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Prediction of fertility after thermal balloon endometrial ablation using color doppler and sonohysterography
August 2001, Vol. 8, No. 3 Supplement The Journal of the American Association of Gynecologic Laparoscopists
Conclusion. Examining patients by vaginal ultrasound and/or office hysteroscopy before inserting IUDs is valuable in reducing related complications.
Conclusion. Color Doppler evaluation of endometrial blood flow and sonohysterographic evaluation of the uterine cavity and the tubes might predict fertility of women undergoing ThermaChoice ablation.
54. Prediction of Successof Thermal Balloon Endometrial Ablation Based on CPK Serum Levels
56. Laparoscopic Surgery for Vaginal Vault Prolapse 1R Fanfani, 2G Valducci, 1F Fanfani. 1Ospedale Cristo, Rome, Italy; 2UCSC, Rome Italy.
AM EI-Minawi, GA EI-Sameea, S Derbala, MF EI-Minawi. Cairo University, Cairo, Egypt.
Objective. To demonstrate the feasibility, efficacy, and safety of laparoscopic approach to vaginal vault prolapse. Measurements and Main Results. Thirty-six patients (mean age 62 yrs, range 49-75 yrs) had descensus of the vaginal cupola after hysterectomy (26) and abdominal hysterectomy (10). If prolapse was not associated with urinary stress incontinence or enterocele, we inserted an extraperitoneal polypropylene graft sutured centrally to the apex of the vault and laterally to the fascia lata close to the iliac spine. We reduced the uteroscral ligaments, suturing them to their original position. All patients were discharged on postoperative day 2 without complications. Conclusion. After 18 months only one recurrence was noted, and no patient reported sexual discomfort or urinary incontinence.
Objective. To evaluate specificity and sensitivity of serum total creatinine phosphokinase (CPK) measurement as a predictor of success of thermal balloon endometrial ablation using ThermaChoice. Measurements and Main Results. Twenty women (age range 3 8 4 6 yrs) with AUB underwent thermal balloon endometrial ablation with the ThermaChoice. Evaluation before the procedure included 3-D ultrasound evaluation of uterine muscle volume and measurement of total serum CPK. Measurement of serum CPK was repeated in the first postoperative week. All patients underwent ablation successfully and completed follow-up. In all patients serum CPK increased postoperatively and correlated with menstrual bleeding patterns months after the procedure. Conclusion. Total serum CPK rises proportionate to initial uterine volume.
57. Laparoscopic-AssistedOvarian Tumorectomy for Patients with Early-Stage Ovarian Cancer
55. Prediction of Fertility after Thermal Balloon Endometrial Ablation Using Color Doppler and Sonohysterography
SA Farghaly. Cornell University Medical College, New York, New York.
GA EI-Sameea, AM EI-Minawi, S Derbala. Cairo University, Cairo, Egypt.
Objective. To describe fertility-sparing surgery in women with early ovarian cancer. Measurements and Main Results. A primary caxmula site is established below the umbilicus and a 12-mm blunt cannula is introduced. Four secondary caamula sites are established: subumbilical, left lower quadrant, right lower quadrant above the pubic hairline, and lateral to deep epigasric vessels. A 12-mm operating laparoscope with 7.5-mm operating channel is used. Ovarian tumorectomy is performed, cutting and coagulating tissues with a 13 C isotope CO2 laser. Surgery involves removing ovarian tumor tissue and leaving the healthy ovary and uterus. In high-risk cases adjuvant chemotherapy must be recommended. Biopsy of the contralateral ovary and pelvic-paraaortic lymphadenectomy should be carried out if indicated. Operating time should not exceed 2 hours.
Objective. To assess whether color Doppler flowmetry of the endometrium combined with sonohysterographic evaluation of the uterus and tubes can predict future fertility after thermal balloon endometrial ablation. Measurements and Main Results. Ii 20 women (age range 32-38 yrs) with AUB who underwent thermal balloon endometrial ablation, endometrial color Doppler and sonohysterographic evaluations of the uterus and tubes were performed preoperatively and postoperatively. Preliminary data show that 17 (85%) achieved normal menstruation and 2 (10%) developed secondary amenorrhea; 1 patient developed secondary oligohypomenorrhea. At least 20% of women had normal endometrial blood flow and patent tubes postoperatively.
S17
Conclusion. Examining patients by vaginal ultrasound and/or office hysteroscopy before inserting IUDs is valuable in reducing related complications.
Conclusion. Color Doppler evaluation of endometrial blood flow and sonohysterographic evaluation of the uterine cavity and the tubes might predict fertility of women undergoing ThermaChoice ablation.
54. Prediction of Successof Thermal Balloon Endometrial Ablation Based on CPK Serum Levels
56. Laparoscopic Surgery for Vaginal Vault Prolapse 1R Fanfani, 2G Valducci, 1F Fanfani. 1Ospedale Cristo, Rome, Italy; 2UCSC, Rome Italy.
AM EI-Minawi, GA EI-Sameea, S Derbala, MF EI-Minawi. Cairo University, Cairo, Egypt.
Objective. To demonstrate the feasibility, efficacy, and safety of laparoscopic approach to vaginal vault prolapse. Measurements and Main Results. Thirty-six patients (mean age 62 yrs, range 49-75 yrs) had descensus of the vaginal cupola after hysterectomy (26) and abdominal hysterectomy (10). If prolapse was not associated with urinary stress incontinence or enterocele, we inserted an extraperitoneal polypropylene graft sutured centrally to the apex of the vault and laterally to the fascia lata close to the iliac spine. We reduced the uteroscral ligaments, suturing them to their original position. All patients were discharged on postoperative day 2 without complications. Conclusion. After 18 months only one recurrence was noted, and no patient reported sexual discomfort or urinary incontinence.
Objective. To evaluate specificity and sensitivity of serum total creatinine phosphokinase (CPK) measurement as a predictor of success of thermal balloon endometrial ablation using ThermaChoice. Measurements and Main Results. Twenty women (age range 3 8 4 6 yrs) with AUB underwent thermal balloon endometrial ablation with the ThermaChoice. Evaluation before the procedure included 3-D ultrasound evaluation of uterine muscle volume and measurement of total serum CPK. Measurement of serum CPK was repeated in the first postoperative week. All patients underwent ablation successfully and completed follow-up. In all patients serum CPK increased postoperatively and correlated with menstrual bleeding patterns months after the procedure. Conclusion. Total serum CPK rises proportionate to initial uterine volume.
57. Laparoscopic-AssistedOvarian Tumorectomy for Patients with Early-Stage Ovarian Cancer
55. Prediction of Fertility after Thermal Balloon Endometrial Ablation Using Color Doppler and Sonohysterography
SA Farghaly. Cornell University Medical College, New York, New York.
GA EI-Sameea, AM EI-Minawi, S Derbala. Cairo University, Cairo, Egypt.
Objective. To describe fertility-sparing surgery in women with early ovarian cancer. Measurements and Main Results. A primary caxmula site is established below the umbilicus and a 12-mm blunt cannula is introduced. Four secondary caamula sites are established: subumbilical, left lower quadrant, right lower quadrant above the pubic hairline, and lateral to deep epigasric vessels. A 12-mm operating laparoscope with 7.5-mm operating channel is used. Ovarian tumorectomy is performed, cutting and coagulating tissues with a 13 C isotope CO2 laser. Surgery involves removing ovarian tumor tissue and leaving the healthy ovary and uterus. In high-risk cases adjuvant chemotherapy must be recommended. Biopsy of the contralateral ovary and pelvic-paraaortic lymphadenectomy should be carried out if indicated. Operating time should not exceed 2 hours.
Objective. To assess whether color Doppler flowmetry of the endometrium combined with sonohysterographic evaluation of the uterus and tubes can predict future fertility after thermal balloon endometrial ablation. Measurements and Main Results. Ii 20 women (age range 32-38 yrs) with AUB who underwent thermal balloon endometrial ablation, endometrial color Doppler and sonohysterographic evaluations of the uterus and tubes were performed preoperatively and postoperatively. Preliminary data show that 17 (85%) achieved normal menstruation and 2 (10%) developed secondary amenorrhea; 1 patient developed secondary oligohypomenorrhea. At least 20% of women had normal endometrial blood flow and patent tubes postoperatively.
S17