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Uterine-Sparing Surgery in the Management of Uterine Adenomyosis in Patients of Reproductive Age
S70
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252
Study Objective: To examine the effectiveness of using a combination of laparoscopy, endometrial ablation and LNG-IUS insertion in the treatment of endometriosis pain. Design: Prospective non-randomized trial. (Canadian Task Force Classification II-2). Setting: University-affiliated hospital. Patients: After REB approval and informed consent, we evaluated sixtyeight women with endometriosis pain who underwent laparoscopy, endometrial ablation, and LNG-IUS insertion from 2001 to 2015. Intervention: Women with endometriosis pain underwent laparoscopy, hysteroscopic endometrial ablation, and insertion of LNG-IUS. Measurements and Main Results: Long-term follow-up on sixty-eight patients treated for endometriosis pain was performed in a prospective analysis. Patient symptoms and need for surgical re-intervention were gathered through chart review and patient interview. All patients had endometriosis pain and 56% of patients also had abnormal uterine bleeding. Median follow-up time was thirty-nine months and mean follow-up time was thirty-eight months. Therapy success was determined by patient satisfaction and need for surgical re-intervention. Ten of sixty-eight patients (15%) would go on to receive a hysterectomy, while two patients (3%) are currently unsatisfied with their symptoms and have planned for hysterectomy. The mean time from procedure to hysterectomy was twenty-one months, the median time was eleven. Eleven patients (16%) were lost to follow-up. Conclusion: Patients suffering from endometriosis pain and abnormal uterine bleeding can be treated effectively with laparoscopy, endometrial ablation, and LNG-IUS insertion. This novel therapy offers patients control of their symptoms and can help them avoid hysterectomy. Our results should be interpreted carefully given the loss of patients to follow-up. 164
Open Communications 12 - Endometriosis (3:25 PM - 5:05 PM) 4:50 PM – GROUP C
Anti-Mullerian Hormone (AMH) – Related Fertility Outcomes in Patients with Endometriosis Darwish B, Stochino-Loi E, Roman H. Obstetrics and Gynecology, Rouen University Hospital, Rouen, Haute Normandy, France Study Objective: To evaluate pregnancy rate in patients operated for deep infiltrating endometriosis with infertility and pregnancy desire in relation to pre- and postoperative levels of AMH. Design: Retrospective study using data prospectively recorded in the CIRENDO database. Setting: University tertiary referral center. Patients: 180 patients with DIE and/or associated ovarian endometriomas > 5 cm known to be infertile and with a desire to conceive treated surgically in our department from June 2010 to December 2015. Patients were divided into two groups according to Pre-operative AMH levels: group A AMH > 2 and group B AMH \ 2. Intervention: Surgical interventions included treatment of DIE. Associated ovarian endometriomas were managed by ablation by PlasmaJet. Measurements and Main Results: Fertility outcomes were compared between the two groups. Among 180 women enrolled, 134 (74.5%) were included in group A with a mean pre-operative AMH of 4.32.1, 46 (25.5%) in group B with a mean AMH level of 10.5 (p\0.001). Post-operative AMH levels were 3.42.5 and 1.20.9 in group A and B respectively (p=0.001). AFSr score averaged 67.842.9 in group A and 6839.3 in group B (p=0.98). 83 (46.4%) were infertile before surgery, 62 (46.6%) in group A and 21(45.6%) in group B (p=0.52) A total of 134 (74.4%) pregnancies were noted following surgery with 74 (55.2) being able to conceive spontaneously. 100 (74.6%) of them were among those of group A, and 34 (73.9%) in group B (p=0.52). The spontaneous pregnancy rate is 54% (54) in group A and 58.8% (20) in group B (p=0.17). Conclusion: No statistically significant difference in pregnancy outcome rate was observed between the two groups. Patients with low AMH levels
have the same spontaneous pregnancy rate as those with a normal AMH. The level of AMH does not therefore seem to be a marker of infertility especially in cases where assisted reproductive technology management is rejected due to reduced ovarian reserve. 165
Open Communications 12 - Endometriosis (3:25 PM - 5:05 PM) 4:57 PM – GROUP C
Uterine-Sparing Surgery in the Management of Uterine Adenomyosis in Patients of Reproductive Age Adamyan LV, Kozachenko IF, Dzhamalutdinova KM, Gavrilova TY, Stepanian AA. Operative Gynecology Department, Russian Scientific Center for Obstetrics, Gynecology and Perinatology named after V.I. Kulakov, Moscow, Russian Federation Study Objective: Adenomyosis is a common condition among women of reproductive age. Because of the limited amount of data available, the use of uterine-sparing surgery in the management of uterine adenomyosis and/or adenomyoma is still controversial. Design: Retrospective study. Setting: Department of operative gynecology of The Research Center for Obstetrics, Gynecology and Perinatology. Patients: 92 patients with nodule adenomyosis were enrolled in the study between 2011 and 2014. Intervention: Laparoscopic excision of adenomyotic lesion with subsequent hormonal therapy with GnRH agonists was performed in all patients. Measurements and Main Results: Mean age of patients was 344.5 years. All patients underwent careful laparoscopic excision of the adenomyosis tissue without damage to the uterine cavity. Mean visual analog scale score of dysmenorrhea and menorrhagia before and after a 3-month follow-up was measured. After surgery, the mean visual analog scale score of dysmenorrhea decreased from 9.4 to 0.8, and anemia due to menorrhagia improved in all women. 76 patients of 92 (82%) get pregnant at 6-18 months after surgery: 46 women conceived spontaneously and 20 after ART. 66 pregnancies were uneventful, and healthy infants were delivered via cesarean section at term. In 10 patients pregnancy loss occurred. Conclusion: Our data support the opinion of the beneficial role of the combination of uterine-sparing surgery and GnRH agonist treatment in managing infertile women with adenomyosis could include the removal of a tumor with a relatively poor blood supply, and the enhancement of the immune function of the host. Laparoscopic uterine-sparing surgery can be an alternative treatment to the use of hypoestrogenic agents or hysterectomy in women with localized adenomyosis, especially for those who want to maintain their fertility and achieve successful pregnancies.
THURSDAY, NOVEMBER 17, 2016 166
Open Communication 13 - Robotics (11:00 AM - 12:00 PM) 11:00 AM – GROUP A
Comparison of Cost and Operative Outcome of Robotic Hysterectomy Compared to Laparoscopic Hysterectomy Across Different Uterine Weights Abi Khalil E,1 Moawad G,1 Shu M,1 Marfori CW,1 Amdur R,2 Samuel D.3 1 Ob/Gyn, George Washington University Hospital, Washington, District of Columbia; 2Surgery, George Washington University, Washington, District of Columbia; 3George Washington University School of Medicine, Washington, District of Columbia Study Objective: To compare operative cost and outcomes between robotic and laparoscopic hysterectomy across different uterine weights.
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252
Study Objective: To examine the effectiveness of using a combination of laparoscopy, endometrial ablation and LNG-IUS insertion in the treatment of endometriosis pain. Design: Prospective non-randomized trial. (Canadian Task Force Classification II-2). Setting: University-affiliated hospital. Patients: After REB approval and informed consent, we evaluated sixtyeight women with endometriosis pain who underwent laparoscopy, endometrial ablation, and LNG-IUS insertion from 2001 to 2015. Intervention: Women with endometriosis pain underwent laparoscopy, hysteroscopic endometrial ablation, and insertion of LNG-IUS. Measurements and Main Results: Long-term follow-up on sixty-eight patients treated for endometriosis pain was performed in a prospective analysis. Patient symptoms and need for surgical re-intervention were gathered through chart review and patient interview. All patients had endometriosis pain and 56% of patients also had abnormal uterine bleeding. Median follow-up time was thirty-nine months and mean follow-up time was thirty-eight months. Therapy success was determined by patient satisfaction and need for surgical re-intervention. Ten of sixty-eight patients (15%) would go on to receive a hysterectomy, while two patients (3%) are currently unsatisfied with their symptoms and have planned for hysterectomy. The mean time from procedure to hysterectomy was twenty-one months, the median time was eleven. Eleven patients (16%) were lost to follow-up. Conclusion: Patients suffering from endometriosis pain and abnormal uterine bleeding can be treated effectively with laparoscopy, endometrial ablation, and LNG-IUS insertion. This novel therapy offers patients control of their symptoms and can help them avoid hysterectomy. Our results should be interpreted carefully given the loss of patients to follow-up. 164
Open Communications 12 - Endometriosis (3:25 PM - 5:05 PM) 4:50 PM – GROUP C
Anti-Mullerian Hormone (AMH) – Related Fertility Outcomes in Patients with Endometriosis Darwish B, Stochino-Loi E, Roman H. Obstetrics and Gynecology, Rouen University Hospital, Rouen, Haute Normandy, France Study Objective: To evaluate pregnancy rate in patients operated for deep infiltrating endometriosis with infertility and pregnancy desire in relation to pre- and postoperative levels of AMH. Design: Retrospective study using data prospectively recorded in the CIRENDO database. Setting: University tertiary referral center. Patients: 180 patients with DIE and/or associated ovarian endometriomas > 5 cm known to be infertile and with a desire to conceive treated surgically in our department from June 2010 to December 2015. Patients were divided into two groups according to Pre-operative AMH levels: group A AMH > 2 and group B AMH \ 2. Intervention: Surgical interventions included treatment of DIE. Associated ovarian endometriomas were managed by ablation by PlasmaJet. Measurements and Main Results: Fertility outcomes were compared between the two groups. Among 180 women enrolled, 134 (74.5%) were included in group A with a mean pre-operative AMH of 4.32.1, 46 (25.5%) in group B with a mean AMH level of 10.5 (p\0.001). Post-operative AMH levels were 3.42.5 and 1.20.9 in group A and B respectively (p=0.001). AFSr score averaged 67.842.9 in group A and 6839.3 in group B (p=0.98). 83 (46.4%) were infertile before surgery, 62 (46.6%) in group A and 21(45.6%) in group B (p=0.52) A total of 134 (74.4%) pregnancies were noted following surgery with 74 (55.2) being able to conceive spontaneously. 100 (74.6%) of them were among those of group A, and 34 (73.9%) in group B (p=0.52). The spontaneous pregnancy rate is 54% (54) in group A and 58.8% (20) in group B (p=0.17). Conclusion: No statistically significant difference in pregnancy outcome rate was observed between the two groups. Patients with low AMH levels
have the same spontaneous pregnancy rate as those with a normal AMH. The level of AMH does not therefore seem to be a marker of infertility especially in cases where assisted reproductive technology management is rejected due to reduced ovarian reserve. 165
Open Communications 12 - Endometriosis (3:25 PM - 5:05 PM) 4:57 PM – GROUP C
Uterine-Sparing Surgery in the Management of Uterine Adenomyosis in Patients of Reproductive Age Adamyan LV, Kozachenko IF, Dzhamalutdinova KM, Gavrilova TY, Stepanian AA. Operative Gynecology Department, Russian Scientific Center for Obstetrics, Gynecology and Perinatology named after V.I. Kulakov, Moscow, Russian Federation Study Objective: Adenomyosis is a common condition among women of reproductive age. Because of the limited amount of data available, the use of uterine-sparing surgery in the management of uterine adenomyosis and/or adenomyoma is still controversial. Design: Retrospective study. Setting: Department of operative gynecology of The Research Center for Obstetrics, Gynecology and Perinatology. Patients: 92 patients with nodule adenomyosis were enrolled in the study between 2011 and 2014. Intervention: Laparoscopic excision of adenomyotic lesion with subsequent hormonal therapy with GnRH agonists was performed in all patients. Measurements and Main Results: Mean age of patients was 344.5 years. All patients underwent careful laparoscopic excision of the adenomyosis tissue without damage to the uterine cavity. Mean visual analog scale score of dysmenorrhea and menorrhagia before and after a 3-month follow-up was measured. After surgery, the mean visual analog scale score of dysmenorrhea decreased from 9.4 to 0.8, and anemia due to menorrhagia improved in all women. 76 patients of 92 (82%) get pregnant at 6-18 months after surgery: 46 women conceived spontaneously and 20 after ART. 66 pregnancies were uneventful, and healthy infants were delivered via cesarean section at term. In 10 patients pregnancy loss occurred. Conclusion: Our data support the opinion of the beneficial role of the combination of uterine-sparing surgery and GnRH agonist treatment in managing infertile women with adenomyosis could include the removal of a tumor with a relatively poor blood supply, and the enhancement of the immune function of the host. Laparoscopic uterine-sparing surgery can be an alternative treatment to the use of hypoestrogenic agents or hysterectomy in women with localized adenomyosis, especially for those who want to maintain their fertility and achieve successful pregnancies.
THURSDAY, NOVEMBER 17, 2016 166
Open Communication 13 - Robotics (11:00 AM - 12:00 PM) 11:00 AM – GROUP A
Comparison of Cost and Operative Outcome of Robotic Hysterectomy Compared to Laparoscopic Hysterectomy Across Different Uterine Weights Abi Khalil E,1 Moawad G,1 Shu M,1 Marfori CW,1 Amdur R,2 Samuel D.3 1 Ob/Gyn, George Washington University Hospital, Washington, District of Columbia; 2Surgery, George Washington University, Washington, District of Columbia; 3George Washington University School of Medicine, Washington, District of Columbia Study Objective: To compare operative cost and outcomes between robotic and laparoscopic hysterectomy across different uterine weights.