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What Every Gynecologist Must Know: Best Practices for Performing a Risk-Reducing Bilateral Salpingo-Oophorectomy
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 Aznaurova YB,1,* Adamyan LV,1 Stepanian AA,2 Garazha AV,3 Buzdin AA3. 1Department of Reproductive Medicine and Surgery, A.I. Evdokimov Moscow State Medical & Dental University, Moscow, Russian Federation; 2Academia of Women’s Health and Endoscopic Surgery, Atlanta, GA; 3OmicsWay Corp., Walnut, CA *Corresponding author. Study Objective: To develop a prototype of a complex gene expression biomarker for the diagnosis of endometriosis based on differences between molecular signatures of endometrium from women with and without endometriosis. Design: Prospective observational cohort study. II-1. Evidence obtained from a well-designed, controlled trial without randomization. Setting: Department of Reproductive Medicine and Surgery at the A.I. Evdokimov Moscow State Medical and Dental University. Patients or Participants: 30 women with endometriosis and 15 women without endometriosis (control group). Interventions: Laparoscopic excision of endometriotic foci, hysteroscopy with endometrial sampling. RNA was isolated from all samples and stored in RNA Later. RNA sequencing was performed using Illumina HiSeq 3000 equipment for single-end sequencing. Unique bioinformatics algorithms were developed and validated using experimental and public gene expression datasets. Measurements and Main Results: We performed gene expression analysis of dataset containing 83 samples (30 endometrial and 53 endometriotic) and 15 samples (endometrial) of patients with and without endometriosis respectively. We extracted a complex molecular signature of 38 genes and found that the expression of 26 genes in it was significantly increased while the expression of 12 genes was significantly repressed in the endometrium of patients with endometriosis. This endometrial genetic signature successfully differentiated 53 samples of endometriotic lesions from 15 endometrial samples of healthy women (area under the ROC curve (AUC) =1. The comparison of our dataset of 83 samples of endometrial and endometriotic tissue with preexisting dataset containing 134 samples of other tissues (cervix, ovary, stomach, lung) revealed high sensitivity (94%) and specificity (97%) in the ability of studied molecular signature to equally identify endometrium and endometriotic tissue of patients with endometriosis. Conclusion: We obtained a complex molecular biomarker that could be used as a basis for early diagnosis of endometriosis via utilization of endometrial biopsy. Our findings indicate that easily accessible eutopic endometrium can be potentially used as a non-surgical marker for the presence of endometriosis.
Plenary 2: Basic Science/Research/Education (2:00 PM − 3:00 PM) 2:50 PM Effect of Length of Surgery on the Incidence of Venous Thromboembolism After Benign Hysterectomy Moulder JK,1,* Moore KJ,2,3 Strassle PD,3 Louie M4. 1Obstetrics and Gynecology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, TN; 2Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC; 3 Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC; 4Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC *Corresponding author. Study Objective: Determine effect of length of surgery (LOS) on risk for venous thromboembolism (VTE) after hysterectomy and determine if differences exist based on age, body mass index (BMI), and surgical approach. Design: Secondary analysis of prospectively-collected surgical quality improvement data. Setting: American College of Surgeons National Surgical Quality Improvement Program database, containing demographic, perioperative
S5 information and 30-day postoperative outcomes from >500 hospitals, and targeted data files including procedure-specific risk factors and outcomes for a subset of hospitals. Patients or Participants: Patients undergoing abdominal (AH), vaginal (VH), or laparoscopic hysterectomy (LH), identified with Current Procedural Terminology (CPT) codes, for benign indications from 2014-2016 were eligible. Patients with cancer, surgery not performed by a gynecologist, not in targeted files, missing LOS, or LOS <30 minutes were excluded. Interventions: Patients were compared with respect to incidence of VTE and LOS, stratified by age, BMI, and surgical approach. Measurements and Main Results: 48,813 patients were included. VTE incidence was 0.3%. Patients with VTE were obese, had greater uterine weight, and had inpatient procedures. Multivariable logistic regression was performed; LOS was treated as a continuous variable. Adjusting for confounders, for each 60 minute increase in LOS, there was a 41% increase in odds of VTE. Stratified by surgical approach, odds of VTE per 60 minute increase in LOS were greatest after AH (aOR 1.56, 95%CI 1.4, 1.75) compared to LH (aOR 1.19, 95%CI 0.76, 1.85) and VH (aOR 1.24, 95%CI 1.04, 1.47). As BMI increased, odds of VTE per 60 minutes increased: <30kg/m2 (aOR 1.31, 95%CI 1.11, 1.55), 30-39kg/m2 (aOR 1.43, 95%CI 1.24, 1.65), and ≥40kg/m2 (aOR 1.46, 95%CI 1.23, 1.72). There was no modification of risk by age. Conclusion: Our study suggests given the increased odds of VTE per 60 minute increase in LOS, the risk of VTE is cumulative. Prolonged LOS or obese patients may benefit from pharmacological and mechanical prophylaxis. Plenary 3: Oncology (3:05 PM − 4:05 PM) 3:05 PM What Every Gynecologist Must Know: Best Practices for Performing a Risk-Reducing Bilateral SalpingoOophorectomy Newcomb LK,1,* Mansuria SM2. 1Minimally Invasive Surgery, University of Pittsburgh Medical Center, Magee Womens Hospital, Pittsburgh, PA; 2 UPMC, Pittsburgh, PA *Corresponding author. Video Objective: This video is intended for any gynecologic surgeon who is performing risk-reducing surgery in their practice. We intend to review the “best practices” recommended by ACOG when performing a riskreducing bilateral salpingo-oophorectomy (RR-BSO) in patients with Hereditary Breast and Ovarian Cancer Syndrome. Setting: Academic Medical Center Interventions: This video describes the case of a 36-year-old female diagnosed with a BRCA 1 mutation who has completed childbearing and desires RR-BSO. There are four elements that are critical to include in risk-reducing procedures: 1. A thorough visualization of all peritoneal surfaces and accessible intraperitoneal organs should be performed. 2. Washings should be obtained. 3. The ovary should be removed in its entirety, and the fallopian tubes should be removed at their uterine insertion point at the cornua. 4. Complete serial sectioning of the ovaries and fallopian tubes performed by pathology is necessary, with microscopic examination for occult cancer. Conclusion: These “best practices” should be employed by all surgeons when performing a RR-BSO in order to most effectively increase detection of early neoplastic changes and occult malignancy, and to decrease their patient’s risk of developing ovarian and fallopian tube cancer. Plenary 3: Oncology (3:05 PM − 4:05 PM) 3:15 PM Triage by Methylation Marker Analysis Versus Colposcopy Biopsy in Women who test HPV-Positive or Abnormal LBC Results on Cervical Samples to Triage Cervical Cancer and HSIL for Further Treatment
Plenary 2: Basic Science/Research/Education (2:00 PM − 3:00 PM) 2:50 PM Effect of Length of Surgery on the Incidence of Venous Thromboembolism After Benign Hysterectomy Moulder JK,1,* Moore KJ,2,3 Strassle PD,3 Louie M4. 1Obstetrics and Gynecology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, TN; 2Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC; 3 Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC; 4Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC *Corresponding author. Study Objective: Determine effect of length of surgery (LOS) on risk for venous thromboembolism (VTE) after hysterectomy and determine if differences exist based on age, body mass index (BMI), and surgical approach. Design: Secondary analysis of prospectively-collected surgical quality improvement data. Setting: American College of Surgeons National Surgical Quality Improvement Program database, containing demographic, perioperative
S5 information and 30-day postoperative outcomes from >500 hospitals, and targeted data files including procedure-specific risk factors and outcomes for a subset of hospitals. Patients or Participants: Patients undergoing abdominal (AH), vaginal (VH), or laparoscopic hysterectomy (LH), identified with Current Procedural Terminology (CPT) codes, for benign indications from 2014-2016 were eligible. Patients with cancer, surgery not performed by a gynecologist, not in targeted files, missing LOS, or LOS <30 minutes were excluded. Interventions: Patients were compared with respect to incidence of VTE and LOS, stratified by age, BMI, and surgical approach. Measurements and Main Results: 48,813 patients were included. VTE incidence was 0.3%. Patients with VTE were obese, had greater uterine weight, and had inpatient procedures. Multivariable logistic regression was performed; LOS was treated as a continuous variable. Adjusting for confounders, for each 60 minute increase in LOS, there was a 41% increase in odds of VTE. Stratified by surgical approach, odds of VTE per 60 minute increase in LOS were greatest after AH (aOR 1.56, 95%CI 1.4, 1.75) compared to LH (aOR 1.19, 95%CI 0.76, 1.85) and VH (aOR 1.24, 95%CI 1.04, 1.47). As BMI increased, odds of VTE per 60 minutes increased: <30kg/m2 (aOR 1.31, 95%CI 1.11, 1.55), 30-39kg/m2 (aOR 1.43, 95%CI 1.24, 1.65), and ≥40kg/m2 (aOR 1.46, 95%CI 1.23, 1.72). There was no modification of risk by age. Conclusion: Our study suggests given the increased odds of VTE per 60 minute increase in LOS, the risk of VTE is cumulative. Prolonged LOS or obese patients may benefit from pharmacological and mechanical prophylaxis. Plenary 3: Oncology (3:05 PM − 4:05 PM) 3:05 PM What Every Gynecologist Must Know: Best Practices for Performing a Risk-Reducing Bilateral SalpingoOophorectomy Newcomb LK,1,* Mansuria SM2. 1Minimally Invasive Surgery, University of Pittsburgh Medical Center, Magee Womens Hospital, Pittsburgh, PA; 2 UPMC, Pittsburgh, PA *Corresponding author. Video Objective: This video is intended for any gynecologic surgeon who is performing risk-reducing surgery in their practice. We intend to review the “best practices” recommended by ACOG when performing a riskreducing bilateral salpingo-oophorectomy (RR-BSO) in patients with Hereditary Breast and Ovarian Cancer Syndrome. Setting: Academic Medical Center Interventions: This video describes the case of a 36-year-old female diagnosed with a BRCA 1 mutation who has completed childbearing and desires RR-BSO. There are four elements that are critical to include in risk-reducing procedures: 1. A thorough visualization of all peritoneal surfaces and accessible intraperitoneal organs should be performed. 2. Washings should be obtained. 3. The ovary should be removed in its entirety, and the fallopian tubes should be removed at their uterine insertion point at the cornua. 4. Complete serial sectioning of the ovaries and fallopian tubes performed by pathology is necessary, with microscopic examination for occult cancer. Conclusion: These “best practices” should be employed by all surgeons when performing a RR-BSO in order to most effectively increase detection of early neoplastic changes and occult malignancy, and to decrease their patient’s risk of developing ovarian and fallopian tube cancer. Plenary 3: Oncology (3:05 PM − 4:05 PM) 3:15 PM Triage by Methylation Marker Analysis Versus Colposcopy Biopsy in Women who test HPV-Positive or Abnormal LBC Results on Cervical Samples to Triage Cervical Cancer and HSIL for Further Treatment