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Surgical Treatment Outcomes in Patients With Recurrent Pregnancy Loss Attributed to Septate Uterus
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Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
adenomyosis, 3 had fibroids and 5 had endometriosis. In the 28 patients with pain and bleeding, 11 had adenomyosis, 11 had fibroids and 3 had endometriosis. In the new onset pain group, 9 of the 16 patients had postablative fibrosis and scarring noted on the pathology report. In the pain and bleeding group there were 7 reports of these changes. Conclusion: Bleeding was the most common reason for Novasure failure. Although one quarter of the women who went on to hysterectomy had some component of new onset pain the majority had some additional pathology consistent with development of pain. In only 3 patients (0.1%) with new onset pain was there no obvious pathology. The finding of postablative scarring and fibrosis was not found universally in the patients with new onset pain, nor was it consistently noted in those patients with a bleeding component, which makes it difficult to attribute it as a consistent or common cause of the pain.
663 Hysteroscopic Removal of Placental Remnants: A Randomized Trial Comparing Hysteroscopic Morcellation With Cold Loop Resectoscopy Hamerlynck TWO,1 Van Vliet HAAM,2 Weyers S,1 Schoot BC.2 1Women’s Clinic, Ghent University Hospital, Ghent, Belgium; 2Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, Netherlands Study Objective: To compare two mechanical hysteroscopic techniques for removal of placental remnants, (a) hysteroscopic morcellation with (b) cold loop resectoscopy, in terms of procedure time, peri- and post-operative adverse events, tissue availability, short-term effectiveness and intrauterine adhesion formation. Design: Multicenter, open label, randomized controlled trial. Setting: A teaching hospital and a university hospital. Patients: Women with placental remnants after pregnancy scheduled for hysteroscopic removal. Intervention: Participants are randomized between hysteroscopic morcellation with the TRUCLEAR 8.0 Tissue Removal System (Smith & Nephew, Inc., Andover (MA), United States) and cold loop resectoscopy with a rigid 8.5 mm bipolar resectoscope (Karl Storz GmbH, Tuttlingen, Germany). Procedures are performed in day surgery under spinal or general anesthesia. An ambulant second look hysteroscopy is performed postoperatively to check for intrauterine adhesions. Measurements and Main Results: We calculated a sample size of 34 women in each group based on the expected difference in operating time. Inclusion started in May 2011 and we expect to end it by June 2015. If selected for the AAGL Global Congress in November 2015, we can present the outcome data of this trial. Conclusion: Soon we will finish the first randomized trial comparing hysteroscopic morcellation with cold loop resectoscopy for removal of placental remnants. Previous studies indicate that hysteroscopic morcellation is faster in treating other types of intrauterine pathology and suggest it is a good alternative for treating placental remnants. If selected, we will communicate the outcome results of this trial (procedure time, adverse events, tissue availability, short-term effectiveness and intrauterine adhesion formation) at the congress.
664 Age at Diagnosis and Mass Size as Clinical Indications for Hysteroscopic Mass Excision Koo YJ, Min KJ, Hong JH, Lee JK. Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Korea Study Objective: An accurate selection of patients with abnormal uterine lesions before hysteroscopic resection is vitally important. The present study aimed to investigate clinical factors associated with abnormal pathologies of endometrial mass resected by hysteroscopy.
Design: Retrospective cohort study. Setting: University and academic hospital. Patients: 190 women who underwent hysteroscopic surgery for a presumptive diagnosis of abnormal uterine mass, such as endometrial polyp or submucosal myoma, between January 2012 and April 2015 were enrolled. Patients who received surgery for remnant placenta, uterine anomaly, or uterine synechiae were excluded from this study. Intervention: Surgery under hysteroscopic view. Measurements and Main Results: In 190 patients, the mean age was 40 8.4 years, and 11 (5.8%) women were virgins. Pathologic diagnosis of the uterine mass was abnormal in 171 (90%) cases, including endometrial polyps in 113 (59.5%), submucosal myomas in 51 (26.8%), endocervical polyps in 15 (7.9%), and endometrial cancer in 1 (0.5%). On the other hand, 19 (10%) women who received the hysteroscopic resection had unremarkable results on pathology, in which the most common finding was proliferative phase of endometrium. Mass size on preoperative sonography was significantly larger in women with abnormal pathologies (2.1 vs. 1.4 cm, p=0.047), and women with abnormal pathologies tended to be older than those with normal pathology (41 vs. 37 years, p=0.076). However, pathologic diagnosis was not significantly associated with the clinical characteristics of menopause, vaginal bleeding, menstrual period at the date of sonography, and location of the mass. Conclusion: Large mass size and old age are the risk factors for abnormal endometrial or endocervical lesions. More careful decision on hysteroscopic removal is recommended for women younger than 41 years and with a mass less than 2 cm within uterine cavity.
665 Surgical Treatment Outcomes in Patients With Recurrent Pregnancy Loss Attributed to Septate Uterus Ono S, Mine K, Kuwabara Y, Akira S, Takesita T. Obstetrics and Gynecology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan Study Objective: Septate uterus is a risk factor for recurrent pregnancy loss. However, the usefulness of surgical interventions such as metroplasty remains controversial. At our hospital, surgical treatment is preferred for patients with recurrent pregnancy loss due to spontaneous abortion attributed to septate uterus. Although laparoscopic-assisted Jones technique (LAJ) was performed at our hospital previously, transcervical resection (TCR) is currently preferred. We examined pregnancy outcomes after surgical treatment at our hospital to identify risk factors for postoperative no-live-birth and secondary infertility (no pregnancy for >1 year postoperatively). Design: Case control study. Patients: According our pregnancy loss screening data over an 8-year period, 46 patients with a history of R2 spontaneous abortions attributed to septate uterus underwent metroplasty at our hospital (TCR = 34, LAJ = 12). Forty patients with available postoperative follow-up data were eventually included. Intervention: Patient background data (age, number of spontaneous abortions, aPL positivity rate, number of postoperative residual septum cases, and number of cases without postoperative adhesions) were compared between postoperative pregnancy (n = 31) and postoperative infertility (n = 4) groups as well as postoperative live-birth (n = 29) and postoperative no-live-birth (n = 6) groups. Data were analyzed with T-tests and multivariate analyses. Measurements and Main Results: Patient age was significantly different between the postoperative pregnancy and infertility groups. However, surgical treatment types were not significantly different between the postoperative pregnancy group and live-birth groups. In patients with high residual septum, the pregnancy and live-birth rates were low. Conclusion: Postoperative live-birth rate was not related to surgical treatment type. However, the postoperative live-birth rate was affected by the degree of residual septum and adhesions.
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
adenomyosis, 3 had fibroids and 5 had endometriosis. In the 28 patients with pain and bleeding, 11 had adenomyosis, 11 had fibroids and 3 had endometriosis. In the new onset pain group, 9 of the 16 patients had postablative fibrosis and scarring noted on the pathology report. In the pain and bleeding group there were 7 reports of these changes. Conclusion: Bleeding was the most common reason for Novasure failure. Although one quarter of the women who went on to hysterectomy had some component of new onset pain the majority had some additional pathology consistent with development of pain. In only 3 patients (0.1%) with new onset pain was there no obvious pathology. The finding of postablative scarring and fibrosis was not found universally in the patients with new onset pain, nor was it consistently noted in those patients with a bleeding component, which makes it difficult to attribute it as a consistent or common cause of the pain.
663 Hysteroscopic Removal of Placental Remnants: A Randomized Trial Comparing Hysteroscopic Morcellation With Cold Loop Resectoscopy Hamerlynck TWO,1 Van Vliet HAAM,2 Weyers S,1 Schoot BC.2 1Women’s Clinic, Ghent University Hospital, Ghent, Belgium; 2Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, Netherlands Study Objective: To compare two mechanical hysteroscopic techniques for removal of placental remnants, (a) hysteroscopic morcellation with (b) cold loop resectoscopy, in terms of procedure time, peri- and post-operative adverse events, tissue availability, short-term effectiveness and intrauterine adhesion formation. Design: Multicenter, open label, randomized controlled trial. Setting: A teaching hospital and a university hospital. Patients: Women with placental remnants after pregnancy scheduled for hysteroscopic removal. Intervention: Participants are randomized between hysteroscopic morcellation with the TRUCLEAR 8.0 Tissue Removal System (Smith & Nephew, Inc., Andover (MA), United States) and cold loop resectoscopy with a rigid 8.5 mm bipolar resectoscope (Karl Storz GmbH, Tuttlingen, Germany). Procedures are performed in day surgery under spinal or general anesthesia. An ambulant second look hysteroscopy is performed postoperatively to check for intrauterine adhesions. Measurements and Main Results: We calculated a sample size of 34 women in each group based on the expected difference in operating time. Inclusion started in May 2011 and we expect to end it by June 2015. If selected for the AAGL Global Congress in November 2015, we can present the outcome data of this trial. Conclusion: Soon we will finish the first randomized trial comparing hysteroscopic morcellation with cold loop resectoscopy for removal of placental remnants. Previous studies indicate that hysteroscopic morcellation is faster in treating other types of intrauterine pathology and suggest it is a good alternative for treating placental remnants. If selected, we will communicate the outcome results of this trial (procedure time, adverse events, tissue availability, short-term effectiveness and intrauterine adhesion formation) at the congress.
664 Age at Diagnosis and Mass Size as Clinical Indications for Hysteroscopic Mass Excision Koo YJ, Min KJ, Hong JH, Lee JK. Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Korea Study Objective: An accurate selection of patients with abnormal uterine lesions before hysteroscopic resection is vitally important. The present study aimed to investigate clinical factors associated with abnormal pathologies of endometrial mass resected by hysteroscopy.
Design: Retrospective cohort study. Setting: University and academic hospital. Patients: 190 women who underwent hysteroscopic surgery for a presumptive diagnosis of abnormal uterine mass, such as endometrial polyp or submucosal myoma, between January 2012 and April 2015 were enrolled. Patients who received surgery for remnant placenta, uterine anomaly, or uterine synechiae were excluded from this study. Intervention: Surgery under hysteroscopic view. Measurements and Main Results: In 190 patients, the mean age was 40 8.4 years, and 11 (5.8%) women were virgins. Pathologic diagnosis of the uterine mass was abnormal in 171 (90%) cases, including endometrial polyps in 113 (59.5%), submucosal myomas in 51 (26.8%), endocervical polyps in 15 (7.9%), and endometrial cancer in 1 (0.5%). On the other hand, 19 (10%) women who received the hysteroscopic resection had unremarkable results on pathology, in which the most common finding was proliferative phase of endometrium. Mass size on preoperative sonography was significantly larger in women with abnormal pathologies (2.1 vs. 1.4 cm, p=0.047), and women with abnormal pathologies tended to be older than those with normal pathology (41 vs. 37 years, p=0.076). However, pathologic diagnosis was not significantly associated with the clinical characteristics of menopause, vaginal bleeding, menstrual period at the date of sonography, and location of the mass. Conclusion: Large mass size and old age are the risk factors for abnormal endometrial or endocervical lesions. More careful decision on hysteroscopic removal is recommended for women younger than 41 years and with a mass less than 2 cm within uterine cavity.
665 Surgical Treatment Outcomes in Patients With Recurrent Pregnancy Loss Attributed to Septate Uterus Ono S, Mine K, Kuwabara Y, Akira S, Takesita T. Obstetrics and Gynecology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan Study Objective: Septate uterus is a risk factor for recurrent pregnancy loss. However, the usefulness of surgical interventions such as metroplasty remains controversial. At our hospital, surgical treatment is preferred for patients with recurrent pregnancy loss due to spontaneous abortion attributed to septate uterus. Although laparoscopic-assisted Jones technique (LAJ) was performed at our hospital previously, transcervical resection (TCR) is currently preferred. We examined pregnancy outcomes after surgical treatment at our hospital to identify risk factors for postoperative no-live-birth and secondary infertility (no pregnancy for >1 year postoperatively). Design: Case control study. Patients: According our pregnancy loss screening data over an 8-year period, 46 patients with a history of R2 spontaneous abortions attributed to septate uterus underwent metroplasty at our hospital (TCR = 34, LAJ = 12). Forty patients with available postoperative follow-up data were eventually included. Intervention: Patient background data (age, number of spontaneous abortions, aPL positivity rate, number of postoperative residual septum cases, and number of cases without postoperative adhesions) were compared between postoperative pregnancy (n = 31) and postoperative infertility (n = 4) groups as well as postoperative live-birth (n = 29) and postoperative no-live-birth (n = 6) groups. Data were analyzed with T-tests and multivariate analyses. Measurements and Main Results: Patient age was significantly different between the postoperative pregnancy and infertility groups. However, surgical treatment types were not significantly different between the postoperative pregnancy group and live-birth groups. In patients with high residual septum, the pregnancy and live-birth rates were low. Conclusion: Postoperative live-birth rate was not related to surgical treatment type. However, the postoperative live-birth rate was affected by the degree of residual septum and adhesions.