Emily R. Goggins

Essure Surgical Removal and Subsequent Symptom Resolution: Case Series and Follow-Up Survey.

Transcervical sterilization is a minimally invasive option for permanent contraception with high reported rates of patient satisfaction. A small percentage of women subsequently choose to have the tubal inserts removed due to regret or perceived side effects. There is limited information with regard to the improvement in the symptom profile following surgical removal of the tubal inserts. We present a retrospective case series of 11 women who underwent surgical removal of Essure by hysteroscopy, salpingectomy, and/or hysterectomy. The predominant symptom at presentation was pain (n = 10; 90.91%), as well as bleeding (n = 6; 54.54%) and/or dyspareunia (n = 5; 45.45%). After surgical removal, the majority of patients (n = 8; 72.72%) reported an improvement of their symptoms. However, 3 (27.27%) patients continued to have persistent symptoms after surgery. Before surgical removal of Essure, it is important to thoroughly discuss the risk of continuing symptoms with patients.

Vasopressin Administration During Laparoscopic Myomectomy: A Randomized Controlled Trial.

Hysteroscopic Endometrial Resection Versus Laparoscopic Supracervical Hysterectomy for Abnormal Uterine Bleeding: Long Term Follow-Up of a Prospective Randomized Trial Zupi E, Centini G, Lazzeri L, Finco A, Zullo F, Exacoustos C. Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy; Department of Biomedicine and Prevention Obstetrics and Gynecological Clinic, University of Rome ‘Tor Vergata,’ Rome, Italy; Department of Obstetrics and Gynecology, University ‘‘Magna Graecia’’ Catanzaro, Catanzaro, Italy

Surgical Outcomes of a Combined Surgical Approach for Apical Prolapse Repair

Introduction We aimed to evaluate the safety, efficacy and surgical outcomes of combined laparoscopic/vaginal prolapse repair by two surgeons. Material and Methods A retrospective chart review of all patients (n = 135) who underwent apical prolapse repair from February 2009 to December 2012 performed in a collaborative manner by a Minimally Invasive Gynecologic Surgeon and a Urogynecologist. Demographic data (age, body mass index [BMI], race, gravidity, parity) and surgical information (estimated blood loss, operative time, intraoperative complications, readmission and reoperation rates, presence of postoperative infection) were collected. Results The majority of patients were postmenopausal (58.91%), multiparous (mean parity = 2.49) and overweight (mean BMI = 27.71). Nearly 20% had previous prolapse surgery. The most common surgical procedure was laparoscopic supracervical hysterectomy (LSH) with sacrocervicopexy (59.26%), and the most common vaginal repair was of the posterior compartment (78.68%). The median operative time was 149 minutes (82-302), and the estimated blood loss was 100 mL (10-530). Five intra-operative complications, five readmissions and four reoperations were noted. Performance of a concomitant hysterectomy did not affect surgical or anatomical outcomes. Conclusion Combination laparoscopic/vaginal prolapse repair by two separate surgeons seems to be an efficient option for operative management.

Morcellation Techniques for Laparoscopic Hysterectomy and Myomectomy: A Retrospective Study

Measurements and Main Results: Anamnesis was studied; US of small pelvic organs, laparoscopy with chromosalpingoscopy, hysteroscopy, uterine cavity curettage with histological investigation of endometrium were performed. Duration of sterility ranged from 3 to 5 years. In both forms of sterility, on the basis of anamnesis, salpingoperitoneal variant was presumed in 45-50% of patients, with laparoscopy – in 100% of cases. Uterine factor was presumed in 19-26% on the basis of anamnesis and US. While using hysteroscopy, chronic endometritis was revealed in case of primary sterility in 26,3% of patients, histologically – in 31,5%, in case of hysteroscopy, endometrial polyps were detected in 15,8%, in case of histological study – in 78,9% of patients; histologically, combination of endometritis with polyps was found in 31,5%. Endometrium turned out to be unchanged in 10,5% of cases of primary sterility. In case of secondary sterility, chronic endometritis by means of hysteroscopy was established in 12,5%, histological study – in 33,3%; endometrial polyps – in 25% hysteroscopically and in 83,3% morphologically. Combination of endometritis with endometrial polyps was revealed in 25% of patients in this group. When using histological study, endometrial pathology was detected in 100% of secondary sterility. Conclusion: Endoscopic methods are the main in sterility diagnostics. Nevertheless, histological study of endometrium is necessary even with unchanged hysteroscopic picture.