- Email: [email protected]
Minitouch Endometrial Ablation: Review of Outcomes and Resource Usage at Basildon University Hospital
S124
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201
No intra-operative complications occurred. Post-operative complications included prolapsed leiomyomas after incomplete resection (2), pelvic infections (2) and self-resolving dyspnoea without any evidence of overload (1). Conclusion: Hysteroscopic morcellation of polyps and submucosal leiomyomas is an effective method to manage women with AUB. Resection of pathology of more than 5 cm is safe, although associated with an increased risk of requiring subsequent surgical procedures.
368
Virtual Posters – Session 1 (9:45 AM–10:45 AM) 10:27 AM – STATION B
Minitouch Endometrial Ablation Performed as an Outpatient (Office) Procedure in Arrowe Park Hospital, a UK District General Hospital – An Update Gent J, Alam M, Steele G, Kubwalo B. Department of Obstetrics & Gynaecology, Arrowe Park Hospital, Upton, Birkenhead, Wirral, United Kingdom Study Objective: Endometrial Ablation is a safe and effective treatment for heavy menstrual bleeding with established NICE guidelines. It can be performed with a combination of analgesics in selected patients in an outpatient setting, thus avoiding the risks of general anaesthetic. We present our updated results of 69 patients who underwent outpatient endometrial ablation; focusing on ease of use, completion of procedure, use of local anaesthetic, patient acceptability, complications, patient satisfaction and outcomes. Design: Retrospective Review. Setting: Nurse led outpatient clinic in a district general hospital in the United Kingdom. Patients: 69 patients. Intervention: Minitouch procedures performed since 2014. Measurements and Main Results: Data from all 69 patients is now available. 59/69 performed by nurse hysteroscopist, 4/69 by consultant, 3/69 by community doctor and 3/69 by registrar. The average age was 44.4, average parity 2.4 and sounding length 9 cm. 4 patients did not complete the procedure (unable to tolerate/cavity not appropriate/failed to gain entry to cavity). 65 patients successfully underwent ablation, treatment time was short and cervical dilatation was not required. Local anaesthetic was used for those with a tender cervix. No immediate complications occurred and only 2 patients required antibiotics for suspected infection. Satisfaction was high and results show a success rate exceeding 81% at 4 month follow up. Conclusion: Minitouch endometrial ablation is an easy to use, safe procedure that does not require cervical dilatation. It is well suited in a nurse led outpatient setting. It has positive outcomes and is an acceptable treatment option for selected patients.
369
Virtual Posters – Session 1 (9:45 AM–10:45 AM) 10:27 AM – STATION C
Minitouch Endometrial Ablation: Review of Outcomes and Resource Usage at Basildon University Hospital Thakur Y,1 Thakur V,2 Karunaratne C,1 Nicholls S1. 1Department of Gynaecology, Basildon University Hospital, Basildon, Essex, United Kingdom; 2Broomfield Hospital, Chelmsford, Essex, United Kingdom Study Objective: We share our experience with Minitouch Endometrial Ablation at a busy university hospital since 2014 in terms of outcomes, resource usage, and ability to treat an expanded patient pool. Design: Records of 107 patients treated till December 2016 were reviewed. Setting: A busy university hospital in the United Kingdom. Patients: Patients treated with Minitouch Endometrial Ablation. Intervention: Minitouch Endometrial Ablation.
Measurements and Main Results: 79.4% procedures were performed in an outpatient clinic with analgesia, but without local anaesthesia. 20.6% were performed in a theatre, when requested by patients, under a customised “minimum-necessary anaesthesia protocol”, selected from Entonox only, intravenous sedation or general anaesthesia. Average patient age was 44.2 (range 31–54). Cavity size (fundus to internal ostium) was 4–9 cm. Follow-up data for 74 patients was available. Overall success rate was 65/ 74(87.8%). At initial follow-up (range 4–6 months), 38/74(51.4%) patients reported amenorrhoea, 20/74(27.0%) reported spotting, and 7/74(9.5%) lighter periods. 7/74(9.5%) patients underwent subsequent hysterectomy and 2/74(2.7%) are being treated with drugs. No complications were identified. Since dilatation is not required, the procedure tray needs only a disposable speculum, vulsellum (if required), Pipelle catheter, and cleaning preparation. A diagnostic hysteroscope is kept ready if ultrasound imaging is inadequate. The outpatient team comprises a gynaecologist, a nurse, and a CSW. Using Minitouch, we have started an outpatient ablation service where we treat an expanded patient pool, especially 1) patients at high risk under GA e.g. due to cardiac /pulmonary co-morbidities, obesity, etc., 2) patients with oversized/undersized cavities or extreme uterine axis bends. Conclusion: Minitouch procedures with their excellent safety and efficacy outcomes and lower resource usage have very clear benefits to our resourceconstrained NHS system.
370
Virtual Posters – Session 1 (9:45 AM–10:45 AM) 10:27 AM – STATION D
Minitouch Outpatient Endometrial Ablation – Learning Curve of 12 Gynaecologists Golash M, Misfar N, Bhatia K. Burnley General Hospital, East Lancashire NHS Trust, Burnley, Lancashire, United Kingdom Study Objective: To describe the learning curve and outcomes of Minitouch endometrial ablation cases done by 12 gynaecologists. Design: Electronic discharge summaries and last outpatient clinic letters were analysed of patients who have completed 4-month follow up. Setting: Day case setting of a general hospital within a National Health Service trust. Patients: Patients treated with Minitouch endometrial ablation between January and December 2016. Intervention: Minitouch endometrial ablation procedures. Measurements and Main Results: 48 Minitouch endometrial ablation cases were performed. Four patients are awaiting 4-month follow up. Electronic discharge summaries and last outpatient clinic letters for the remaining 44 patients were analysed. All cases were done in a day case setting by 12 gynaecologists, resulting in an average 3.7 cases per operator. Patients’ average age was 42.9 (range 28–53) and their indications were: 39/44 menorrhagia, 2/44 irregular bleeding, and 3/44 metromenorrhagia. Fibroids measuring 9–46 mm were identified during pre-op ultrasound in 15/44 (34.1%) patients, included 11 intramural, 4 sub-mucosal, and 2 sub-serosal. One or more pharmacological treatments had previously failed in 30/44 (68.2%) patients. All patients had normal cavities with an average sounding length of 8.9 cm (range 7–14 cm). 4/44 patients (9.1%) had a history of 1–2 LSCS. Successful resolution of symptoms (amenorrhea, spotting or lighter periods) at 4-months was identified in 36/44 (82%) patients. One of these patients is not completely satisfied and is scheduled for second review. Another is being treated with Esmya. No adverse event was reported. Of the remaining 8/44(18%) patients with persistent symptoms, one patient is under wait and watch, five are receiving pharmacological treatment, one underwent rollerball ablation, and one total laparoscopic hysterectomy. Conclusion: The learning curve for our large team of gynaecologists with varying experience levels was short and consistent as demonstrated by ex-
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201
No intra-operative complications occurred. Post-operative complications included prolapsed leiomyomas after incomplete resection (2), pelvic infections (2) and self-resolving dyspnoea without any evidence of overload (1). Conclusion: Hysteroscopic morcellation of polyps and submucosal leiomyomas is an effective method to manage women with AUB. Resection of pathology of more than 5 cm is safe, although associated with an increased risk of requiring subsequent surgical procedures.
368
Virtual Posters – Session 1 (9:45 AM–10:45 AM) 10:27 AM – STATION B
Minitouch Endometrial Ablation Performed as an Outpatient (Office) Procedure in Arrowe Park Hospital, a UK District General Hospital – An Update Gent J, Alam M, Steele G, Kubwalo B. Department of Obstetrics & Gynaecology, Arrowe Park Hospital, Upton, Birkenhead, Wirral, United Kingdom Study Objective: Endometrial Ablation is a safe and effective treatment for heavy menstrual bleeding with established NICE guidelines. It can be performed with a combination of analgesics in selected patients in an outpatient setting, thus avoiding the risks of general anaesthetic. We present our updated results of 69 patients who underwent outpatient endometrial ablation; focusing on ease of use, completion of procedure, use of local anaesthetic, patient acceptability, complications, patient satisfaction and outcomes. Design: Retrospective Review. Setting: Nurse led outpatient clinic in a district general hospital in the United Kingdom. Patients: 69 patients. Intervention: Minitouch procedures performed since 2014. Measurements and Main Results: Data from all 69 patients is now available. 59/69 performed by nurse hysteroscopist, 4/69 by consultant, 3/69 by community doctor and 3/69 by registrar. The average age was 44.4, average parity 2.4 and sounding length 9 cm. 4 patients did not complete the procedure (unable to tolerate/cavity not appropriate/failed to gain entry to cavity). 65 patients successfully underwent ablation, treatment time was short and cervical dilatation was not required. Local anaesthetic was used for those with a tender cervix. No immediate complications occurred and only 2 patients required antibiotics for suspected infection. Satisfaction was high and results show a success rate exceeding 81% at 4 month follow up. Conclusion: Minitouch endometrial ablation is an easy to use, safe procedure that does not require cervical dilatation. It is well suited in a nurse led outpatient setting. It has positive outcomes and is an acceptable treatment option for selected patients.
369
Virtual Posters – Session 1 (9:45 AM–10:45 AM) 10:27 AM – STATION C
Minitouch Endometrial Ablation: Review of Outcomes and Resource Usage at Basildon University Hospital Thakur Y,1 Thakur V,2 Karunaratne C,1 Nicholls S1. 1Department of Gynaecology, Basildon University Hospital, Basildon, Essex, United Kingdom; 2Broomfield Hospital, Chelmsford, Essex, United Kingdom Study Objective: We share our experience with Minitouch Endometrial Ablation at a busy university hospital since 2014 in terms of outcomes, resource usage, and ability to treat an expanded patient pool. Design: Records of 107 patients treated till December 2016 were reviewed. Setting: A busy university hospital in the United Kingdom. Patients: Patients treated with Minitouch Endometrial Ablation. Intervention: Minitouch Endometrial Ablation.
Measurements and Main Results: 79.4% procedures were performed in an outpatient clinic with analgesia, but without local anaesthesia. 20.6% were performed in a theatre, when requested by patients, under a customised “minimum-necessary anaesthesia protocol”, selected from Entonox only, intravenous sedation or general anaesthesia. Average patient age was 44.2 (range 31–54). Cavity size (fundus to internal ostium) was 4–9 cm. Follow-up data for 74 patients was available. Overall success rate was 65/ 74(87.8%). At initial follow-up (range 4–6 months), 38/74(51.4%) patients reported amenorrhoea, 20/74(27.0%) reported spotting, and 7/74(9.5%) lighter periods. 7/74(9.5%) patients underwent subsequent hysterectomy and 2/74(2.7%) are being treated with drugs. No complications were identified. Since dilatation is not required, the procedure tray needs only a disposable speculum, vulsellum (if required), Pipelle catheter, and cleaning preparation. A diagnostic hysteroscope is kept ready if ultrasound imaging is inadequate. The outpatient team comprises a gynaecologist, a nurse, and a CSW. Using Minitouch, we have started an outpatient ablation service where we treat an expanded patient pool, especially 1) patients at high risk under GA e.g. due to cardiac /pulmonary co-morbidities, obesity, etc., 2) patients with oversized/undersized cavities or extreme uterine axis bends. Conclusion: Minitouch procedures with their excellent safety and efficacy outcomes and lower resource usage have very clear benefits to our resourceconstrained NHS system.
370
Virtual Posters – Session 1 (9:45 AM–10:45 AM) 10:27 AM – STATION D
Minitouch Outpatient Endometrial Ablation – Learning Curve of 12 Gynaecologists Golash M, Misfar N, Bhatia K. Burnley General Hospital, East Lancashire NHS Trust, Burnley, Lancashire, United Kingdom Study Objective: To describe the learning curve and outcomes of Minitouch endometrial ablation cases done by 12 gynaecologists. Design: Electronic discharge summaries and last outpatient clinic letters were analysed of patients who have completed 4-month follow up. Setting: Day case setting of a general hospital within a National Health Service trust. Patients: Patients treated with Minitouch endometrial ablation between January and December 2016. Intervention: Minitouch endometrial ablation procedures. Measurements and Main Results: 48 Minitouch endometrial ablation cases were performed. Four patients are awaiting 4-month follow up. Electronic discharge summaries and last outpatient clinic letters for the remaining 44 patients were analysed. All cases were done in a day case setting by 12 gynaecologists, resulting in an average 3.7 cases per operator. Patients’ average age was 42.9 (range 28–53) and their indications were: 39/44 menorrhagia, 2/44 irregular bleeding, and 3/44 metromenorrhagia. Fibroids measuring 9–46 mm were identified during pre-op ultrasound in 15/44 (34.1%) patients, included 11 intramural, 4 sub-mucosal, and 2 sub-serosal. One or more pharmacological treatments had previously failed in 30/44 (68.2%) patients. All patients had normal cavities with an average sounding length of 8.9 cm (range 7–14 cm). 4/44 patients (9.1%) had a history of 1–2 LSCS. Successful resolution of symptoms (amenorrhea, spotting or lighter periods) at 4-months was identified in 36/44 (82%) patients. One of these patients is not completely satisfied and is scheduled for second review. Another is being treated with Esmya. No adverse event was reported. Of the remaining 8/44(18%) patients with persistent symptoms, one patient is under wait and watch, five are receiving pharmacological treatment, one underwent rollerball ablation, and one total laparoscopic hysterectomy. Conclusion: The learning curve for our large team of gynaecologists with varying experience levels was short and consistent as demonstrated by ex-