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Ovarian Endometrioma Ablation Using Plasma Energy vs. Cystectomy: A Step toward a Better Preservation of the Ovarian Parenchyma in Women Wishing To Become Pregnant
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Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S71–S90 Open Communications 13dEndometriosis (3:09 PM d 3:14 PM)
Ovarian Endometrioma Ablation Using Plasma Energy vs. Cystectomy: A Step toward a Better Preservation of the Ovarian Parenchyma in Women Wishing To Become Pregnant Roman H, Auber M, Mokdad C, Martin C, Marpeau L. Rouen University Hospital, Rouen, Normandy, France Study Objective: To compare the loss of ovarian parenchyma following ovarian endometrioma ablation using plasma energy vs. cystectomy, using three-dimensional (3D) ultrasound. Design: Retrospective comparative study. Setting: Rouen University Hospital Patients: Patients presenting with a unilateral ovarian endometrioma >30mm, free from prior ovarian surgery, were managed by the same surgeon experienced in the treatment of endometriosis. From January 2008 till December 2009 every patient was treated by cystectomy using an ovarian tissu sparing technique. Ablation using plasma energy was carried out from January to November 2010 based on an original technique. Intervention: We measured the surface in longitudinal section, the volume and the number of antral follicles (AFC) of both ovaries during a postoperative ultrasound evaluation that was conducted at least 3 months postoperatively. Measurements and Main Results: Of the 151 women operated for ovarian endometriosis over the time periods mentioned earlier, 15 operated by cystectomy and 10 operated by ablation met the inclusion criteria. There were no statistically significant differences between the women in the 2 groups regarding age (P = 0.60), parity (P = 0.20), preoperative diameter of the cysts (P = 0.11), AFC, surface and volume of the healthy ovaries (respectively P = 0.87, 0.74 and 0.20). Women operated by cystectomy showed a statistically significant reduction of ovarian volume (0.005), ovarian surface (0.005) and CFA (\0.001) when compared to those operated by ablation using plasma energy. The multivariate analysis showed that the relationship between the change in ovarian parameters and the surgical technique remained statistically significant after adjustment for age, parity, cyst diameter, and contralateral ovary values. Conclusion: Compared to plasma energy ablation, cystectomy is responsible for a significant loss of ovarian parenchyma and a significant reduction in AFC. This data must be taken into account in the therapeutic decision for women attempting pregnancy, especially if there are other risk factors for ovarian failure postoperatively. 241
Open Communications 13dEndometriosis (3:15 PM d 3:20 PM)
Predictive Factors of Intestinal Deep Endometriosis among the Women with Endometriosis Chapron C,1 Campin L,1 Lafay-Pillet M-C,1 Borghese B,1 Dousset B,2 Leconte M,2 Santulli P,1 de Ziegler D.1 1Department of Gynecology Obstetrics II and Reproductive Medicine, Universite Paris Descartes, APHP, CHU Cochin Saint Vincent de Paul, Paris, France; 2Department of General Surgery, Universite Paris Descartes, AP- HP, CHU Cochin Saint Vincent de Paul, Paris, France Study Objective: For women with histologically proven endometriosis, the aim of this study was to investigate whether exist preoperatively predictive factors for intestinal DIE. Design: 440 patients with histologically proved endometriosis and complete exeresis of all symptomatic endometriotic lesions. For each patient, data were collected preoperatively using a structured prospective questionnaire. Measurements and Main Results: 147 patients (33,4%) presented intestinal DIE. Family history of endometriosis (17% vs 8%; p=0,005) was more frequentl in cases of intestinal DIE patients. Rectorrhagia (28,6% vs 4,8%; p\0,001), secondary dysmenorrhea (58% vs 39%; p\0,001) occurring earlier (mean age 22.6 6.8 vs 24.8 7.8,p\0,05) and menorrhagia (60% vs 42%; p=0,001) were more frequent in intestinal DIE patients. During adolescence, intestinal DIE patients had more absenteeism from school (38% vs 29%; p=0,06) and loss of consciousness (20% vs 13%; p=0,05) during menstruation because pelvic pain intensity.
OCP use for treating severe dysmenorrhea was more frequent (62% vs 48%; p=0.04) in cases of intestinal DIE. Intestinal DIE patients had more previous surgical history of endometriosis (69,4% vs 30,4%; p\0,001), of endometrioma (39,6% vs 10,1%; p\0,001) with an increased mean number of previous surgery for endometriosis (1,85 1 vs 1,45 0,9; p=0,006). Intestinal DIE patients were painful with significantly more pain (p\0,001) and longer duration of pain before consultation (85 75 months vs 42 56 months; p\0,001). All mean preoperative painful scores were significantly more severe in cases of DIE lesions (p\0,001). Conclusion: These results are of prime importance in the daily practice for the gynecologist. In presence of these significant parameters, the practitioner must check for intestinal DIE by performing an adequate imaging process. This strategy, based on preoperative questioning, will avoid incomplete and unnecessary surgery. 242
Open Communications 13dEndometriosis (3:21 PM d 3:26 PM)
Urodynamic Evaluation of Patients with Deep Infiltrating Endometriosis: A Comparison of Pre- and Postoperative Findings – Preliminary Results de Oliveira MA, Crispi C, Dibi R, Soares T, Carvalhal E. Ginecologia, Instituto Fernandes Figueira- Fiocruz, Rio de Janeiro, Brazil Study Objective: To assess, by means of urodynamic testing, the pre- and postoperative urinary function of patients undergoing laparoscopic surgery for management of deep endometriosis. Design: Prospective case series. Canadian Task Force Classification II-3.It was included patients who underwent laparoscopic surgery for deep endometriosis in the period from March 2008 to April 2009 with urodynamic evaluation before and after surgery. Setting: Private Hospital Patients: 11 consecutive patients who underwent laparoscopic surgery for deep infiltrative endometriosis (DIE) in the period from March 2008 to April 2009 with urodynamic evaluation before and after surgery. Intervention: Urodynamic testing consisted of three stages, including uroflowmetry, cystometry, and pressure flow study. Testing was performed with a Dynapack MPX 816 P/Uromaster II 4.2 system in 11 patients undergoing laparoscopic surgery for deep endometriosis. Measurements and Main Results: Median age was 37.1 (range, 24-53) years. Urodynamic findings were considered normal in 10 patients (91% of cases) preoperatively and in all cases postoperatively. Of the 11 laparoscopic surgeries performed, 45.5% of patients required ureterolysis and 63.7% underwent resection of the uterosacral ligaments. Rectosigmoidectomy with nerve-sparing technique was performed in 45.5% of cases. Conclusion: In our sample, the vast majority of patients with deep endometriosis had no demonstrable urinary abnormalities before surgery; preoperative urodynamic evaluation was within normal limits in all but one patient (91%). Comparison of pre- and postoperative urodynamic evaluation findings showed that nerve-sparing laparoscopic surgery for DIE had no effect on urodynamic parameters.
243
Video Session 7dUrogynecology (2:15 PM d 2:23 PM)
Simplified LeFort Colpocleisis with Incorporated Perineorraphy for the General Gynecologist Robinson CA, Jones K, Harmanli O. OB/GYN, Tufts University School of Medicine, Baystate Medical Center, Springfield, Massachusetts The LeFort Colpocleisis procedure is a safe and effective surgery for elderly women with advanced pelvic organ prolapse, who no longer desire coital function. This procedure has been shown to have an efficacy rate exceeding 90% and is an excellent option as it offers a short operating time, few complications, amenability of local anesthesia, and high patient satisfaction. We compiled both live surgical cases with overlying anatomical illustrations to describe our simplified technique with incorporated perineorrhaphy. General gynecologists can adapt this approach as it utilizes routine colporrhaphy skills.
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S71–S90 Open Communications 13dEndometriosis (3:09 PM d 3:14 PM)
Ovarian Endometrioma Ablation Using Plasma Energy vs. Cystectomy: A Step toward a Better Preservation of the Ovarian Parenchyma in Women Wishing To Become Pregnant Roman H, Auber M, Mokdad C, Martin C, Marpeau L. Rouen University Hospital, Rouen, Normandy, France Study Objective: To compare the loss of ovarian parenchyma following ovarian endometrioma ablation using plasma energy vs. cystectomy, using three-dimensional (3D) ultrasound. Design: Retrospective comparative study. Setting: Rouen University Hospital Patients: Patients presenting with a unilateral ovarian endometrioma >30mm, free from prior ovarian surgery, were managed by the same surgeon experienced in the treatment of endometriosis. From January 2008 till December 2009 every patient was treated by cystectomy using an ovarian tissu sparing technique. Ablation using plasma energy was carried out from January to November 2010 based on an original technique. Intervention: We measured the surface in longitudinal section, the volume and the number of antral follicles (AFC) of both ovaries during a postoperative ultrasound evaluation that was conducted at least 3 months postoperatively. Measurements and Main Results: Of the 151 women operated for ovarian endometriosis over the time periods mentioned earlier, 15 operated by cystectomy and 10 operated by ablation met the inclusion criteria. There were no statistically significant differences between the women in the 2 groups regarding age (P = 0.60), parity (P = 0.20), preoperative diameter of the cysts (P = 0.11), AFC, surface and volume of the healthy ovaries (respectively P = 0.87, 0.74 and 0.20). Women operated by cystectomy showed a statistically significant reduction of ovarian volume (0.005), ovarian surface (0.005) and CFA (\0.001) when compared to those operated by ablation using plasma energy. The multivariate analysis showed that the relationship between the change in ovarian parameters and the surgical technique remained statistically significant after adjustment for age, parity, cyst diameter, and contralateral ovary values. Conclusion: Compared to plasma energy ablation, cystectomy is responsible for a significant loss of ovarian parenchyma and a significant reduction in AFC. This data must be taken into account in the therapeutic decision for women attempting pregnancy, especially if there are other risk factors for ovarian failure postoperatively. 241
Open Communications 13dEndometriosis (3:15 PM d 3:20 PM)
Predictive Factors of Intestinal Deep Endometriosis among the Women with Endometriosis Chapron C,1 Campin L,1 Lafay-Pillet M-C,1 Borghese B,1 Dousset B,2 Leconte M,2 Santulli P,1 de Ziegler D.1 1Department of Gynecology Obstetrics II and Reproductive Medicine, Universite Paris Descartes, APHP, CHU Cochin Saint Vincent de Paul, Paris, France; 2Department of General Surgery, Universite Paris Descartes, AP- HP, CHU Cochin Saint Vincent de Paul, Paris, France Study Objective: For women with histologically proven endometriosis, the aim of this study was to investigate whether exist preoperatively predictive factors for intestinal DIE. Design: 440 patients with histologically proved endometriosis and complete exeresis of all symptomatic endometriotic lesions. For each patient, data were collected preoperatively using a structured prospective questionnaire. Measurements and Main Results: 147 patients (33,4%) presented intestinal DIE. Family history of endometriosis (17% vs 8%; p=0,005) was more frequentl in cases of intestinal DIE patients. Rectorrhagia (28,6% vs 4,8%; p\0,001), secondary dysmenorrhea (58% vs 39%; p\0,001) occurring earlier (mean age 22.6 6.8 vs 24.8 7.8,p\0,05) and menorrhagia (60% vs 42%; p=0,001) were more frequent in intestinal DIE patients. During adolescence, intestinal DIE patients had more absenteeism from school (38% vs 29%; p=0,06) and loss of consciousness (20% vs 13%; p=0,05) during menstruation because pelvic pain intensity.
OCP use for treating severe dysmenorrhea was more frequent (62% vs 48%; p=0.04) in cases of intestinal DIE. Intestinal DIE patients had more previous surgical history of endometriosis (69,4% vs 30,4%; p\0,001), of endometrioma (39,6% vs 10,1%; p\0,001) with an increased mean number of previous surgery for endometriosis (1,85 1 vs 1,45 0,9; p=0,006). Intestinal DIE patients were painful with significantly more pain (p\0,001) and longer duration of pain before consultation (85 75 months vs 42 56 months; p\0,001). All mean preoperative painful scores were significantly more severe in cases of DIE lesions (p\0,001). Conclusion: These results are of prime importance in the daily practice for the gynecologist. In presence of these significant parameters, the practitioner must check for intestinal DIE by performing an adequate imaging process. This strategy, based on preoperative questioning, will avoid incomplete and unnecessary surgery. 242
Open Communications 13dEndometriosis (3:21 PM d 3:26 PM)
Urodynamic Evaluation of Patients with Deep Infiltrating Endometriosis: A Comparison of Pre- and Postoperative Findings – Preliminary Results de Oliveira MA, Crispi C, Dibi R, Soares T, Carvalhal E. Ginecologia, Instituto Fernandes Figueira- Fiocruz, Rio de Janeiro, Brazil Study Objective: To assess, by means of urodynamic testing, the pre- and postoperative urinary function of patients undergoing laparoscopic surgery for management of deep endometriosis. Design: Prospective case series. Canadian Task Force Classification II-3.It was included patients who underwent laparoscopic surgery for deep endometriosis in the period from March 2008 to April 2009 with urodynamic evaluation before and after surgery. Setting: Private Hospital Patients: 11 consecutive patients who underwent laparoscopic surgery for deep infiltrative endometriosis (DIE) in the period from March 2008 to April 2009 with urodynamic evaluation before and after surgery. Intervention: Urodynamic testing consisted of three stages, including uroflowmetry, cystometry, and pressure flow study. Testing was performed with a Dynapack MPX 816 P/Uromaster II 4.2 system in 11 patients undergoing laparoscopic surgery for deep endometriosis. Measurements and Main Results: Median age was 37.1 (range, 24-53) years. Urodynamic findings were considered normal in 10 patients (91% of cases) preoperatively and in all cases postoperatively. Of the 11 laparoscopic surgeries performed, 45.5% of patients required ureterolysis and 63.7% underwent resection of the uterosacral ligaments. Rectosigmoidectomy with nerve-sparing technique was performed in 45.5% of cases. Conclusion: In our sample, the vast majority of patients with deep endometriosis had no demonstrable urinary abnormalities before surgery; preoperative urodynamic evaluation was within normal limits in all but one patient (91%). Comparison of pre- and postoperative urodynamic evaluation findings showed that nerve-sparing laparoscopic surgery for DIE had no effect on urodynamic parameters.
243
Video Session 7dUrogynecology (2:15 PM d 2:23 PM)
Simplified LeFort Colpocleisis with Incorporated Perineorraphy for the General Gynecologist Robinson CA, Jones K, Harmanli O. OB/GYN, Tufts University School of Medicine, Baystate Medical Center, Springfield, Massachusetts The LeFort Colpocleisis procedure is a safe and effective surgery for elderly women with advanced pelvic organ prolapse, who no longer desire coital function. This procedure has been shown to have an efficacy rate exceeding 90% and is an excellent option as it offers a short operating time, few complications, amenability of local anesthesia, and high patient satisfaction. We compiled both live surgical cases with overlying anatomical illustrations to describe our simplified technique with incorporated perineorrhaphy. General gynecologists can adapt this approach as it utilizes routine colporrhaphy skills.