Bipolar Coagulation Of Uterine Vessels Research Articles

Robotic-Assisted Laparoscopic Excision of C-Section Scar Ectopic Pregnancy with Bipolar Coagulation of Uterine Vessels

Video Objective To describe a technique of robotic-assisted laparoscopic excision of c-section scar ectopic pregnancy (CSP) with bipolar coagulation of uterine vessels. Setting CSP occurs when a gestational sac (GS) is located in the anterior uterine wall with diminished myometrium between the sac and the bladder, and a discontinuity in the anterior wall of the uterus adjacent to the GS, with an empty uterus and cervical canal. It is estimated that 4.2% of ectopic pregnancies are CSP. Laparoscopic bipolar coagulation of uterine vessels is mostly described in myomectomies: it aids in decreasing blood loss, preserves the uterus, and there are pregnancies and term pregnancies post-procedure reported in the literature, with approximately 40% early miscarriage rate. This is a video case report of a 35yo G6P3023 7weeks pregnant with CSP on sonogram, failed multidose regimen methotrexate and developed lower abdominal pain with vaginal bleeding. She was counseled on surgical treatment of CSP. Interventions In this video, we describe the surgical approach opted for this patient. The minimally invasive surgery was recommended considering decreased blood loss, postoperative pain and hospital stay. Considering her history of prior 3 c-sections, the robotic approach would offer better visualization for lysis of adhesions and greater instruments range of motion. In anticipation of bleeding of difficult control, bipolar coagulation of uterine vessels was planned preoperatively. Preoperative imaging was also crucial. It was noted firm adhesions from the bladder to the lower uterine segment, carefully dissected off until identification and removal of GS, confirmed with frozen section. The hysterotomy was repaired with barbed suture. Excellent hemostasis with minimal blood loss (EBL 20ml) noted. Patient did well postoperatively, with beta HCG followed to zero. Conclusion Robotic-assisted laparoscopic excision of CSP should be considered as a valuable treatment option, and preparedness is paramount.

P493 Treatment of symptomatic uterine fibroids by laparoscopic bipolar coagulation of uterine vessels

P493 Treatment of symptomatic uterine fibroids by laparoscopic bipolar coagulation of uterine vessels

Comparison of the outcome of laparoscopic-assisted vaginal hysterectomy versus laparoscopic bipolar coagulation of uterine vessels plus LAVH in the management of myoma and adenomyosis

Comparison of the outcome of laparoscopic-assisted vaginal hysterectomy versus laparoscopic bipolar coagulation of uterine vessels plus LAVH in the management of myoma and adenomyosis

Laparoscopic Devascularization of Uterine Myomata Followed by Enucleation of the Myomas by Direct Morcellation

Most intraoperative conversions of laparoscopic myomectomy to laparotomy reported in the literature occur because of intraoperative bleeding. Devascularization of a uterine myoma at the start of myomectomy would help reduce the blood supply to the uterus and hence to the myoma. Another advantage of the procedure is that the need to separate the myoma from the uterus completely before morcellation, as in conventional laparoscopic myomectomy, is obviated. The tumor can be enucleated only up to about half its circumference by standard enucleation before morcellation is begun. Traction accorded by the 15-mm traumatic serrated-edge claw forceps of the morcellator during morcellation causes progressive separation of the myoma from the uterine wall, thus completing enucleation. In two patients, myomas were devascularized at the outset of myomectomy, in one by intracorporeal suturing of uterine vessels and in the other by laparoscopic bipolar coagulation of uterine vessels.

Pregnancy following treatment of symptomatic myomas with laparoscopic bipolar coagulation of uterine vessels.

Laparoscopic bipolar coagulation of uterine vessels (LBCUV) has been employed for women with symptomatic uterine myomas, but its effect on subsequent pregnancy has not been characterized. Four-hundred and twenty-three women entered the study between March 1999 and December 2001. Of these, 142 women (33.6%) were under the age of 40 years at the time of LBCUV, 36 of whom (36/142, 25.3%) were sexually active without contraception. In a prospective study of 142 patients (<40 years old) undergoing LBCUV for symptomatic myomas, 15 women became pregnant (17 total pregnancies) and were evaluated by physical and ultrasound examinations. The volume of the dominant myoma was 117.4 +/- 118.4 and 36.8 +/- 56.8 cm(3) before and after LBCUV respectively. Volume of the dominant myoma after pregnancy was 46.2 +/- 76.7 cm(3) (mean +/- SD). There was a significant difference in myoma volume before and after LBCUV (P = 0.002), but no significant difference in myoma volume when comparing post-partum size with post-LBCUV size (P = 0.269). Pregnancy outcomes included seven miscarriages in the first trimester and one premature rupture of membrane (PPROM). Although the other pregnancies were regarded as uncomplicated, only two women were delivered of normal neonates as the other seven pregnancies were terminated secondary to patient request. The pregnancy and term pregnancy rates in sexually active women without contraception were 41.6% (15/36) and 5.6% (2/36) respectively. Because a relatively high rate (7/17, 41.2%) of early miscarriages was observed, we recommend that this procedure be employed only for women who do not desire additional children.

Successful pregnancy in a woman with symptomatic fibroids who underwent laparoscopic bipolar coagulation of uterine vessels

Objective: To report a case of successful pregnancy after laparoscopic bipolar coagulation of uterine vessels (LBCUV). Design: Case report. Setting: University-affiliated tertiary referral center. Patient(s): One woman, treated with LBCUV for symptomatic fibroids, who subsequently had a successful pregnancy. Intervention(s): Laparoscopic bipolar coagulation of uterine arteries and anastomotic sites of uterine arteries with ovarian arteries. Main Outcome Measure(s): Patient evaluation by physical and ultrasound examinations. Result(s): Complete resolution of menorrhagia and dysmenorrhea was found after LBCUV. Reduction in fibroid size was seen by ultrasound. Two months later, the patient conceived a singleton pregnancy without the use of assisted reproductive technologies. The woman delivered by cesarean section. Neither myoma recurrence nor abnormality in uterine function was observed. Conclusion(s): Although fecundity- and pregnancy-related complications after LBCUV for managing uterine fibroids are still unclear, this first case report of successful pregnancy after LBCUV is promising. LBCUV might be a safe and effective alternative to myomectomy and hysterectomy.

Early Pregnancy Uninterrupted by Laparoscopic Bipolar Coagulation of Uterine Vessels

Laparoscopic bipolar coagulation of uterine vessels (LBCUV) is reported to treat clinically symptomatic myomas that caused severe menorrhagia, but the viability of pregnancy after operation is unknown. A woman with clinically diagnosed uterine myomas, possibly with adenomyosis, had unexpected early pregnancy diagnosed at the time of LBCUV. The procedure resulted in improvement of menorrhagia to normal menstruation and reductions in the volume of both uterus and myomas. The intrauterine pregnancy was terminated at the woman's request. Pregnancy may be possible after LBCUV, although none has been reported.

Rapid Enlargement of Uterine Myomas after Laparoscopic Bipolar Coagulation of Uterine Vessels

Degenerative changes occur relatively frequently in uterine leiomyomas. Morphologic changes such as necrosis, hyalinization, and alterations in cellularity are described after uterine artery embolization. A modified method to interrupt the uterine blood supply is laparoscopic bipolar coagulation of uterine vessels (LBCUV). Although the success rate is good, occasional patients require hysterectomy because of complications or continuing symptoms. A woman with symptomatic myomas underwent LBCUV, but required hysterectomy due to rapid enlargement of myomas and intractable symptoms including pelvic pain and pressure, and acute urinary retention. The combination of degenerative and iatrogenic changes resulted in a histologic appearance resembling diffuse hyalinization and hydropic degeneration of the leiomyomas.

Comparison of Two Procedures for Laparoscopic-Assisted Vaginal Hysterectomy of Large Myomatous Uteri

Study Objective To evaluate whether laparoscopic bipolar coagulation of uterine vessels (LBCUV) and supracervical amputation improve laparoscopic-assisted vaginal hysterectomy (LAVH). Design Prospective, randomized, longitudinal study (Canadian Task Force classification II-1). Setting Private practice, university-affiliated hospital. Patients Sixty-four women (age 31–52 yrs) with symptomatic myomatous uteri larger than 12 weeks on bimanual examination. Interventions LAVH with or without LBCUV and laparoscopic supracervical amputation followed by trachelectomy. Measurements and Main Results LBCUV and laparoscopic supracervical amputation followed by trachelectomy and removal of the specimen vaginally were performed successfully in 29 women (group A). Hysterectomy was performed successfully in 32 comparable patients (group B) with severing of the round ligament, ovarian ligament, or infundibulopelvic ligament, and preparation of the bladder flap in the laparoscopic phase, and severing of uterine vessels and cardinal-uterosacral ligament complex through the vagina. Average blood loss was 169.8 and 308.7 ml in groups A and B, respectively (p <0.05); average operating time was 126.4 and 152.8 minutes, respectively (p <0.05); hemoglobin decreased on average 0.9 and 1.7 g/100 ml, respectively (p <0.05). Conclusion LBCUV and laparoscopic supracervical amputation followed by trachelectomy reduce operating time and blood loss in LAVH, and allow conversion of many abdominal procedures to laparoscopy.

Successful treatment of symptomatic arteriovenous malformation of the uterus using laparoscopic bipolar coagulation of uterine vessels

Objective: To report a case of symptomatic arteriovenous malformation (AVM) of the uterus that was successfully treated with laparoscopic bipolar coagulation of uterine vessels. Design: Case report. Setting: University-affiliated tertiary referral center. Patient(s): A 66-year-old woman with symptomatic AVM of the uterus. Intervention(s): Laparoscopic bipolar coagulation of uterine vessels. Main Outcome Measure(s): Clinical symptoms, color Doppler sonographic examination, and pelvic magnetic resonance imaging. Result(s): Remarkable shrinkage of the lesion size, obvious decrease in all of the impedance measurements (pulsatility, resistance, velocity indexes [systolic/diastolic]), and freedom from symptoms. Conclusion(s): This modality is a new alternative method for the management of patients with symptomatic AVM of the uterus who do not respond to conservative treatment.

Addition of Laparoscopic Uterine Nerve Ablation to Laparoscopic Bipolar Coagulation of Uterine Vessels for Women with Uterine Myomas and Dysmenorrhea

Study ObjectiveTo assess the effectiveness of laparoscopic uterine nerve ablation (LUNA) in women with dysmenorrhea caused by uterine myomas treated by laparoscopic bipolar coagulation of uterine vessels (LBCUV). DesignProspective, randomized, longitudinal study (Canadian Task Force classification II-1). SettingPrivate practice, university-affiliated hospital. PatientsEighty-five women with uterine leiomyomas and associated dysmenorrhea. InterventionLaparoscopic bipolar coagulation of uterine vessels with or without LUNA. Measurements and Main ResultsOf 85 patients who entered the study, 41 were assigned to undergo LBCUV-LUNA (group A), which was successful in 40 (97.6%). In 44 women assigned to have LBCUV only (group B), 43 (97.7%) underwent successful surgery. Eighty women completed 1-, 3-, and 6-month follow-up (38 group A, 42 group B). The groups did not differ significantly in age, history of abdominopelvic surgery, intraperitoneal adhesions, endometriosis, concomitant surgery, and operating time. Seven (18.4%) of 38 women in group A and 12 (28.6%) of 42 in group B experienced lower abdominal pain postoperatively. Acceptable pain was defined as a score of zero or 1: 31 and 30 women in groups A and B reported scores of zero; 3 and 2 reported scores of 1; 4 and 8 reported scores of 2; zero and 2 reported scores of 3; and no patients reported scores of 4. The frequency and severity of postoperative pain were less in group A than in group B (both p <0.05). The efficacy of both methods was almost equal in shrinking the uterus and dominant myoma, and in improving menorrhagia and bulk-related symptoms. Dysmenorrhea improvement was 84.2% and 61.9% in groups A and B at 3 months and 92.1% and 73.8% at 6 months, respectively. This was more significant in group A than in group B (p <0.05). ConclusionOur results suggest that LUNA may decrease postoperative ischemic pain and improve dysmenorrhea associated with uterine myomas treated by LBCUV.

The ancillary role of LUNA to laparoscopic bipolar coagulation of uterine vessels

The ancillary role of LUNA to laparoscopic bipolar coagulation of uterine vessels

Laparoscopic Bipolar Coagulation of Uterine Vessels to Treat Symptomatic Myomas in Women with Elevated CA 125

Study Objective To assess laparoscopic bipolar coagulation of uterine vessels (LBCUV) for symptomatic myomas in women with elevated CA 125 (>35 U/ml). Design Prospective, longitudinal study (Canadian Task Force classification II–1). Setting Private practice, university-affiliated hospital. Patients Forty-six women (age 30–50 yrs) with symptomatic myomas and elevated CA 125 level. Intervention Laparoscopic bipolar coagulation of uterine vessels performed over 10 months. Measurements and Main Results All patients underwent successful LBCUV and coagulation of anastomotic site of uterine arteries with ovarian arteries without intraoperative complication. One, 3, and 6 months after treatment, respectively, 52.2%, 65.2%, and 71.7% of women reported improvement in menorrhagia, 19.6%, 45.7%, and 56.5% noted improvement in dysmenorrhea, and 6.5%, 16.1%, and 38.7% had improvement in bulk-related symptoms. Average reduction in uterine volume was 9.1%, 16.9%, and 38.3% and average reduction in dominant myoma was 12.1%, 23.9%, and 59.1% at those times; the average reduction of CA 125 in all patients was 39.8, 75.4, and 126.1U/ml. Conclusion Symptoms were improved and uterine volume and dominant myoma were reduced by LBCUV. The CA 125 level fell during follow-up in 40 patients (87.0%). Improvement in symptoms, especially menorrhagia, and shrinkage of uterine volume and dominant myoma seemed to be more pronounced in women with decreased than in those without decreased CA 125 after treatment (p = 0.045). The CA 125 level may be a valuable indicator for monitoring the efficacy of LBCUV.

Laparoscopic bipolar coagulation of uterine vessels: a new method for treating symptomatic fibroids

Objective: To evaluate the effects of laparoscopic bipolar coagulation of uterine vessels in treating symptomatic fibroids. Design: Prospective clinical study. Setting: University-affiliated tertiary referral center. Patient(s): Eighty-seven women with symptomatic fibroids warranting surgical treatment and wanting to retain their uteri. Intervention(s): Laparoscopic bipolar coagulation of uterine arteries and anastomotic sites of uterine arteries with ovarian arteries. Main Outcome Measure(s): Percentage reduction in the dominant fibroid size and clinical response evaluation. Result(s): Eighty-five (97.7%) of 87 patients underwent technically successful laparoscopic coagulation of uterine vessels without intraoperative complications. The mean follow-up time was 10.2 months. Symptomatic improvement was reported in 76 (89.4%) of 85 patients, including 18 (21.2%) with complete resolution of symptoms. Significant reductions in the dominant fibroid size (average, 76%) and the uterine volume (average, 46%) were sonographically demonstrated. Two patients conceived 4 and 9 months, respectively, after treatment. Three (3.5%) premenopausal women became postmenopausal postoperatively. Conclusion(s): Laparoscopic bipolar coagulation of uterine vessels appears to be a promising new method for treating fibroid-related menorrhagia and pelvic pain.

Laparoscopic bipolar coagulation of uterine vessels to treat symptomatic leiomyomas

Laparoscopic bipolar coagulation of uterine vessels was performed in three women with symptomatic myomas who required conventional surgical treatment. Uterine size and dominant myoma size were assessed by ultrasonography before and after surgery. Both uterine arteries, as well as anastomosis zone of uterine arteries with ovarian arteries, were occluded in all three women. Surgery was uneventful, and patients were hospitalized for only 2 days. All women experienced improvement in symptoms with no complications. Postoperative ultrasound showed progressive reduction in size of the dominant myoma. A larger series and longer follow-up are required to evaluate long-term effects and to identify appropriate candidates.