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Prophylactic ovarian electrocoagulation in women with severe PCOS prevents ovarian hyperstimulation syndrome, pregnancy wastage, and multiple pregnancies
Abstracts
104. Prophylactic Ovarian Electrocoagulation in Women with Severe PCOS Prevents Ovarian Hyperstimulation Syndrome, Pregnancy Wastage, and Multiple Pregnancies
Salpingectomy was performed with the patient in 30degree Trendelenburg position. Two days later dull pain and fullness sensation developed over the right subcoa-tical area. Culture showed Psuedomonas infection. Laparotomy was performed for irrigation and repair of intestine injured by laparoscopy. Conclusion. Suphrenic abscess is rare in lower abdominal laparoscopic surgery. In this woman it may have been due to spread of bacteria from the pelvic cavity during irrigation. We suggest that irrigation fluid be removed completely, and a drain placed in case of pelvic infection.
A Lissak, A Sharon, O Fruchter, O Brandes-Klein, O Kogan, H Abramovici. Lady Davis Carmel Medical Center, Haifa, Israel.
Objective. To study the beneficial effect of ovarian electrocoagulation on endocrine profile, ovarian hyperstimulation syndrome (OHSS) rates, and pregnancy outcome in women with PCOS. Measurements and Main Results. Forty patients underwent laparoscopic ovarian electrocoagulation of both ovaries, with 8 to 10 applications on each ovary. Serum concentration of LH, FSH, testosterone, E2, and prolactin were measured before and during the follicular phase 30, 60, and 90 days after each procedure. There was a significant reduction in the serum levels of LH and E2 after the procedure compared with before (p <0.05), and a slight but not significant reduction in serum testosterone concentrations. The pregnancy rate was 37.5 % (range 15-40%) and spontaneous abortion rate was 20% (range 3-15%). There was only one multiple pregnancy. Conclusion, Ovarian electrocoagulation in women with severe PCOS decreases the rate of OHSS, pregnancy wastage, and multiple pregnancies, and improves pregnancy outcome.
103. An Improved Simple Method for Total Laparoscopic Hysterectomy and Bilateral Salpingo-oophorectomy Using the Rumi Colpotomizer A Lissak, O Fruchter, O Brandes-Klein, A Sharon, O Kogan, H Abramovici. Lady Davis Carmel Medical Center, Haifa, Israel.
Objective. To report a safe reproducible technique for shortening and simplifying TLH-BSO with the RumiKoh colpotomizer. Measurements and Main Results. Instead of using a tenaculum, we prefer to stabilize the cervix by placing a 1-0 polypropylene suture through the anterior lip of the cervix. Once pulled, the free ends of the suture exert effective countertraction on the cervix as the lubricated cup is easily applied around it. The initial operative step involves isolating the uterus from the adnexa using a single application of an Endo-GIA device to divide round and suspensory ovarian ligaments together with fallopian tubes in proximity to uterine cornua. After securing uterine arteries by bipolar electrocoagulation, dissection of the uterus and cervix off the vagina is greatly facilitated by the Rumi-Koh colpotomizer, which clearly delineates the proper level of dissection while keeping ureters off the colpotomy plane. In the final step, both ovaries are removed by dividing their immediate mesovarium by bipolar electrocoagulation, leaving infundibulopelvic ligaments intact. Conclusion. This method of TLH-BSO is safe, easily performed and learned, and, in our experience, considerably shortens operating time.
105. Treatment of Perimenopausal Menorrhagia in Women with Scarred Uteri and Submucosal Myomas Using Thermal Balloon with and without GnRH Analog Pretreatment A Lissak, O Fruchter, O Brandes-Klein, A Sharon, O Kogan, H Abramovici. Lady Davis Carmel Medical Center, Haifa, Israel.
Objective. To assess the efficacy of thermal balloon ablation without pretreatment by endometrium-thinning agents in the management of benign premenopausal menorrhagia, and to examine the safety of the procedure in women with scarred uteri and submucous myomas. Measurements and Main Results. Thirty women (age 46-51 yrs) were randomly assigned to be treated either 30 days after administration of a single dose of intramuscular GnRH analog (13 patients) or without pretreatment (17). Two patients underwent submucous myomectomy at the time of ablation, and six had a
$30
104. Prophylactic Ovarian Electrocoagulation in Women with Severe PCOS Prevents Ovarian Hyperstimulation Syndrome, Pregnancy Wastage, and Multiple Pregnancies
Salpingectomy was performed with the patient in 30degree Trendelenburg position. Two days later dull pain and fullness sensation developed over the right subcoa-tical area. Culture showed Psuedomonas infection. Laparotomy was performed for irrigation and repair of intestine injured by laparoscopy. Conclusion. Suphrenic abscess is rare in lower abdominal laparoscopic surgery. In this woman it may have been due to spread of bacteria from the pelvic cavity during irrigation. We suggest that irrigation fluid be removed completely, and a drain placed in case of pelvic infection.
A Lissak, A Sharon, O Fruchter, O Brandes-Klein, O Kogan, H Abramovici. Lady Davis Carmel Medical Center, Haifa, Israel.
Objective. To study the beneficial effect of ovarian electrocoagulation on endocrine profile, ovarian hyperstimulation syndrome (OHSS) rates, and pregnancy outcome in women with PCOS. Measurements and Main Results. Forty patients underwent laparoscopic ovarian electrocoagulation of both ovaries, with 8 to 10 applications on each ovary. Serum concentration of LH, FSH, testosterone, E2, and prolactin were measured before and during the follicular phase 30, 60, and 90 days after each procedure. There was a significant reduction in the serum levels of LH and E2 after the procedure compared with before (p <0.05), and a slight but not significant reduction in serum testosterone concentrations. The pregnancy rate was 37.5 % (range 15-40%) and spontaneous abortion rate was 20% (range 3-15%). There was only one multiple pregnancy. Conclusion, Ovarian electrocoagulation in women with severe PCOS decreases the rate of OHSS, pregnancy wastage, and multiple pregnancies, and improves pregnancy outcome.
103. An Improved Simple Method for Total Laparoscopic Hysterectomy and Bilateral Salpingo-oophorectomy Using the Rumi Colpotomizer A Lissak, O Fruchter, O Brandes-Klein, A Sharon, O Kogan, H Abramovici. Lady Davis Carmel Medical Center, Haifa, Israel.
Objective. To report a safe reproducible technique for shortening and simplifying TLH-BSO with the RumiKoh colpotomizer. Measurements and Main Results. Instead of using a tenaculum, we prefer to stabilize the cervix by placing a 1-0 polypropylene suture through the anterior lip of the cervix. Once pulled, the free ends of the suture exert effective countertraction on the cervix as the lubricated cup is easily applied around it. The initial operative step involves isolating the uterus from the adnexa using a single application of an Endo-GIA device to divide round and suspensory ovarian ligaments together with fallopian tubes in proximity to uterine cornua. After securing uterine arteries by bipolar electrocoagulation, dissection of the uterus and cervix off the vagina is greatly facilitated by the Rumi-Koh colpotomizer, which clearly delineates the proper level of dissection while keeping ureters off the colpotomy plane. In the final step, both ovaries are removed by dividing their immediate mesovarium by bipolar electrocoagulation, leaving infundibulopelvic ligaments intact. Conclusion. This method of TLH-BSO is safe, easily performed and learned, and, in our experience, considerably shortens operating time.
105. Treatment of Perimenopausal Menorrhagia in Women with Scarred Uteri and Submucosal Myomas Using Thermal Balloon with and without GnRH Analog Pretreatment A Lissak, O Fruchter, O Brandes-Klein, A Sharon, O Kogan, H Abramovici. Lady Davis Carmel Medical Center, Haifa, Israel.
Objective. To assess the efficacy of thermal balloon ablation without pretreatment by endometrium-thinning agents in the management of benign premenopausal menorrhagia, and to examine the safety of the procedure in women with scarred uteri and submucous myomas. Measurements and Main Results. Thirty women (age 46-51 yrs) were randomly assigned to be treated either 30 days after administration of a single dose of intramuscular GnRH analog (13 patients) or without pretreatment (17). Two patients underwent submucous myomectomy at the time of ablation, and six had a
$30