Vivek R. Katukuri

Recurrence After Robotic Myomectomy: Is It Associated With Use of GnRH Agonists Preoperatively? [9Q]

INTRODUCTION: GnRH agonist administration is a routine practice before myomectomy. GnRH agonist administration preoperatively not only makes myomectomy easier by decreasing the size the fibroids but also safer by decreasing operative time and blood loss. The primary objective of this study was study the association between GnRH agonist administration before robotic myomectomy and symptomatic recurrence of fibroids. METHODS: A retrospective chart review was performed and a total of 118 patients who underwent robotic-assisted laparoscopic myomectomy between January 2005 and December 2009 were analyzed. Electronic medical records of all women who were at least 2 years out from surgery were reviewed. RESULTS: We identified 17 (14.4%) symptomatic recurrences as early as 5 months to as late as 30. Recurrence group had significantly higher preoperative GnRH use (35% vs 9%; P=.009). 7.6% of all patients underwent a second surgical procedure. When comparing subset of patients who underwent a second surgical procedure, GnRH agonist use was significantly higher in patients with reoperation (56%) than those without (9%; P=.002). Cavity entry during the initial surgery was also more frequent in the reoperation group (56% vs 20%; P=.030) whereas presence of multiple fibroids, size of the largest leiomyoma, and uterine volume were not statistically significant. CONCLUSION: The overall symptomatic recurrence of uterine fibroids after a Robotic assisted Laparoscopic myomectomy was 14.4% at 2 years. Preoperative use of GnRH agonists before the surgery is associated with increased recurrence. Cavity entry during the initial surgery and GnRH use preoperatively is associated with reoperation.

Understanding Endosalpingiosis [89]

INTRODUCTION: Endosalpingiosis is ectopic tubal epithelium. The significance of this is not well understood as a result of the rarity and limited knowledge of the condition. It has been associated with varied diagnoses in the literature from chronic pelvic pain to malignancy. METHODS: We identified 32 cases of endosalpingiosis between 2006 and 2012. We reviewed different descriptive epidemiologic factors including, but not limited to, age, menstrual history, and associated malignancies in these cases. RESULTS: Fifteen patients were between the ages of 30 and 49 years and comprised of 52% of all patients with endosalpingiosis. Endosalpingiosis was found in almost all organs and surfaces of the abdomen and pelvis including the uterus, ovaries, lymph nodes, appendix, omentum, and the peritoneal surfaces but was most commonly seen on the uterus (17%, n=5), omentum (17%, n=5), and peritoneum (17%, n=5). Thirty-eight percent of the patients (n=11) had unexplained abdominal pain and 17% (n=5) had pain lasting between 6 and 12 months with one patient having pain for more than 12 months. Endosalpingiosis coexisted with endometriosis in 14% (n=4) of the patients. Ovarian cancer was seen in 44% (n=13) of the patients and four others had a borderline serous tumor of the ovary. Seven percent (n=2) of the patients had uterine cancer. CONCLUSION: Endosalpingiosis is a rare condition, which is most commonly seen in age groups of 30–49 years and could be a cause of abdominal pain. It affects all the organs in the abdomen and pelvis. Higher associations were found with ovarian cancer, endometriosis, and uterine cancer.