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Retrograde Tubal Catheterization: About a Retrospective Study of 103 Cases
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Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S36–S70
Conclusion: Because subsequent fertility at two years did not differ significantly according to treatment, management of ectopic pregnancy should be reconsidered and dissociated from considerations of fertility.
143
pregnancy. Informed consent obtained for RAAC which was placed at 13 weeks gestation after early prenatal genetic testing results received. An uncomplicated RAAC was performed to the patient under transvaginal ultrasonographic guidance.
Open Communications 9dReproductive Issues (4:20 PM d 4:25 PM)
Retrograde Tubal Catheterization: About a Retrospective Study of 103 Cases Faller E, Garbin O, Hummel M, Nisand I. Gynecology, CMCO, Universitary Hospital, Schiltigheim, France Study Objective: Evaluate the Retrograde tubal catheterization, a minimally invasive technique for recanalization of proximal tubal obstruction (PTO) which can associate hysterosalpingography (HSG) and hysteroscopy. Design: It is a descriptive single-center retrospective study that analyzed all patients who have benefitted by this technique from the 1st of January 1991 to the 1st of June 2011. Setting: Gynecology department of Universitary Hospital of Strasbourg, France. Patients: Inclusion criteria were infertile patients with at least one tube with proximal obstruction in HSG controlled under general anesthesia in order to exclude spasm. Intervention: The primary endpoint was the unilateral or bilateral tubal recanalization. Success was defined by the recanalization of at least one tube. The secondary endpoint was the obtaining of pregnancy within one year after the surgery. The ‘‘real successes’’ were defined by pregnancies obtained spontaneously or by intrauterine insemination (IUI) in patients with bilateral PTO or unilateral PTO with a single tube in whom recanalisation has been successful. Measurements and Main Results: 103 patients were included. At least one tube has been recanalized in 75% of procedures with a pregnancy rate at one year of 23% including 10% of ectopic pregnancies. The ‘‘real successes’’ of the technique are: 19% of pregnancies and 9.5% of ‘‘take home baby’’. Conclusion: Retrograde tubal catheterization can be an alternative or complement to support ART with pregnancy rates close to those in IUI. Its feasibility and low morbidity must be a technique to offer first.
144
Open Communications 9dReproductive Issues (4:26 PM d 4:31 PM)
Ultrasound Guided Robotic-Assisted Abdominal Cerclage in a Pregnant Patient: Overcoming the Limitations of Minimally Invasive Surgery Walsh TM,1 Borahay M,1 Tapisiz OL,2 Fox K,1 Rodriguez AM,1 Kilic GS.1 1 Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas; 2Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women’s Health Training and Research Hospital, Ankara, Turkey Study Objective: To report the first case of utilizing the da Vinci Si system providing simultaneous ultrasound view with the actual surgery to the surgeon’s attention in the same screen during the robotic-assisted abdominal cerclage (RAAC) placement in a pregnant woman. Design: Case report. Setting: Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX. Patients: A 35 year-old female, G2P1, presented with a history of cervical incompetence. Her history was significant for excisional cervical biopsy twice for dysplasia. First pregnancy was complicated with ultrasound findings including her cervical length 1.4 cm with funneling to the external os. Decision made for open abdominal cerclage placement and proceeded. During her primary c-section cerclage mesh was left in place for her next pregnancies. Postpartum she developed hematometria due to cervical stenosis which led to removal of mesh. Three months later she presented with her next
The patient was discharged on the following morning. Currently her pregnancy reached to third trimester. Intervention: The patient underwent ultrasound guided RAAC. Conclusion: The TileProÔ multi-input display feature of the da Vinci Si model allowed a traditional ultrasound machine to be connected to the da Vinci console. Transvaginal ultrasound enabled correct cerclage placement by following the trajectory of the needle through the uterine wall. In conclusion, ultrasound assisted RAAC may combine the advantages of minimally invasive surgery with the precision of ultrasound-guided placement granting the best outcomes for both the mother and the fetus.
145
Open Communications 9dReproductive Issues (4:32 PM d 4:37 PM)
Pregnancy Outcome after Laparoscopic Myomectomy for Large Submucosal Myomatas Eun D, Shin K, Choi Y, Oh Y, Kim H, Park J. Obstetrics and Gynecology, Eun’s Hospital, Gwangju, Jeonlanamdo, Republic of Korea Study Objective: To estimate possibility and safety for pregnancy of laparoscopic myomectomy for the large submucousal myomata that the hysteroscopic resection couldn’t be performed. Design: Prospective analysis from Jan.2004 to Dec.2011. Setting: Eun’s gynecological laparoscopic hospital, South Korea. Patients: 84 pregnant women who had laparoscopic myomectomy for large submucosal myomatas. Intervention: 1. 3 trocars insertion; Insert 10mm trocar into the umbelicus insert 5mm trocar left to and 2 cm below the umbelicus., insert 5 mm trocar into 3cm medially to left ASIS. 2. Hydration; 500cc injection of 1;500 diluted vasopressin into the myometrium covering the myoma. 3. Hysterotomy and enucleation of the submucosal myoma. The endometrium and myometrium were cut with the scissors rather than monopolar instrument in order to avoid being burnt. The exposed submucosal myoma was extracted out of the endometrium by two blunt tipped, strong poles without bleeding. 4. Suturing. The suturing of thin inextensible endometrium is conducted perpendiculary to the incision margin but the case of the expansile myometrium due to elastic and plastic properties should be done mainly paralelly to it in order to keep adhering the full thickness of myometrium without slipping outside. The seromuscular surface were sutured continuously in wide distance for dead space. Measurements and Main Results: 84 of 336 laparoscopic myomectomies for large submucosal myoma have conceived for 8yrs. Laparoconversion due to difficulties of haemostasis and/or difficulties in suturing time was never occurred in our group. The natural pregnancy was observed 3 months after myomectomy and IVF was started 6 month after operation.
Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S36–S70
Conclusion: Because subsequent fertility at two years did not differ significantly according to treatment, management of ectopic pregnancy should be reconsidered and dissociated from considerations of fertility.
143
pregnancy. Informed consent obtained for RAAC which was placed at 13 weeks gestation after early prenatal genetic testing results received. An uncomplicated RAAC was performed to the patient under transvaginal ultrasonographic guidance.
Open Communications 9dReproductive Issues (4:20 PM d 4:25 PM)
Retrograde Tubal Catheterization: About a Retrospective Study of 103 Cases Faller E, Garbin O, Hummel M, Nisand I. Gynecology, CMCO, Universitary Hospital, Schiltigheim, France Study Objective: Evaluate the Retrograde tubal catheterization, a minimally invasive technique for recanalization of proximal tubal obstruction (PTO) which can associate hysterosalpingography (HSG) and hysteroscopy. Design: It is a descriptive single-center retrospective study that analyzed all patients who have benefitted by this technique from the 1st of January 1991 to the 1st of June 2011. Setting: Gynecology department of Universitary Hospital of Strasbourg, France. Patients: Inclusion criteria were infertile patients with at least one tube with proximal obstruction in HSG controlled under general anesthesia in order to exclude spasm. Intervention: The primary endpoint was the unilateral or bilateral tubal recanalization. Success was defined by the recanalization of at least one tube. The secondary endpoint was the obtaining of pregnancy within one year after the surgery. The ‘‘real successes’’ were defined by pregnancies obtained spontaneously or by intrauterine insemination (IUI) in patients with bilateral PTO or unilateral PTO with a single tube in whom recanalisation has been successful. Measurements and Main Results: 103 patients were included. At least one tube has been recanalized in 75% of procedures with a pregnancy rate at one year of 23% including 10% of ectopic pregnancies. The ‘‘real successes’’ of the technique are: 19% of pregnancies and 9.5% of ‘‘take home baby’’. Conclusion: Retrograde tubal catheterization can be an alternative or complement to support ART with pregnancy rates close to those in IUI. Its feasibility and low morbidity must be a technique to offer first.
144
Open Communications 9dReproductive Issues (4:26 PM d 4:31 PM)
Ultrasound Guided Robotic-Assisted Abdominal Cerclage in a Pregnant Patient: Overcoming the Limitations of Minimally Invasive Surgery Walsh TM,1 Borahay M,1 Tapisiz OL,2 Fox K,1 Rodriguez AM,1 Kilic GS.1 1 Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas; 2Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women’s Health Training and Research Hospital, Ankara, Turkey Study Objective: To report the first case of utilizing the da Vinci Si system providing simultaneous ultrasound view with the actual surgery to the surgeon’s attention in the same screen during the robotic-assisted abdominal cerclage (RAAC) placement in a pregnant woman. Design: Case report. Setting: Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX. Patients: A 35 year-old female, G2P1, presented with a history of cervical incompetence. Her history was significant for excisional cervical biopsy twice for dysplasia. First pregnancy was complicated with ultrasound findings including her cervical length 1.4 cm with funneling to the external os. Decision made for open abdominal cerclage placement and proceeded. During her primary c-section cerclage mesh was left in place for her next pregnancies. Postpartum she developed hematometria due to cervical stenosis which led to removal of mesh. Three months later she presented with her next
The patient was discharged on the following morning. Currently her pregnancy reached to third trimester. Intervention: The patient underwent ultrasound guided RAAC. Conclusion: The TileProÔ multi-input display feature of the da Vinci Si model allowed a traditional ultrasound machine to be connected to the da Vinci console. Transvaginal ultrasound enabled correct cerclage placement by following the trajectory of the needle through the uterine wall. In conclusion, ultrasound assisted RAAC may combine the advantages of minimally invasive surgery with the precision of ultrasound-guided placement granting the best outcomes for both the mother and the fetus.
145
Open Communications 9dReproductive Issues (4:32 PM d 4:37 PM)
Pregnancy Outcome after Laparoscopic Myomectomy for Large Submucosal Myomatas Eun D, Shin K, Choi Y, Oh Y, Kim H, Park J. Obstetrics and Gynecology, Eun’s Hospital, Gwangju, Jeonlanamdo, Republic of Korea Study Objective: To estimate possibility and safety for pregnancy of laparoscopic myomectomy for the large submucousal myomata that the hysteroscopic resection couldn’t be performed. Design: Prospective analysis from Jan.2004 to Dec.2011. Setting: Eun’s gynecological laparoscopic hospital, South Korea. Patients: 84 pregnant women who had laparoscopic myomectomy for large submucosal myomatas. Intervention: 1. 3 trocars insertion; Insert 10mm trocar into the umbelicus insert 5mm trocar left to and 2 cm below the umbelicus., insert 5 mm trocar into 3cm medially to left ASIS. 2. Hydration; 500cc injection of 1;500 diluted vasopressin into the myometrium covering the myoma. 3. Hysterotomy and enucleation of the submucosal myoma. The endometrium and myometrium were cut with the scissors rather than monopolar instrument in order to avoid being burnt. The exposed submucosal myoma was extracted out of the endometrium by two blunt tipped, strong poles without bleeding. 4. Suturing. The suturing of thin inextensible endometrium is conducted perpendiculary to the incision margin but the case of the expansile myometrium due to elastic and plastic properties should be done mainly paralelly to it in order to keep adhering the full thickness of myometrium without slipping outside. The seromuscular surface were sutured continuously in wide distance for dead space. Measurements and Main Results: 84 of 336 laparoscopic myomectomies for large submucosal myoma have conceived for 8yrs. Laparoconversion due to difficulties of haemostasis and/or difficulties in suturing time was never occurred in our group. The natural pregnancy was observed 3 months after myomectomy and IVF was started 6 month after operation.