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Treatment of Adenomyosis by Hysteroscopy
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 deliveries. Dilatation and curettage (D&C) is the gold standard to manage these cases. D&C can aggravate endometrial trauma, resulting in incomplete evacuation and intra-uterine adhesions in the long term. Hysteroscopy is a better and clearer approach to complete evacuation, reduce endometrial trauma and improve future fertility prospects. Hysteroscopic removal of RPOC is certainly more rational in uterine anomalies, in recurrent persistent RPOC with failed prior attempts. In this video, hysteroscopic diagnosis and removal of persistent RPOC in five cases is presented. For all cases, prior attempts at medical and surgical evacuation of the uterus had failed. 345 Treatment of Adenomyosis by Hysteroscopy Zhang J, Shi W. Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China Our objective is to introduce a new hysteroscopic operation which is successfully used to treat patients suffering adenomyosis. Hysteroscopy fits well with the modern concept of minimally invasive surgery. We have treated 11 cases in the past year and got satisfying outcomes. The amount of intraoperative bleeding is 4535ml and the operation time is 25-129 minutes. There were no intraoperative and postoperative complications. Furthermore, it took only 6 hours for patients to resume normal diet and activities. The postoperative VAS scores of dysmenorrhea and menstrual blood volume declined significantly after operation. 6 months after the operation the uterine volume evaluated by MRI reduced by about 33%. Therefore, hysteroscope provides an effective and optional conservative technique for the treatment of adenomyosis. 346 Resection of Uterine Septum Using the MyoSure Tissue Removal System Malik R,1 Rizwan S,1 Rizk B.2 1Advanced Fertility Centers, Odessa, Texas; 2 University of South Alabama, Mobile, Alabama The septate uterus is the most common structural uterine malformation. The uterine septum is associated with the highest incidence of infertility and poorest obstetrical outcome. Studies have shown that surgical correction of the uterine septum performed hysteroscopically can improve reproductive outcomes. In this video, we demonstrate the technique of a uterine septum resection using the MyoSure Tissue Removal system. 347 Hysteroscopic Metroplasty Sikka S. Obstetrics and Gynecology, Holy Cross Hospital, Silverspring, Maryland
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Lot of women with menorrhagia present with the diagnosis of submucus fibroids. Hysteroscopic myomectomy give good results irespective of the number, size and location of fibroids. The limitation being operator skills. Case selection does help in giving best results. Hysteroscopic multiple myomectomy can be carried out safely in complex cases with results which are good and do not hamper future child bearing. 349 Vasopressin Myoma Infiltration During Hysteroscopic Myomectomy Canseco-Lima JM, Hernandez-Denis A, Audifred-Salomon J. Gynecological Endoscopy, Hospital Central Sur de Alta Especialidad - PEMEX, Ciudad de Mexico, Distrito Federal, Mexico To determine if the use of vasopressin infiltration allows less blood loss during hystersocopic myomectomy. A 25 years old female with menometrorrhagia. Office hysteroscopy with a type zero sub mucous myoma filling over 70% of the endometrial cavity. The vasopressin infiltration was performed using a flexible reusable injection needle through the working channel of the diagnostic hysteroscope. Dilution used is one vasopressin milliliter on twenty milliliters of normal saline solution. A 40 years old female with menometrorrhagia. Office hysteroscopy with a type zero sub mucous myoma filling over 90% of the endometrial cavity. Full vasoconstriction effect was achieved through vasopressin injection. Minimal blood loss was seen during the procedure despite of the large size of the tumor. The benefits of using vasopressin infiltration are number one allows a clean visual field, number two minimal or no blood loss and number three excellent when working with large myomas. 350 Tips for Hysteroscopic Sterilization With In-Situ Intrauterine Device Patel NR, Hines MR, Wilson SF. Obstetrics & Gynecology, Christiana Care Health System, Newark, Delaware Hysteroscopic sterilization has been performed in over 750,000 patients worldwide. Historically, these cases were performed with an empty uterine cavity. With increasing utilization of intrauterine contraceptive devices (IUD), there have been cases where a patient desires to transition from long-acting reversible contraception to permanent sterilization. The objective of this video is to illustrate that hysteroscopic sterilization can be performed with an in-situ intrauterine device. Techniques are described that may help facilitate placement of the tubal inserts while maintaining the placement of the IUD during the procedure. In conclusion, hysteroscopic sterilization can be successfully performed in women that currently have intrauterine devices. In addition, the IUD can be retained in utero for contraception until the 3 month post-procedure hysterosalpingogram. 351
Septate uterus is a common uterine anomaly and is very amenable to surgical correction. This video demonstrates the technique of hysteroscopic metroplasty using a bipolar twizzle electrode through a 5F operative hysteroscope. The first patient had a partial septum which was resected under ultrasound guidance. In the second patient partial septum resection was performed under simultaneous laparoscopic guidance. The resection of the septum was carried out until both the tubal ostia were noted in the same transverse plane. Hysteroscopic metroplasty is a safe and feasible treatment for uterine septum. 348 Hysteroscopic Multiple Myomectomy Bhardwaj P. Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, Delhi, India Operative hysteroscopy is a gratifying surgery. Conservative surgery for young woman with relief of symptomatology is imperative in a number of cases. Fibroids are of common occurrence in women of reproductive age group.
Retained Products of Conception: A Hysteroscopic Directed Resection Tam T, Juarez L, Placek J. Obstetrics and Gynecology, Presence Saint Joseph Hospital, Chicago, Illinois The objective of the video is to demonstrate the advantages of hysteroscopic directed resection in the management of retained products of conception. The video includes two separate cases of two patients diagnosed with spontaneous abortion in the first trimester managed with suction curettage who were subsequently diagnosed with retained products of conception. Hysteroscopic directed resection was performed for each patient. The procedure provided both diagnostic and therapeutic benefits in each case. Examples of the varied appearances of retained products of conception in a normal uterine cavity and bicornuate uterus are exhibited. The video also includes a discussion of the benefits of hysteroscopic directed resection as surgical management for retained products of conception. The benefits include direct visualization, targeted removal, improved safety, efficiency and decreased risk of intrauterine adhesions. Hysteroscopic directed resection is a viable and advantageous option for the management of retained products of conception.
S123
Lot of women with menorrhagia present with the diagnosis of submucus fibroids. Hysteroscopic myomectomy give good results irespective of the number, size and location of fibroids. The limitation being operator skills. Case selection does help in giving best results. Hysteroscopic multiple myomectomy can be carried out safely in complex cases with results which are good and do not hamper future child bearing. 349 Vasopressin Myoma Infiltration During Hysteroscopic Myomectomy Canseco-Lima JM, Hernandez-Denis A, Audifred-Salomon J. Gynecological Endoscopy, Hospital Central Sur de Alta Especialidad - PEMEX, Ciudad de Mexico, Distrito Federal, Mexico To determine if the use of vasopressin infiltration allows less blood loss during hystersocopic myomectomy. A 25 years old female with menometrorrhagia. Office hysteroscopy with a type zero sub mucous myoma filling over 70% of the endometrial cavity. The vasopressin infiltration was performed using a flexible reusable injection needle through the working channel of the diagnostic hysteroscope. Dilution used is one vasopressin milliliter on twenty milliliters of normal saline solution. A 40 years old female with menometrorrhagia. Office hysteroscopy with a type zero sub mucous myoma filling over 90% of the endometrial cavity. Full vasoconstriction effect was achieved through vasopressin injection. Minimal blood loss was seen during the procedure despite of the large size of the tumor. The benefits of using vasopressin infiltration are number one allows a clean visual field, number two minimal or no blood loss and number three excellent when working with large myomas. 350 Tips for Hysteroscopic Sterilization With In-Situ Intrauterine Device Patel NR, Hines MR, Wilson SF. Obstetrics & Gynecology, Christiana Care Health System, Newark, Delaware Hysteroscopic sterilization has been performed in over 750,000 patients worldwide. Historically, these cases were performed with an empty uterine cavity. With increasing utilization of intrauterine contraceptive devices (IUD), there have been cases where a patient desires to transition from long-acting reversible contraception to permanent sterilization. The objective of this video is to illustrate that hysteroscopic sterilization can be performed with an in-situ intrauterine device. Techniques are described that may help facilitate placement of the tubal inserts while maintaining the placement of the IUD during the procedure. In conclusion, hysteroscopic sterilization can be successfully performed in women that currently have intrauterine devices. In addition, the IUD can be retained in utero for contraception until the 3 month post-procedure hysterosalpingogram. 351
Septate uterus is a common uterine anomaly and is very amenable to surgical correction. This video demonstrates the technique of hysteroscopic metroplasty using a bipolar twizzle electrode through a 5F operative hysteroscope. The first patient had a partial septum which was resected under ultrasound guidance. In the second patient partial septum resection was performed under simultaneous laparoscopic guidance. The resection of the septum was carried out until both the tubal ostia were noted in the same transverse plane. Hysteroscopic metroplasty is a safe and feasible treatment for uterine septum. 348 Hysteroscopic Multiple Myomectomy Bhardwaj P. Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, Delhi, India Operative hysteroscopy is a gratifying surgery. Conservative surgery for young woman with relief of symptomatology is imperative in a number of cases. Fibroids are of common occurrence in women of reproductive age group.
Retained Products of Conception: A Hysteroscopic Directed Resection Tam T, Juarez L, Placek J. Obstetrics and Gynecology, Presence Saint Joseph Hospital, Chicago, Illinois The objective of the video is to demonstrate the advantages of hysteroscopic directed resection in the management of retained products of conception. The video includes two separate cases of two patients diagnosed with spontaneous abortion in the first trimester managed with suction curettage who were subsequently diagnosed with retained products of conception. Hysteroscopic directed resection was performed for each patient. The procedure provided both diagnostic and therapeutic benefits in each case. Examples of the varied appearances of retained products of conception in a normal uterine cavity and bicornuate uterus are exhibited. The video also includes a discussion of the benefits of hysteroscopic directed resection as surgical management for retained products of conception. The benefits include direct visualization, targeted removal, improved safety, efficiency and decreased risk of intrauterine adhesions. Hysteroscopic directed resection is a viable and advantageous option for the management of retained products of conception.