 11:44 AM)
Neovagina Creation Using Split-Thickness Skin Graft To Treat the Iatrogenic Foreshortened Vagina Ridgeway B, Frick AC, Paraiso MF. Obstetrics, Gynecology, and Women’s Health Institute, Cleveland Clinic, Cleveland, OH Study Objective: This video describes techniques for neovagina creation in women with an iatrogenically foreshortened vagina. This includes skin graft procurement, development and placement of the neovagina using a stent, then omental or peritoneal coverage to promote neovascularization. Limited clinical outcomes are presented. We are encouraged by our outcomes with neovagina creation using a split-thickness skin graft in women with an iatrogenically foreshortened vagina. Thus far, we have encountered minimal morbidity. While vaginal dilators should remain a first line therapy for women with a foreshortened vagina, our technique offers a viable option for women who fail dilator therapy. The procedure both restores normal anatomy and sexual function in women with inadequate vaginal length.
22
Video Session 1dEducation (11:45 AM d 11:53 AM)
Surgical Managment of the Non-Communicating Uterine Horn Sovino H, Villarroel C, Cespedes P, Devoto L. Instituto de Investigaciones Materno Infantil, Universidad de Chile, Santiago de Chile, Region Metropolitana, Chile Study Objective: This video is intended to present the surgical management of the non-communicating Uterine Horn. It considers the embryologic development of this pathology. Anatomical variants of presentation must be considered in order to plan the surgery. Noncommunicating uterine horn can be broadly attached to the functional horn by an extense septum or can be separated by a fibrous band. In some cases an enlarged horn can be observed due to haematometra. In many cases surgery is complicated by the existence of different grades of endometriosis. Surgery requires a systematic approach that is described in the video. In our Reproductive Medicine Unit we have treated 5 cases in two years. Patients have consulted for severe pelvic pain and the presence of haematometra. We have found a 40% of urinary malformation associated. Endometriosis was found in 4 of 5 cases. No complications were observed. A significant improvement on dismenorrhea was observed after surgery.
23
Video Session 1dEducation (11:54 AM d 11:57 AM)
The Laparoscopic Repair of a Vaginal Evisceration McCullough MC, Cox C, Hart SR. Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL Study Objective: A 17 year old nulligravida, without any significant past medical or surgical history, presented to the emergency room with complaints of heavy vaginal bleeding and pain after attempting intercourse. On speculum examination, small bowel was noted to protrude through a 4 cm horizontal laceration in the posterior fornix. The patient was taken to the operating room for laparoscopic repair of the vaginal evisceration. The procedure was performed without complications and the patient had a rapid recovery. Only 100 cases of vaginal evisceration have
S7
been reported in the medical literature; of these, only three were repaired using entirely laparoscopic technique. This case demonstrates that minimally invasive techniques allow safe and effective repair of a vaginal evisceration.
24
Open Communications 1dUltrasound/Imaging Techniques (12:05 PM d 12:10 PM)
The Value of 3-Dimensional Gel Instillation Sonohysterography in the Detection and Classification of Intracavitary Uterine Abnormalities Bij de Vaate M, Huirne J, Van der Slikke JW, Bartholomew J, Bro¨lmann H. Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands Study Objective: To compare the diagnostic accuracy of 3-dimensional gel instillation sonohysterography (3D GIS) with 2D GIS in the detection and classification of intrauterine abnormalities and planning of hysteroscopy with the hysteroscopic procedure as reference. Design: Prospective cohort study. Setting: Academic teaching hospital. Patients: Fifty women suspected for having an intrauterine abnormality after conventional 2D transvaginal sonography, scheduled for GIS. Intervention: 2D GIS and 3D GIS were performed in one session, followed by hysteroscopy by a gynaecologist blinded for the GIS results. 3D GIS recordings were evaluated afterwards by examiners blinded for the 2D and hysteroscopy findings. Planning for the hysteroscopic procedure was made based on 2D GIS, 3D GIS and an ideal planning based on the hysteroscopic findings. Measurements and Main Results: Sensitivity and specificity for detection of a polyp were 75% and 95% for 2D GIS and 85% and 95% for 3D GIS, and the area under the ROC curve (ROC-AUC) for 2D and 3D GIS 0.84 and 0.90, respectively (p ! 0.001). Sensitivity and specificity for detection of a submucous fibroid were 82% and 92% for 2D GIS and 100% for 3D GIS, and the ROC-AUC for 2D and 3D GIS 0.84 and 1.00, respectively (p ! 0.001). Level of agreement (kappa) with hysteroscopy was better for 3D GIS compared with 2D GIS for both the detection of a polyp (0.79 versus 0.64) and a submucous fibroid (1.0 versus 0.70). Correct classification (polyp; type 0, 1 and 2 fibroid) could be improved with 21% using 3D GIS instead of 2D GIS. 3D GIS improved correct planning of hysteroscopy with 13.6%. Conclusion: 3D GIS is more accurate in the detection and classification of intracavitary abnormalities in comparison with 2D GIS. The planning of hysteroscopic procedures can be improved if the planning is made based on 3D GIS instead of 2D GIS.
25
Open Communications 1dUltrasound/Imaging Techniques (12:11 PM d 12:16 PM)
The Diagnostic Accuracy of Gel Instillation Sonohysterography (GIS) Compared with Saline Infusion Sonohysterography (SIS); a Randomised Controlled Trial Emanuel MH, Tromp I, Betlem M. OB/GYN, Spaarne Hospital, Hoofddorp, The Netherlands Study Objective: To compare the diagnostic accuracy of Gel Instillation Sonohysterography (GIS) with the diagnostic accuracy of Saline Infusion Sonohysterography (SIS). Design: Prospective Randomised Controlled Trial. Setting: A large University affiiated training centre. Patients: Between Aug 2007 and Dec 2008 103 consecutive patients with abnormal uterine bleeding and an abnormal transvaginal ultrasound were recruited. Intervention: Patients were randomised for the use of Gel Instillation or Saline Infusion during Sonohysterography. Abnormalities detected during Sonohysterography were classified as pedunculated polyp, sessile polyp, pedunculated myoma (type 0), sessile myoma (type 1) and sessile myoma (type 2). Hysteroscopy was used as gold standard in case of abnormalities. The primary outcome measure was diagnostic accuracy.
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S1eS51
Analysis of single surgeon’s experience:MIRCS made 62.5% of all the cervical surgeries: 37% in 2002-2003, 60% in 2004e2005, 66.6% in 2006e2007, and 100% in 2008. The change of the surgical technique pattern by a single surgeon with time Surgical Technique Open Radical Hysterectomy MIRCS Total
2002e 2003
2004e 2005
2006e 2007
5
6
7
3 8
9 15
14 21
2008e July-2008
Total
17
18 4 4
30 48
MIRCS (Minimally Invasive Radical Cancer Surgery). Patients with ORH compared to MIRCS had higher BMI (29.7 vs. 24.8; p 5 .01),higher EBL (1044 vs. 199 ml; p 5 .0006),and an insignificant shorter total surgical time (300 vs. 328 minutes; p 5 .07). MIRCS had a total immediate surgical complication rate of 16% compared to 5.5% in the ORH. Surgical time and EBL for MIRCS have not significantly changed with the integration of MIRCS. Conclusion: A dedicated surgeon can virtually eliminate need for ORH with the adoption of MIRCS. The many MIRCS options allow individualized care while providing known fertility and post-operative advantages for the patient. MIRCS takes longer to perform, with a higher rate of urinary tract injury and significantly less EBL.
15
Study Objective: The purpose of this video is to demonstrate a technique for extracorporeal knot tying. The video explains instrumentation and techniques for extracorporeal knot tying using a pelvic trainer. The first segment reviews the required instrumentation. This is followed by a stepby-step explanation of technique for extracorporeal knot tying. The final section offers refinements on technique and trouble shooting.
Plenary Session 3dOncology (11:44 AM d 11:54 AM)
Video Session 1dEducation (11:09 AM d 11:14 AM)
Use of the Mid-Sagittal Hemi-Pelvis To Demonstrate Surgical Anatomy for Vaginal Surgery Miller D,1 Giles D.2 1Wheaton Franciscan Healthcare, Wauwatosa, WI; 2 Reproductive Specialty Center, Milwaukee, WI Study Objective: To demonstrate the adaptation of the mid-sagittally cut hemi-pelvis as a teaching aid for surgical anatomy and to visually enhance the demonstration of transvaginal procedures with a low cost portable setup. Instruction in vaginal surgery is often limited to viewing the back of the primary surgeons hand while they attempt to relay relevant anatomy. Even when whole pelvis cadaveric specimens are employed the observers view is restricted. We demonstrate the use of a hemi-pelvis for surgical instruction. This allows for the simultaneous abdominal and vaginal point-of-view. Observers can watch the appropriate placement of clamps and surgical devices, confirm their understanding of the described technique, and measure the distance to neurovascular structures that could be injured. In an era of new anatomically challenging vaginal surgeries, there is a critical need for more detailed anatomic instruction.
Laparoscopic Staging of Endometrial Cancer. Is Further Evidence Needed? Zullo F, Mocciaro R, Annununziata G, Palomba S. Department of Obstetrics and Gynecology, University Magna Graecia of Catanzaro, Catanzaro, Italy
18
Study Objective: To define, if any, type I clinical evidence regarding the safety and efficacy of the laparoscopic approach to endometrial cancer. Design: Meta-analysis of randomized control trial (RCTs). Setting: Department of Gynecology and Obstetrics, University ‘‘Magna Graecia’’ Catanzaro, Italy. Patients: Patients with early stage endometrial cancer surgically treated. Intervention: We searched randomized control trials (RCTs) that compare laparoscopic and laparotomic approach about efficacy and safety data, to treat patients with early stage endometrial cancer. Measurements and Main Results: Five RCTs were identified and included in the final analysis. Significantly longer operative time (OR 5 53.48, 95%CI 37.28 to 69.68, P 5 0.0002), lower intraoperative blood loss (OR 5 266.86, 95%CI 454.82 to 78.90, P 5 0.005) and postoperative complications (OR 5 0.40, 95%CI 0.23 to 0.70, P 5 0.007) were associated to laparoscopy. No effect of laparoscopy on pelvic (OR 5 0.62, 95%CI 1.47 to 2.71, P 5 0.560) and para-aortic (OR 5 1.49, 95%CI 2.49 to 5.60, P 5 0.477) nodes yield, and intraoperative complications (OR 5 1.60, 95%CI 0.49 to 5.22, P5 0.390) was observed. No significant difference between laparoscopic and laparotomic approaches to endometrial cancer in overall survival (OR50.96, 95% CI 0.51 to 1.81, P 5 0.976), disease-free survival (OR 5 0.95, 95% CI 0.51 to 1.80, P 5 0.986), and cancer-related survival (OR 5 0.91, 95% CI 0.27 to 573.06, P 5 0.883) was observed. Conclusion: Our data suggest that laparoscopic approach should be considered an effective and safe procedure for patients with early stage endometrial cancer as well as laparotomic one.
Study Objective: The objective of this video is to review the avascular planes of the pelvis. Understanding the avascular planes of the pelvis is essential in performing advanced gynecologic surgery. The anatomy of the anterior and posterior cul-de-sacs, paravesical and pararectal spaces, vesicovaginal and rectovaginal spaces are reviewed in this video. The clinical relevance of these spaces is demonstrated in various gynecologic procedures such as abdominal and vaginal hysterectomies, laparoscopic excision of endometriosis, abdominal sacral colpopexy, and radical trachelectomy. Familiarity with the avascular planes of the pelvis is important in performing a variety of advanced gynecologic procedures.
16
20
Video Session 1dEducation (11:00 AM d 11:08 AM)
Extracorporeal Knot Tying Mercer J, Bajzak K. Obstetrics and Gynecology, Memorial University of Newfoundland, St. John’s, NL, Canada
Video Session 1dEducation (11:15 AM d 11:20 AM)
A Vascular Planes of the Pelvis Park AJ, Falcone T, Barber MD. Obstetrics & Gynecology, Cleveland Clinic, Cleveland, OH
19
Video Session 1dEducation (11:21 AM d 11:26 AM)
Anatomy of the Uterus and Its Surgical Removal Park AJ, Falcone T, Barber MD. Obstetrics & Gynecology, Cleveland Clinic, Cleveland, OH Study Objective: The objective of this video is to review the anatomy of the uterus and adnexa and to highlight surgically relevant anatomic relationships. The anatomy of the uterus and adnexa are reviewed in this video, including the basic pelvic anatomy and relationships to the urinary tract. The levels of uterine and vaginal support are also demonstrated. A thorough understanding of the anatomy of the uterus and its adnexa is important for the appropriate surgical planning. Video Session 1dEducation (11:27 AM d 11:35 AM)
Management of Unintentional Fetoscopy Kho KA, Nezhat C. Atlanta Center for Special Minimally Invasive Surgery and Reproductive Medicine, Atlanta, GA
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S1eS51 Study Objective: Approximately 1 in 500 women will require non-obstetric surgery during pregnancy and minimally invasive approaches are being more widely used in this setting. This video presents a never previously reported case of injury to a gravid uterus resulting in a full thickness hysterotomy and unintentional fetoscopy. In a thought provoking manner, the video highlights key steps in conceptualization and management of this complication.
21
Video Session 1dEducation (11:36 AM d 11:44 AM)
Neovagina Creation Using Split-Thickness Skin Graft To Treat the Iatrogenic Foreshortened Vagina Ridgeway B, Frick AC, Paraiso MF. Obstetrics, Gynecology, and Women’s Health Institute, Cleveland Clinic, Cleveland, OH Study Objective: This video describes techniques for neovagina creation in women with an iatrogenically foreshortened vagina. This includes skin graft procurement, development and placement of the neovagina using a stent, then omental or peritoneal coverage to promote neovascularization. Limited clinical outcomes are presented. We are encouraged by our outcomes with neovagina creation using a split-thickness skin graft in women with an iatrogenically foreshortened vagina. Thus far, we have encountered minimal morbidity. While vaginal dilators should remain a first line therapy for women with a foreshortened vagina, our technique offers a viable option for women who fail dilator therapy. The procedure both restores normal anatomy and sexual function in women with inadequate vaginal length.
22
Video Session 1dEducation (11:45 AM d 11:53 AM)
Surgical Managment of the Non-Communicating Uterine Horn Sovino H, Villarroel C, Cespedes P, Devoto L. Instituto de Investigaciones Materno Infantil, Universidad de Chile, Santiago de Chile, Region Metropolitana, Chile Study Objective: This video is intended to present the surgical management of the non-communicating Uterine Horn. It considers the embryologic development of this pathology. Anatomical variants of presentation must be considered in order to plan the surgery. Noncommunicating uterine horn can be broadly attached to the functional horn by an extense septum or can be separated by a fibrous band. In some cases an enlarged horn can be observed due to haematometra. In many cases surgery is complicated by the existence of different grades of endometriosis. Surgery requires a systematic approach that is described in the video. In our Reproductive Medicine Unit we have treated 5 cases in two years. Patients have consulted for severe pelvic pain and the presence of haematometra. We have found a 40% of urinary malformation associated. Endometriosis was found in 4 of 5 cases. No complications were observed. A significant improvement on dismenorrhea was observed after surgery.
23
Video Session 1dEducation (11:54 AM d 11:57 AM)
The Laparoscopic Repair of a Vaginal Evisceration McCullough MC, Cox C, Hart SR. Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL Study Objective: A 17 year old nulligravida, without any significant past medical or surgical history, presented to the emergency room with complaints of heavy vaginal bleeding and pain after attempting intercourse. On speculum examination, small bowel was noted to protrude through a 4 cm horizontal laceration in the posterior fornix. The patient was taken to the operating room for laparoscopic repair of the vaginal evisceration. The procedure was performed without complications and the patient had a rapid recovery. Only 100 cases of vaginal evisceration have
S7
been reported in the medical literature; of these, only three were repaired using entirely laparoscopic technique. This case demonstrates that minimally invasive techniques allow safe and effective repair of a vaginal evisceration.
24
Open Communications 1dUltrasound/Imaging Techniques (12:05 PM d 12:10 PM)
The Value of 3-Dimensional Gel Instillation Sonohysterography in the Detection and Classification of Intracavitary Uterine Abnormalities Bij de Vaate M, Huirne J, Van der Slikke JW, Bartholomew J, Bro¨lmann H. Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands Study Objective: To compare the diagnostic accuracy of 3-dimensional gel instillation sonohysterography (3D GIS) with 2D GIS in the detection and classification of intrauterine abnormalities and planning of hysteroscopy with the hysteroscopic procedure as reference. Design: Prospective cohort study. Setting: Academic teaching hospital. Patients: Fifty women suspected for having an intrauterine abnormality after conventional 2D transvaginal sonography, scheduled for GIS. Intervention: 2D GIS and 3D GIS were performed in one session, followed by hysteroscopy by a gynaecologist blinded for the GIS results. 3D GIS recordings were evaluated afterwards by examiners blinded for the 2D and hysteroscopy findings. Planning for the hysteroscopic procedure was made based on 2D GIS, 3D GIS and an ideal planning based on the hysteroscopic findings. Measurements and Main Results: Sensitivity and specificity for detection of a polyp were 75% and 95% for 2D GIS and 85% and 95% for 3D GIS, and the area under the ROC curve (ROC-AUC) for 2D and 3D GIS 0.84 and 0.90, respectively (p ! 0.001). Sensitivity and specificity for detection of a submucous fibroid were 82% and 92% for 2D GIS and 100% for 3D GIS, and the ROC-AUC for 2D and 3D GIS 0.84 and 1.00, respectively (p ! 0.001). Level of agreement (kappa) with hysteroscopy was better for 3D GIS compared with 2D GIS for both the detection of a polyp (0.79 versus 0.64) and a submucous fibroid (1.0 versus 0.70). Correct classification (polyp; type 0, 1 and 2 fibroid) could be improved with 21% using 3D GIS instead of 2D GIS. 3D GIS improved correct planning of hysteroscopy with 13.6%. Conclusion: 3D GIS is more accurate in the detection and classification of intracavitary abnormalities in comparison with 2D GIS. The planning of hysteroscopic procedures can be improved if the planning is made based on 3D GIS instead of 2D GIS.
25
Open Communications 1dUltrasound/Imaging Techniques (12:11 PM d 12:16 PM)
The Diagnostic Accuracy of Gel Instillation Sonohysterography (GIS) Compared with Saline Infusion Sonohysterography (SIS); a Randomised Controlled Trial Emanuel MH, Tromp I, Betlem M. OB/GYN, Spaarne Hospital, Hoofddorp, The Netherlands Study Objective: To compare the diagnostic accuracy of Gel Instillation Sonohysterography (GIS) with the diagnostic accuracy of Saline Infusion Sonohysterography (SIS). Design: Prospective Randomised Controlled Trial. Setting: A large University affiiated training centre. Patients: Between Aug 2007 and Dec 2008 103 consecutive patients with abnormal uterine bleeding and an abnormal transvaginal ultrasound were recruited. Intervention: Patients were randomised for the use of Gel Instillation or Saline Infusion during Sonohysterography. Abnormalities detected during Sonohysterography were classified as pedunculated polyp, sessile polyp, pedunculated myoma (type 0), sessile myoma (type 1) and sessile myoma (type 2). Hysteroscopy was used as gold standard in case of abnormalities. The primary outcome measure was diagnostic accuracy.