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Simplified laparoscopic hysterectomy in women with a significantly enlarged uterus
Abstracts
correction of associated pathology, and safety. Operating time, blood loss, complications, and postoperative hospital stay were compared with values of laparotomic procedures, showing the advantage of endoscopic methods. Histologic, histochemical, and electron-microscopic studies of biopsy tissues from sites of resection of submucous myomas and intrauterine septa obtained 3 months after procedures revealed complete restoration and functional adequacy of endometrium. Endometrial ablation or resection appeared effective resulting in amenorrhea or hypomenorrhea in 73.1% of patients. Of women wishing to conceive, 76.3% were successful, and 69.9% had full-term pregnancies. Conclusion. We believe hysteroscopic management of these intrauterine conditions is more advantageous than laparotomy or radical surgery.
manipulation was morcellation. Blood loss did not exceed 150 ml, and no intraoperative or postoperative complications occurred. Conclusion. Our experience shows that laparoscopic intrafascial technique, even in women with a significax~tly enlarged uterus, avoids excessive risky pelvic dissection and preserves supporting pelvic structures.
108. Assessment of Intraoperative and Postoperative Pain in Patients Treated with NovaSure GEA and ThermaChoice PY Laberge. Laval University, Pavilion, Sainte-Foy, Quebec, Canada.
Objective. To assess and compare intraoperative and postoperative pain levels in women treated with NovaSure GEA and ThermaChoice endometrial ablation, and recommend anesthesia regimens for both treatments. Measurements and Main Results. Up to 80 women with menorrhagia secondary to DUB underwent endometrial ablation with NovaSure GEA or ThermaChoice device as part of a pilot study to test the hypothesis that the NovaSure GEA thermally destroys (deactivates) and simultaneously vacuums away prostaglandins effectively, thereby reducing intraoperative and postoperative pain. Serum prostaglandin levels were analyzed before surgery and 5, 30, and 60 minutes postoperatively. Subjective patient ratings of intraoperative and postoperative pain were documented using VAS and numeric rating scale. Conclusion. Complete study results will be presented.
107. Simplified Laparoscopic Hysterectomy in Women with a Significantly Enlarged Uterus VI Kulakov, LV Adarnyan, SI Kiselev. Scientific Center for Obstetrics, Gynecology, and Perinatology, Moscow, Russia.
Objective. To evaluate the feasibility of TLH in women with a significantly enlarged uterus. Measurements and Main Results. In 678 women uterine size ranged from 12 to 20 gestational weeks; in 384 it was over 14 weeks (average 15.8 wks, weight 654 g). In 102 patients large myomas were intraligamentary or in the lower uterine segment. Intrafascial TLH consisted of bipolar coagulation and transection of both round ligaments with simultaneous opening of uterovesical fold; creation of windows in broad ligaments, peeling the posterior leaf to uterosacral ligaments with subsequent partial transection, and ligation of upper pedicles; dissection and suturing of uterine vessels close to the cervix at the level of intemal os; cutting upper pedicles after uterine vessel ligation (if technically feasible); cutting vessels and circular transection of pelvic fascia and vaginal walls and uterosacral-cardinal complex with a monopolar cutter, pushing the vaginal fomix with a uterine manipulator; and placing two or more figure-of-eight sutures on vaginal cuff including peritoneum of posterior cul-de-sac and uterosacral ligaments. In multiparous women or in those with a tendency to pelvic floor relaxation, we performed prophylactic McCall or Moscovitz technique. There were no conversions to laparotomy or vaginal approach. The only vaginal
109. NovaSure GEA Technology PY Laberge. Laval University, Pavilion, Sainte-Foy, Quebec, Canada.
Objective. To describe the technology of the NovaSure GEA system. Measurements and Main Results. NovaSure GEA technology allows for well-controlled ablation and consistent results because the procedure is based not on temperature and time, but on well-analyzed physical characteristics of tissue. A 3-D bipolar electrode controls energy delivery by monitoring tissue impedance level. Once the myometrial layer is reached, tissue resistance quickly increases and ablation automatically terminates. As a result, thickness of the endometrial layer is not relevant and patients can be treated successfully at any time during the menstrual
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correction of associated pathology, and safety. Operating time, blood loss, complications, and postoperative hospital stay were compared with values of laparotomic procedures, showing the advantage of endoscopic methods. Histologic, histochemical, and electron-microscopic studies of biopsy tissues from sites of resection of submucous myomas and intrauterine septa obtained 3 months after procedures revealed complete restoration and functional adequacy of endometrium. Endometrial ablation or resection appeared effective resulting in amenorrhea or hypomenorrhea in 73.1% of patients. Of women wishing to conceive, 76.3% were successful, and 69.9% had full-term pregnancies. Conclusion. We believe hysteroscopic management of these intrauterine conditions is more advantageous than laparotomy or radical surgery.
manipulation was morcellation. Blood loss did not exceed 150 ml, and no intraoperative or postoperative complications occurred. Conclusion. Our experience shows that laparoscopic intrafascial technique, even in women with a significax~tly enlarged uterus, avoids excessive risky pelvic dissection and preserves supporting pelvic structures.
108. Assessment of Intraoperative and Postoperative Pain in Patients Treated with NovaSure GEA and ThermaChoice PY Laberge. Laval University, Pavilion, Sainte-Foy, Quebec, Canada.
Objective. To assess and compare intraoperative and postoperative pain levels in women treated with NovaSure GEA and ThermaChoice endometrial ablation, and recommend anesthesia regimens for both treatments. Measurements and Main Results. Up to 80 women with menorrhagia secondary to DUB underwent endometrial ablation with NovaSure GEA or ThermaChoice device as part of a pilot study to test the hypothesis that the NovaSure GEA thermally destroys (deactivates) and simultaneously vacuums away prostaglandins effectively, thereby reducing intraoperative and postoperative pain. Serum prostaglandin levels were analyzed before surgery and 5, 30, and 60 minutes postoperatively. Subjective patient ratings of intraoperative and postoperative pain were documented using VAS and numeric rating scale. Conclusion. Complete study results will be presented.
107. Simplified Laparoscopic Hysterectomy in Women with a Significantly Enlarged Uterus VI Kulakov, LV Adarnyan, SI Kiselev. Scientific Center for Obstetrics, Gynecology, and Perinatology, Moscow, Russia.
Objective. To evaluate the feasibility of TLH in women with a significantly enlarged uterus. Measurements and Main Results. In 678 women uterine size ranged from 12 to 20 gestational weeks; in 384 it was over 14 weeks (average 15.8 wks, weight 654 g). In 102 patients large myomas were intraligamentary or in the lower uterine segment. Intrafascial TLH consisted of bipolar coagulation and transection of both round ligaments with simultaneous opening of uterovesical fold; creation of windows in broad ligaments, peeling the posterior leaf to uterosacral ligaments with subsequent partial transection, and ligation of upper pedicles; dissection and suturing of uterine vessels close to the cervix at the level of intemal os; cutting upper pedicles after uterine vessel ligation (if technically feasible); cutting vessels and circular transection of pelvic fascia and vaginal walls and uterosacral-cardinal complex with a monopolar cutter, pushing the vaginal fomix with a uterine manipulator; and placing two or more figure-of-eight sutures on vaginal cuff including peritoneum of posterior cul-de-sac and uterosacral ligaments. In multiparous women or in those with a tendency to pelvic floor relaxation, we performed prophylactic McCall or Moscovitz technique. There were no conversions to laparotomy or vaginal approach. The only vaginal
109. NovaSure GEA Technology PY Laberge. Laval University, Pavilion, Sainte-Foy, Quebec, Canada.
Objective. To describe the technology of the NovaSure GEA system. Measurements and Main Results. NovaSure GEA technology allows for well-controlled ablation and consistent results because the procedure is based not on temperature and time, but on well-analyzed physical characteristics of tissue. A 3-D bipolar electrode controls energy delivery by monitoring tissue impedance level. Once the myometrial layer is reached, tissue resistance quickly increases and ablation automatically terminates. As a result, thickness of the endometrial layer is not relevant and patients can be treated successfully at any time during the menstrual
$32