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Total Laparoscopic Hysterectomy (TLH) for Enlarged Uteri
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159 ongoing pregnancy. The reproductive outcome was not affected by type, size, or number of submucous myomas. Conclusion: Hysteroscopic myomectomy for treatment of infertility in patients with submucous fibroid appears to be safe and effective in improving reproductive outcome. 231
Open Communication Session 8dHysterectomy and Advanced Laparoscopy (3:35 PM d 3:40 PM)
Evaluation of an Advanced Bipolar Electrosurgical Vessel Sealer Versus Conventional Ligation Technique in Abdominal Hysterectomy Bruno R, Soto-Wright V, El-Sahwi K, Dick A, Birdsall M, McLellan R. Gynecology, Lahey Clinic Foundation, Inc., Burlington, Massachusetts Study Objective: Preliminary findings of a prospective randomized IRB study comparing an advanced bipolar electrosurgical vessel sealer (Ligasure impact, using the Force Triad energy platform) versus traditional clamp and suture in abdominal hysterectomy. Design: Prospective randomized study of traditional clamp and suture versus an advanced bipolar electrosurgical vessel sealer to perform abdominal hysterectomies. Setting: University affiliated, tertiary care teaching hospital. Patients: Patients with benign and malignant pelvic disease between the ages of 84 and 99 were treated. Intervention: Abdominal hysterectomy using either clamp and suture or the advanced bipolar electrosurgical vessel sealer, Ligasure Tissue Fusion technology. Measurements and Main Results: Procedure time was defined from skin incision to closure of the vaginal cuff with satisfactory hemostasis. Blood loss was estimated by the Anesthesia Service. The use of the Ligasure impact device resulted in shorter surgery times. The mean time savings was 15 minutes (30 % difference), 35 minutes in the impact group versus 50 minutes in the clamp and suture arm. Blood loss was less in the vessel sealing group 80 ml versus 122 ml in the suture group (34% difference). Average length of stay for the suture group was 3.5 days versus 2.6 in the vessel sealing group. No major intra-op complications were noted in either group. There were 8 post-op transfusions in the traditional group versus 4 in the vessel sealing group. Results will be updated at the time of presentation. Conclusion: Initial results indicate shorter operative times, less blood loss, less transfusions and shorter hospital stays.
232
Open Communication Session 8dHysterectomy and Advanced Laparoscopy (3:41 PM d 3:46 PM)
Vaginal Hysterectomy with Bicoagulation Clamps ‘‘MarClamp’’ Application Popov A, Shaginian G, Manannikova T, Ramazanov M, Fedorov A, Krasnopolskaya I, Machanskite O, Slobodianiouk B, Zemskov Y. Endoscopyc Surgery, Moscow Regional Reserch Institute of Obsterics and Gynecology, Moscow, Russian Federation Study Objective: The most popular method of surgical treatment of hormone-depended non-malignant disease of uteri is hysterectomy. Laparotomyc and laparoscopyc techinque of hysterectomy have a high frequency of postoperative complications: wound of the bladder and ureter 0.5-0.8%, wound of the intestine 0.3%. Also disadvantages are: the syndrome of pelvic pain, haematoma in parameterizes, long period of rehabilitation. The operation by vaginal admission is less traumatic, short period of hospitalization, the better quality of life and short period of standing normal activity. Absenting the signs of operation with the using of modern methods of plastical gynecology allows woman to make a secret of fact of operation and have a high quality sexual life. The aim of trial is to study results of vaginal hysterectomy with using of bipolar coagulation clamps ‘‘MarClump’’. Design: Vaginal hysterectomy with using of bipolar coagulation clamps ‘‘MarClump’’ was done in our clinic at 48 patients with sub mucosal
S61
nodes of myoma, recurrence of endometrial hyperplasia and impossibility of gormonotherapy. The middle age of the patients was 45.7 4.2 years. The idea of using of bipolar coagulation was got from laparoscopy. Bipolar current is producing by high frequency electrosurgical block and following cross bipolar clamp, which use as an electrocoagulation instrument. Operation length is about 15- 30 minutes. The operation wound remains dry and less of blood. Measurements and Main Results: The follow advantages of the vaginal hysterectomy with using bipolar coagulation clamps ‘‘MarClump’’ in comparison with classical methods were discovered. The time of operation and the volume of bleeding are decrease. Intraoperation and late postoperative complications are absent. The using of this method allows decreasing the duration postoperative period (from 2 or 3 days maximum). Especially, the advantage of this method is obvious among the patients with extreme high weight, cause of difficulties of stitches of vessels and ligaments.
233
Open Communication Session 8dHysterectomy and Advanced Laparoscopy (3:47 PM d 3:52 PM)
Total Laparoscopic Hysterectomy (TLH) for Enlarged Uteri Vignali M, Zoppo S Del, Bertazzoli M, Oggioni G, Stoppelli S, Busacca M. Obstetrics and Gynecology, Macedonio Melloni Hospital-University of Milan, Milan, Italy Study Objective: The objective of this study was to evaluate short-term results of Total Laparoscopic Hysterectomy (TLH) in patients with large uterus (O 280 g), traditionally contraindicated to a vaginal approach. Design: Sixty patients with enlarged uterus undergoing TLH were prospectively evaluated. Setting: University hospital. Patients: Sixty women with enlarged uterus, mean age 45.45 3.75 (3755) years, mean BMI 24.5 3.2 (17.8-32.7), mean number of deliveries 1.41 1.20 (0-6), who underwent TLH since January 2004 to December 2007. Intervention: Total laparoscopic hysterectomy. Measurements and Main Results: Indication to hysterectomy was fibroids in 90% of cases, the mean uterine weight was 445 159 (280930) g, mean operating time was 139 37 (45-240) minutes, mean postoperative hospital stay was 5.06 0.83 (3-7) days, estimated blood loss was 138 101 (50-500) ml. One major complications was encountered: a vesico-vaginal fistula that was successfully corrected 2 months later. One conversion to laparotomy occurred, due to fibroids shape and localization. Conclusion: Total laparoscopic hysterectomy may replace abdominal hysterectomy in most patients with enlarged uterus, bigger than 280 grams, which represents a limit to vaginal approach. In skilled hands, these patients could benefit all the advantages related to minimally invasive approach such as minimal blood loss, short hospital stay, prompt recovery, obtaining a satisfactory result, comparable to the vaginal approach.
234
Open Communication Session 8dHysterectomy and Advanced Laparoscopy (3:53 PM d 3:58 PM)
Robot-Assisted Laparoscopic Hysterectomy: Comparison with Total Laparoscopic Hysterectomy Morozov VV, Nezhat CH. Nezhat Medical Center, Atlanta Center for Special Minimally Invasive Surgery and Reproductive Medicine, Atlanta, Georgia Study Objective: To compare robot-assisted laparoscopic hysterectomy (RALH) with total laparoscopic hysterectomy (TLH). Design: Prospective database and retrospective analysis. Setting: Metropolitan hospital. Patients: One hundred and forty patients (60 TLH and 80 RALH) underwent hysterectomy at a tertiary care center. Indications for surgery
Open Communication Session 8dHysterectomy and Advanced Laparoscopy (3:35 PM d 3:40 PM)
Evaluation of an Advanced Bipolar Electrosurgical Vessel Sealer Versus Conventional Ligation Technique in Abdominal Hysterectomy Bruno R, Soto-Wright V, El-Sahwi K, Dick A, Birdsall M, McLellan R. Gynecology, Lahey Clinic Foundation, Inc., Burlington, Massachusetts Study Objective: Preliminary findings of a prospective randomized IRB study comparing an advanced bipolar electrosurgical vessel sealer (Ligasure impact, using the Force Triad energy platform) versus traditional clamp and suture in abdominal hysterectomy. Design: Prospective randomized study of traditional clamp and suture versus an advanced bipolar electrosurgical vessel sealer to perform abdominal hysterectomies. Setting: University affiliated, tertiary care teaching hospital. Patients: Patients with benign and malignant pelvic disease between the ages of 84 and 99 were treated. Intervention: Abdominal hysterectomy using either clamp and suture or the advanced bipolar electrosurgical vessel sealer, Ligasure Tissue Fusion technology. Measurements and Main Results: Procedure time was defined from skin incision to closure of the vaginal cuff with satisfactory hemostasis. Blood loss was estimated by the Anesthesia Service. The use of the Ligasure impact device resulted in shorter surgery times. The mean time savings was 15 minutes (30 % difference), 35 minutes in the impact group versus 50 minutes in the clamp and suture arm. Blood loss was less in the vessel sealing group 80 ml versus 122 ml in the suture group (34% difference). Average length of stay for the suture group was 3.5 days versus 2.6 in the vessel sealing group. No major intra-op complications were noted in either group. There were 8 post-op transfusions in the traditional group versus 4 in the vessel sealing group. Results will be updated at the time of presentation. Conclusion: Initial results indicate shorter operative times, less blood loss, less transfusions and shorter hospital stays.
232
Open Communication Session 8dHysterectomy and Advanced Laparoscopy (3:41 PM d 3:46 PM)
Vaginal Hysterectomy with Bicoagulation Clamps ‘‘MarClamp’’ Application Popov A, Shaginian G, Manannikova T, Ramazanov M, Fedorov A, Krasnopolskaya I, Machanskite O, Slobodianiouk B, Zemskov Y. Endoscopyc Surgery, Moscow Regional Reserch Institute of Obsterics and Gynecology, Moscow, Russian Federation Study Objective: The most popular method of surgical treatment of hormone-depended non-malignant disease of uteri is hysterectomy. Laparotomyc and laparoscopyc techinque of hysterectomy have a high frequency of postoperative complications: wound of the bladder and ureter 0.5-0.8%, wound of the intestine 0.3%. Also disadvantages are: the syndrome of pelvic pain, haematoma in parameterizes, long period of rehabilitation. The operation by vaginal admission is less traumatic, short period of hospitalization, the better quality of life and short period of standing normal activity. Absenting the signs of operation with the using of modern methods of plastical gynecology allows woman to make a secret of fact of operation and have a high quality sexual life. The aim of trial is to study results of vaginal hysterectomy with using of bipolar coagulation clamps ‘‘MarClump’’. Design: Vaginal hysterectomy with using of bipolar coagulation clamps ‘‘MarClump’’ was done in our clinic at 48 patients with sub mucosal
S61
nodes of myoma, recurrence of endometrial hyperplasia and impossibility of gormonotherapy. The middle age of the patients was 45.7 4.2 years. The idea of using of bipolar coagulation was got from laparoscopy. Bipolar current is producing by high frequency electrosurgical block and following cross bipolar clamp, which use as an electrocoagulation instrument. Operation length is about 15- 30 minutes. The operation wound remains dry and less of blood. Measurements and Main Results: The follow advantages of the vaginal hysterectomy with using bipolar coagulation clamps ‘‘MarClump’’ in comparison with classical methods were discovered. The time of operation and the volume of bleeding are decrease. Intraoperation and late postoperative complications are absent. The using of this method allows decreasing the duration postoperative period (from 2 or 3 days maximum). Especially, the advantage of this method is obvious among the patients with extreme high weight, cause of difficulties of stitches of vessels and ligaments.
233
Open Communication Session 8dHysterectomy and Advanced Laparoscopy (3:47 PM d 3:52 PM)
Total Laparoscopic Hysterectomy (TLH) for Enlarged Uteri Vignali M, Zoppo S Del, Bertazzoli M, Oggioni G, Stoppelli S, Busacca M. Obstetrics and Gynecology, Macedonio Melloni Hospital-University of Milan, Milan, Italy Study Objective: The objective of this study was to evaluate short-term results of Total Laparoscopic Hysterectomy (TLH) in patients with large uterus (O 280 g), traditionally contraindicated to a vaginal approach. Design: Sixty patients with enlarged uterus undergoing TLH were prospectively evaluated. Setting: University hospital. Patients: Sixty women with enlarged uterus, mean age 45.45 3.75 (3755) years, mean BMI 24.5 3.2 (17.8-32.7), mean number of deliveries 1.41 1.20 (0-6), who underwent TLH since January 2004 to December 2007. Intervention: Total laparoscopic hysterectomy. Measurements and Main Results: Indication to hysterectomy was fibroids in 90% of cases, the mean uterine weight was 445 159 (280930) g, mean operating time was 139 37 (45-240) minutes, mean postoperative hospital stay was 5.06 0.83 (3-7) days, estimated blood loss was 138 101 (50-500) ml. One major complications was encountered: a vesico-vaginal fistula that was successfully corrected 2 months later. One conversion to laparotomy occurred, due to fibroids shape and localization. Conclusion: Total laparoscopic hysterectomy may replace abdominal hysterectomy in most patients with enlarged uterus, bigger than 280 grams, which represents a limit to vaginal approach. In skilled hands, these patients could benefit all the advantages related to minimally invasive approach such as minimal blood loss, short hospital stay, prompt recovery, obtaining a satisfactory result, comparable to the vaginal approach.
234
Open Communication Session 8dHysterectomy and Advanced Laparoscopy (3:53 PM d 3:58 PM)
Robot-Assisted Laparoscopic Hysterectomy: Comparison with Total Laparoscopic Hysterectomy Morozov VV, Nezhat CH. Nezhat Medical Center, Atlanta Center for Special Minimally Invasive Surgery and Reproductive Medicine, Atlanta, Georgia Study Objective: To compare robot-assisted laparoscopic hysterectomy (RALH) with total laparoscopic hysterectomy (TLH). Design: Prospective database and retrospective analysis. Setting: Metropolitan hospital. Patients: One hundred and forty patients (60 TLH and 80 RALH) underwent hysterectomy at a tertiary care center. Indications for surgery