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Outpatient Endometrial Ablation (Minitouch) – A Procedure with Minimal Resource Requirements
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252 Incidence of Thermal Vasculopathy
AEGEA RB WB RFA
Tx to Surgery
Thermal Vasculopathy
162 21 months 710 months 41 months
0% 25% 86% 78%
The primary treatment failure etiology histologically appeared to be bleeding from abnormal thermally-fixed vessels in 25% RB, 72% WB and 42% RFA cases. Similar vessels, combined with cycling endometrium, were identified in an additional 14% WB and 33% RFA cases. None of the non-desiccating vapor treated uteri (AEGEA) had similarly identifiable thermal vascular changes. Conclusion: Hyperthermic vasculopathy was identified in those uteri treated with thermal doses (temperature-time combinations; RB \\ WB and RFA) that resulted in tissue desiccation with subsequent vascular thermal/heat fixation. In contrast, hyperthermic vasculopathy was not identified in the uteri treated with the non-desiccating AEGEA vaporbased system. These results suggest that non-desiccating therapies may have the potential to reduce endometrial ablation failures associated with hyperthermic vasculopathy. 273
Open Communications 24 - Hysteroscopy, Endometrial Ablation and Sterilization (3:25 PM - 5:05 PM) 4:36 PM – GROUP C
Outpatient Endometrial Ablation (Minitouch) – A Procedure with Minimal Resource Requirements Thakur Y,1 Thakur V,2 Nicholls S.1 1Basildon University Hospital, Basildon, Essex, United Kingdom; 2Broomfield Hospital, Chelmsford, Essex, United Kingdom Study Objective: Characterise the resource advantage of Minitouch outpatient procedures. Endometrial ablations are typically performed in the theatre. Even when performed in the outpatient setting, significant resources are still needed. We selected Minitouch because it does not require cervical dilatation, anaesthesia or sedation. It is ideal for outpatient use due to small size, flexibility and short procedure duration. Design: Retrospective study of Minitouch procedures performed in the outpatient setting at Basildon University Hospital since 2014. Setting: Our Minitouch procedure room comprises a procedure couch, ultrasound scanner, and diagnostic hysteroscopy setup (performed only in case of abnormalities such as fibroids). The tray consists of a disposable plastic speculum, vulsellum (if required), Pipelle, and cleaning preparation. A gynaecologist, a nurse and a health care assistant (vocal-local) conducted the procedure. Patients: Patients who underwent Minitouch procedures. Intervention: Minitouch procedures were performed in the outpatient setting. The procedure protocol includes no fasting and taking oral painkillers an hour pre-procedure. There was no need for menstrual cycle timing or hormonal pre-treatment. Measurements and Main Results: Followup available for 40 patients showed that 90% (36/40) had lighter or no periods. No adverse events have been reported. All Minitouch patients tolerated the procedure. Pain or cramping during treatment was comparable to period pain (menstrual cramps) and subsided rapidly after the treatment. Dedicated recovery ward was not necessary. Patients were typically discharged after 10-15 minutes post-procedure. This procedure does not need a recovery set up which eliminates the need for a dedicated recovery bay, a recovery nurse, and monitoring equipment. Conclusion: Minitouch procedures are ideally suited for the outpatient setting. Compared to theatre-based procedures and currently performed outpatient procedures, they need significantly less resources while
S115
providing high efficacy. In these days of financial constraints, a procedure providing better outcomes despite requiring minimal resources is a welcome step forward. 274
Open Communications 24 - Hysteroscopy, Endometrial Ablation and Sterilization (3:25 PM - 5:05 PM) 4:43 PM – GROUP C
Cesarean Scar Defect (Istmocele): Hysterorrhaphic Technique as Etheologic Factor in Cesarean Section Leon JA, Romer M, Milano A, Suarez O. Gynecology, Clınica Maternidad Santa Ana, Caracas, Distrito Capital, Venezuela Study Objective: Evaluate the technique as an etiologic factor hysterorraphy cesarean scar defect in patients who underwent segmental cesarean section. Design: Exploratory research, prospective, longitudinal type was performed. Setting: Academic Hospital of post graduate. Patients: The population consists of patients who underwent cesarean section without prior uterine surgery, in 2015 a total of 1,164 patients previous calculation of the sample of 106 patients was conducted to evaluate. Intervention: The technique employed by hysterorraphy was evaluated by number of planes, type of suture material and thickness of the uterine segment. Cesarean scar defect the appearance of the patients was evaluated at 2,4,6 and 12 months after cesarean section by hysteroscopy and transvaginal ecosonography. Measurements and Main Results: 104 cesarean scar defect (98.11%) were diagnosed by hysteroscopy, and was confirmed by transvaginal ultrasound. The distribution of patients according to area ultrasound, in 36 patients the area was 15 mm2 or less (Grade 1), 36 was between 16 and 24 mm2 (grade 2) and in 32 cases was 25mm2 or more (grade 3). There was no difference in the type of hysterorraphy technique and suture material used with the appearance of cesarean scar defect. The ratio of the thickness of the uterine segment and the sonographic features of cesarean scar defect the highest number of cases of 9- 10 mm thickness 35 cases (33.65%) and a lesser amount in the segments of 3- 4 mm2 is observed 10 cases ( 9.6%). Conclusion: The appearance of cesarean scar defect not dependent on the technique and hysterorraphy suture material used. Being greater thickness uterine segment cesarean scar defect area increases.
Figure 1: association between the thickness of the uterine segment and cesarean scar defect area, the correlation coefficient being 0.395. It was observed that control the area in mm2 1 year the cesarean scar defect decreases.
AEGEA RB WB RFA
Tx to Surgery
Thermal Vasculopathy
162 21 months 710 months 41 months
0% 25% 86% 78%
The primary treatment failure etiology histologically appeared to be bleeding from abnormal thermally-fixed vessels in 25% RB, 72% WB and 42% RFA cases. Similar vessels, combined with cycling endometrium, were identified in an additional 14% WB and 33% RFA cases. None of the non-desiccating vapor treated uteri (AEGEA) had similarly identifiable thermal vascular changes. Conclusion: Hyperthermic vasculopathy was identified in those uteri treated with thermal doses (temperature-time combinations; RB \\ WB and RFA) that resulted in tissue desiccation with subsequent vascular thermal/heat fixation. In contrast, hyperthermic vasculopathy was not identified in the uteri treated with the non-desiccating AEGEA vaporbased system. These results suggest that non-desiccating therapies may have the potential to reduce endometrial ablation failures associated with hyperthermic vasculopathy. 273
Open Communications 24 - Hysteroscopy, Endometrial Ablation and Sterilization (3:25 PM - 5:05 PM) 4:36 PM – GROUP C
Outpatient Endometrial Ablation (Minitouch) – A Procedure with Minimal Resource Requirements Thakur Y,1 Thakur V,2 Nicholls S.1 1Basildon University Hospital, Basildon, Essex, United Kingdom; 2Broomfield Hospital, Chelmsford, Essex, United Kingdom Study Objective: Characterise the resource advantage of Minitouch outpatient procedures. Endometrial ablations are typically performed in the theatre. Even when performed in the outpatient setting, significant resources are still needed. We selected Minitouch because it does not require cervical dilatation, anaesthesia or sedation. It is ideal for outpatient use due to small size, flexibility and short procedure duration. Design: Retrospective study of Minitouch procedures performed in the outpatient setting at Basildon University Hospital since 2014. Setting: Our Minitouch procedure room comprises a procedure couch, ultrasound scanner, and diagnostic hysteroscopy setup (performed only in case of abnormalities such as fibroids). The tray consists of a disposable plastic speculum, vulsellum (if required), Pipelle, and cleaning preparation. A gynaecologist, a nurse and a health care assistant (vocal-local) conducted the procedure. Patients: Patients who underwent Minitouch procedures. Intervention: Minitouch procedures were performed in the outpatient setting. The procedure protocol includes no fasting and taking oral painkillers an hour pre-procedure. There was no need for menstrual cycle timing or hormonal pre-treatment. Measurements and Main Results: Followup available for 40 patients showed that 90% (36/40) had lighter or no periods. No adverse events have been reported. All Minitouch patients tolerated the procedure. Pain or cramping during treatment was comparable to period pain (menstrual cramps) and subsided rapidly after the treatment. Dedicated recovery ward was not necessary. Patients were typically discharged after 10-15 minutes post-procedure. This procedure does not need a recovery set up which eliminates the need for a dedicated recovery bay, a recovery nurse, and monitoring equipment. Conclusion: Minitouch procedures are ideally suited for the outpatient setting. Compared to theatre-based procedures and currently performed outpatient procedures, they need significantly less resources while
S115
providing high efficacy. In these days of financial constraints, a procedure providing better outcomes despite requiring minimal resources is a welcome step forward. 274
Open Communications 24 - Hysteroscopy, Endometrial Ablation and Sterilization (3:25 PM - 5:05 PM) 4:43 PM – GROUP C
Cesarean Scar Defect (Istmocele): Hysterorrhaphic Technique as Etheologic Factor in Cesarean Section Leon JA, Romer M, Milano A, Suarez O. Gynecology, Clınica Maternidad Santa Ana, Caracas, Distrito Capital, Venezuela Study Objective: Evaluate the technique as an etiologic factor hysterorraphy cesarean scar defect in patients who underwent segmental cesarean section. Design: Exploratory research, prospective, longitudinal type was performed. Setting: Academic Hospital of post graduate. Patients: The population consists of patients who underwent cesarean section without prior uterine surgery, in 2015 a total of 1,164 patients previous calculation of the sample of 106 patients was conducted to evaluate. Intervention: The technique employed by hysterorraphy was evaluated by number of planes, type of suture material and thickness of the uterine segment. Cesarean scar defect the appearance of the patients was evaluated at 2,4,6 and 12 months after cesarean section by hysteroscopy and transvaginal ecosonography. Measurements and Main Results: 104 cesarean scar defect (98.11%) were diagnosed by hysteroscopy, and was confirmed by transvaginal ultrasound. The distribution of patients according to area ultrasound, in 36 patients the area was 15 mm2 or less (Grade 1), 36 was between 16 and 24 mm2 (grade 2) and in 32 cases was 25mm2 or more (grade 3). There was no difference in the type of hysterorraphy technique and suture material used with the appearance of cesarean scar defect. The ratio of the thickness of the uterine segment and the sonographic features of cesarean scar defect the highest number of cases of 9- 10 mm thickness 35 cases (33.65%) and a lesser amount in the segments of 3- 4 mm2 is observed 10 cases ( 9.6%). Conclusion: The appearance of cesarean scar defect not dependent on the technique and hysterorraphy suture material used. Being greater thickness uterine segment cesarean scar defect area increases.
Figure 1: association between the thickness of the uterine segment and cesarean scar defect area, the correlation coefficient being 0.395. It was observed that control the area in mm2 1 year the cesarean scar defect decreases.