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Successful hysteroscopic treatment of benign intrauterine pathologies with a 5 Fr. Bipolar electrode
Oral Presentations
be advocated for removal of all emps from these two groups regardless of size or symptoms.
156. Hysteroscopic Surgery for Submucous Myoma LV Adamyan, ER Tkachenko, SI Kiselev. Research Centre for Obstetrics, Gynecology & Perinatology, Moscow, Russian Federation.
Objective. To evaluate the results of hysteroscopic surgery for submucous myoma. Design. Out of total number of 1200 cases of different intrauterine conditions managed by hysteroscopy, 140 hysteroresectoscopic procedures performed in patients with submucous myoma were submitted to the analysis. Setting. Department of Operative Gynecology of Scientific Center for Obst., Gyn. & Perinatology, Moscow, Russia. Patients. One hundred forty women with submucous myoma (aged 26-45 yrs). Interventions. All patients underwent resectoscopy, assisted by laparoscopy in 53 cases, used for final diagnosis and correction of associated pathology (endometriosis, ovarian mass, fibroids of intramural or subserous localisation) and safety control. Measurements and Main Results. Operating time (av. 34.2+11.1), blood loss (47.8+33.1), complications rate (0.7%), postoperative hospital stay (av. 2.3 +1.2) were compared to the parameters of analogous laparotomic procedures, showing the advantage of hysteroresectoscopy. Histologic, histochemical and electron-microscopical studies of endometrial bioptates from the sites of surgery and outside, obtained 3-6 months after procedures revealed complete restoration and functional adequacy of endometrium in all patients. 51.1% of 84 patients willing to conceive, succeeded, and in 83.7% cases pregnancies fulltermed by via naturalis. Conclusion. The study advocates for hysteroscopic management of submucous myoma, beneficial for morphofunctional restoration of endometrium and resulting in good reproductive outcomes.
157. Hysteroscopy Combined with Endometrial Ablation for Recurrent Benign Endometrial Polyp in the Postmenopausal Patient: A Pilot Study A Sharon, O Brandes-Klein, B Feiner, Z Alter, A Lissak. Carmel Medical Center, Haifa, Israel.
Objective. To determine the efficacy of hysteroscopy combined with endometrial ablation for recurrent endometrial polyp in the postmenopansal women for prevention of future endometrial polyp. Design. A prospective pilot study. Setting. University-affiliated hospital. Patients. Sixteen postmenopansal patients with a recurrent endometrial polyp, who were planned to undergo a hysteroscopic polypectomy.
Intervention. A hysteroscopic polypectomy followed by an endometrial balloon ablation or resection at the same session, performed on a day-care basis. Measurements and Main Results. Of 16 postmenopausal patients which were recruited to the study, 5 complained of postmenopansal bleeding (PMB). A transvaginal sonography revealed a recurrent endometrial polyp in all patients. The polyp size ranged from 10-30 mm in the longest diameter. A histology was made following the removal of the polyp by hysteroscopy. In 2 cases no polyp was demonstrated. In order to prevent additional recurrence of a polyp or PMB, endometrial balloon ablation was performed. Eight patients underwent endometrial ablation or resection in the same session (ThermaChoice, Gynecare). The histology of the specimen from all patients was of a benign endometrial polyp. The follow-up period was 1-3 years, at which time no recurrent of PMB or endometrial polyp was found. Conclusion. Our preliminary result of this approach suggest the benefit of endometrial ablation in cases of recurrent endometrial polyp, are encouraging and may prevent the growth of future polyps, and thus avoid additional surgical interventions.
158. Successful Hysteroscopic Treatment of Benign Intrauterine Pathologies with a 5 Ft. Bipolar Electrode 10 Ceci, 1S Bettocchi, 1L Nappi, 1A Pellegrino, 1R Di Venere, 1V Pansini, 1A Santoro, 2L Selvaggi. 1University of Bari, Italy; 2University "Cattolica del Sacro Cuore," Rome, Italy.
Objective. Demonstration of advanced operative office hysteroscopy: the treatment of benign intrauterine pathologies using a 5 Fr. bipolar probe and its efficacy in terms of recurrence of the pathologies and patient compliance. Methods. From 1999 to 2001 we performed, at our Center 1860 Office hysteroscopic procedures, without analgesia or anaesthesia, for the treatment of benign intrauterine pathologies. In 501 cases we used a Versapoint bipolar electrical generator to remove submucosal and partially intramural myomas ranging between 0.6 and 2.0 cm, as well as endometrial polyps between 0.5 and 4.5 cm. Results. After 6 months of follow-up we demonstrated any recurrence or persistence of the pathologies in the uterine cavity of all treated patients. Only in one case we discovered at histology a focal adenocarcinoma on the base of endometrial polyp in a menopausal patient. Concerning patient compliance, more than half of the patients (from 47.6 % to 79.3 %) accepted the procedure without discomfort, with a pain score ranging from 0 to 4; in 21,7% of the cases, patients referred a pain score ranging from 5 to 10, but the majority was menopausal women with a small and atrophic uterine cavity Conclusion. The combined use of a new generation small diameter hysteroscope and a new bipolar 5 Fr electrode (Versapoint) allows to the endoscopic gynaecologist to perform office hysteroscopy without analgesia and anaesthesia
$50
August 2003, Vol. 10, No. 3 Supplement
TheJournal of the American Association of Gynecologic Laparoscopists
for the treatment of benign intrauterine pathologies, with very good results in terms of recurrence and persistence of the pathologies and a satisfactory patient compliance.
159. Office Outpatient Hysteroscopy in Patients Affected by Menorrhagia C De Angelis. Department of Gynecological Sciences, Perinatology and Child Care, Rome, Italy. To evaluate the incidence of endometrial pathologies in patients affected by menorrhagia; to determine if a significant association between menorrhagia and benign or malignant anomalies of the uterus it does exist. Prospective case-control study. Centre for Minimally Invasive Surgery, Department of Gynecological Science and Perinatology, University of Rome, "La Sapienza", Italy. One hundred eighteen consecutive women affected by menorrhagia. Office diagnostic hysteroscopy. The uterine cavity was normal in 44% of women affected by menorrhagia, instead the incidence of endometrial cancer was 0.9%. The multivariate analysis of logistic regression has shown a significant association between menorrhagia and age (O.R. 0.08 per year), and between menorrhagia and submucous myomas (O.R. 2.6). The presence of endometrial polyps was instead not significant. Menorrhagia is one of the most common gynecologic complaints especially in 40-50 age. Very low is the incidence of endometrial cancer. A strong association has been found with the age and the presence of submucous fibroids.
160. Diagnostic Hysteroscopy Alone Is Not Sufficient for the Diagnosis of Patients with Abnormal Uterine Bleeding MD Mueller, E Dreher. Universitaets-Frauenklinik, Berne, Switzerland.
Objective. To evaluate the diagnostic accuracy of hysteroscopy (HSC) in two teaching Hospitals. DesigFz. Retrospective clinical study. Sett#zg. University hospitals. Patierzts arzdMethods. The histologic findings of 1872 consecutive patients who underwent a diagnostic HSC followed by TC for abnormal uterine bleeding or suspicious endometrium at ultrasound where compared to the HSC findings. Mairz Results. Patients (990) were premenopansal (mean age 41.9 + 6.8 years) where as 882 patients were postmenopansal (mean 60.5 + 7.7 years). HSC was non-diagnostic in 5 cases (0.3%) while the material obtained at TC was too scant for a histological diagnosis in 15 cases (0.8%). Pathology revealed an endometrial cancer in 68 cases (incidence 3.6%), but only 32 cases (47%) were recognized at HSC. When compared with the histologic diagnosis obtained by TC the hysteroscopic findings showed a diagnostic sensitivity of 47%, a specificity of 99%, a positive predictive value (PPV) of 78 %, and a negative predictive value (NPV)
of 98 %. The diagnostic accuracy of HSC was similar in both hospitals included in the study. CoFzclusioFz. This study demonstrates that the diagnostic accuracy of HSC is not sufficient in the diagnosis of abnormal uterine bleeding and that a TC is mandatory.
161. The Analysis of the Curative Effect and the Factors Causing the Failure of Using Transcervical Resection of Endometrium to Treat DU B O Hua. Fuxing Hospital, affiliated to Capital University of Medical Sciences Center of Hysteroscopy, Beijing, China.
Objective. To study the mechanism, curative efficacy and factors related to recurrence of TCRE in treating women with dysfunctional uterine bleeding (DUB). Methods. From May 1990 to May 2000, 220 cases with DUB were performed TCRE, in which there are 10 cases are recurrence where the patients agreed to remove the uterus after the TCRE procedure. By these cases, the specimens were stained by hemaloxylin-eosin. Results. The average depth of myometrium in removed endometrium strip is 2.683 mm, 2.120 mm, and 3.260 mm. The following up time after operation is 24 months to 144 months. Overall efficiency is 94.5% in which amenorrhea rate is 25.8%, menstruation reduction is 68.7%. 25 cases were given medicine treatment as a result of recurrence. Three cases were performed re-TCRE and 10 cases required subsequent hysterectomy. Endometrium regrowth is seen in the uterine specimens in relapsed cases, adenomyosis is also found in the intra-uterine wall. The effective rate of corrective anemia is 97.6% and the satisfaction rate for this operation is 92.3%. CoFzclusioFz.TCRE is a useful alternative treatment for dysfunctional uterine bleeding. The recurrence is caused by adenomyosis and the uncompleted removing endometrium during the operations.
Open Communications 8--Miscellaneous 162. Essure Hysteroscopic Sterilization: Results Based on Utilizing a New Coil Catheter Delivery System JF Kerin. University of Adelaide Reproductive Medicine Unit, North Adelaide, Australia. One hundred women seeking sterilization were enrolled in the Essure Coil Catheter Safety and Effectiveness study by 5 investigators. The average age was 36 years with gravidity/ parity of 3/3. The bilateral placement rate using the coil catheter was 98% (98/100 procedures) as compared to the Pivotal Multicentre Study of 86% using the existing catheter. Two women who did not have successful device placement due to apparent tubal obstruction underwent an HSG. In one case there was poor tubal filling. Fibrosis with thickening
$51
be advocated for removal of all emps from these two groups regardless of size or symptoms.
156. Hysteroscopic Surgery for Submucous Myoma LV Adamyan, ER Tkachenko, SI Kiselev. Research Centre for Obstetrics, Gynecology & Perinatology, Moscow, Russian Federation.
Objective. To evaluate the results of hysteroscopic surgery for submucous myoma. Design. Out of total number of 1200 cases of different intrauterine conditions managed by hysteroscopy, 140 hysteroresectoscopic procedures performed in patients with submucous myoma were submitted to the analysis. Setting. Department of Operative Gynecology of Scientific Center for Obst., Gyn. & Perinatology, Moscow, Russia. Patients. One hundred forty women with submucous myoma (aged 26-45 yrs). Interventions. All patients underwent resectoscopy, assisted by laparoscopy in 53 cases, used for final diagnosis and correction of associated pathology (endometriosis, ovarian mass, fibroids of intramural or subserous localisation) and safety control. Measurements and Main Results. Operating time (av. 34.2+11.1), blood loss (47.8+33.1), complications rate (0.7%), postoperative hospital stay (av. 2.3 +1.2) were compared to the parameters of analogous laparotomic procedures, showing the advantage of hysteroresectoscopy. Histologic, histochemical and electron-microscopical studies of endometrial bioptates from the sites of surgery and outside, obtained 3-6 months after procedures revealed complete restoration and functional adequacy of endometrium in all patients. 51.1% of 84 patients willing to conceive, succeeded, and in 83.7% cases pregnancies fulltermed by via naturalis. Conclusion. The study advocates for hysteroscopic management of submucous myoma, beneficial for morphofunctional restoration of endometrium and resulting in good reproductive outcomes.
157. Hysteroscopy Combined with Endometrial Ablation for Recurrent Benign Endometrial Polyp in the Postmenopausal Patient: A Pilot Study A Sharon, O Brandes-Klein, B Feiner, Z Alter, A Lissak. Carmel Medical Center, Haifa, Israel.
Objective. To determine the efficacy of hysteroscopy combined with endometrial ablation for recurrent endometrial polyp in the postmenopansal women for prevention of future endometrial polyp. Design. A prospective pilot study. Setting. University-affiliated hospital. Patients. Sixteen postmenopansal patients with a recurrent endometrial polyp, who were planned to undergo a hysteroscopic polypectomy.
Intervention. A hysteroscopic polypectomy followed by an endometrial balloon ablation or resection at the same session, performed on a day-care basis. Measurements and Main Results. Of 16 postmenopausal patients which were recruited to the study, 5 complained of postmenopansal bleeding (PMB). A transvaginal sonography revealed a recurrent endometrial polyp in all patients. The polyp size ranged from 10-30 mm in the longest diameter. A histology was made following the removal of the polyp by hysteroscopy. In 2 cases no polyp was demonstrated. In order to prevent additional recurrence of a polyp or PMB, endometrial balloon ablation was performed. Eight patients underwent endometrial ablation or resection in the same session (ThermaChoice, Gynecare). The histology of the specimen from all patients was of a benign endometrial polyp. The follow-up period was 1-3 years, at which time no recurrent of PMB or endometrial polyp was found. Conclusion. Our preliminary result of this approach suggest the benefit of endometrial ablation in cases of recurrent endometrial polyp, are encouraging and may prevent the growth of future polyps, and thus avoid additional surgical interventions.
158. Successful Hysteroscopic Treatment of Benign Intrauterine Pathologies with a 5 Ft. Bipolar Electrode 10 Ceci, 1S Bettocchi, 1L Nappi, 1A Pellegrino, 1R Di Venere, 1V Pansini, 1A Santoro, 2L Selvaggi. 1University of Bari, Italy; 2University "Cattolica del Sacro Cuore," Rome, Italy.
Objective. Demonstration of advanced operative office hysteroscopy: the treatment of benign intrauterine pathologies using a 5 Fr. bipolar probe and its efficacy in terms of recurrence of the pathologies and patient compliance. Methods. From 1999 to 2001 we performed, at our Center 1860 Office hysteroscopic procedures, without analgesia or anaesthesia, for the treatment of benign intrauterine pathologies. In 501 cases we used a Versapoint bipolar electrical generator to remove submucosal and partially intramural myomas ranging between 0.6 and 2.0 cm, as well as endometrial polyps between 0.5 and 4.5 cm. Results. After 6 months of follow-up we demonstrated any recurrence or persistence of the pathologies in the uterine cavity of all treated patients. Only in one case we discovered at histology a focal adenocarcinoma on the base of endometrial polyp in a menopausal patient. Concerning patient compliance, more than half of the patients (from 47.6 % to 79.3 %) accepted the procedure without discomfort, with a pain score ranging from 0 to 4; in 21,7% of the cases, patients referred a pain score ranging from 5 to 10, but the majority was menopausal women with a small and atrophic uterine cavity Conclusion. The combined use of a new generation small diameter hysteroscope and a new bipolar 5 Fr electrode (Versapoint) allows to the endoscopic gynaecologist to perform office hysteroscopy without analgesia and anaesthesia
$50
August 2003, Vol. 10, No. 3 Supplement
TheJournal of the American Association of Gynecologic Laparoscopists
for the treatment of benign intrauterine pathologies, with very good results in terms of recurrence and persistence of the pathologies and a satisfactory patient compliance.
159. Office Outpatient Hysteroscopy in Patients Affected by Menorrhagia C De Angelis. Department of Gynecological Sciences, Perinatology and Child Care, Rome, Italy. To evaluate the incidence of endometrial pathologies in patients affected by menorrhagia; to determine if a significant association between menorrhagia and benign or malignant anomalies of the uterus it does exist. Prospective case-control study. Centre for Minimally Invasive Surgery, Department of Gynecological Science and Perinatology, University of Rome, "La Sapienza", Italy. One hundred eighteen consecutive women affected by menorrhagia. Office diagnostic hysteroscopy. The uterine cavity was normal in 44% of women affected by menorrhagia, instead the incidence of endometrial cancer was 0.9%. The multivariate analysis of logistic regression has shown a significant association between menorrhagia and age (O.R. 0.08 per year), and between menorrhagia and submucous myomas (O.R. 2.6). The presence of endometrial polyps was instead not significant. Menorrhagia is one of the most common gynecologic complaints especially in 40-50 age. Very low is the incidence of endometrial cancer. A strong association has been found with the age and the presence of submucous fibroids.
160. Diagnostic Hysteroscopy Alone Is Not Sufficient for the Diagnosis of Patients with Abnormal Uterine Bleeding MD Mueller, E Dreher. Universitaets-Frauenklinik, Berne, Switzerland.
Objective. To evaluate the diagnostic accuracy of hysteroscopy (HSC) in two teaching Hospitals. DesigFz. Retrospective clinical study. Sett#zg. University hospitals. Patierzts arzdMethods. The histologic findings of 1872 consecutive patients who underwent a diagnostic HSC followed by TC for abnormal uterine bleeding or suspicious endometrium at ultrasound where compared to the HSC findings. Mairz Results. Patients (990) were premenopansal (mean age 41.9 + 6.8 years) where as 882 patients were postmenopansal (mean 60.5 + 7.7 years). HSC was non-diagnostic in 5 cases (0.3%) while the material obtained at TC was too scant for a histological diagnosis in 15 cases (0.8%). Pathology revealed an endometrial cancer in 68 cases (incidence 3.6%), but only 32 cases (47%) were recognized at HSC. When compared with the histologic diagnosis obtained by TC the hysteroscopic findings showed a diagnostic sensitivity of 47%, a specificity of 99%, a positive predictive value (PPV) of 78 %, and a negative predictive value (NPV)
of 98 %. The diagnostic accuracy of HSC was similar in both hospitals included in the study. CoFzclusioFz. This study demonstrates that the diagnostic accuracy of HSC is not sufficient in the diagnosis of abnormal uterine bleeding and that a TC is mandatory.
161. The Analysis of the Curative Effect and the Factors Causing the Failure of Using Transcervical Resection of Endometrium to Treat DU B O Hua. Fuxing Hospital, affiliated to Capital University of Medical Sciences Center of Hysteroscopy, Beijing, China.
Objective. To study the mechanism, curative efficacy and factors related to recurrence of TCRE in treating women with dysfunctional uterine bleeding (DUB). Methods. From May 1990 to May 2000, 220 cases with DUB were performed TCRE, in which there are 10 cases are recurrence where the patients agreed to remove the uterus after the TCRE procedure. By these cases, the specimens were stained by hemaloxylin-eosin. Results. The average depth of myometrium in removed endometrium strip is 2.683 mm, 2.120 mm, and 3.260 mm. The following up time after operation is 24 months to 144 months. Overall efficiency is 94.5% in which amenorrhea rate is 25.8%, menstruation reduction is 68.7%. 25 cases were given medicine treatment as a result of recurrence. Three cases were performed re-TCRE and 10 cases required subsequent hysterectomy. Endometrium regrowth is seen in the uterine specimens in relapsed cases, adenomyosis is also found in the intra-uterine wall. The effective rate of corrective anemia is 97.6% and the satisfaction rate for this operation is 92.3%. CoFzclusioFz.TCRE is a useful alternative treatment for dysfunctional uterine bleeding. The recurrence is caused by adenomyosis and the uncompleted removing endometrium during the operations.
Open Communications 8--Miscellaneous 162. Essure Hysteroscopic Sterilization: Results Based on Utilizing a New Coil Catheter Delivery System JF Kerin. University of Adelaide Reproductive Medicine Unit, North Adelaide, Australia. One hundred women seeking sterilization were enrolled in the Essure Coil Catheter Safety and Effectiveness study by 5 investigators. The average age was 36 years with gravidity/ parity of 3/3. The bilateral placement rate using the coil catheter was 98% (98/100 procedures) as compared to the Pivotal Multicentre Study of 86% using the existing catheter. Two women who did not have successful device placement due to apparent tubal obstruction underwent an HSG. In one case there was poor tubal filling. Fibrosis with thickening
$51