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Minitouch Endometrial Ablation: The Walsall Manor Experience
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Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252
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Rate of Pregnancy After Hysteroscopic Management of Synechiae Capmas P, Mihalache A, Fernandez H. Bicetre Hospital, Le Kremlin Bic^etre, France
Minitouch Endometrial Ablation Performed as an Out-Patient (Office) Procedure in a UK District General Hospital Bhatt DB, Stoke N, Steele G, Alam A, Kubwalo B, Frizelle J. Department of Obstetrics & Gynaecology, Arrowe Park Hospital Upton, Wirral, United Kingdom
Study Objective: To evaluate rate of pregnancy after hysteroscopic management of intrauterine synechiae. Design: Retrospective study. Setting: Gynecologic unit of a teaching hospital. Patients: Women in reproductive age with intrauterine synechiae. Intervention: Operative hysteroscopy to section intra-uterine synechiae. Office hysteroscopy 6 weeks later. Measurements and Main Results: 202 women had a synechiae section under hysteroscopy in day care surgery from 2009 to 2014. 112 women tried to get pregnant after surgery. Mean age was 34 [32.8-35.6]. Synechiae were type 1 synechiae in 4% of case, type 2 in 20%, type 3 in 25%, type 4 in 25% and isthmic synechiae in 26%. A one time procedure was observed for 80% of women, a two time procedure was required for 7.6% and more than two time for 12.4%. The pregnancy rate was 52% (58 out of 112) with a rate of first trimester pregnancy loss of 37%. Term birth was obtained for 45 pregnancies. Placentation anomalies were observed in 8.6% of cases. Conclusion: A 52% pregnancy rate can be obtained after hysteroscopic section of intra-uterine adhesions. A high rate of placentation anomalies is also found. 625 Minitouch Endometrial Ablation: The Walsall Manor Experience Pepper J, Gulati N, Parry-Smith W. Walsall Manor Hospital, Walsall, West Midlands, United Kingdom Study Objective: Ambulatory gynaecology is rapidly evolving. The Minitouch endometrial ablation epitomises this evolution. Presently there is scarce data on its efficacy. Our objective is to describe the outcomes of patients who underwent Minitouch ablation, specifically the effect on menstruation and patient acceptability. Design: Retrospective review. Setting: Outpatient gynaecology clinic of Walsall Manor Hospital. Patients: Patients who underwent Minitouch ablation for heavy menstrual bleeding (HMB) between 1st March 2015 and 1st February 2016 (n=27). Intervention: Patients took two forms of simple analgesia pre-operatively and received pre-ablation local anaesthetic infiltration in to the endometrium. Ablation was performed by the same consultant gynaecologist (JP) in our hospital’s outpatient clinic. Procedure time was 60-90 seconds depending on cavity size. All patients were offered Mirena coil insertion post-ablation. In March 2016, patients were followed-up through a semi-structured telephone interview, conducted by NG and WPS to reduce response bias. Measurements and Main Results: Median age of patients was 46 years, with a median parity of 2. Median uterine cavity length measured 5.5cm. Response rate for follow-up was 81% (22/27). 59% (13/22) reported amenorrhoea 1-12 months post-procedure. An additional 32% (7/22) reported hypomenorrhoea. Only 1 patient reported any post-procedure complications (infection). 82% (18/22) consented to the Mirena, of which 78% (14/18) were satisfied with it. Despite 64% (14/22) describing Minitouch as ‘‘painful’’, 91% (20/22) of responders would recommend it to family and friends. Conclusion: With an overwhelmingly positive response to treatment, we demonstrate the effectiveness of Minitouch and its acceptability to patients. Further research is required comparing the outcome of Minitouch with and without the Mirena, but this preliminary data suggests the two treatment modalities combined provide a good outcome.
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 oral/parenteral/local anaesthetic in selected patients, thus avoiding the risks associated with general anaesthetic. We present our experience with over 50 Minitouch procedures regarding ease of use, use of local anaesthesia, patient acceptability, complications, patient satisfaction and outcomes. Design: Retrospective review. Setting: Nurse led outpatient clinic in Arrowe Park Hospital, a district general hospital in United Kingdom. Patients: Patients treated with Minitouch procedures. Intervention: Minitouch procedures performed since 2014. Measurements and Main Results: Data from the first 44 cases is available. 39/44 of the cases were performed by a nurse hysteroscopist (GS), 2/44 cases by a consultant (MA) and 3/44 cases by a community hospital doctor. The patients’ average age was 44.1 years, parity 2.2 and sounding length 8.9 cm. The procedure was easy to perform. Treatment time was short and cervix dilatation was not needed in any patient. Local anaesthesia was administered in 13/44 cases in patients with tender cervix. There were no complications, other than two patients who were given antibiotics for suspected infection. Patient satisfaction was high. Initial results show a success rate exceeding 80 %. Latest available results will be presented at the meeting. Conclusion: Minitouch is a flexible device requiring no dilatation. The procedure is easy to use, safe, acceptable to patients and has positive outcomes. It is well-suited for use in a nurse led outpatient clinic. 627 Outpatient Hysteroscopy; See and Treat Approach Nargund AM, Speers LJ. Obstetrics & Gynaecology, Royal Gwent Hospital, Newport, Wales, United Kingdom Study Objective: To review the use of non-electrosurgical instruments, (with or without local anaesthesia) in the management of endometrial polyps incidentally found during outpatient hysteroscopy. In addition, to assess the success of see and treat hysteroscopy with the use of a patient evaluation questionnaire. Design: Prospective observational study. Setting: Outpatient postmenopausal bleeding one-stop clinic at a District General Hospital. Patients: Postmenopausal women referred to outpatient postmenopausal bleeding clinic with an endometrial polyp diagnosed at hysteroscopy were offered inclusion into the study. Intervention: Women diagnosed with a polyp were offered immediate hysteroscopic excision using hysteroscopic scissors and forceps (with or without local anaesthesia). Measurements and Main Results: Data is being collected prospectively. Completeness of the procedure, pain score, patient’s overall satisfaction and ‘friends and family’ test are all parameters measured. As this study is currently on going further data will be presented. Until the present time, 15 women diagnosed with an endometrial polyp underwent resection using hysteroscopic scissors and forceps. In 80% of cases resection was complete; 20% required resection under general/regional anaesthesia. The average pain score was between 2 and 4. Recommendation of the procedure to family and friends reached 100% in women whom resection was complete.
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252
624
626
Rate of Pregnancy After Hysteroscopic Management of Synechiae Capmas P, Mihalache A, Fernandez H. Bicetre Hospital, Le Kremlin Bic^etre, France
Minitouch Endometrial Ablation Performed as an Out-Patient (Office) Procedure in a UK District General Hospital Bhatt DB, Stoke N, Steele G, Alam A, Kubwalo B, Frizelle J. Department of Obstetrics & Gynaecology, Arrowe Park Hospital Upton, Wirral, United Kingdom
Study Objective: To evaluate rate of pregnancy after hysteroscopic management of intrauterine synechiae. Design: Retrospective study. Setting: Gynecologic unit of a teaching hospital. Patients: Women in reproductive age with intrauterine synechiae. Intervention: Operative hysteroscopy to section intra-uterine synechiae. Office hysteroscopy 6 weeks later. Measurements and Main Results: 202 women had a synechiae section under hysteroscopy in day care surgery from 2009 to 2014. 112 women tried to get pregnant after surgery. Mean age was 34 [32.8-35.6]. Synechiae were type 1 synechiae in 4% of case, type 2 in 20%, type 3 in 25%, type 4 in 25% and isthmic synechiae in 26%. A one time procedure was observed for 80% of women, a two time procedure was required for 7.6% and more than two time for 12.4%. The pregnancy rate was 52% (58 out of 112) with a rate of first trimester pregnancy loss of 37%. Term birth was obtained for 45 pregnancies. Placentation anomalies were observed in 8.6% of cases. Conclusion: A 52% pregnancy rate can be obtained after hysteroscopic section of intra-uterine adhesions. A high rate of placentation anomalies is also found. 625 Minitouch Endometrial Ablation: The Walsall Manor Experience Pepper J, Gulati N, Parry-Smith W. Walsall Manor Hospital, Walsall, West Midlands, United Kingdom Study Objective: Ambulatory gynaecology is rapidly evolving. The Minitouch endometrial ablation epitomises this evolution. Presently there is scarce data on its efficacy. Our objective is to describe the outcomes of patients who underwent Minitouch ablation, specifically the effect on menstruation and patient acceptability. Design: Retrospective review. Setting: Outpatient gynaecology clinic of Walsall Manor Hospital. Patients: Patients who underwent Minitouch ablation for heavy menstrual bleeding (HMB) between 1st March 2015 and 1st February 2016 (n=27). Intervention: Patients took two forms of simple analgesia pre-operatively and received pre-ablation local anaesthetic infiltration in to the endometrium. Ablation was performed by the same consultant gynaecologist (JP) in our hospital’s outpatient clinic. Procedure time was 60-90 seconds depending on cavity size. All patients were offered Mirena coil insertion post-ablation. In March 2016, patients were followed-up through a semi-structured telephone interview, conducted by NG and WPS to reduce response bias. Measurements and Main Results: Median age of patients was 46 years, with a median parity of 2. Median uterine cavity length measured 5.5cm. Response rate for follow-up was 81% (22/27). 59% (13/22) reported amenorrhoea 1-12 months post-procedure. An additional 32% (7/22) reported hypomenorrhoea. Only 1 patient reported any post-procedure complications (infection). 82% (18/22) consented to the Mirena, of which 78% (14/18) were satisfied with it. Despite 64% (14/22) describing Minitouch as ‘‘painful’’, 91% (20/22) of responders would recommend it to family and friends. Conclusion: With an overwhelmingly positive response to treatment, we demonstrate the effectiveness of Minitouch and its acceptability to patients. Further research is required comparing the outcome of Minitouch with and without the Mirena, but this preliminary data suggests the two treatment modalities combined provide a good outcome.
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 oral/parenteral/local anaesthetic in selected patients, thus avoiding the risks associated with general anaesthetic. We present our experience with over 50 Minitouch procedures regarding ease of use, use of local anaesthesia, patient acceptability, complications, patient satisfaction and outcomes. Design: Retrospective review. Setting: Nurse led outpatient clinic in Arrowe Park Hospital, a district general hospital in United Kingdom. Patients: Patients treated with Minitouch procedures. Intervention: Minitouch procedures performed since 2014. Measurements and Main Results: Data from the first 44 cases is available. 39/44 of the cases were performed by a nurse hysteroscopist (GS), 2/44 cases by a consultant (MA) and 3/44 cases by a community hospital doctor. The patients’ average age was 44.1 years, parity 2.2 and sounding length 8.9 cm. The procedure was easy to perform. Treatment time was short and cervix dilatation was not needed in any patient. Local anaesthesia was administered in 13/44 cases in patients with tender cervix. There were no complications, other than two patients who were given antibiotics for suspected infection. Patient satisfaction was high. Initial results show a success rate exceeding 80 %. Latest available results will be presented at the meeting. Conclusion: Minitouch is a flexible device requiring no dilatation. The procedure is easy to use, safe, acceptable to patients and has positive outcomes. It is well-suited for use in a nurse led outpatient clinic. 627 Outpatient Hysteroscopy; See and Treat Approach Nargund AM, Speers LJ. Obstetrics & Gynaecology, Royal Gwent Hospital, Newport, Wales, United Kingdom Study Objective: To review the use of non-electrosurgical instruments, (with or without local anaesthesia) in the management of endometrial polyps incidentally found during outpatient hysteroscopy. In addition, to assess the success of see and treat hysteroscopy with the use of a patient evaluation questionnaire. Design: Prospective observational study. Setting: Outpatient postmenopausal bleeding one-stop clinic at a District General Hospital. Patients: Postmenopausal women referred to outpatient postmenopausal bleeding clinic with an endometrial polyp diagnosed at hysteroscopy were offered inclusion into the study. Intervention: Women diagnosed with a polyp were offered immediate hysteroscopic excision using hysteroscopic scissors and forceps (with or without local anaesthesia). Measurements and Main Results: Data is being collected prospectively. Completeness of the procedure, pain score, patient’s overall satisfaction and ‘friends and family’ test are all parameters measured. As this study is currently on going further data will be presented. Until the present time, 15 women diagnosed with an endometrial polyp underwent resection using hysteroscopic scissors and forceps. In 80% of cases resection was complete; 20% required resection under general/regional anaesthesia. The average pain score was between 2 and 4. Recommendation of the procedure to family and friends reached 100% in women whom resection was complete.