Barbed vs. Standard Suture; a Randomized Comparison of Adhesion Formation and Ease of Use

Barbed vs. Standard Suture; a Randomized Comparison of Adhesion Formation and Ease of Use

Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S91–S113 Conclusion: In laparoscopically naive students, certain background factors may...

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Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S91–S113 Conclusion: In laparoscopically naive students, certain background factors may influence initial performance of virtual laparoscopic dexterity. Degree of experience with video games may dictate the most effective laparocopic training program for particular medical students. 338

Open Communications 17dLaparoscopy (8:54 AM d 8:59 AM)

Incidence of Septate Uterus in Reproductive-Aged Women with and without Endometriosis LaMonica R, Pinto J, Luciano DE, Luciano AA. The Center for Fertility and Women’s Health, The Hospital of Central Connecticut, New Britain, New Britain, Connecticut Study Objective: Although a correlation between obstructive Mullerian anomalies and endometriosis has been well established, its link with nonobstructive anomalies, remains controversial. To elucidate whether there is a correlation between endometriosis and non-obstructive anomalies, we conducted this prospective study on all patients admitted to our surgical service from 7/1/09 through 3/31/11. All patients underwent both hysteroscopy and laparoscopy for the management of infertility, pelvic pain, or both. The presence or absence of endometriosis and uterine anomalies were recorded after each surgery and subsequently analyzed. Endometriosis was staged according to the AFS Classification and treated. Since uterine septum is the most common Mullerian anomaly, we considered only this anomaly to test the hypothesis that uterine septum may be associated with an increased incidence of endometriosis or vice versa. Design: Prospective study, approved by IRB. Setting: University-affiliated referral center. Patients: Reproductive-aged women who underwent laparoscopy and hysteroscopy. Intervention: The presence or absence of endometriosis, uterine anomalies, and AFS score were recorded and analyzed. Measurements and Main Results: 168 patients were included in the study. The diagnosis of septate uterus was made at hysteroscopy when the endometrial cavity was separated by an avascular septum that obscured visualization of both cornua when the hysteroscope was advanced to the mid-uterine segment. The incidence of uterine septum was 26% in our patient population. In patients with histologically confirmed endometriosis, the incidence was 29%. However, when only Stage IV disease was considered, the incidence was 39% (P \0.05). Conversely, the relative risk of Stage-IV endometriosis with a uterine septum was 2.4, P =0.04. Conclusion: The incidence of septate uterus in our population with infertility and/or pelvic pain ranges between 26% to 29%, but increases significantly in women with Stage-IV disease. The question of whether or not the presence of the septum may predispose to more advanced disease is suggested by our data but remains to be elucidated. 339

Open Communications 17dLaparoscopy (9:00 AM d 9:05 AM)

Retrospective Study Assessing Laparoscopic Versus Robotic Assisted Laparoscopic Treatment of Severe Endometriosis Chu CM, Chang-Jackson S-C, Nezhat FR. Dept of Obstetrics and Gynecology: Minimally Invasive Surgery, St. Luke’s-Roosevelt Hospital Center, New York City, New York Study Objective: To compare and assess robotic-assisted laparoscopy versus standard laparoscopy in the treatment of severe endometriosis. Design: Retrospective analysis of 121 patients with severe endometriosis. Setting: Northeastern urban teaching hospital. Patients: One hundred and twenty-one patients with severe endometriosis classified by operative findings of dense adhesions, presence of infiltrative endometriosis, and/or presence of endometriosis in extirpative procedures. Intervention: Robotic-assisted laparoscopic versus standard laparoscopic ablation and excision of endometriosis, lysis of adhesions, extirpative procedures (e.g. hysterectomy, oopherectomy) or fertility sparing procedures (e.g. myomectomy, chromopertubation).

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Measurements and Main Results: Of the 121 patients classified with severe endometriosis, 96 underwent treatment with standard laparoscopy and 25 with robotic-assisted laparoscopy. Demographics assessed included age, race and body mass index (BMI). Operative time, estimated blood loss, hospitalization duration, intraoperative complications and postoperative complications were also analyzed. The patients were similar in age and race, although the robotic group had a significantly higher BMI (mean 30.4 vs 24.8, P = 0.004). Mean operative time for roboticassisted laparoscopy was 238 minutes (120-630 min) compared with 190 minutes (71-674 min, P = 0.05) during standard laparoscopy. There were no significant differences in estimated blood loss, hospitalization, or complication rate. There were no conversions to laparotomy. Conclusion: Both robotic-assisted and standard laparoscopy are safe and feasible alternatives to laparotomy in the treatment of severe endometriosis. However, increased operative time and cost of equipment associated with the robotic approach, which may lead to increased total operative costs, must also be taken into consideration. 340

Open Communications 17dLaparoscopy (9:06 AM d 9:11 AM)

Barbed vs. Standard Suture; a Randomized Comparison of Adhesion Formation and Ease of Use Einarsson JI. Division of Minimally Invasive Gynecologic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts Study Objective: To compare adhesions formation and ease of use of barbed vs. traditional suture during a myometrial closure in a sheep model. Design: A randomized trial using each subject as it’s own control. Design Classification: Canadian Task Force Classification Level I. Setting: A certified animal research facility. Patients: 23 non-pregnant ewes. Intervention: The Harmonic Scalpel was used to create a myometrial incision into each uterine horn and the incisions were randomly allocated to be closed using either vicryl or barbed suture. Ease of use was evaluated by comparing closure times. Adhesion formation was compared at necropsy 3 months later using a standardized adhesion formation scoring system. Measurements and Main Results: The average total procedure time was 13.3 minutes. Myometrial closure with barbed suture was significantly faster with barbed vs. traditional suture (126.5 seconds vs 272.6 seconds, p\0.001). At necropsy 3 months later, adhesions were found in 12 (52.2%) sheep in the barbed suture group vs. 10 (43.5%) sheep in the vicryl group (p = 0.77). The mean adhesion score was not significantly different between barbed suture 3.78 (3.92) vs vicryl 3.04 (3.75), p = 0.34. Conclusion: Barbed suture significantly facilitates myometrial closure and results in similar rates of adhesion formation in an animal model. 341

Open Communications 17dLaparoscopy (9:12 AM d 9:17 AM)

Before Conception Laparoscopic Cervical Cerclage Using Cerclage Tape Enlan X, Yuhuan L, Xiaowu H, Jie Z, Dan Y, Ning M, Jing Q. Hysteroscopic Center, Fuxing Hospital, Capital Medical University, Beijing, China Study Objective: To evaluate the feasibility and safety of laparoscopic transabdominal cervico-isthmic cerclage (LTCC) before conception using Mersilene tape Design: Clinical practice since Dec. 2008 to Dec. 2010. Setting: Teaching Hospital. Patients: Seven cases were performed LTCC who had 31 times second Trimester miscarriage. Three patients had the history of previous failed vaginal cervical cerclage. Intervention: LTCC was performed using Mersilene tape at the level of the internal cervical os in the non-pregnancy period. Measurements and Main Results: The laparoscopic approach enabled placement of a suture with no morbidity, and rapid patient recovery in seven cases. One year after surgery one case had delivered a live baby by