G. Sacco

A New Technique of Hysteroscopic Myomectomy with Enucleation in Toto

STUDY OBJECTIVE To determine the safety and effectiveness of a new technique for hysteroscopic resection of uterine submucous myomas with high intramural involvement (G2 type, European Society of Hysteroscopy classification). DESIGN Prospective study (Canadian Task Force classification II-1). SETTING University hospital. PATIENTS Forty-four women. INTERVENTION Hysteroscopic myoma enucleation in toto. MEASUREMENTS AND MAIN RESULTS With a hysteroresectoscope and Collins electrode, an elliptic incision of endometrial mucosa that covers the myoma is made at the level of its reflection on the uterine wall until the cleavage zone of the myoma is reached. Connecting bridges between myoma and surrounding muscle fibers are resected. This allows nearly complete protrusion of the myoma into the uterine cavity, facilitating complete myomectomy by slicing. The procedure was performed in 41 (93.1%) of 44 women. Of these, 38 (92.6%) had myomas between 2 and 4 cm in diameter and 3 (7.4%) had myomas exceeding 4 cm. Mean operating time was 27 minutes (range 10-45 min). CONCLUSION This technique is efficient and allows complete resection of submucous myomas with large intramural component by favoring intracavitary protrusion of that part.

Is Antibiotic Prophylaxis Necessary in Elective Laparoscopic Surgery for Benign Gynecologic Conditions

Background: The use of prophylactic antibiotics in gynecologic laparoscopic surgery is still popular and many gynecologic surgeons believe that prophylactic antibiotic therapy will decrease the incidence of postoperative infection complications. Aim: The aim of this prospective cohort study was to investigate the opportunity of prophylactic antibiotics to prevent early postoperative infections and febrile morbidity in elective laparoscopic surgery for benign gynecological conditions. Methods: 300 women who underwent laparoscopic surgery for benign gynecological conditions were included in the study. After the patients were included they were divided in two groups (ratio 1:1). Group A (n = 150) received 2 g of cefazolin (Cefamezin®; Pfizer Italia Srl, Italy) 30 min before surgery and group B (n = 150) received no antibiotic prophylaxis. Results: No postoperative infection was diagnosed for a total of 300 study patients. The overall rate of febrile morbidity was 3.3% for a total of 300 patients (1.3% for group A and 2% for group B). No differences in infection complications and febrile morbidity were found between the two groups. Conclusion: Postoperative infection complications in laparoscopic gynecologic surgery without antimicrobial prophylaxis are negligible and overlapping to those obtained with cefazolin prophylaxis.