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Use of a Hysteroscopic Rotating Morcellator for Endometrial Sampling Around an Exposed Essure™ Device
S52
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S47–S70
Table 2 Delivery Outcomes in Fibroid vs. Control group
167
Delivery
Fibroid (mean)
Control (mean)
P Value
Gestational Age Birth Weight 1 minute APGARS 5 minute APGARS estimated blood loss
35.25 2634.78 6.7 7.8 732.73
38.56 3181.35 7.9 8.8 466.05
\.001 \.001 \.001 \.0011 \.001
race was shown to be significantly higher in the fibroid group (p\.001). Past medical histories were comparable, except chronic hypertension, p=.040. Tables 1 and 2 describe labor and delivery outcomes between the two groups. Of note there were no J or T incisions during cesarean in the control group, although not significant they compromised 8.0% of the fibroid group. There was no difference in the type of malpresentation, between transverse, breech, or oblique (=.720). Conclusion: Fibroids not only have an impact on fertility but also complicate the labor and delivery course as well as have an significant impact of neonatal outcomes. The APGARS need to be correlated further clinically. 165
Video Session 5d Hysteroscopy (11:00 AM d 11:08 AM)
Essure Confirmation Transvaginal Ultrasound Connor VF. Section of Minimally Invasive Gynecology, Cleveland Clinic Florida, Weston, Florida Presently around the world the most commonly performed Essure confirmation tests are pelvic X-ray and HSG. In contrast to these, ultrasound offers the unique advantage of the ability to visualize soft tissue and the relationship between structures. Ultrasound also has several significant safety advantages, including lack of exposure to radiation, and no risk of infection or allergic reaction. Ultrasound is readily accessible in most gynecologist’s offices, and can be repeated as often as necessary. The metallic composition of Essure micro-inserts creates highly echogenic, readily identifiable, unique and reproducible ultrasound images. Commercial experience and several retrospective series suggest that pregnancy outcomes are the same when ultrasound is used for Essure confirmation in uncomplicated placement procedures, instead of HSG or X ray. To date however, no one has described procedure steps for an Essure confirmation ultrasound, or criteria for unsatisfactory location, and these are the goals of this video abstract. 166
Video Session 5d Hysteroscopy (11:09 AM d 11:14 AM)
Use of a Hysteroscopic Rotating Morcellator for Endometrial Sampling Around an Exposed EssureÔ Device Wagner CA,1 Gimpelson RJ.2 1Obstetrics & Gynecology, St. John’s Mercy Medical Center, St. Louis, Missouri; 2Gynecology, St. Lukes Hospital, St. Louis, Missouri A 41 year old female was referred for evaluation and treatment of menorrhagia. Transvaginal ultrasound showed a normal-sized uterus with a thickened lining (17.8 mm) and a pedunculated endometrial polyp. Hysteroscopy was performed. An EssureÔ coil was found protruding into the uterine cavity from the left ostia. No pedunculated polyp could be identified. The endometrial lining, however, was globally irregular in appearance, concerning for hyperplasia or sessile polyps. Several treatment options were considered, including sharp curettage, electrosurgical resectoscopy, hysteroscopy-directed biopsies, and endometrial resection using the hysteroscopic rotating morcellator. The latter option was believed to be optimal since it allowed for complete sampling/resection of the abnormal-appearing endometrium with minimal risk of disrupting the EssureÔ coil or causing thermal injury. Resection of all abnormal-appearing endometrial tissue was accomplished using the hysteroscopic morcellator without complications.
Video Session 5d Hysteroscopy (11:15 AM d 11:20 AM)
Hysteroscopic Treatment of Cesarean Scar Ectopic Pregnancy with Cold Resection Chang Y,1 Kay N.2 1Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 2E-Da Hospital, Kaohsiung County, Taiwan Video Objective: To report successful hysteroscopic treatment of cesarean scar ectopic pregnancy with cold resection. Patient and Methods: A 29 year-old, G3P2A0, multi-para presented to the OPD with vaginal spotting for 21 days. She reported having amenorrhea for 8 weeks. Sonography showed ectopic pregnancy in previous cesarean delivery scar (PCDS) defect. The serum beta-hCG was 5968 mIU/ml in level. Under the impression of ectopic pregnancy in PCDS defect, hysteroscopy surgery was arranged. We used pitressin injected into the cervix and removed the ectopic gestational tissue by resectoscopy successfully. Conclusion: Cesarean scar pregnancy is a rare form of ectopic pregnancy. There was no treatment protocol defined in the past. Minimal invasive management has become the main-stream treatment of disease nowadays. Hysteroscopy was applied as a helpful tool for treatment of ectopic pregnancy in PCDS defect. 168
Video Session 5d Hysteroscopy (11:21 AM d 11:29 AM)
Hysteroscopy and Rescetion of Submucous Fibroids with an Intramural Component Al-Khaduri M,1 Shawki O.2 1Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman; 2Obstetrics and Gynecology, Cairo University, Heliopolis, Cairo, Egypt The objective of this video is to demonstrate the technique of hysteroscopic resection of submucous fibroids with an intramural component using a monopolar loop. We present the case of a 29 yr old nulliparous woman married for 7 months and trying to conceive. She was complaining of irregular menses but no history of menorrhagia or dysmenorrhea. An ultrasound showed multiple 3-5 cm fibroids distorting the uterine cavity so a saline infusion sonography was performed and demonstrated an irregular cavity with submucous fibroids. We performed a hysteroscopy and were able to successfully resect the submucous fibroids and restore a normal uterine cavity using a monopolar loop. 169
Video Session 5d Hysteroscopy (11:30 AM d 11:36 AM)
Hysteroscopic Resection with Myosure Device DellaBadia C. OB/GYN, Drexel University College of Medicine, Philadelphia, Pennsylvania This is a 6 minute video demonstrating two cases of intrauterine resection using a new electronic tissue removal device. The device is recommended for use with 3 cm fibroids or polyps. This video pushes the limits of the device and demonstrates the removal of a 4 cm fibroid and a second case of the removal of a 9 cm polyp. The benefits of using a mechanical device over resectoscope are the ability to use a smaller scope size, saline for distension, no electrical energy, no chips in the operative field, and better pathologic specimens. 170
Video Session 5d Hysteroscopy (11:37 AM d 11:41 AM)
Hysteroscopic Resection of Retained Products of Conception Following Uterine Artery Embolization Guan X, Zurawin RK. Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas A 36-year-old gravida 3, para 1, abortus 2 had a full term delivery by Cesarean section after which she bled persistently. Two months
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S47–S70
Table 2 Delivery Outcomes in Fibroid vs. Control group
167
Delivery
Fibroid (mean)
Control (mean)
P Value
Gestational Age Birth Weight 1 minute APGARS 5 minute APGARS estimated blood loss
35.25 2634.78 6.7 7.8 732.73
38.56 3181.35 7.9 8.8 466.05
\.001 \.001 \.001 \.0011 \.001
race was shown to be significantly higher in the fibroid group (p\.001). Past medical histories were comparable, except chronic hypertension, p=.040. Tables 1 and 2 describe labor and delivery outcomes between the two groups. Of note there were no J or T incisions during cesarean in the control group, although not significant they compromised 8.0% of the fibroid group. There was no difference in the type of malpresentation, between transverse, breech, or oblique (=.720). Conclusion: Fibroids not only have an impact on fertility but also complicate the labor and delivery course as well as have an significant impact of neonatal outcomes. The APGARS need to be correlated further clinically. 165
Video Session 5d Hysteroscopy (11:00 AM d 11:08 AM)
Essure Confirmation Transvaginal Ultrasound Connor VF. Section of Minimally Invasive Gynecology, Cleveland Clinic Florida, Weston, Florida Presently around the world the most commonly performed Essure confirmation tests are pelvic X-ray and HSG. In contrast to these, ultrasound offers the unique advantage of the ability to visualize soft tissue and the relationship between structures. Ultrasound also has several significant safety advantages, including lack of exposure to radiation, and no risk of infection or allergic reaction. Ultrasound is readily accessible in most gynecologist’s offices, and can be repeated as often as necessary. The metallic composition of Essure micro-inserts creates highly echogenic, readily identifiable, unique and reproducible ultrasound images. Commercial experience and several retrospective series suggest that pregnancy outcomes are the same when ultrasound is used for Essure confirmation in uncomplicated placement procedures, instead of HSG or X ray. To date however, no one has described procedure steps for an Essure confirmation ultrasound, or criteria for unsatisfactory location, and these are the goals of this video abstract. 166
Video Session 5d Hysteroscopy (11:09 AM d 11:14 AM)
Use of a Hysteroscopic Rotating Morcellator for Endometrial Sampling Around an Exposed EssureÔ Device Wagner CA,1 Gimpelson RJ.2 1Obstetrics & Gynecology, St. John’s Mercy Medical Center, St. Louis, Missouri; 2Gynecology, St. Lukes Hospital, St. Louis, Missouri A 41 year old female was referred for evaluation and treatment of menorrhagia. Transvaginal ultrasound showed a normal-sized uterus with a thickened lining (17.8 mm) and a pedunculated endometrial polyp. Hysteroscopy was performed. An EssureÔ coil was found protruding into the uterine cavity from the left ostia. No pedunculated polyp could be identified. The endometrial lining, however, was globally irregular in appearance, concerning for hyperplasia or sessile polyps. Several treatment options were considered, including sharp curettage, electrosurgical resectoscopy, hysteroscopy-directed biopsies, and endometrial resection using the hysteroscopic rotating morcellator. The latter option was believed to be optimal since it allowed for complete sampling/resection of the abnormal-appearing endometrium with minimal risk of disrupting the EssureÔ coil or causing thermal injury. Resection of all abnormal-appearing endometrial tissue was accomplished using the hysteroscopic morcellator without complications.
Video Session 5d Hysteroscopy (11:15 AM d 11:20 AM)
Hysteroscopic Treatment of Cesarean Scar Ectopic Pregnancy with Cold Resection Chang Y,1 Kay N.2 1Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 2E-Da Hospital, Kaohsiung County, Taiwan Video Objective: To report successful hysteroscopic treatment of cesarean scar ectopic pregnancy with cold resection. Patient and Methods: A 29 year-old, G3P2A0, multi-para presented to the OPD with vaginal spotting for 21 days. She reported having amenorrhea for 8 weeks. Sonography showed ectopic pregnancy in previous cesarean delivery scar (PCDS) defect. The serum beta-hCG was 5968 mIU/ml in level. Under the impression of ectopic pregnancy in PCDS defect, hysteroscopy surgery was arranged. We used pitressin injected into the cervix and removed the ectopic gestational tissue by resectoscopy successfully. Conclusion: Cesarean scar pregnancy is a rare form of ectopic pregnancy. There was no treatment protocol defined in the past. Minimal invasive management has become the main-stream treatment of disease nowadays. Hysteroscopy was applied as a helpful tool for treatment of ectopic pregnancy in PCDS defect. 168
Video Session 5d Hysteroscopy (11:21 AM d 11:29 AM)
Hysteroscopy and Rescetion of Submucous Fibroids with an Intramural Component Al-Khaduri M,1 Shawki O.2 1Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman; 2Obstetrics and Gynecology, Cairo University, Heliopolis, Cairo, Egypt The objective of this video is to demonstrate the technique of hysteroscopic resection of submucous fibroids with an intramural component using a monopolar loop. We present the case of a 29 yr old nulliparous woman married for 7 months and trying to conceive. She was complaining of irregular menses but no history of menorrhagia or dysmenorrhea. An ultrasound showed multiple 3-5 cm fibroids distorting the uterine cavity so a saline infusion sonography was performed and demonstrated an irregular cavity with submucous fibroids. We performed a hysteroscopy and were able to successfully resect the submucous fibroids and restore a normal uterine cavity using a monopolar loop. 169
Video Session 5d Hysteroscopy (11:30 AM d 11:36 AM)
Hysteroscopic Resection with Myosure Device DellaBadia C. OB/GYN, Drexel University College of Medicine, Philadelphia, Pennsylvania This is a 6 minute video demonstrating two cases of intrauterine resection using a new electronic tissue removal device. The device is recommended for use with 3 cm fibroids or polyps. This video pushes the limits of the device and demonstrates the removal of a 4 cm fibroid and a second case of the removal of a 9 cm polyp. The benefits of using a mechanical device over resectoscope are the ability to use a smaller scope size, saline for distension, no electrical energy, no chips in the operative field, and better pathologic specimens. 170
Video Session 5d Hysteroscopy (11:37 AM d 11:41 AM)
Hysteroscopic Resection of Retained Products of Conception Following Uterine Artery Embolization Guan X, Zurawin RK. Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas A 36-year-old gravida 3, para 1, abortus 2 had a full term delivery by Cesarean section after which she bled persistently. Two months