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Patient Positioning 101: A Guide for Gynecologic Laparoscopists
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S25–S46 Patients: Ninety-eight women who underwent hysterectomy with the diagnosis of endometriosis. Intervention: We identified 98 women who underwent hysterectomy by the author with the diagnosis of endometriosis from October 2002- March 2009. Follow-up information was obtained from medical records, outpatient charts, and telephone surveys. Measurements and Main Results: Fifty-nine women had hysterectomy with at least one ovary preserved and no evidence of disease around the preserved ovary; 39 had all ovarian tissue removed. All underwent extensive resection of the endometriosis with surgery. Of those with ovarian preservation, 8 of 59 (13.5%) had recurrent pain and 2 of 59 (3.3%) required reoperation. Of those who had no ovarian preservation, 5 of 39 (12.8%) had recurrent symptoms and 2 of 39 (5.1%) required reoperation, though one was for reasons other than the endometriosis, thus 1 of 39 (2.5%). Ovarian conservation was associated with a relative risk for pain recurrence of 1.1 (95% confidence interval [CI] 0.5 to 1.6) compared with patients with oophorectomy in a Cox proportional hazards model. The relative risk for reoperation in patients with ovarian conservation was 0.8 (95% CI 0.4 to 0.95) -modified to 1.1 (95% CI 0.8 to 1.2). Conclusion: Compared with women who had oophorectomy for endometriosis, patients who underwent hysterectomy with ovarian conservation had 1.1 times greater risk of developing recurrent pain and 1.1 times greater risk of reoperation. Considering this, ovarian preservation should be considered strongly for patients with at least one healthy ovary. Patients ovarian conservation were unanimously more satisfied than the women who had oophorectomy along with their hysterectomy.
90
Open Communications 4dEndometriosis (3:03 PM d 3:08 PM)
S29
Study Objective: To correlate specific symptoms with anatomical distribution of endometriosis at laparoscopy. Design: Retrospective study (Canadian Task Force classification II-3). Setting: Tertiary care centre for the treatment of endometriosis. Patients: 466 women who underwent laparoscopy excision of endometriosis. Intervention: We recorded symptoms and anatomical locations of endometriosis at laparoscopy. We studied the incidence of various gynaecological symptoms, in relation to population characteristics and location of endometriosis at laparoscopy. Measurements and Main Results: Comparing women with and without symptoms, women with menorrhagia were significantly older, whilst women with dysmenorrhoea, left or right iliac fossa pain and dyschezia were significantly younger. Dyspareunia and constipation were significantly associated with increased likelihood of infertility; left or right iliac fossa pain and lower abdominal pain with a decreased likelihood. We found a strong association between dyspareunia, dyschezia, constipation and endometriosis of the bowel (p = 0.001, p \ 0.001, and p = 0.029). Dyschezia was also associated with obliteration of the POD (p = 0.001). Dysmenorrhoea was significantly associated with both bowel endometriosis and endometriosis of the anterior compartment (p = 0.025, p = 0.002). Dyspareunia and unilateral pain (left or right iliac pain) were associated with endometriosis of the uterosacral ligaments (p = 0.018, p = 0.024). Lower abdominal pain and lower back pain were not associated with any specific location of endometriosis. Conclusion: The type of pelvic pain reflects the anatomical site affected by endometriosis, dyschezia and dyspareunia being the most site-specific symptoms.
Serum Levels of Antimullerian Hormone Appear To Be Unaffected by the Presence of Deep-Infiltrating Endometriosis Associated to Endometriomas Bianchi PHM,1 Zanatta A,1 Pereira RMA,1 Chamie LP,2 Motta ELA,1 Rocha AM,1 Fettback PB,1 Serafini P.1 1Huntington Medicina Reprodutiva, Sao Paulo, Brazil; 2Fleury Medicina Diagnostica, Sao Paulo, Brazil
92
Study Objective: We aimed to evaluate the effect of endometrioma on the ovarian reserve by the measurement of antimullerian hormone (AMH). Design: Cross-sectional study. Setting: Private fertility center. Patients: Infertile patients were divided in three groups according to the findings of transvaginal sonography after bowel preparation: (a) those with evidence of deep-infiltrating endometriosis (DIE), (b) those with endometrioma concurrent to DIE, and (c) those without die (WDIE). Intervention: Measurement of serum AMH; transvaginal sonography after bowel preparation (tvs-bp). Measurements and Main Results: Antimullerian hormone levels were assessed by ELISA and ranged from 0.1 to 6.5 ng/mL. One hundred and fity five patients were evaluated during the year of 2009. Thirdy seven patients had DIE (a), 11 had DIE and endometriomas (b) and 107 didn’t have sonographic signs of DIE (c). Age was similar between groups (DIE = 36.56.1 years; DIE with endometrioma = 365 years; WDIE = 37.54.5 years; p = 0.3). Mean AMH was also similar in the 3 groups (DIE = 1.51.3 ng/mL; DIE with endometrioma = 1.51.3 ng/mL; WDIE = 1.41.4 ng/mL; p = 0.9). Conclusion: The presence of sonographic signs of deep-infiltrating endometriosis along with endometriomas does not seem to affect the ovarian reserve as measured by serum AMH.
Hysterectomy is one of the most common surgical procedures performed in the US. Close to 600,000 hysterectomies are performed yearly. Despite the increasing popularity of minimally invasive surgery, close to 70% of hysterectomies are performed through an abdominal incision. It is our belief that laparoscopic hysterectomy should be the replacement for almost all abdominal hysterectomies. The objective of this video is to show in a step by step fashion how to teach residents to perform a laparoscopic hysterectomy. It has been our observation that despite having laparoscopic skills, residents and recent graduates struggle with this procedure. We feel that part of this is not approaching the surgery in a systematic fashion and having difficult knowing or obtaining the necessary views. We attempt to show in this video how to overcome these hurdles. Thank you for consideration.
91
Open Communications 4dEndometriosis (3:09 PM d 3:14 PM)
Correlation between Symptoms and Location of Endometriosis at Laparoscopy Bignardi T, Khong S-Y, Kew C, Luscombe G, Lam A. Centre for Advanced Reproductive Endosurgery (CARE), Royal North Shore Hospital, University of Sydney, St Leonards, NSW, Australia
Video Session 3dSurgical Education (2:15 PM d 2:22 PM)
Laparoscopic Hysterectomy: A Teaching Guide for Residents Pollard RR, Krajewski C. Obstetrics & Gynecology, MetroHealth Medical Center, Cleveland, Ohio
93
Video Session 3dSurgical Education (2:23 PM d 2:31 PM)
Patient Positioning 101: A Guide for Gynecologic Laparoscopists Yunker AC, Siedhoff MT, Steege JF. Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina Laparoscopic surgery poses a safety risk to both patients and surgeons. Incorrect positioning and joint misalignment expose the patient to postoperative complications, including neuropathies and pressure ulcers. When done correctly, the proper position not only reduces that risk, but it creates a safer environment for the surgeon. This video demonstrates, in a step-wise method, how to properly and safely position the patient for laparoscopic surgery. In the first part, the video describes the equipment needed for positioning. In the second part, each individual position is demonstrated with a volunteer assistant. The video concludes by showing how patient positioning can affect the ergonomics of operating laparoscopically.
90
Open Communications 4dEndometriosis (3:03 PM d 3:08 PM)
S29
Study Objective: To correlate specific symptoms with anatomical distribution of endometriosis at laparoscopy. Design: Retrospective study (Canadian Task Force classification II-3). Setting: Tertiary care centre for the treatment of endometriosis. Patients: 466 women who underwent laparoscopy excision of endometriosis. Intervention: We recorded symptoms and anatomical locations of endometriosis at laparoscopy. We studied the incidence of various gynaecological symptoms, in relation to population characteristics and location of endometriosis at laparoscopy. Measurements and Main Results: Comparing women with and without symptoms, women with menorrhagia were significantly older, whilst women with dysmenorrhoea, left or right iliac fossa pain and dyschezia were significantly younger. Dyspareunia and constipation were significantly associated with increased likelihood of infertility; left or right iliac fossa pain and lower abdominal pain with a decreased likelihood. We found a strong association between dyspareunia, dyschezia, constipation and endometriosis of the bowel (p = 0.001, p \ 0.001, and p = 0.029). Dyschezia was also associated with obliteration of the POD (p = 0.001). Dysmenorrhoea was significantly associated with both bowel endometriosis and endometriosis of the anterior compartment (p = 0.025, p = 0.002). Dyspareunia and unilateral pain (left or right iliac pain) were associated with endometriosis of the uterosacral ligaments (p = 0.018, p = 0.024). Lower abdominal pain and lower back pain were not associated with any specific location of endometriosis. Conclusion: The type of pelvic pain reflects the anatomical site affected by endometriosis, dyschezia and dyspareunia being the most site-specific symptoms.
Serum Levels of Antimullerian Hormone Appear To Be Unaffected by the Presence of Deep-Infiltrating Endometriosis Associated to Endometriomas Bianchi PHM,1 Zanatta A,1 Pereira RMA,1 Chamie LP,2 Motta ELA,1 Rocha AM,1 Fettback PB,1 Serafini P.1 1Huntington Medicina Reprodutiva, Sao Paulo, Brazil; 2Fleury Medicina Diagnostica, Sao Paulo, Brazil
92
Study Objective: We aimed to evaluate the effect of endometrioma on the ovarian reserve by the measurement of antimullerian hormone (AMH). Design: Cross-sectional study. Setting: Private fertility center. Patients: Infertile patients were divided in three groups according to the findings of transvaginal sonography after bowel preparation: (a) those with evidence of deep-infiltrating endometriosis (DIE), (b) those with endometrioma concurrent to DIE, and (c) those without die (WDIE). Intervention: Measurement of serum AMH; transvaginal sonography after bowel preparation (tvs-bp). Measurements and Main Results: Antimullerian hormone levels were assessed by ELISA and ranged from 0.1 to 6.5 ng/mL. One hundred and fity five patients were evaluated during the year of 2009. Thirdy seven patients had DIE (a), 11 had DIE and endometriomas (b) and 107 didn’t have sonographic signs of DIE (c). Age was similar between groups (DIE = 36.56.1 years; DIE with endometrioma = 365 years; WDIE = 37.54.5 years; p = 0.3). Mean AMH was also similar in the 3 groups (DIE = 1.51.3 ng/mL; DIE with endometrioma = 1.51.3 ng/mL; WDIE = 1.41.4 ng/mL; p = 0.9). Conclusion: The presence of sonographic signs of deep-infiltrating endometriosis along with endometriomas does not seem to affect the ovarian reserve as measured by serum AMH.
Hysterectomy is one of the most common surgical procedures performed in the US. Close to 600,000 hysterectomies are performed yearly. Despite the increasing popularity of minimally invasive surgery, close to 70% of hysterectomies are performed through an abdominal incision. It is our belief that laparoscopic hysterectomy should be the replacement for almost all abdominal hysterectomies. The objective of this video is to show in a step by step fashion how to teach residents to perform a laparoscopic hysterectomy. It has been our observation that despite having laparoscopic skills, residents and recent graduates struggle with this procedure. We feel that part of this is not approaching the surgery in a systematic fashion and having difficult knowing or obtaining the necessary views. We attempt to show in this video how to overcome these hurdles. Thank you for consideration.
91
Open Communications 4dEndometriosis (3:09 PM d 3:14 PM)
Correlation between Symptoms and Location of Endometriosis at Laparoscopy Bignardi T, Khong S-Y, Kew C, Luscombe G, Lam A. Centre for Advanced Reproductive Endosurgery (CARE), Royal North Shore Hospital, University of Sydney, St Leonards, NSW, Australia
Video Session 3dSurgical Education (2:15 PM d 2:22 PM)
Laparoscopic Hysterectomy: A Teaching Guide for Residents Pollard RR, Krajewski C. Obstetrics & Gynecology, MetroHealth Medical Center, Cleveland, Ohio
93
Video Session 3dSurgical Education (2:23 PM d 2:31 PM)
Patient Positioning 101: A Guide for Gynecologic Laparoscopists Yunker AC, Siedhoff MT, Steege JF. Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina Laparoscopic surgery poses a safety risk to both patients and surgeons. Incorrect positioning and joint misalignment expose the patient to postoperative complications, including neuropathies and pressure ulcers. When done correctly, the proper position not only reduces that risk, but it creates a safer environment for the surgeon. This video demonstrates, in a step-wise method, how to properly and safely position the patient for laparoscopic surgery. In the first part, the video describes the equipment needed for positioning. In the second part, each individual position is demonstrated with a volunteer assistant. The video concludes by showing how patient positioning can affect the ergonomics of operating laparoscopically.