Prevalence and predictors of atypical histology in endometrial polyps removed by hysteroscopy: a secondary analysis from the SICMIG hysteroscopy trial

The aim of this study is to assess the prevalence of atypical hyperplasia (AH) and endometrial cancer (EC) within endometrial polyps (EPs) removed by hysteroscopy

Stress urinary incontinence after hysterectomy : a 10-year national follow-up study

Purpose Hysterectomy has been associated with increased risk for developing stress urinary incontinence (SUI) and having a SUI operation. We examined the long-term rate of SUI operations after hysterectomy and associated risk factors. Methods We followed up 5000 women without prior urinary incontinence (UI) who had a hysterectomy in a prospective FINHYST 2006 cohort study until the end of 2016 through a national health register. The main outcome was SUI operations, and secondary outcomes were outpatient visits for UI, and their association of preoperative patient and operation factors. Results During the median follow-up time of 10.6 years (IQR 10.3-10.8), 111 (2.2%) women had a SUI operation and 241 (4.8%) had an outpatient visit for UI. The SUI operation rate was higher after vaginal hysterectomy and laparoscopic hysterectomy (n = 71 and 28, 3.3% and 1.8%, respectively) compared to abdominal hysterectomy (n = 11, 0.8%). In a multivariate risk analysis by Cox regression, the association with vaginal hysterectomy and SUI operation remained significant when adjusted for vaginal deliveries, preceding pelvic organ prolapse (POP), uterus size, age and BMI (HR 2.4, 95% CI 1.1-5.3). Preceding POP, three or more deliveries and laparoscopic hysterectomy were significantly associated with UI visits but not with SUI operations. Conclusion After hysterectomy, 2.2% of women underwent operative treatment for SUI. The number of SUI operations was more than double after vaginal hysterectomy compared to abdominal hysterectomy, but preceding POP explained this added risk partially. Preceding POP and three or more vaginal deliveries were independently associated with UI visits after hysterectomy.Peer reviewe

Post-Ablation Cavity Evaluation: A Prospective Multicenter Observational Clinical Study to Evaluate Hysteroscopic Access to the Uterine Cavity 4 Years after Water Vapor Endometrial Ablation for the Treatment of Heavy Menstrual Bleeding

Study Objective: Patients who have undergone endometrial ablation may present a diagnostic challenge when they subsequently develop vaginal bleeding, pelvic pain, or postmenopausal bleeding. Extensive scarring of the uterine cavity often precludes evaluation and/or conservative treatment. For further research on this topic, we performed hysteroscopic examination in study subjects a mean duration of 4 years after they had undergone water vapor endometrial ablation. Design: Prospective, multicenter, observational clinical study. Setting: Eight private practice or outpatient sites in the United States and Mexico. Patients: Seventy subjects who had completed their 36-month follow-up in the AEGEA Pivotal Trial. Interventions: Diagnostic hysteroscopy. Measurements and Main Results: The subjects were screened for general health and infection and underwent diagnostic hysteroscopy. Menstrual bleeding status was recorded. The video of the hysteroscopic examination was analyzed by an independent reviewer, who assessed uterine cavity access and visualization of the cornua and tubal ostia as well as characterized adhesions on the basis of the criteria by March et al. An independent reviewer also subjectively assessed whether Pipelle endometrial biopsy or intrauterine device placement would be feasible. Uterine cavity access was achieved in 90% (63/70) of subjects. Among subjects with cavity access, the cornua and ostia were visualized in 79% (50/63) and adhesions were absent in 75% (47/63), with only 2 women having severe adhesions (3%, 2/63). Biopsy was projected to be feasible in 86% (62/70) and intrauterine device placement in 60% (42/70) of all subjects. The subjects’ bleeding statuses were not correlated with uterine cavity access. The results were consistent for subjects with large uterine cavities and International Federation of Gynecologic and Obstetrics type II to VI myomas ≤4 cm. Conclusion: Water vapor endometrial ablation preserved an accessible uterine cavity and visualization of the ostia in most subjects, with minimal incidence of severe adhesions, a mean of 4 years after the ablation procedure

Power morcellation for women undergoing laparoscopic supracervical hysterectomy — safety of procedure and clinical experience from 426 cases

  Objectives: Minimally invasive gynaecological surgeries are performed for several malignant and nonmalignant indications. The aim of our study was to evaluate the rate of unexpected malignancies among women who underwent laparoscopical supracervical hysterectomy (LASH) with power morcellation. Material and methods: The retrospective analysis included clinical data of 426 consecutive female patients who underwent LASH with power morcellation due to presumed benign disorders (78.4% — symptomatic uterine fibromas, 12.7% — abnormal uterine bleeding, 8.9% — suspicion of uterine adenomyosis) between January 2011 and December 2015. Pre­malignant or malignant preoperative abnormalities in the cervix and the uterine corpus were contraindications for LASH. Results: The unexpected malignancies were found in four patients from study group: one ovarian cancer located on the inner part of simple ovarian cyst and 3 endometrial carcinomas (0.9%) were documented. All these patients underwent abdominal reoperations and no histological abnormalities were detected in the extirpated cervix and adnexa. Conclusions: The incidence of unintended endometrial carcinoma in morcellated uterus after LASH was relatively small. However, careful pre-operative counseling should be undertaken in order to exclude the possibility of any malignant disease in uteri among women scheduled to power morcellation.

Implementing an Advanced Laparoscopic Procedure by Monitoring with a Visiting Surgeon

Study Objective: To investigate the feasibility of safely implementing a total laparoscopic hysterectomy (LH) in established gynecologists' practices with on-site coaching and monitoring of the learning curve by an experienced visiting surgeon. Design: Multicenter prospective feasibility and implementation study (Canadian Task Force classification II-2). Setting: Eleven general gynecologists in 8 hospitals (1 university hospital and 7 regional hospitals) participated. Patients: Laparoscopic hysterectomy was performed in 83 patients during the learning curve, and in 83 patients after the learning curve. Interventions: During the learning curve, an experienced visiting laparoscopist was available for coaching during each LH. A competence score was marked on an Objective Structured Assessment of Technical Skills (OSATS) form. Complications were recorded intraoperatively and postoperatively for 6 weeks after surgery in all patients. Measurements and Main Results: Nine of 11 gynecologists reached the competence score of at least 28 points during the study, from January 2005 to January 2007. A major complication occurred in 3 of 83 LH procedures (4%) performed during the learning curve, and in 5 of 83 LH procedures (6%) performed after the learning curve (p = .72). Conclusion: The concept of a visiting surgeon for on-site coaching and monitoring of established gynecologists during the learning curve of an advanced laparoscopic procedure using Objectively Structured Assessment of Technical Skills is feasible. According to the observed complication rate during and after the learning curve, on-site coaching is a useful tool when implementing a new laparoscopic technique in established gynecologists' practices. Journal of Minimally Invasive Gynecology (2010) 17, 771-778 (C) 2010 AAGL. All rights reserved

A RETROSPECTIVE ANALYSIS OF UNEXPECTED UTERUS MALIGNOMAS’ APPEARANCE BY USING POWER MORCELLATION AND ELABORATION OF FOLLOW-UP DATA BETWEEN 2008 AND 2016 LEVERKUSEN MUNICIPAL HOSPITAL

I. Abstract Introduction: Due to the development of minimal invasive surgery (MIC), power electromechanical morcellation (EMM) has become a routine technique. Despite important advantages of morcellation, it may lead to dissemination of uterine tissue throughout the peritoneal cavity and thus spread of occult malignant cells which would result in upstaging of the cancer. The aim of this study was to estimate the frequency and clinical impact of unexpected malignoma after morcellation in a patient cohort at our department. Materials and methods: This retrospective study included patients treated for symptomatic fibroids between 2008-2016 who underwent laparoscopic or robotic myomectomy or hysterectomy with use of EMM. Results: A total of 471 patients were analysed, 51.7% had received laparoscopic supracervical hysterectomy (LASH), 17.9% total laparoscopic hysterectomy (TLH) and 30.6% laparoscopic myomectomy. An unexpected malignancy occurred in 3 of 471 patients representing 0.63%. All three cases histological report showed a diagnosis of sarcoma [2 x leiomyosarcoma (LS), 1 x endometrial stroma sarcomas (ESS)]. All patients underwent secondary surgery for complete surgical staging and no histological dissemination of sarcoma was found. However, two of three patients experienced tumor recurrence after 36 and 63 months. One of the patients with intraabdominal recurrence underwent a third surgery achieving complete resection once more. The second patient had a distant metastasis in the sternum. The third patient had no evidence of recurrence within follow-up of 31 months after surgical staging operation. At final follow-up all patients were in good general health. Conclusion: There is an inherent risk of spreading occult malignoma in EMM. Potential risk factors indicating occult malignancies need to be considered preoperatively. In high-risk patients EMM should be avoided. The outcome of unexpected morcellated malignoma even with adequate secondary surgery and potential differences in prognosis remain unclear. The small number of cases within the cohort does not allow any definite statements.Zusammenfassung Einleitung: Durch die Entwicklung der minimal-invasiven Chirurgie wurde das elektromechanische Morcellement (EMM) als Routinetechnik etabliert. Trotz der wichtigen Vorteile des Morcellements, birgt das Verfahren jedoch prinzipiell das Risiko der Verbreitung von Uteruszellen im Bauchraum und daher bei okkultem Malignom zum Upstaging des Tumorstadiums. Das Ziel dieser Arbeit war die Erhebung der Prävalenz morcellierter maligner Befunde in unserer Abteilung und die Abschätzung der klinischen Konsequenzen für Patientinnen. Patientinnen und Methodik: In dieser retrospektiven Studie wurden alle Patientinnen, die zwischen 2008-2016 aufgrund von symptomatischen Myomen in unserer Abteilung mittels laparoskopischer Myomektomie oder Hysterektomie behandelt wurden eingeschlossen. Ergebnisse: Es wurden insgesamt 471 Patienten eingeschossen, hiervon hatten 51,7% eine LASH, 17,9 % eine TLH und 30,6% eine laparoskopische Myomektomie erhalten. Bei 3 von 471 Patientinnen wurde ein zufälliges Malignom entdeckt, dies entspricht 0,63%. In allen drei Fällen wurde histologisch ein Sarkom nachgewiesen [2 x Leiomyosarkom (LS), 1 x endometriales Stromasarkom (ESS)]. Die Patientinnen wurden mit einer Re-Operation zur Komplettierung des operativen Stagings behandelt, histologisch konnte keine Disseminierung des Sarkoms nachgewiesen werden. Jedoch kam es bei zwei von Patientinnen zu einem Rezidiv nach 36 und 63 Monaten. Eine der Patientinnen mit intrabdominalem Rezidiv konnte mit einer dritten Operation behandelt werden, wobei eine vollständige Resektion erreicht werden konnte. Bei der zweiten Patientin wurde eine Sternummetastase festgestellt. Die dritte Patientin hatte nach Follow-up von 31 Monaten nach der Operation kein Hinweis für ein intraabdominales Rezidiv. Die Patientinnen waren alle beim letzten Follow-up in einem gutem Allgemeinzustand. Schlußfolgerung: Es besteht ein inhärentes Risiko für die Disseminierung von okkulten Sarkomzellen bei Verwendung der EMM. Risikofaktoren für das Vorliegen von okkulten Uterusmalignomen sind präoperativ zu berücksichtigen. Bei Patientinnen mit hohem Risiko für okkulte Malignome sollte ein EMM vermieden werden. Die prognostischen Auswirkungen nach akzidentellem Morcellement von Uterusmalignomen auch mit adäquater sekundärer Operation sind nicht eindeutig geklärt. Aufgrund der geringen Fallzahl innerhalb des Kollektivs können keine präzisen Aussagen getroffen werden

Recurrence Rate and Morbidity after Ultrasound-guided Transvaginal Aspiration of Ultrasound Benign-appearing Adnexal Cystic Masses with and without Sclerotherapy: A Systematic Review and Meta-analysis

To determine the pooled recurrence rate of benign adnexal masses/cysts (namely simple cyst, endometrioma, hydrosalpinx, peritoneal cyst) after transvaginal ultrasound-guided aspiration, with or without sclerotherapy

Randomized control trial of intra-peritoneal instillation of bupivacaine versus placebo for post-operative analgesia after laparoscopic hysterectomy

Background: Laparoscopy is an established method to perform major surgeries, with many advantages over open surgeries. Hysterectomy is a common procedure performed with increased use of laparoscopy, having postoperative pain management is a major issue. Effective pain management promotes early ambulation, lowering the risk of DVT and PE.Methods: The present study aimed to assess effect of bupivacaine intraperitoneally during laparoscopic hysterectomy to reduce postoperative pain. 48 women undergoing laparoscopic hysterectomy under ASA I and II general anesthesia were included, divided into 2 groups, group A receiving 0.25% bupivacaine intraperitoneally; group B receiving saline. A blind observer observed both groups for 6 hours post-surgery or until the VAS was 4, whichever came first, need for rescue analgesia, side-effects, and total dose of analgesia required in 24 hours. Diclofenac sodium and paracetamol was used as rescue analgesia for both groups.Results: There was no significant difference reported in demographic parameters between two study groups. The VAS scores at 6, 12 and 24 hours after laparoscopy was significantly lower in group A than group B. There was significant increase in the time required for 1st analgesia, while amount of analgesia required was significantly low in group A as compared to group B. There were significantly more number of patients in group B who needed opioids than group A.Conclusions: Peritoneal bupivacaine instillation after laparoscopic hysterectomy was found to be useful to reduce the pain as compared to use of saline (placebo), significant reduction in need for analgesics in the postoperative period