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Quality of life outcomes after laparoscopic supracervical hysterectomy versus laparoscopic myomectomy with ablation of endometrium for fibroid uteri
Oral Presentations
arms: 10 patients were treated postoperatively with GnRH analogs, 10 patients received no treatment. Myoma diameters were 4 to 8 cm. Echography with power color Doppler imaging was performed preoperatively and postoperatively to assess regression of myomas vascularization and volume. Pictorial blood loss assessment, SF-36 questionnaire and visual analog scale were used to assess differences between the two groups in terms of pre and postoperative bleeding, quality of life and degree of pelvic pain. Evaluation of urinary incontinence was evaluated. Measuremerzts arm Mairz Results. One-, 3-, and 6-month follow-up data will be presented. Corzclusiorz. This study confirms the effectiveness and safety of laparoscopic cryomyolysis for the treatment of symptomatic uterine myomas. GnRH analogs postoperative treatment was showed to be useful in terms of faster postoperative recovery and absence of symptoms after laparoscopic cryomyolysis.
74. Transvaginal Occlusion of the Uterine Arteries for Symptomatic Leiomyomas: Clinical Outcome M Lichtinger, S Herbert. Fort Lauderdale, Florida.
Study Objective. To evaluate the feasibility, safety, and clinical outcomes of temporary bilateral uterine artery occlusion using a transvaginal Doppler clamp in women with symptomatic leiomyomas. Desigrz. Prospective trial, under Institutional Review Board. Settirzg. Nonprofit community hospital. lrzterverztiorz. Fifteen patients underwent diagnostic hysteroscopy, dilatation, and curettage of the uterus followed by audible identification and temporary occlusion of the uterine arteries using an intravaginal Doppler guided device for 6 hours. Measuremerzts arm Mairz Results. Confirmation of closure of the uterine arteries by loss of audible Doppler signal. Clinical outcome was evaluated by change in baseline in uterine and myoma volume using 2D ultrasound at 1 and 3 months, change from baseline renal sonogram, change from baseline hematocrit, hemoglobin, and FSH, and change from baseline menorrhagia and health status questionnaire at 1 and 3 months. Confirmation of closure without evidence of cervicovaginal trauma occurred in all 15 patients. During the 6 hours of clamp application, the 15 patients reported pain of less than 6 on a scale of 1 to 10. All 15 patients had no change from baseline renal sonogram. At 3 months sonographic average decrease of uterus and dominant myoma was 38% and 48%. Two patients with anemia had normal red cell counts after 3 months. All 15 patients with menorrhagia reported satisfactory decrease. Corzclusiorz. The transvaginal method and device proved to be a safe and reliable method to locate and access the uterine arteries. Short-term clinical outcome showed that temporary transvaginal occlusion of the uterine arteries can be a safe and efficient method to treat symptomatic leiomyomas and may be an alternative to resective surgery in selected patients.
75. Quality of Life Outcomes after Laparoscopic Supracervical Hysterectomy versus Laparoscopic Myomectomy with Ablation of Endometrium for Fibroid Uteri T Brown, ML Moore, M Cohen. Advanced Women's Health Institute, Denver, Colorado.
Study Objective. To compare changes in quality of life after laparoscopic supracervical hysterectomy (LSH) versus laparoscopic myomectomy with ablation (LMA) for the treatment of fibroid uteri. Desigrz. Prospective observational study of nonrandomized cohorts. Settirzg. Private practice. Patierzts. One hundred women. lrzterverztiorz. Surgical treatment for myomas. Measummerzts arm Mairz Results. Forty-eight patients who underwent LSH and 52 who underwent LMA completed the Short Form-36 General Health Status Questionnaire preoperatively and at 1 year postoperatively. Comparisons were made within and between the two cohorts. The LSH group demonstrated statistical improvement in role function and social function (p <.05) as well as pain and energy (p <.01). The LMA group showed improvements in social function (p <.05) and role function, pain, energy, and role emotional (p <.01). Comparison in overall changes between the two groups revealed a greater statistical improvement (in role function and role emotional) for the LMA group versus LSH (p <.01). Corzclusiorz. Both groups showed improvement in quality of life. Improvements were even more significant in the LMA, or uterine preserving, group. However, only a randomized controlled trial can demonstrate if there truly is a benefit from partial uterine preservation.
Plenary 12--Laparoscopy 76. Hemodynamic and Pulmonary Compliance Changes During Hyper-Pneumoperitoneum Laparoscopic Entry in Gynecologic Surgery GA Vilos, B Abu-Rafeh. The University of Western Ontario, St. Joseph's Health Care, London, Ontario, Canada.
Study Objective. To determine the hemodynamic and pulmonary compliance changes during laparoscopic entry using the hyper-pneumoperitoneum with 30 mm Hg pressure. Desigrz. Prospective measurements. Settirzg. University-affiliated teaching hospital. Patierzts. Sixty healthy women, mean age 35 years (range 19-58 years) and body mass index 25 (range 17-36), underwent operative laparoscopy consecutively for chronic pelvic pain (CPP, n = 40), pelvic mass (n = 6), CPP and pelvic mass (n = 3), and primary or secondary infertility (n = 11). Irzterverztiorz. Under general anesthesia, using muscle relaxants, and in a horizontal position, pneumoperitoneum was established by a Veress needle. We measured the initial intraperitoneal pressure (IPP) and carbon dioxide volume, heart rate, blood pressure, and pulmonary compliance at various fixed IPPs. At IPP of 30 mm Hg the primary trocar was
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arms: 10 patients were treated postoperatively with GnRH analogs, 10 patients received no treatment. Myoma diameters were 4 to 8 cm. Echography with power color Doppler imaging was performed preoperatively and postoperatively to assess regression of myomas vascularization and volume. Pictorial blood loss assessment, SF-36 questionnaire and visual analog scale were used to assess differences between the two groups in terms of pre and postoperative bleeding, quality of life and degree of pelvic pain. Evaluation of urinary incontinence was evaluated. Measuremerzts arm Mairz Results. One-, 3-, and 6-month follow-up data will be presented. Corzclusiorz. This study confirms the effectiveness and safety of laparoscopic cryomyolysis for the treatment of symptomatic uterine myomas. GnRH analogs postoperative treatment was showed to be useful in terms of faster postoperative recovery and absence of symptoms after laparoscopic cryomyolysis.
74. Transvaginal Occlusion of the Uterine Arteries for Symptomatic Leiomyomas: Clinical Outcome M Lichtinger, S Herbert. Fort Lauderdale, Florida.
Study Objective. To evaluate the feasibility, safety, and clinical outcomes of temporary bilateral uterine artery occlusion using a transvaginal Doppler clamp in women with symptomatic leiomyomas. Desigrz. Prospective trial, under Institutional Review Board. Settirzg. Nonprofit community hospital. lrzterverztiorz. Fifteen patients underwent diagnostic hysteroscopy, dilatation, and curettage of the uterus followed by audible identification and temporary occlusion of the uterine arteries using an intravaginal Doppler guided device for 6 hours. Measuremerzts arm Mairz Results. Confirmation of closure of the uterine arteries by loss of audible Doppler signal. Clinical outcome was evaluated by change in baseline in uterine and myoma volume using 2D ultrasound at 1 and 3 months, change from baseline renal sonogram, change from baseline hematocrit, hemoglobin, and FSH, and change from baseline menorrhagia and health status questionnaire at 1 and 3 months. Confirmation of closure without evidence of cervicovaginal trauma occurred in all 15 patients. During the 6 hours of clamp application, the 15 patients reported pain of less than 6 on a scale of 1 to 10. All 15 patients had no change from baseline renal sonogram. At 3 months sonographic average decrease of uterus and dominant myoma was 38% and 48%. Two patients with anemia had normal red cell counts after 3 months. All 15 patients with menorrhagia reported satisfactory decrease. Corzclusiorz. The transvaginal method and device proved to be a safe and reliable method to locate and access the uterine arteries. Short-term clinical outcome showed that temporary transvaginal occlusion of the uterine arteries can be a safe and efficient method to treat symptomatic leiomyomas and may be an alternative to resective surgery in selected patients.
75. Quality of Life Outcomes after Laparoscopic Supracervical Hysterectomy versus Laparoscopic Myomectomy with Ablation of Endometrium for Fibroid Uteri T Brown, ML Moore, M Cohen. Advanced Women's Health Institute, Denver, Colorado.
Study Objective. To compare changes in quality of life after laparoscopic supracervical hysterectomy (LSH) versus laparoscopic myomectomy with ablation (LMA) for the treatment of fibroid uteri. Desigrz. Prospective observational study of nonrandomized cohorts. Settirzg. Private practice. Patierzts. One hundred women. lrzterverztiorz. Surgical treatment for myomas. Measummerzts arm Mairz Results. Forty-eight patients who underwent LSH and 52 who underwent LMA completed the Short Form-36 General Health Status Questionnaire preoperatively and at 1 year postoperatively. Comparisons were made within and between the two cohorts. The LSH group demonstrated statistical improvement in role function and social function (p <.05) as well as pain and energy (p <.01). The LMA group showed improvements in social function (p <.05) and role function, pain, energy, and role emotional (p <.01). Comparison in overall changes between the two groups revealed a greater statistical improvement (in role function and role emotional) for the LMA group versus LSH (p <.01). Corzclusiorz. Both groups showed improvement in quality of life. Improvements were even more significant in the LMA, or uterine preserving, group. However, only a randomized controlled trial can demonstrate if there truly is a benefit from partial uterine preservation.
Plenary 12--Laparoscopy 76. Hemodynamic and Pulmonary Compliance Changes During Hyper-Pneumoperitoneum Laparoscopic Entry in Gynecologic Surgery GA Vilos, B Abu-Rafeh. The University of Western Ontario, St. Joseph's Health Care, London, Ontario, Canada.
Study Objective. To determine the hemodynamic and pulmonary compliance changes during laparoscopic entry using the hyper-pneumoperitoneum with 30 mm Hg pressure. Desigrz. Prospective measurements. Settirzg. University-affiliated teaching hospital. Patierzts. Sixty healthy women, mean age 35 years (range 19-58 years) and body mass index 25 (range 17-36), underwent operative laparoscopy consecutively for chronic pelvic pain (CPP, n = 40), pelvic mass (n = 6), CPP and pelvic mass (n = 3), and primary or secondary infertility (n = 11). Irzterverztiorz. Under general anesthesia, using muscle relaxants, and in a horizontal position, pneumoperitoneum was established by a Veress needle. We measured the initial intraperitoneal pressure (IPP) and carbon dioxide volume, heart rate, blood pressure, and pulmonary compliance at various fixed IPPs. At IPP of 30 mm Hg the primary trocar was
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