Arnold Jacobson

Low-dose aspirin for oocyte donation recipients with a thin endometrium: prospective, randomized study

OBJECTIVEnTo evaluate the effect of low-dose aspirin use in oocyte donation recipients with an endometrial thickness of < 8 mm.nnnDESIGNnA prospective, randomized study.nnnSETTINGnAn oocyte donation program in a private infertility practice.nnnPATIENT(S)nTwenty-eight recipients undergoing oocyte donation who failed to develop an endometrial thickness of at least 8 mm in a previous evaluation cycle.nnnINTERVENTION(S)nFifteen recipients received low-dose aspirin (81 mg/d) in addition to standard hormone replacement for an oocyte donation cycle. The remaining 13 recipients did not receive aspirin.nnnMAIN OUTCOME MEASURE(S)nClinical pregnancy rates, delivery rates, implantation rates, and change in endometrial thickness were compared in the aspirin and nonaspirin groups.nnnRESULT(S)nThere was no demonstrable increase in endometrial thickness in the aspirin-treated group. However, there was a statistically significant increase in implantation rates in the aspirin-treated group (24% versus 9%) and in implantation rates and clinical pregnancy rates in the aspirin-treated group when the final endometrial thickness was < 8 mm.nnnCONCLUSION(S)nLow-dose aspirin therapy improves implantation rates in oocyte donation recipients with a thin endometrium.

Reduction of cannula-related laparoscopic complications using a radially expanding access device

STUDY OBJECTIVEnTo determine the safety of a new radially expanding access device compared with complication rates associated with sharp laparoscopic cannulas.nnnDESIGNnProspective, multicenter study (Canadian Task Force classification II-1).nnnSETTINGnFree-standing and hospital-based ambulatory surgery centers.nnnPATIENTSnTwo hundred twelve women undergoing various laparoscopic procedures and followed over 44 months.nnnINTERVENTIONnFive hundred forty-one radially dilating access devices were used exclusively for laparoscopic abdominal wall access.nnnMEASUREMENTS AND MAIN RESULTSnNo major vascular injury, abdominal wall bleeding, intestinal injury, bladder or ureteral injury, liver trauma, or postoperative incisional hernia occurred. One patient developed a postoperative mesenteric hematoma probably caused by a venous injury from the Veress needle. Of the 541 radially expanding access cannulas placed, only 6 (1%) slipped, despite absence of fascial anchoring devices.nnnCONCLUSIONnRadially dilating abdominal access devices may reduce laparoscopic complications, lessen a surgeons exposure to liability, and improve patient outcomes while reducing facility costs. (J Am Assoc Gynecol Laparosc 6(1):79-84, 1999)

Outpatient laparoscopic-assisted vaginal hysterectomy

STUDY OBJECTIVEnTo compare laparoscopic-assisted hysterectomy (LAVH) with conventional abdominal hysterectomy.nnnDESIGNnFirst 50 consecutive LAVH procedures.nnnSETTINGnAn outpatient facility at a major medical center (35 procedures) and a nonhospital free-standing surgicenter (15).nnnPATIENTSnSequential sample of 50 women requiring hysterectomy.nnnINTERVENTIONSnLAVH in 46 women, converted to open laparotomy in 4.nnnMEASUREMENTS AND MAIN RESULTSnOutpatient LAVH was performed successfully in the majority of women. Most patients had significant uterine enlargement, pelvic adhesions, or endometriosis. Only six required replacement of autologous blood postoperatively. Other complications were cystotomy and postoperative pelvic hematoma in one patient each.nnnCONCLUSIONSnLAVH can be performed safely in free-standing surgicenters. It offers several advantages to patients, and is considered cost effective by third-party payers.

Improvement of pregnancy rates with oocyte donation in older recipients with the addition of progesterone vaginal suppositories

Pregnancy rates and implantation rates with oocyte donation in recipients 40 years of age and older were significantly lower than those obtained in recipients under the age of 40. This difference was eliminated when P vaginal suppositories were added to the luteal regimen in older recipients. Our experience suggests that uterine aging may play a role in the successful initiation of a pregnancy, but this may be overcome with the preparation of the uterus with P vaginal suppositories.

Argon beam coagulation rescue to correct bleeding during pelviscopy

A new technique of unipolar laparoscopic coagulation is particularly useful for the treatment of pelvic or abdominal bleeding during laparoscopic procedures. Blood present at the coagulation site is blown clear with a stream of argon gas prior to tissue coagulation. Of particular importance is the virtual absence of smoke, and because the procedure involves a nontouch technique, eschar is not removed inadvertently. The speed of tissue coagulation is faster than that of conventional bipolar and unipolar techniques.