Laparoscopic Bipolar Coagulation Research Articles

A Case of Recurrent Massive Secondary Postpartum Haemorrhage following Caesarean Section Due to the Eroded Left Uterine Artery Sealed by Laparoscopic Bipolar Coagulation

Background: Recurrent massive secondary postpartum haemorrhage (PPH) due to uterine wound dehiscence with uterine artery erosion following LSCS causes management challenges.

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.

Effect of Laparoscopic Suturing Versus Bipolar Coagulation on Ovarian Reserve in Patients Undergoing Endometriotic Ovarian Cystectomy.

Effect of Laparoscopic Suturing Versus Bipolar Coagulation on Ovarian Reserve in Patients Undergoing Endometriotic Ovarian Cystectomy.

Probability of pregnancy after sterilization: a comparison of hysteroscopic versus laparoscopic sterilization

ObjectiveTo compare the expected probability of pregnancy after hysteroscopic versus laparoscopic sterilization based on available data using decision analysis. Study designWe developed an evidence-based Markov model to estimate the probability of pregnancy over 10 years after three different female sterilization procedures: hysteroscopic, laparoscopic silicone rubber band application and laparoscopic bipolar coagulation. Parameter estimates for procedure success, probability of completing follow-up testing and risk of pregnancy after different sterilization procedures were obtained from published sources. ResultsIn the base case analysis at all points in time after the sterilization procedure, the initial and cumulative risk of pregnancy after sterilization is higher in women opting for hysteroscopic than either laparoscopic band or bipolar sterilization. The expected pregnancy rates per 1000 women at 1 year are 57, 7 and 3 for hysteroscopic sterilization, laparoscopic silicone rubber band application and laparoscopic bipolar coagulation, respectively. At 10 years, the cumulative pregnancy rates per 1000 women are 96, 24 and 30, respectively. Sensitivity analyses suggest that the three procedures would have an equivalent pregnancy risk of approximately 80 per 1000 women at 10 years if the probability of successful laparoscopic (band or bipolar) sterilization drops below 90% and successful coil placement on first hysteroscopic attempt increases to 98% or if the probability of undergoing a hysterosalpingogram increases to 100%. ConclusionBased on available data, the expected population risk of pregnancy is higher after hysteroscopic than laparoscopic sterilization. Consistent with existing contraceptive classification, future characterization of hysteroscopic sterilization should distinguish “perfect” and “typical” use failure rates. ImplicationsPregnancy probability at 1 year and over 10 years is expected to be higher in women having hysteroscopic as compared to laparoscopic sterilization.

Laparoscopic Bipolar Coagulation of Hypogastric Artery in Postpartum Haemorrhage: A Case Report

Background. Postpartum haemorrhage (PPH) is a significant contributor to worldwide maternal morbidity and mortality. When PPH continues despite aggressive medical treatment, early consideration should be given to surgical intervention. Various surgical interventions may be used but conservative interventions are recommended primarily. Case. This case report describes laparoscopic coagulation of hypogastric artery technique in a patient with PPH. Conclusions. Laparoscopic ligature of the hypogastric artery for PPH treatment can be a valid alternative to laparotomy in patients with vaginal delivery.

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

Laparoscopic tubal bipolar coagulation and corpus luteum function

Tubal sterilization (TS) is preferred by approximately 20% of women in the United States. Luteal phase defect (LPD) observed in 3--40% of the female population is associated with decreased progesterone secretion by corpus luteum (CL) which is the majority source of progesterone in women. In surgically sterilized women LPD may be associated with menstrual irregularity dysmenorrhea and exposing unopposed estrogen. The aim of this study was to investigate the effect of laparoscopic tubal bipolar coagulation (LTBC) on progesterone production of CL using mid-luteal serum progesterone (MLSP) assay. (excerpt)

Effects of three different sterilization methods on utero-ovarian Doppler blood flow and serum levels of ovarian hormones

Objective:The aim of the study was to assess pre-operative and post-operative serum levels of ovarian hormones and changes in utero-ovarian arterial blood flow by Doppler ultrasonography in women in whom one of three different sterilization methods was applied. Study design:The Pomeroy method of tubal ligation, fimbriectomy, or laparoscopic bipolar coagulation were applied in 42 patients. Serum levels of sex hormones were checked, and utero-ovarian arterial Doppler measurements were performed pre-operatively and post-operatively. The presence or absence of dysmenorrhea was noted before and after the operations. Results:We detected a significant increase in the average uterine arterial resistivity index (RI) and both ovarian arterial pulsatility index (PI) values in the Pomeroy method group (p<0.05). There was a significant increase in dysmenorrhea complaints in the total number of patients (p<0.05), particularly in the fimbriectomy group. Conclusion:The significant increase in uterine arterial Doppler measurements with the Pomeroy method may be due to the removal of a larger tubal segment. Even though the increase is not statistically significant, fimbriectomy should not be applied in young women, because it may increase dysmenorrhea and the procedure is not reversible.

Ovarian Function and Vascular Resistance After Tubal Sterilization

In this study, 19 women who underwent tubal sterilization with laparoscopic bipolar coagulation were evaluated before the sterilization procedure and 1 year after. Baseline levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol were measured during the early follicular phase (day 3) of the patient's menstrual cycle before tubal sterilization. Ovarian volume, antral follicle counts, and ovarian blood flow rates were determined using transvaginal ultrasonography (TVU). One year after laparoscopy, the hormone measures were repeated, on day 3 of the menstrual cycle, and a repeat TVU was performed. Pre- and postoperative levels of FSH, LH, and estradiol were essentially unchanged. Also, the mean ovarian volume, follicle counts, and ovarian artery resistivity index remained unchanged. When all measurements were compared, ovarian volume and follicle counts were significantly correlated, both before and after sterilization, (P <0.05), and both measures correlated with baseline FSH levels. No other associations were seen.

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.

Laparoscopic Bipolar Coagulation of Uterine Vessels to Manage Delayed Postpartum Hemorrhage

Postpartum hemorrhage (PPH) is a big challenge for obstetricians. Fertility-preserving procedures are encouraged, especially in young women. Bilateral hypogastric (internal iliac) artery ligation, bilateral uterine artery ligation after vaginal delivery or after cesarean delivery, and uterine artery embolization are well documented vascular occlusive methods for treating PPH. To our knowledge, the laparoscopic approach to uterine artery ligation has not been reported. A 29-year-old woman experienced delayed PPH. Although curettage of the uterine cavity to remove retained placenta was performed, bleeding did not stop. We successfully performed a relatively new method—laparoscopic bipolar coagulation of uterine vessels—to stop bleeding and preserve the uterus.

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.

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.

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.

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