Interstitial Ectopic Pregnancy, Management and Subsequent Reproductive Outcome

Interstitial Ectopic Pregnancy, Management and Subsequent Reproductive Outcome

S146 Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159 Patients: Fetal bilateral chylothorax in 23 weeks of pregnancy. Interven...

79KB Sizes 1 Downloads 14 Views

S146

Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159

Patients: Fetal bilateral chylothorax in 23 weeks of pregnancy. Intervention: First, 21 gauge spinal needle was inserted into fetal thorax through pregnant abdomen. and pig tail catheters made by myselfwas introduced with radiofocus introducer II (Terumo, Japan). By using 3D ultrasound (Medison. Seoul, Korea), placement of the thoracoamniotic shunt resulted in near complete drainage of bilateral pleural effusion with normalization of intrathoracic anatomic relationship. Measurements and Main Results: After 10 days of catheter insertion, fetus detected death in utero because of the internalization of one catheter. Conclusion: Catheter insertion through amniotic fluid for complete drainage of bilateral pleural effusion is very useful method with minimal invasiveness, but internalization of catheter may be develop after procedure, we should have attention cafefulnessly by using 3dimensional ultrasound.

spontaneous abortion, 2 cases (1.8%) of primary amenorrhea, 1 case (0.9%) of pelvic inflammatory disease, 1 case (0.9%) of no symptom. The overall term delivery rate was 46.9% (113/241), and spontaneous abortion (24.34%), perterm delivery (9.5%), ectopic pregnancy (0.83%) occured in those patients. The rate of breech presentation in women with uterine anomalies was 16.67% and eighty one percent of the deliveries were performed by cesarean section. Conclusion: Most women with congenital uterine anomalies have initial syptoms such as dysmenorrhea, but some with no symptom were accidentally diagnosed. Congenital uterine anomalies are more often associated with spontaneous abortion than fertility, obstetric consequences such as preterm delivery, breech presentation, intrauterine growth retardation. Our results suggest that relatively successful pregnancy outcome after intensive care in women with uterine anomalies may be expected.

525 Clinical Study of 110 Women with Uterine Anomalies Kim MR, Kim HJ, Shin HM. Obstetrics and Gynecology, The Catholic University of Seoul, Kangnam St. Mary’s Hospital, Seoul, Republic of Korea

526

Study Objective: To evaluate the clinical symptom, diagnostic methods, fertility, obstetric consequences of women with uterine anomalies and metroplasty. Design: A retrospective study was made on 110 patients with uterine anomalies from January 1990 to December 2007. Setting: Department of Obstetrics anf Gynecology, the Catholic University of Korea, Kangnam St’Mary’s Hospital. Patients: 110 patients with uterine anomalies. Intervention: Aretrospective study was made on 110 patients with uterine anomalies.

Study Objective: To directly compare Adept(R), Spraygel(R), Seprafilm(R) and Intercoat (R) as adhesion barriers in a realistic animal model. Design: Randomized controlled experimental trial. Setting: Experimental surgery. Patients: 75 female Wistar rats. Intervention: In-vivo adhesion prophylaxis was assessed in a rat model involving traumatisation by standardised electrocautery (an area of 2 x 0.5 cm, 40 W; subsequent suturing with 5 vicryl single knots). Treatment with AdeptÒ, SpraygelÒ, SeprafilmÒor IntercoatÒ was compared to an untreated control group. Each group consisted of 15 animals and a total of 75 rats were operated. The relevant tissue was also examined histologically. Measurements and Main Results: Adhesion formation was significantly reduced after treatment with the adhesion barriers than after no treatment. Coverage of the traumatized areas with adhesions was 79% in the control group. This was reduced to 54% by the liquid barrier Adept(R) and to 69% by the gel barrier Spraygel(R). Data from Seprafilm and Intercoat is also within this range. Conclusion: Adhesion barriers reduce adhesion formation in comparison to a non-treated control group. There are significant differences in the efficacy of some of the currently available adhesion barriers.

Classification of uterine anomaly class

patients (%)

metroplasty (%)

combined renal anomaly (%)

I II III IV V VI TOTAL

3(2.73) 3(2.73) 39(35.45) 42(38.18) 22(20) 1(0.9) 110(100)

2(7.69) 1(3.84) 6(23.07) 9(34.61) 8(30.77) 0(0) 26(23.64)

1(4.76) 2(9.52) 9(42.86) 7(33.33) 2(9.52) 0(0) 21(19.09)

Comparison of Liquid and Solid Adhesion Barriers in a Rat Model Kraemer B, Wallwiener M, Planck C, Wallwiener C, Rajab T. Obstetrics and Gynecology, University Hospital Tuebingen, Tuebingen, Germany

Reproductive performance of patients with uterine anomalies

type

No. of No. of total preg. cases pregnancy

tubal preg. (%)

abortion prematurity term (%) (%) (%)

I II III IV V VI TOTAL

0 2 33 37 20 1 92

0 0 1 1 0 0 2

0 4 35 43 17 5 104

0 6 92 92 47 5 242

0 1 11 6 5 0 23

0 1 45 42 25 0 113

Measurements and Main Results: The incidences of uterine anomalies are 0.1085(1/927 outpatients). Most uterine anomalies were diagnosed by means of ultrasonogram and pelvic examination (45.5%), cesarean section (24.5%), and other operative procedure. There were 42 cases (38.2%) of bicornuate uterus, 39 cases (35.5%) od didelphys, and 21/ 110(19.1%) cases were combined with renal anomalies. Of the 26patients who performed metroplasty, there were 9 cases (34.6%) of bicornuate uterus, 8 cases (30.8%) of septate uterus. During antenatal care, there was 39 cases (35.5%) of sonographically uterine anomaly with pregnancy. Other initial syptoms were dysmenorrhea, pelvic pain, habitual abortion. There were 3 cases (2.7%) of primary infertility, which was less than

527 Interstitial Ectopic Pregnancy, Management and Subsequent Reproductive Outcome Kulkarni M,1 Ashraf M,1,2,3 Abuzeid MI.1,2,3 1Department of OB/GYN, Hurley Medical Center, Flint, Michigan; 2Reproductive Endocrinology and Infertility, Department OB/GYN Hurley Medical Center, IVF Michigan, Flint, Michigan; 3Department of OB/GYN, Michigan State University, College of Human Medicine, E. Lansing, Michigan Study Objective: Interstitial pregnancy (a rare type of ectopic pregnancy) traditionally has been treated by cornual resection or hysterectomy. Current diagnostic modalities opened up new avenues for conservative treatment by laparoscopy. Reich et al. reported the first case of laparoscopic management of interstitial pregnancies in 1988. The techniques used during laparoscopy continue to evolve. There are case reports of uterine rupture in subsequent pregnancies. We report two cases of interstitial pregnancies treated conservatively with subsequent successful reproductive outcomes and no uterine rupture. The aim of this study is to assess operative techniques, follow-up and reproductive outcomes following conservative surgical treatment of interstitial pregnancy. Design: Retrospective analysis of two cases with interstitial pregnancy. Setting: Tertiary Care Teaching Hospital.

Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159 Patients: Two patients with unruptured interstitial ectopic pregnancies. Intervention: Cornuostomy for surgical treatment of interstitial pregnancy during laparotomy or laparoscopy. Measurements and Main Results: A 37-year-old with primary infertility underwent in-vitro fertilization and embryo transfer subsequently presented with an interstitial ectopic pregnancy. After an initial treatment attempt with methotrexate failed, definitive surgery was performed. Laparotomy and conservative surgical treatment in the form of cornuostomy and repair of the myometrium was successfully performed. Her subsequent pregnancy was uneventful and she delivered a healthy neonate at 36 weeks by C-section. In the second case a 36-year-old G3P2 with a history of secondary infertility for 2.5 years and a past obstetric history of preterm labor underwent in-vitro fertilization and embryo transfer. 8 weeks later a transvaginal ultrasound scan showed an interstitial ectopic pregnancy. This was followed by laparoscopy and a left linear cornuostomy (a video clip of the surgical technique will be presented). The patient subsequently conceived spontaneously and delivered at 28 weeks by classical C-section. Conclusion: Conservative surgical management of interstitial ectopic pregnancy is safe, effective and may have beneficial effect on subsequent reproductive outcome.

528 Evaluation of Adverse Effects of Polyactic Bioabsorbable Sheet (SurgiwrapÒ) for the Reduction of Pelvic Adhesion in Gynecologic Surgery Lee J. Department of Obstetrics and Gynecology, Kyungpook National University Hospital, Daegu, Republic of Korea Study Objective: The aim of this study was to examine the use of polyactic bioabsorbable sheet (SurgiwrapÒ), an adhesion barrier, and to evaluate adverse reactions with regards to its use. Design: This was a retrospective study of 115 patients who underwent gynecological surgery at the Kyungpook National University hospital’s gynecology department from July, 2006 to August, 2007. Setting: All procedures used the polyactic acid bioabsorbable sheet (SurgiwrapÒ, MASTÒ) post surgery to prevent tissue adhesion. Patients: The age of research subjects ranged from 15 to 87 with an average of 42. Average body mass index (Q-index: Kg/m2) was 22.9 (range: 17.932.0). Intervention: Among the 115 cases, 48 cases (41.8%) were total laparoscopic hysterectomy, 32 cases (27.8%) were laparoscopic adnexal cystectomy, 22 cases (19.1%) were laparoscopic myomectomy, 2 cases (1.7%) were laparoscopic subtotal hysterectomy, 8 cases (7.0%) were total abdominal hysterectomy, 2 cases (1.7%) were myomectomy, and 1 case (0.9%) was adnexal cystectomy. Measurements and Main Results: Total time spent in surgery ranged from 30e355 minutes with an average surgical procedure lasting 111 minutes. The range of post surgical hemoglobin reduction was between 0.2 g/dl and 4.7 g/dl with an average reduction of 1.5 g/dl. Hospital stays ranged between 4e32 days with an average stay of 7 days. Loss of blood during surgery ranged from 0e825.5 ml with an average loss of 137.2 ml. Among the 115 cases of Surgiwrap use, 2 cases (1.7%) showed post surgical protrusion of Surgiwrap outside the vaginal stump. It seemed to be related to infections of the vaginal stump. Conclusion: The use of polyactic acid bioabsorbable sheet (SurgiwrapÒ, MASTÒ) in laparotomy or gynecological laparoscopic procedures, with the aim of preventing tissue adhesion, is a safe and easy practice. Caution, however, must be taken since Surgiwrap can protrude from the vaginal stump after surgical procedures.

529 A Case of Mayer-Rokitansky-Kustner-Hauser Syndrome e Laparoscopic Neovagina Creation Lee KB,1,6 Na YJ,2,6 Kim HG,2,6 Sun ST,3,6 Park JS,4,6 Kim TG.5,6 1 Obstetrics and Gynecology, Pusan Paik Hospital, Busan, Republic of Korea; 2Obstetrics and Gynecology, Pusan National University, Busan,

S147

3

Republic of Korea; Obstetrics and Gynecology, Ja Mo Women’s Hospital, Busan, Republic of Korea; 4Obstetrics and Gynecology, Changwon Fatima Hospital, Changwon, Republic of Korea; 5Obstetrics and Gynecology, Wallace Memorial Baptist Hospital, Busan, Republic of Korea; 6Obstetrics and Gynecology, Busan Kyeongnam Gynecologic Endoscopist Group (BKGEG), Busan, Republic of Korea Study Objective: To present combined technique of laparoscopically and vaginally assisted neovagina creation. Patients: A 24-year-old female with primary amenorrhea. Physical examination revealed normal pubertal development with normal external genitalia with vaginal dimpling(vaginal agenesis). The karyotype was 46.XX. USG and MRI findings were as followings: normal bilateral ovaries, small rudimentary horn. Intervention: Under general anesthesia, the patient was placed in the dorsal lithotomy position. After foley catheterization of the bladder and about 1 cm vertical incision at subumbilical area, the primary trocar was inserted blindly and pneumoperitoneum was created. After a 10-mm laparoscope was inserted, two 5-mm accessory ports were inserted under direct visualization laterally at the level of anterior superior iliac spines. To creat upper part of neovagina the laparoscopic pursestring suture using 1e0 vicryl was performed in pelvic side wall, sigmoid colon, bladder peritoneum and uterine remmant. After a horizontal incision was made at introitus, blunt dissection was performed between bladder and rectum to reach peritoneum. The pelvic peritoneum was grasped with forceps and pulled down. After trimming the peritoneum, the peritoneum was sutured to the edge of vaginal introitus. A tempporary soft vaginal mold was used to prevent vaginal constriction. Measurements and Main Results: The combined laparoscopic and vaginal approach for creation of neovagina was performed satisfactorily without perioperative or postoperative complications. The 4-year follow-up revealed that the patient’s satisfaction in terms of cosmetics and sexual function was excellent. Conclusion: The technique of laparoscopically assisted neovagina creation using patient’s peritoneum provided the patient with a functional vagina, allowing satisfactory intercourse.

530 Evaluation of New Tools in Postgraduate Surgical Education Nassif J,1 Zacharopoulou C,1 Attieh E,2 Wattiez A.1 1Gynecology Department, IRCAD/EITS, Strasbourg, Bas Rhin, France; 2Obstetrics and Gynecology Department, Hotel Dieu de France, University Hospital, Ashrafieh, Beirut, Lebanon Study Objective: To evaluate surgical e-learning and intensive courses programs. Design: Conventional postgraduate educational programs are made up of congresses and seminars. New educational tools such as the surgical elearning and intensive courses programs become popular. We sent a questionnaire via the internet to participant to the course in EITS (European Institute for Telesurgery). We collected the answers that were given in the next month tafter the questionnaire was sent. Setting: EITS Strasbourg - France. Patients: 1300 participants to EITS courses during 2007. Intervention: We sent 1300 questionnaires by email for the participants to courses at the EITS (European Institute for Telesurgery) during 2007. The questionnaire consisted of 21 questions about the EITS course and WeBSurg (World electronic Book of Surgery) site (which is an e-learning example). Participants answeed according if they totally do not agree, they rather do not agree, they do not agree but do not disagree, they rather agree or they totally agree. Measurements and Main Results: We collected 294 answers from 13 March to 13 April 2008, with two incomplete answers. Responders are 41.82  10.21 years old, from 52 nationalities, 63 % are general surgeons and 13 % gynaecologists. The number of years of surgical and laparoscopic practice is 6 to 10 years in 32 %, and 0 to 5 years in 48 % respectively. 55.6% totally agree that WeBSurg is useful to discover new surgical techniques and in their surgical career in general. 62.66 % totally agree that EITS course is useful to improve their surgical skills 70.54 %