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Retrospective review of laparoscopic, laparoscopic-assisted, and abdominal myomectomy
August 1998, Vd. 5, No. 3 Supplement The Journal of the American Association of Gynecologic Laparoscopists
having a bilateral nerve block twice, another requiring only one unilateral block, and the third needing a single unilateral block twice. Conclusion. Despite the need for several injections in some patients, CT-guided pudendal nerve block seems to be well tolerated and efficacious in the treatment of pudendal nerve-related chronic vulvar pain.
37. Retrospective Review of Laparoscopic, Laparoscopic-Assisted, and Abdominal Myomectomy
35. Fertility Outcomes of Two Groups of Women Undergoing Conservative Management of Ectopic Pregnancy
Objective. To review indications for and surgical variables of myomectomy performed by three different techniques. Measurements and Main Results. Abdominal (ABD) myomectomy was performed in 178 (86%), laparoscopic-assisted (LA) myomectomy in 14 (7%), and complete laparoscopic (LS) myomectomy in 15 (7%) women for menorrbagia, pain, abdominal mass, infertility, or recurrent pregnancy loss. The groups did not differ in age, gravity, BMI, prior surgery, indication, or other surgical interventions (>85% had additional procedures). A greater percentage of patients in the ABD group received depot leuprolide preoperatively. The mean number and weight of myomas were 4.6 +5.3 and 409.1 +453.7 g, 3.1 +2.7 and 168.8 +99.1 g, and 1.3 + 0.6 and 24.2 + 42.3 g for the ABD, LA, and LS groups, respectively. Mean length of hospitalization was 70.3 + 25.6, 40.5 + 27.7, and 5.7 + 5.9 hours, respectively. Two patients were converted from LA to ABD and three in the ABD group were converted to hysterectomy. Conclusion. Criteria for assigning patients to different types of myomectomies remain to be established.
~T Falcone, 1B Amundson, 1L Bradley, 1j Goldberg, ~M Attaran, 2R Lindsey, rE Mascha. 1Cleveland Clinic Foundation, Cleveland, Ohio; 2Case Western Reserve Medical School, Cleveland, Ohio.
MF EI-Minawi. Cairo University, Cairo, Egypt.
Objective. To determine whether open versus laparoscopic management of ectopic pregnancy had any effect on subsequent fertility of two groups of women (retrospective cohort design). Measurements and Main Results. Ectopic pregnancy was treated with conservative surgical management by open laparotomy in 37 women and laparoscopy in 26. A slight but significant decrease in subsequent fertility was found in the former group. No differences were encountered in rate of repeat ectopic pregnancy. Conclusion. Compared with laparoscopic management, open microsurgical management of ectopic pregnancy produced good results in experienced hands.
36. Prognostic Factors for/aparoscopic Management of Distal Tubal Disease S El Sahwi. University of Alexandria, Alexandria, Egypt.
38. One Hundred Fifty Cases of Uterine Artery Ligation with the Ultrasonically Activated Scalpel
Objective. To develop simple, clinically applicable scoring systems to predict success of laparoscopic 9 management (retrospective analysis). Measurements and Main Results. All 368 women (132 fimbrial phimosis, 236 distal obstruction) treated by laparoscopic surgery were assessed by HSG, laparoscopy, and tuboscopy, and treated by laparoscopic surgery. Two simple scoring systems were developed, one for phimosis, one for obstruction. Patients were categorized as having good (5-7), moderate (8-11), or poor prognosis (12-15). Two-year cumulative intrauterine pregnancy rates were 72%, 58%, and 11%, respectively, for women with phimosis, and 54%, 46%, and 12% for those with obstruction. Conclusion. These two scoring systems are simple and of high predictive value. Patients with good and moderate scores can be treated by laparoscopic surgery. Those with high scores should be treated with IVF.
R] Ferland, M Kauko, CE Miller. Women and Infants Hospital and Rhode Island Hospital, Barrington, Rhode Island.
Objective. To assess efficacy and safety of the ultrasonically activated scalpel in uterine artery ligation. Measurements and Main Results. Laparoscopic hysterectomy was performed with the ultrasonically activated scalpel (UAS) in 150 women. Mean uterine weight was 198 g (range 92-622 g). Mean operating time was 92 minutes (range 50-172 min). Mean decrease in hematocrit was 7% (range 3-11%). An additional method of hemostasis by reapplication of UAS, clips, or sutures at the time of division was required in 28% of patients. No woman experienced postoperative bleeding or required reoperation to control
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having a bilateral nerve block twice, another requiring only one unilateral block, and the third needing a single unilateral block twice. Conclusion. Despite the need for several injections in some patients, CT-guided pudendal nerve block seems to be well tolerated and efficacious in the treatment of pudendal nerve-related chronic vulvar pain.
37. Retrospective Review of Laparoscopic, Laparoscopic-Assisted, and Abdominal Myomectomy
35. Fertility Outcomes of Two Groups of Women Undergoing Conservative Management of Ectopic Pregnancy
Objective. To review indications for and surgical variables of myomectomy performed by three different techniques. Measurements and Main Results. Abdominal (ABD) myomectomy was performed in 178 (86%), laparoscopic-assisted (LA) myomectomy in 14 (7%), and complete laparoscopic (LS) myomectomy in 15 (7%) women for menorrbagia, pain, abdominal mass, infertility, or recurrent pregnancy loss. The groups did not differ in age, gravity, BMI, prior surgery, indication, or other surgical interventions (>85% had additional procedures). A greater percentage of patients in the ABD group received depot leuprolide preoperatively. The mean number and weight of myomas were 4.6 +5.3 and 409.1 +453.7 g, 3.1 +2.7 and 168.8 +99.1 g, and 1.3 + 0.6 and 24.2 + 42.3 g for the ABD, LA, and LS groups, respectively. Mean length of hospitalization was 70.3 + 25.6, 40.5 + 27.7, and 5.7 + 5.9 hours, respectively. Two patients were converted from LA to ABD and three in the ABD group were converted to hysterectomy. Conclusion. Criteria for assigning patients to different types of myomectomies remain to be established.
~T Falcone, 1B Amundson, 1L Bradley, 1j Goldberg, ~M Attaran, 2R Lindsey, rE Mascha. 1Cleveland Clinic Foundation, Cleveland, Ohio; 2Case Western Reserve Medical School, Cleveland, Ohio.
MF EI-Minawi. Cairo University, Cairo, Egypt.
Objective. To determine whether open versus laparoscopic management of ectopic pregnancy had any effect on subsequent fertility of two groups of women (retrospective cohort design). Measurements and Main Results. Ectopic pregnancy was treated with conservative surgical management by open laparotomy in 37 women and laparoscopy in 26. A slight but significant decrease in subsequent fertility was found in the former group. No differences were encountered in rate of repeat ectopic pregnancy. Conclusion. Compared with laparoscopic management, open microsurgical management of ectopic pregnancy produced good results in experienced hands.
36. Prognostic Factors for/aparoscopic Management of Distal Tubal Disease S El Sahwi. University of Alexandria, Alexandria, Egypt.
38. One Hundred Fifty Cases of Uterine Artery Ligation with the Ultrasonically Activated Scalpel
Objective. To develop simple, clinically applicable scoring systems to predict success of laparoscopic 9 management (retrospective analysis). Measurements and Main Results. All 368 women (132 fimbrial phimosis, 236 distal obstruction) treated by laparoscopic surgery were assessed by HSG, laparoscopy, and tuboscopy, and treated by laparoscopic surgery. Two simple scoring systems were developed, one for phimosis, one for obstruction. Patients were categorized as having good (5-7), moderate (8-11), or poor prognosis (12-15). Two-year cumulative intrauterine pregnancy rates were 72%, 58%, and 11%, respectively, for women with phimosis, and 54%, 46%, and 12% for those with obstruction. Conclusion. These two scoring systems are simple and of high predictive value. Patients with good and moderate scores can be treated by laparoscopic surgery. Those with high scores should be treated with IVF.
R] Ferland, M Kauko, CE Miller. Women and Infants Hospital and Rhode Island Hospital, Barrington, Rhode Island.
Objective. To assess efficacy and safety of the ultrasonically activated scalpel in uterine artery ligation. Measurements and Main Results. Laparoscopic hysterectomy was performed with the ultrasonically activated scalpel (UAS) in 150 women. Mean uterine weight was 198 g (range 92-622 g). Mean operating time was 92 minutes (range 50-172 min). Mean decrease in hematocrit was 7% (range 3-11%). An additional method of hemostasis by reapplication of UAS, clips, or sutures at the time of division was required in 28% of patients. No woman experienced postoperative bleeding or required reoperation to control
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