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O079 SINGLE INCISION LAPAROSCOPIC SURGERY (SILS) IN EARLY ENDOMETRIAL CANCER: A PROSPECTIVE STUDY
S288
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
cycle. A transvaginal Ultrasonographic examination on day 2–5 of the menstrual cycle was done for antral follicle count and ovarian volume. A correlation between BMI and ovarian reserve parameters like FSH, LH, Inhibin B, antral follicle count (AFC) and ovarian volume was noted. Data were presented as number (%) or mean±SD as appropriate. The p value less than 0.05 was considered statistically significant. The statistical analysis was carried out using STATA 9.0 (College Station, Texas, USA). Results: The age of the patients ranged from 20–42 years (mean 32.13 years). The mean duration of infertility was 8.38 years. According to their Body Mass Index (BMI), 93 (50.8%) had a normal weight (18.5–24.9 kg/m2 ), 69 (37.7%) were overweight (25– 29.9 kg/m2 ) and 21 (11.5%) were obese (≥30 kg/m2 ). Compared to the normal weight, the overweight and obese women had a statistically significantly low antral follicle count (p < 0.0129). There was a negative correlation between BMI and AFC (−0.18, p < 0.05) and BMI and Inhibin B ()_0.20, p < 0.032) upto the age of 36 years. Inhibin B, AFC and other ovarian reserve markers were independent of BMI beyond 36 years. Conclusions: There is a scarcity of strong evidence on this topic, future studies with a larger sample size are required to clarify the predictive value of obesity on ovarian reserve in infertile women. Incorporating AMH, as a newer marker for ovarian reserve, perhaps may benefit these obese infertile women. The quench for the perfect biochemical or ultrasonographic ovarian reserve marker that can predict the response to assisted reproductive cycle remains unfulfilled. Table: Primary and secondary outcome variables BMI category
Antral Follicle Count ovary
Ovarian volume in cm3
Inhibin B
FSH in IU/l
Normal (18.5–24.9 kg/m2 )
7±2.64 (1–12)
5.1±3.68 (1.6–25)
40±39.8 (2.45–248.64)
5.9±1.85 (2.62–11.82)
Overweight (25–29.9 kg/m2 )
6±2.46 (2–10)
4.8±2.75 (2.4–14.9)
31.8±42.79 (5.22–284)
6.3±2.48 (2.67–13.79)
Obese (≥30 kg/m2 )
5±2.66 (0–10)
p value
0.0129
3.8±3.56 (1.5–13.7) 0.1437
20.8±9.62 (10.3–46.3) 0.0082
6.4±2.01 (2.91–10.56) 0.2413
p value < 0.05 significant
Figure: BMI vs AFC. O078 LAPAROSCOPIC MANAGEMENT OF ADENEXAL MASS R.D. Baharani1 . 1 Obs-Gynae, JHRC, Jabalpur, Madhya Pradesh, India Objectives: To review management of Adenexal Mass with the introduction of Laparoscopic service. Materials: Zero degree 10mm laparoscope, single chip video camera, light source, video monitor, light cable, trocars,5mm grasping forceps, scissors, suction irrigation, 10mm claw forceps, endobag.
Methods: A retrospective analysis of 50 cases of Adenexal Mass managed at our hospital from June, 2005- June, 2010 was done, Pre-operative evaluation of cases was done with CA 125 level, USG & Colour Doppler. Cases showing features of malignancy on USG were not taken in this study. Post operatively HPR of every specimen was done. Results: In this study, 68% of patients were between 30–40 years of age. 26% were between 20–30 years of age and 6% were less than 20 yrs. of age. Parity wise 12% were Gr0P0 72% were P1-P3 16% were P4-P6 Out of 50 cases 96% patients were managed by Laparoscopic Surgery, 2% by Open Surgery. 2% of Patients couldn’t be managed surgically these were the cases of T.O. Mass with dense adhesions on laparoscopy which were later managed conservatively. 82% of cases were managed by Intraperitoneal Method and 18% were managed by Transperitoneal Method. 1. Laparoscopic Ovarian Cystectomy was done in 68% cases. 2. Laparoscopic Oophorectomy was done in 20%. 3.Laparoscopic Salpingooophorectomy was done in 2%. 4.Laparoscopic Endometriotic Cyst Enucleation was done in 10% cases. Size of Adenexal Mass was – a) 6–10 cm in 46% cases b) 11–16 cm in 45% cases c) More than 16 cm in 9% On HPR a) Benign Cystadenoma was found in 34% b) Simple Serous Cyst was found in 56% c) Endometriotic Ovarian Cyst was found in 09% d) Dermoid Ovarian Cyst was found in 01%. Conclusions: Laparoscopic Management for Adenexal Mass avoids laparotomy with satisfactory results. Safety, efficacy of laparoscopic management has been established by this study. Short hospital stay, less post OP pain, less requirement of analgesic and other drugs, less chances of post OP adhesions. Faster return to normal activities are the advantages over open surgery. O079 SINGLE INCISION LAPAROSCOPIC SURGERY (SILS) IN EARLY ENDOMETRIAL CANCER: A PROSPECTIVE STUDY E. Vizza1 , E. Baiocco1 , E. Mancini1 , L. Patrizi2 , M. Saltari2 , S. Sindico1 , M. Cimino1 , G. Corrado3 . 1 Gynecologic Oncology Unit, National Cancer Institute “Regina Elena”, Rome, Italy; 2 Department of Surgery, Section of Gynecology and Obstetrics, “Tor Vergata” University, Rome, Italy; 3 Gynecologic Oncology Unit, ‘John Paul II’ Foundation for Research and Care, Campobasso, Italy Objectives: Minimally invasive surgical techniques have been utilized with increasing frequency in endometrial cancer. Recently, single incision laparoscopic surgery (SILS) has been introduced in the treatment of benign gynecological diseases. The purpose of this study was to assess the feasibility of SILS for the surgical treatment of early endometrial cancer. Materials: Patients with histologically proven endometrioid endometrial carcinoma at the preoperative biopsy, clinical FIGO stage IA – IB, were enrolled in this study. Methods: Radical hysterectomy type A and bilateral salpingoophorectomy plus or less pelvic lymphadenectomy using the SILS TM Port Multiple Instrument Access Port. Results: Between July 2009 and February 2012 twenty patients were enrolled. The median age was 59 years (range, 42–77 years) and the median BMI was 31.7 kg/m2 (range 19–48 kg/m2 ). The mean operative time was 110.5 minutes (range, 55–180 min), The median blood loss was 157.5 ml (range, 50–300 ml), with the median drop of Haemoglobin of 1.9 g/L (range, 0.4–3.6 g/L) before and 24 hours after operation. None of the patients required intraoperative or postoperative blood transfusion. The mean length of hospital stay was 2 (range, 1–4 days). In three patients a pelvic lymph node dissection was performed. No Conversion to standard laparoscopic technique was required in any patient. No intra-operative were reported while a patient had a vaginal cuff dehiscence. Conclusions: Laparoscopic single site surgery for the treatment of the early endometrial cancer is feasible, safe and effective and the procedure could be learned over a short period time.
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
cycle. A transvaginal Ultrasonographic examination on day 2–5 of the menstrual cycle was done for antral follicle count and ovarian volume. A correlation between BMI and ovarian reserve parameters like FSH, LH, Inhibin B, antral follicle count (AFC) and ovarian volume was noted. Data were presented as number (%) or mean±SD as appropriate. The p value less than 0.05 was considered statistically significant. The statistical analysis was carried out using STATA 9.0 (College Station, Texas, USA). Results: The age of the patients ranged from 20–42 years (mean 32.13 years). The mean duration of infertility was 8.38 years. According to their Body Mass Index (BMI), 93 (50.8%) had a normal weight (18.5–24.9 kg/m2 ), 69 (37.7%) were overweight (25– 29.9 kg/m2 ) and 21 (11.5%) were obese (≥30 kg/m2 ). Compared to the normal weight, the overweight and obese women had a statistically significantly low antral follicle count (p < 0.0129). There was a negative correlation between BMI and AFC (−0.18, p < 0.05) and BMI and Inhibin B ()_0.20, p < 0.032) upto the age of 36 years. Inhibin B, AFC and other ovarian reserve markers were independent of BMI beyond 36 years. Conclusions: There is a scarcity of strong evidence on this topic, future studies with a larger sample size are required to clarify the predictive value of obesity on ovarian reserve in infertile women. Incorporating AMH, as a newer marker for ovarian reserve, perhaps may benefit these obese infertile women. The quench for the perfect biochemical or ultrasonographic ovarian reserve marker that can predict the response to assisted reproductive cycle remains unfulfilled. Table: Primary and secondary outcome variables BMI category
Antral Follicle Count ovary
Ovarian volume in cm3
Inhibin B
FSH in IU/l
Normal (18.5–24.9 kg/m2 )
7±2.64 (1–12)
5.1±3.68 (1.6–25)
40±39.8 (2.45–248.64)
5.9±1.85 (2.62–11.82)
Overweight (25–29.9 kg/m2 )
6±2.46 (2–10)
4.8±2.75 (2.4–14.9)
31.8±42.79 (5.22–284)
6.3±2.48 (2.67–13.79)
Obese (≥30 kg/m2 )
5±2.66 (0–10)
p value
0.0129
3.8±3.56 (1.5–13.7) 0.1437
20.8±9.62 (10.3–46.3) 0.0082
6.4±2.01 (2.91–10.56) 0.2413
p value < 0.05 significant
Figure: BMI vs AFC. O078 LAPAROSCOPIC MANAGEMENT OF ADENEXAL MASS R.D. Baharani1 . 1 Obs-Gynae, JHRC, Jabalpur, Madhya Pradesh, India Objectives: To review management of Adenexal Mass with the introduction of Laparoscopic service. Materials: Zero degree 10mm laparoscope, single chip video camera, light source, video monitor, light cable, trocars,5mm grasping forceps, scissors, suction irrigation, 10mm claw forceps, endobag.
Methods: A retrospective analysis of 50 cases of Adenexal Mass managed at our hospital from June, 2005- June, 2010 was done, Pre-operative evaluation of cases was done with CA 125 level, USG & Colour Doppler. Cases showing features of malignancy on USG were not taken in this study. Post operatively HPR of every specimen was done. Results: In this study, 68% of patients were between 30–40 years of age. 26% were between 20–30 years of age and 6% were less than 20 yrs. of age. Parity wise 12% were Gr0P0 72% were P1-P3 16% were P4-P6 Out of 50 cases 96% patients were managed by Laparoscopic Surgery, 2% by Open Surgery. 2% of Patients couldn’t be managed surgically these were the cases of T.O. Mass with dense adhesions on laparoscopy which were later managed conservatively. 82% of cases were managed by Intraperitoneal Method and 18% were managed by Transperitoneal Method. 1. Laparoscopic Ovarian Cystectomy was done in 68% cases. 2. Laparoscopic Oophorectomy was done in 20%. 3.Laparoscopic Salpingooophorectomy was done in 2%. 4.Laparoscopic Endometriotic Cyst Enucleation was done in 10% cases. Size of Adenexal Mass was – a) 6–10 cm in 46% cases b) 11–16 cm in 45% cases c) More than 16 cm in 9% On HPR a) Benign Cystadenoma was found in 34% b) Simple Serous Cyst was found in 56% c) Endometriotic Ovarian Cyst was found in 09% d) Dermoid Ovarian Cyst was found in 01%. Conclusions: Laparoscopic Management for Adenexal Mass avoids laparotomy with satisfactory results. Safety, efficacy of laparoscopic management has been established by this study. Short hospital stay, less post OP pain, less requirement of analgesic and other drugs, less chances of post OP adhesions. Faster return to normal activities are the advantages over open surgery. O079 SINGLE INCISION LAPAROSCOPIC SURGERY (SILS) IN EARLY ENDOMETRIAL CANCER: A PROSPECTIVE STUDY E. Vizza1 , E. Baiocco1 , E. Mancini1 , L. Patrizi2 , M. Saltari2 , S. Sindico1 , M. Cimino1 , G. Corrado3 . 1 Gynecologic Oncology Unit, National Cancer Institute “Regina Elena”, Rome, Italy; 2 Department of Surgery, Section of Gynecology and Obstetrics, “Tor Vergata” University, Rome, Italy; 3 Gynecologic Oncology Unit, ‘John Paul II’ Foundation for Research and Care, Campobasso, Italy Objectives: Minimally invasive surgical techniques have been utilized with increasing frequency in endometrial cancer. Recently, single incision laparoscopic surgery (SILS) has been introduced in the treatment of benign gynecological diseases. The purpose of this study was to assess the feasibility of SILS for the surgical treatment of early endometrial cancer. Materials: Patients with histologically proven endometrioid endometrial carcinoma at the preoperative biopsy, clinical FIGO stage IA – IB, were enrolled in this study. Methods: Radical hysterectomy type A and bilateral salpingoophorectomy plus or less pelvic lymphadenectomy using the SILS TM Port Multiple Instrument Access Port. Results: Between July 2009 and February 2012 twenty patients were enrolled. The median age was 59 years (range, 42–77 years) and the median BMI was 31.7 kg/m2 (range 19–48 kg/m2 ). The mean operative time was 110.5 minutes (range, 55–180 min), The median blood loss was 157.5 ml (range, 50–300 ml), with the median drop of Haemoglobin of 1.9 g/L (range, 0.4–3.6 g/L) before and 24 hours after operation. None of the patients required intraoperative or postoperative blood transfusion. The mean length of hospital stay was 2 (range, 1–4 days). In three patients a pelvic lymph node dissection was performed. No Conversion to standard laparoscopic technique was required in any patient. No intra-operative were reported while a patient had a vaginal cuff dehiscence. Conclusions: Laparoscopic single site surgery for the treatment of the early endometrial cancer is feasible, safe and effective and the procedure could be learned over a short period time.