The Mumbai Obstetric & Gynecological Society

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Endoscopy

Abstracts

Fertility Outcome in Laparoscopic Single Tube Reanastomosis

P. G. Paul, M.B.B.S., D.G.O., Sheetal A. Bhosale, M.B.B.S., M.S., Shabnam Khan, M.B.B.S., M.S., Prathap Talwar, M.B.B.S., M.S., Dimple Kandhari, M.B.B.S., M.S., and Harneet Kaur, M.B.B.S., M.S.

OBJECTIVE: To evaluate the fertility outcome in laparoscopic unilateral tubal reanastomosis.

STUDY DESIGN: This was a retrospective observational study. The medical records of all patients who underwent laparoscopic unilateral tubal reanastomosis from October 2003 to October 2010 at the Center for Advanced Endoscopy and Infertility Treatment, Paul’s Hospital, Cochin, Kerala, India, were analyzed.

RESULTS: A total of 71 patients out of 81 could be followed up. Of those 71 women 39 (54.9%) conceived, and most of them within 1 year (36/39). Overall intrauterine pregnancy rate was 52.11%. Thirty delivered a live infant (delivery rate 42.25%), 7 had abortions, 1 ectopic pregnancy was noted in the operated tube and 1 in the contralateral tube. Final tubal length of ≥5 cm showed statistically significant association with pregnancy rate (p=0.0056). There was no significant difference in mean age, duration between sterilization and reanastomosis, or type of sterilization between the 2 groups.

CONCLUSION: Though bilateral tubal reanastomosis is an ideal procedure, unilateral laparoscopic tubal reanastomosis gives an acceptable pregnancy rate. Unilateral laparoscopic reanastomosis is feasible in most of the cases, as most of the time only 1 tube is suitable for reanastomosis. Also, the surgical team can perform the unilateral procedure more efficiently, and the patient receives less anesthesia since the duration of surgery is shorter when compared to the bilateral procedure. Bilateral anastomosis is better when both tubes are accessible, especially in older women.

 

Laparoendoscopic single-site surgery in gynaecology: A new frontier in minimally invasive surgery

Amanda Nickles Fader, Kimberly L Levinson, Camille C Gunderson, Abigail D Winder, and Pedro F Escobar1

REVIEW OBJECTIVE: To review the recent developments and published literature on laparoendoscopic single-site (LESS) surgery in gynaecology.

RECENT FINDINGS: Minimally invasive surgery has become a standard of care for the treatment of many benign and malignant gynaecological conditions. Recent advances in conventional laparoscopy and robotic-assisted surgery have favorably impacted the entire spectrum of gynaecological surgery. With the goal of improving morbidity and cosmesis, continued efforts towards refinement of laparoscopic techniques have lead to minimization of size and number of ports required for these procedures. LESS surgery is a recently proposed surgical term used to describe various techniques that aim at performing laparoscopic surgery through a single, small-skin incision concealed within the umbilicus. In the last 5 years, there has been a surge in the developments in surgical technology and techniques for LESS surgery, which have resulted in a significant increase in utilisation of LESS across many surgical subspecialties. Recently published outcomes data demonstrate feasibility, safety and reproducibility for LESS in gynaecology. The contemporary LESS literature, extent of gynaecological procedures utilising these techniques and limitations of current technology will be reviewed in this manuscript.

CONCLUSIONS: LESS surgery represents the newest frontier in minimally invasive surgery. Comparative data and prospective trials are necessary in order to determine the clinical impact of LESS in treatment of gynaecological conditions.

 

Vaginoscopy Compared to Traditional Hysteroscopy for Hysteroscopic Sterilization: A Randomized Trial

Hector O. Chapa, M.D., F.A.C.O.G., and Gonzalo Venegas, M.D., F.A.C.O.G.

OBJECTIVE: To compare vaginoscopic hysteroscopic sterilization with traditional hysteroscopic approach for differences in pain, bilateral microinsert placement rates, and procedure time.

STUDY DESIGN: We performed a prospective, randomized, single-blinded study of hysteroscopic sterilization using the Essure System. The study setting was an inner city ObGyn clinic. Ninety patients were randomized to either vaginoscopy or traditional approach. The traditional approach was speculum insertion, paracervical analgesia, and tenaculum. All procedures were done with a 5 mm, 30 degree rigid hysteroscope. Main outcome measures were pain scores (10-point visual analog scale), bilateral placement rates, and procedure times.

RESULTS: Vaginoscopy was successful in 42/45 patients (93%). There was no statistically significant difference in pain scores for microinsert placement between the groups (p=0.71). First attempt, bilateral microinsert placement rate was 95% (40/42) with vaginoscopy and 95% (43/45) with traditional (p=0.89). Time for treatment completion was 16 minutes (mean) (range, 13–21) in the traditional group versus vaginoscopy time of 9 minutes (mean) (range, 7–11) (p=0.03).

CONCLUSION: Hysteroscopic sterilization via vaginoscopy is feasible with bilateral microinsert rates comparable to those of traditional hysteroscopy. Vaginoscopy is associated with less overall discomfort and is faster to perform.

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