AAGL Global Congress of Minimally Invasive Gynecology 2017

NATIONAL HARBOR, MD. – Laparoscopic retroperitoneal nerve-sparing surgery is a safe approach that relieves pain in women with deep infiltrating endometriosis, according to findings presented by Giovanni Roviglione, MD, at the AAGL Global Congress.

The prospective case series study with a single gynecologic surgeon in Verona, Italy, involved 382 women who had deep infiltrating endometriosis with sciatica and anogenital pain. All of the women had some level of nervous compression of somatic structures and infiltration of their fascial envelope.

The surgery involved whole decompression and partial neurolysis of nervous structures for most patients, while nearly 20% of women required complete neurolysis based on their level of infiltration. Most women (64%) had severe enough infiltration that a concomitant bowel resection was also necessary.

The surgeon performed a medial approach for deep pelvic endometriosis with rectal and/or parametrial involvement extending to the pelvic wall and somatic nerve, or a lateral approach for isolated endometriosis of the pelvic wall and somatic nerves.

At 6 months after surgery, all patients reported complete relief from pain. However, 77 women (20%) experienced postoperative neuritis, which was successfully treated with corticosteroids, antiepileptics, and opioids.

Endometriosis that extends into somatic nerves and the sacral roots is a common cause of pelvic pain, Dr. Roviglione said.

“This kind of endometriosis is resistant to opioids and drugs,” he said. The difficulty in treating deep infiltrating endometriosis is compounded by the often long delay in diagnosis, he added.

Using laparoscopy for neurolysis and decompression of somatic nerves affected by endometriosis is a “more accurate and effective treatment” for providing pain relief, Dr. Roviglione said. But laparoscopic retroperitoneal nerve-sparing surgery should be performed only by skilled neuroanatomy surgeons at referral centers because of the complex nature of the procedure, he noted.

Dr. Roviglione reported having no relevant financial disclosures.

ilacy@frontlinemedcom.com

SOURCE: Ceccaroni M et al. AAGL 2017 Abstract 166.

NATIONAL HARBOR, MD. – Laparoscopic retroperitoneal nerve-sparing surgery is a safe approach that relieves pain in women with deep infiltrating endometriosis, according to findings presented by Giovanni Roviglione, MD, at the AAGL Global Congress.

The prospective case series study with a single gynecologic surgeon in Verona, Italy, involved 382 women who had deep infiltrating endometriosis with sciatica and anogenital pain. All of the women had some level of nervous compression of somatic structures and infiltration of their fascial envelope.

The surgery involved whole decompression and partial neurolysis of nervous structures for most patients, while nearly 20% of women required complete neurolysis based on their level of infiltration. Most women (64%) had severe enough infiltration that a concomitant bowel resection was also necessary.

The surgeon performed a medial approach for deep pelvic endometriosis with rectal and/or parametrial involvement extending to the pelvic wall and somatic nerve, or a lateral approach for isolated endometriosis of the pelvic wall and somatic nerves.

At 6 months after surgery, all patients reported complete relief from pain. However, 77 women (20%) experienced postoperative neuritis, which was successfully treated with corticosteroids, antiepileptics, and opioids.

Endometriosis that extends into somatic nerves and the sacral roots is a common cause of pelvic pain, Dr. Roviglione said.

“This kind of endometriosis is resistant to opioids and drugs,” he said. The difficulty in treating deep infiltrating endometriosis is compounded by the often long delay in diagnosis, he added.

Using laparoscopy for neurolysis and decompression of somatic nerves affected by endometriosis is a “more accurate and effective treatment” for providing pain relief, Dr. Roviglione said. But laparoscopic retroperitoneal nerve-sparing surgery should be performed only by skilled neuroanatomy surgeons at referral centers because of the complex nature of the procedure, he noted.

Dr. Roviglione reported having no relevant financial disclosures.

ilacy@frontlinemedcom.com

SOURCE: Ceccaroni M et al. AAGL 2017 Abstract 166.

NATIONAL HARBOR, MD. – Laparoscopic retroperitoneal nerve-sparing surgery is a safe approach that relieves pain in women with deep infiltrating endometriosis, according to findings presented by Giovanni Roviglione, MD, at the AAGL Global Congress.

The prospective case series study with a single gynecologic surgeon in Verona, Italy, involved 382 women who had deep infiltrating endometriosis with sciatica and anogenital pain. All of the women had some level of nervous compression of somatic structures and infiltration of their fascial envelope.

The surgery involved whole decompression and partial neurolysis of nervous structures for most patients, while nearly 20% of women required complete neurolysis based on their level of infiltration. Most women (64%) had severe enough infiltration that a concomitant bowel resection was also necessary.

The surgeon performed a medial approach for deep pelvic endometriosis with rectal and/or parametrial involvement extending to the pelvic wall and somatic nerve, or a lateral approach for isolated endometriosis of the pelvic wall and somatic nerves.

At 6 months after surgery, all patients reported complete relief from pain. However, 77 women (20%) experienced postoperative neuritis, which was successfully treated with corticosteroids, antiepileptics, and opioids.

Endometriosis that extends into somatic nerves and the sacral roots is a common cause of pelvic pain, Dr. Roviglione said.

“This kind of endometriosis is resistant to opioids and drugs,” he said. The difficulty in treating deep infiltrating endometriosis is compounded by the often long delay in diagnosis, he added.

Using laparoscopy for neurolysis and decompression of somatic nerves affected by endometriosis is a “more accurate and effective treatment” for providing pain relief, Dr. Roviglione said. But laparoscopic retroperitoneal nerve-sparing surgery should be performed only by skilled neuroanatomy surgeons at referral centers because of the complex nature of the procedure, he noted.

Dr. Roviglione reported having no relevant financial disclosures.

ilacy@frontlinemedcom.com

SOURCE: Ceccaroni M et al. AAGL 2017 Abstract 166.

NATIONAL HARBOR, MD. – Intravenous (IV) acetaminophen does little to improve patient satisfaction and decrease pain after laparoscopic hysterectomy, according to results from a prospective, randomized trial.

Noah Rindos, MD, and his colleagues investigated the effectiveness of preoperative IV acetaminophen, encouraged by previous studies demonstrating its effectiveness in preoperative pain. Dr. Rindos of the University of Pittsburgh and his team researched acetaminophen as an alternative to opioid pain management.

“The theory is if you give something to block the pain, then you’ll have less of it after surgery. And then you won’t need as many narcotics,” Dr. Rindos said at the AAGL Global Congress.

Prior to surgery, 91 patients were administered 1,000 mg of IV acetaminophen and 92 received IV saline. Follow-up doses were administered 6 hours later. Induction of anesthesia and other postoperative pain management was uniform between the two cohorts. Patients also were asked to report their pain and nausea levels. Three patients withdrew from the study, two from postoperative pain and one for evaluation of stroke.

Using the visual analog scale, patients were asked to report their postoperative pain and nausea levels at 2, 4, 6, 12, and 24 hours. Patients also reported their satisfaction scores 24 hours post surgery.

Generalized abdominal pain visual analog scores between the IV saline and IV acetaminophen groups showed no significant differences at 2 hours (3.6 vs 4.4), 4 hours (3.5 vs. 3.9), 6 hours (3.6 vs. 3.8), 12 hours (3.3 vs. 3.7), and 24 hours (3.3 vs. 3.6). Similar results were observed for upper abdomen, lower abdomen and umbilical pain, and nausea. There was no statistically significant difference between saline and acetaminophen postoperative satisfaction scores (P = .319).

The results of this study are particularly relevant because of the relatively high cost of acetaminophen ($23.20 per dose in this study). The price, combined with the lack of effectiveness and the availability of alternatives, make the routine use of acetaminophen unnecessary during hysterectomy, Dr. Rindos said.“This has actually led to a practice change within our institution where we are no longer giving IV Tylenol preoperatively,” Dr. Rindos said. “If we have a large expense ... and we are not getting much benefit to the patient or to their overall satisfaction, maybe we should reevaluate the utility of it.”

The study was supported by the Magee-Womens Hospital Medical Staff Fund. Dr. Rindos reported having no relevant financial disclosures.

ilacy@frontlinemedcom.com

NATIONAL HARBOR, MD. – Intravenous (IV) acetaminophen does little to improve patient satisfaction and decrease pain after laparoscopic hysterectomy, according to results from a prospective, randomized trial.

Noah Rindos, MD, and his colleagues investigated the effectiveness of preoperative IV acetaminophen, encouraged by previous studies demonstrating its effectiveness in preoperative pain. Dr. Rindos of the University of Pittsburgh and his team researched acetaminophen as an alternative to opioid pain management.

“The theory is if you give something to block the pain, then you’ll have less of it after surgery. And then you won’t need as many narcotics,” Dr. Rindos said at the AAGL Global Congress.

Prior to surgery, 91 patients were administered 1,000 mg of IV acetaminophen and 92 received IV saline. Follow-up doses were administered 6 hours later. Induction of anesthesia and other postoperative pain management was uniform between the two cohorts. Patients also were asked to report their pain and nausea levels. Three patients withdrew from the study, two from postoperative pain and one for evaluation of stroke.

Using the visual analog scale, patients were asked to report their postoperative pain and nausea levels at 2, 4, 6, 12, and 24 hours. Patients also reported their satisfaction scores 24 hours post surgery.

Generalized abdominal pain visual analog scores between the IV saline and IV acetaminophen groups showed no significant differences at 2 hours (3.6 vs 4.4), 4 hours (3.5 vs. 3.9), 6 hours (3.6 vs. 3.8), 12 hours (3.3 vs. 3.7), and 24 hours (3.3 vs. 3.6). Similar results were observed for upper abdomen, lower abdomen and umbilical pain, and nausea. There was no statistically significant difference between saline and acetaminophen postoperative satisfaction scores (P = .319).

The results of this study are particularly relevant because of the relatively high cost of acetaminophen ($23.20 per dose in this study). The price, combined with the lack of effectiveness and the availability of alternatives, make the routine use of acetaminophen unnecessary during hysterectomy, Dr. Rindos said.“This has actually led to a practice change within our institution where we are no longer giving IV Tylenol preoperatively,” Dr. Rindos said. “If we have a large expense ... and we are not getting much benefit to the patient or to their overall satisfaction, maybe we should reevaluate the utility of it.”

The study was supported by the Magee-Womens Hospital Medical Staff Fund. Dr. Rindos reported having no relevant financial disclosures.

ilacy@frontlinemedcom.com

NATIONAL HARBOR, MD. – Intravenous (IV) acetaminophen does little to improve patient satisfaction and decrease pain after laparoscopic hysterectomy, according to results from a prospective, randomized trial.

Noah Rindos, MD, and his colleagues investigated the effectiveness of preoperative IV acetaminophen, encouraged by previous studies demonstrating its effectiveness in preoperative pain. Dr. Rindos of the University of Pittsburgh and his team researched acetaminophen as an alternative to opioid pain management.

“The theory is if you give something to block the pain, then you’ll have less of it after surgery. And then you won’t need as many narcotics,” Dr. Rindos said at the AAGL Global Congress.

Prior to surgery, 91 patients were administered 1,000 mg of IV acetaminophen and 92 received IV saline. Follow-up doses were administered 6 hours later. Induction of anesthesia and other postoperative pain management was uniform between the two cohorts. Patients also were asked to report their pain and nausea levels. Three patients withdrew from the study, two from postoperative pain and one for evaluation of stroke.

Using the visual analog scale, patients were asked to report their postoperative pain and nausea levels at 2, 4, 6, 12, and 24 hours. Patients also reported their satisfaction scores 24 hours post surgery.

Generalized abdominal pain visual analog scores between the IV saline and IV acetaminophen groups showed no significant differences at 2 hours (3.6 vs 4.4), 4 hours (3.5 vs. 3.9), 6 hours (3.6 vs. 3.8), 12 hours (3.3 vs. 3.7), and 24 hours (3.3 vs. 3.6). Similar results were observed for upper abdomen, lower abdomen and umbilical pain, and nausea. There was no statistically significant difference between saline and acetaminophen postoperative satisfaction scores (P = .319).

The results of this study are particularly relevant because of the relatively high cost of acetaminophen ($23.20 per dose in this study). The price, combined with the lack of effectiveness and the availability of alternatives, make the routine use of acetaminophen unnecessary during hysterectomy, Dr. Rindos said.“This has actually led to a practice change within our institution where we are no longer giving IV Tylenol preoperatively,” Dr. Rindos said. “If we have a large expense ... and we are not getting much benefit to the patient or to their overall satisfaction, maybe we should reevaluate the utility of it.”

The study was supported by the Magee-Womens Hospital Medical Staff Fund. Dr. Rindos reported having no relevant financial disclosures.

ilacy@frontlinemedcom.com

NATIONAL HARBOR, MD. – Robotic hysterectomy combined with extraction of the uterus via mini-laparotomy led to significantly shorter lengths of stay, lower estimated blood loss, and fewer postoperative complications compared with open hysterectomy when the uterus weighed more than 250 grams.

Gynecologic surgeons are seeking ways to safely perform minimally invasive hysterectomy on patients with larger uteri in light of the 2014 Food and Drug Administration admonition regarding power morcellation. To this end, Natasha Gupta, MD, and her colleagues at the University of Tennessee, Chattanooga, retrospectively reviewed all patients with uterine sizes larger than 250 grams undergoing hysterectomy at their institution between 2012 and 2015.

Denise Fulton/Frontline Medical News

Courtesy Dr. Natasha Gupta

dfulton@frontlinemedcom.com

On Twitter @denisefulton

NATIONAL HARBOR, MD. – Robotic hysterectomy combined with extraction of the uterus via mini-laparotomy led to significantly shorter lengths of stay, lower estimated blood loss, and fewer postoperative complications compared with open hysterectomy when the uterus weighed more than 250 grams.

Gynecologic surgeons are seeking ways to safely perform minimally invasive hysterectomy on patients with larger uteri in light of the 2014 Food and Drug Administration admonition regarding power morcellation. To this end, Natasha Gupta, MD, and her colleagues at the University of Tennessee, Chattanooga, retrospectively reviewed all patients with uterine sizes larger than 250 grams undergoing hysterectomy at their institution between 2012 and 2015.

Denise Fulton/Frontline Medical News

Courtesy Dr. Natasha Gupta

dfulton@frontlinemedcom.com

On Twitter @denisefulton

NATIONAL HARBOR, MD. – Robotic hysterectomy combined with extraction of the uterus via mini-laparotomy led to significantly shorter lengths of stay, lower estimated blood loss, and fewer postoperative complications compared with open hysterectomy when the uterus weighed more than 250 grams.

Gynecologic surgeons are seeking ways to safely perform minimally invasive hysterectomy on patients with larger uteri in light of the 2014 Food and Drug Administration admonition regarding power morcellation. To this end, Natasha Gupta, MD, and her colleagues at the University of Tennessee, Chattanooga, retrospectively reviewed all patients with uterine sizes larger than 250 grams undergoing hysterectomy at their institution between 2012 and 2015.

Denise Fulton/Frontline Medical News

Courtesy Dr. Natasha Gupta

dfulton@frontlinemedcom.com

On Twitter @denisefulton

NATIONAL HARBOR, MD. – Laparoscopy offers advantages over laparotomy when performing nonobstetrical surgery on pregnant women, Yuval Kaufman, MD, said at the AAGL Global Congress.

“When we talk about advantages in referral to the pregnant patient, one of the most important things is early ambulation,” Dr. Kaufman, a gynecologic surgeon at Carmel Medical Center in Haifa, Israel, said in an interview. “These patients are in a hypercoagulable state; they are more likely to have DVT and PE. You need them up and running as soon as possible.”

Laparoscopy also tends to be better in terms of handling of the uterus, offering a field of view so that the uterus doesn’t need to be moved as much. In addition, laparoscopy is associated with a smaller, more easily healed scar, and usually requires fewer analgesics, which is better for the fetus, he said.

The Society of American Gastrointestinal and Endoscopic Surgeons recently issued guidelines for the use of laparoscopy during pregnancy, advising surgeons that these procedures can be safely performed during any trimester when the operation is indicated, he said.

“There was an older misconception that surgery has to be done in the second trimester only,” Dr. Kaufman said. “But they actually contradict that; they show that if you postpone surgery for this reason you might be doing much more damage to the mother and to the fetus.”

Dr. Kaufman reported having no relevant financial disclosures.

ezimmerman@frontlinemedcom.com

On Twitter @eaztweets

NATIONAL HARBOR, MD. – Laparoscopy offers advantages over laparotomy when performing nonobstetrical surgery on pregnant women, Yuval Kaufman, MD, said at the AAGL Global Congress.

“When we talk about advantages in referral to the pregnant patient, one of the most important things is early ambulation,” Dr. Kaufman, a gynecologic surgeon at Carmel Medical Center in Haifa, Israel, said in an interview. “These patients are in a hypercoagulable state; they are more likely to have DVT and PE. You need them up and running as soon as possible.”

Laparoscopy also tends to be better in terms of handling of the uterus, offering a field of view so that the uterus doesn’t need to be moved as much. In addition, laparoscopy is associated with a smaller, more easily healed scar, and usually requires fewer analgesics, which is better for the fetus, he said.

The Society of American Gastrointestinal and Endoscopic Surgeons recently issued guidelines for the use of laparoscopy during pregnancy, advising surgeons that these procedures can be safely performed during any trimester when the operation is indicated, he said.

“There was an older misconception that surgery has to be done in the second trimester only,” Dr. Kaufman said. “But they actually contradict that; they show that if you postpone surgery for this reason you might be doing much more damage to the mother and to the fetus.”

Dr. Kaufman reported having no relevant financial disclosures.

ezimmerman@frontlinemedcom.com

On Twitter @eaztweets

NATIONAL HARBOR, MD. – Laparoscopy offers advantages over laparotomy when performing nonobstetrical surgery on pregnant women, Yuval Kaufman, MD, said at the AAGL Global Congress.

“When we talk about advantages in referral to the pregnant patient, one of the most important things is early ambulation,” Dr. Kaufman, a gynecologic surgeon at Carmel Medical Center in Haifa, Israel, said in an interview. “These patients are in a hypercoagulable state; they are more likely to have DVT and PE. You need them up and running as soon as possible.”

Laparoscopy also tends to be better in terms of handling of the uterus, offering a field of view so that the uterus doesn’t need to be moved as much. In addition, laparoscopy is associated with a smaller, more easily healed scar, and usually requires fewer analgesics, which is better for the fetus, he said.

The Society of American Gastrointestinal and Endoscopic Surgeons recently issued guidelines for the use of laparoscopy during pregnancy, advising surgeons that these procedures can be safely performed during any trimester when the operation is indicated, he said.

“There was an older misconception that surgery has to be done in the second trimester only,” Dr. Kaufman said. “But they actually contradict that; they show that if you postpone surgery for this reason you might be doing much more damage to the mother and to the fetus.”

Dr. Kaufman reported having no relevant financial disclosures.

ezimmerman@frontlinemedcom.com

On Twitter @eaztweets

NATIONAL HARBOR, MD. – The biggest theme of the 2017 AAGL Global Congress was the importance of understanding anatomy, Charles E. Miller, MD, a minimally invasive gynecologic surgeon in Naperville, Ill., and past president of the AAGL, said at the meeting.

“It’s about doing surgery in the right place, in the right space,” he said.

One of the advantages of this year’s Congress is a greater emphasis on cadaveric dissections, Dr. Miller said during an interview. “Understanding how the nerves are placed, how the vessels are in place, the muscles and the different spaces, and how that all relates to our most complex dissections.”

In a presentation on neuropelveology, Michael Hibner, MD, and Mario Castellanos, MD, of St. Joseph’s Hospital and Medical Center, Phoenix, performed a live cadaveric dissection showing how to deal with a trapped pudendal nerve, working over the gluteus maximus and dissecting down.

In a video session, surgeons demonstrated a needleless robotic-assisted transabdominal cerclage. The nonneedle procedure used a unique, posterior placement of the cerclage knot, a technique which Dr. Miller said he plans to use in his own practice.

The incorporation of colleagues from around the country, and around the world, was another strength of this year’s Congress, said Dr. Miller, particularly a presentation from a Chinese ob.gyn. association on isthmoceles. “To be able to see that this transcends miles upon miles upon miles, but yet we’re seeing the same type of problems, is quite interesting,” he said.

ezimmerman@frontlinemedcom.com

On Twitter @eaztweets

NATIONAL HARBOR, MD. – The biggest theme of the 2017 AAGL Global Congress was the importance of understanding anatomy, Charles E. Miller, MD, a minimally invasive gynecologic surgeon in Naperville, Ill., and past president of the AAGL, said at the meeting.

“It’s about doing surgery in the right place, in the right space,” he said.

One of the advantages of this year’s Congress is a greater emphasis on cadaveric dissections, Dr. Miller said during an interview. “Understanding how the nerves are placed, how the vessels are in place, the muscles and the different spaces, and how that all relates to our most complex dissections.”

In a presentation on neuropelveology, Michael Hibner, MD, and Mario Castellanos, MD, of St. Joseph’s Hospital and Medical Center, Phoenix, performed a live cadaveric dissection showing how to deal with a trapped pudendal nerve, working over the gluteus maximus and dissecting down.

In a video session, surgeons demonstrated a needleless robotic-assisted transabdominal cerclage. The nonneedle procedure used a unique, posterior placement of the cerclage knot, a technique which Dr. Miller said he plans to use in his own practice.

The incorporation of colleagues from around the country, and around the world, was another strength of this year’s Congress, said Dr. Miller, particularly a presentation from a Chinese ob.gyn. association on isthmoceles. “To be able to see that this transcends miles upon miles upon miles, but yet we’re seeing the same type of problems, is quite interesting,” he said.

ezimmerman@frontlinemedcom.com

On Twitter @eaztweets

NATIONAL HARBOR, MD. – The biggest theme of the 2017 AAGL Global Congress was the importance of understanding anatomy, Charles E. Miller, MD, a minimally invasive gynecologic surgeon in Naperville, Ill., and past president of the AAGL, said at the meeting.

“It’s about doing surgery in the right place, in the right space,” he said.

One of the advantages of this year’s Congress is a greater emphasis on cadaveric dissections, Dr. Miller said during an interview. “Understanding how the nerves are placed, how the vessels are in place, the muscles and the different spaces, and how that all relates to our most complex dissections.”

In a presentation on neuropelveology, Michael Hibner, MD, and Mario Castellanos, MD, of St. Joseph’s Hospital and Medical Center, Phoenix, performed a live cadaveric dissection showing how to deal with a trapped pudendal nerve, working over the gluteus maximus and dissecting down.

In a video session, surgeons demonstrated a needleless robotic-assisted transabdominal cerclage. The nonneedle procedure used a unique, posterior placement of the cerclage knot, a technique which Dr. Miller said he plans to use in his own practice.

The incorporation of colleagues from around the country, and around the world, was another strength of this year’s Congress, said Dr. Miller, particularly a presentation from a Chinese ob.gyn. association on isthmoceles. “To be able to see that this transcends miles upon miles upon miles, but yet we’re seeing the same type of problems, is quite interesting,” he said.

ezimmerman@frontlinemedcom.com

On Twitter @eaztweets

NATIONAL HARBOR, MD. – Pathologic findings from preoperative endocervical sampling were fairly consistent with the underlying pathologies identified at trachelectomy, based on a single-center, retrospective chart review presented at the AAGL Global Congress.

“Preoperative endocervical sampling can be performed safely and adequately with results consistent with final trachelectomy pathology,” said Sarah Krantz, MD, of Vanderbilt University, Nashville, Tenn. Importantly, performing preoperative sampling may identify a missed diagnosis of cancer and allows for subsequent appropriate preoperative planning, she added.

Dr. Krantz and her colleagues included 47 women who had a supracervical hysterectomy and subsequently underwent trachelectomy at Vanderbilt from April 1999 to April 2015. Indications for surgery included vaginal bleeding (24), abnormal pap smears (7), pain (16), prolapse (13), and cancer (2). If patients had a prior diagnosis of gynecologic malignancy, they were excluded from the study.

Endocervical sampling was performed in 18 of the 47 women by a gynecologist. Samples were collected by way of various methods, including Pap smear, endocervical brushings and curettage, and endometrial pipelle. The pathologic findings in endocervical samples coincided with the final surgical pathology in 9 of 10 patients with benign findings, 1 of 6 patients with dysplasia, and 2 of 2 patients with cancer.

Among the 29 women who did not undergo preoperative endocervical sampling, one was diagnosed with cervical cancer at final surgical pathology.

In the 24 women with vaginal bleeding, cervicitis was identified in 1 of 10 patients who underwent preoperative endocervical sampling and was found on final pathology in 12 of 24 patients.Given the high incidence of cervicitis in women who report vaginal bleeding, consideration should be given for medical management prior to surgical excision, Dr. Krantz said.

Dr. Krantz reported having no relevant financial disclosures.

ilacy@frontlinemedcom.com

NATIONAL HARBOR, MD. – Pathologic findings from preoperative endocervical sampling were fairly consistent with the underlying pathologies identified at trachelectomy, based on a single-center, retrospective chart review presented at the AAGL Global Congress.

“Preoperative endocervical sampling can be performed safely and adequately with results consistent with final trachelectomy pathology,” said Sarah Krantz, MD, of Vanderbilt University, Nashville, Tenn. Importantly, performing preoperative sampling may identify a missed diagnosis of cancer and allows for subsequent appropriate preoperative planning, she added.

Dr. Krantz and her colleagues included 47 women who had a supracervical hysterectomy and subsequently underwent trachelectomy at Vanderbilt from April 1999 to April 2015. Indications for surgery included vaginal bleeding (24), abnormal pap smears (7), pain (16), prolapse (13), and cancer (2). If patients had a prior diagnosis of gynecologic malignancy, they were excluded from the study.

Endocervical sampling was performed in 18 of the 47 women by a gynecologist. Samples were collected by way of various methods, including Pap smear, endocervical brushings and curettage, and endometrial pipelle. The pathologic findings in endocervical samples coincided with the final surgical pathology in 9 of 10 patients with benign findings, 1 of 6 patients with dysplasia, and 2 of 2 patients with cancer.

Among the 29 women who did not undergo preoperative endocervical sampling, one was diagnosed with cervical cancer at final surgical pathology.

In the 24 women with vaginal bleeding, cervicitis was identified in 1 of 10 patients who underwent preoperative endocervical sampling and was found on final pathology in 12 of 24 patients.Given the high incidence of cervicitis in women who report vaginal bleeding, consideration should be given for medical management prior to surgical excision, Dr. Krantz said.

Dr. Krantz reported having no relevant financial disclosures.

ilacy@frontlinemedcom.com

NATIONAL HARBOR, MD. – Pathologic findings from preoperative endocervical sampling were fairly consistent with the underlying pathologies identified at trachelectomy, based on a single-center, retrospective chart review presented at the AAGL Global Congress.

“Preoperative endocervical sampling can be performed safely and adequately with results consistent with final trachelectomy pathology,” said Sarah Krantz, MD, of Vanderbilt University, Nashville, Tenn. Importantly, performing preoperative sampling may identify a missed diagnosis of cancer and allows for subsequent appropriate preoperative planning, she added.

Dr. Krantz and her colleagues included 47 women who had a supracervical hysterectomy and subsequently underwent trachelectomy at Vanderbilt from April 1999 to April 2015. Indications for surgery included vaginal bleeding (24), abnormal pap smears (7), pain (16), prolapse (13), and cancer (2). If patients had a prior diagnosis of gynecologic malignancy, they were excluded from the study.

Endocervical sampling was performed in 18 of the 47 women by a gynecologist. Samples were collected by way of various methods, including Pap smear, endocervical brushings and curettage, and endometrial pipelle. The pathologic findings in endocervical samples coincided with the final surgical pathology in 9 of 10 patients with benign findings, 1 of 6 patients with dysplasia, and 2 of 2 patients with cancer.

Among the 29 women who did not undergo preoperative endocervical sampling, one was diagnosed with cervical cancer at final surgical pathology.

In the 24 women with vaginal bleeding, cervicitis was identified in 1 of 10 patients who underwent preoperative endocervical sampling and was found on final pathology in 12 of 24 patients.Given the high incidence of cervicitis in women who report vaginal bleeding, consideration should be given for medical management prior to surgical excision, Dr. Krantz said.

Dr. Krantz reported having no relevant financial disclosures.

ilacy@frontlinemedcom.com

NATIONAL HARBOR, MD. – Moving hysterectomy and advanced gynecologic procedures to the ambulatory surgical environment is better for patients, surgeons, and the health care system, Richard B. Rosenfield, MD, who is in private practice in Portland, Ore., said at the AAGL Global Congress.

“We’ve been basically proving this model over the last decade by performing advanced laparoscopic surgery in the outpatient environment, and we do this for a number of reasons,” Dr. Rosenfield said in an interview. “The patients get to go home the same day, which they typically enjoy, we avoid the hospital-acquired infections, which is great, and in addition to that, the physicians tend to really appreciate the efficiency of an outpatient center.”

But with the focus on value-based payment under federal health programs, there should also be a greater focus on getting more high-volume surgeons to perform their procedures, he said. The idea is to lower the hospital readmissions, complications, and infections that could arise during procedures by less experienced surgeons and redirect the cost savings toward payments for surgeons with better outcomes, Dr. Rosenfield said. But this should be coupled with training and mentoring for lower-volume surgeons, he said.

Dr. Rosenfield reported having no relevant financial disclosures.

ezimmerman@frontlinemedcom.com

On Twitter @eaztweets

NATIONAL HARBOR, MD. – Moving hysterectomy and advanced gynecologic procedures to the ambulatory surgical environment is better for patients, surgeons, and the health care system, Richard B. Rosenfield, MD, who is in private practice in Portland, Ore., said at the AAGL Global Congress.

“We’ve been basically proving this model over the last decade by performing advanced laparoscopic surgery in the outpatient environment, and we do this for a number of reasons,” Dr. Rosenfield said in an interview. “The patients get to go home the same day, which they typically enjoy, we avoid the hospital-acquired infections, which is great, and in addition to that, the physicians tend to really appreciate the efficiency of an outpatient center.”

But with the focus on value-based payment under federal health programs, there should also be a greater focus on getting more high-volume surgeons to perform their procedures, he said. The idea is to lower the hospital readmissions, complications, and infections that could arise during procedures by less experienced surgeons and redirect the cost savings toward payments for surgeons with better outcomes, Dr. Rosenfield said. But this should be coupled with training and mentoring for lower-volume surgeons, he said.

Dr. Rosenfield reported having no relevant financial disclosures.

ezimmerman@frontlinemedcom.com

On Twitter @eaztweets

NATIONAL HARBOR, MD. – Moving hysterectomy and advanced gynecologic procedures to the ambulatory surgical environment is better for patients, surgeons, and the health care system, Richard B. Rosenfield, MD, who is in private practice in Portland, Ore., said at the AAGL Global Congress.

“We’ve been basically proving this model over the last decade by performing advanced laparoscopic surgery in the outpatient environment, and we do this for a number of reasons,” Dr. Rosenfield said in an interview. “The patients get to go home the same day, which they typically enjoy, we avoid the hospital-acquired infections, which is great, and in addition to that, the physicians tend to really appreciate the efficiency of an outpatient center.”

But with the focus on value-based payment under federal health programs, there should also be a greater focus on getting more high-volume surgeons to perform their procedures, he said. The idea is to lower the hospital readmissions, complications, and infections that could arise during procedures by less experienced surgeons and redirect the cost savings toward payments for surgeons with better outcomes, Dr. Rosenfield said. But this should be coupled with training and mentoring for lower-volume surgeons, he said.

Dr. Rosenfield reported having no relevant financial disclosures.

ezimmerman@frontlinemedcom.com

On Twitter @eaztweets

NATIONAL HARBOR, MD. – Women with a greater body mass index (BMI) were less likely to need reoperation after hysterectomy, according to findings presented at the AAGL Global Congress.

“What’s unusual is women who are considered overweight or obese are generally thought to be at higher risk of any complication, including reoperation,” Janelle Moulder, MD, of the department of ob.gyn. at the University of Tennessee, Knoxville, said in an interview prior to the meeting. “We don’t have enough data to say what exactly might be protective. And to see that women who are at normal or below normal BMI were at increased risk makes you pause as to what could potentially put them at risk.”

Dr. Moulder and her colleagues analyzed data on 28,487 women who underwent an abdominal, vaginal, or laparoscopic hysterectomy from 2014 to 2015. The data came from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database.

Patients were excluded if they had cancer, their surgery was not performed by a gynecologist, or their BMI data was missing.

A majority of patients (13,000) had a BMI of 30 kg/m² or greater.

Compared with patients with a normal BMI of 24 kg/m², patients with a BMI of 39 kg/m² had the lowest odds of reoperation (adjusted odds ratio, 0.73; P = .02). Patients with BMIs of 29 kg/m² and 34 kg/m² were also at lower odds of reoperation, with adjusted odds ratios of 0.83 (P = .003) and 0.75 (P = .005), respectively.

Patients with a low normal BMI of 18.5 kg/m² were at a higher risk of reoperation (aOR = 1.33; P = .001).

Researchers were unable to comment on women with a BMI of 45 kg/m² or greater, due to the limited number of women in this group.

Researchers did not have access to the reason for reoperation, which may have limited the scope of the study.

“The next thing to be evaluated is what is the protective effect of the increasing BMI on reoperation and also look at variables that may put low normal BMI women at risk for reoperation,” Dr. Moulder said.

The researchers reported having no relevant financial disclosures.

ezimmerman@frontlinemedcom.com

On Twitter @eaztweets

NATIONAL HARBOR, MD. – Women with a greater body mass index (BMI) were less likely to need reoperation after hysterectomy, according to findings presented at the AAGL Global Congress.

“What’s unusual is women who are considered overweight or obese are generally thought to be at higher risk of any complication, including reoperation,” Janelle Moulder, MD, of the department of ob.gyn. at the University of Tennessee, Knoxville, said in an interview prior to the meeting. “We don’t have enough data to say what exactly might be protective. And to see that women who are at normal or below normal BMI were at increased risk makes you pause as to what could potentially put them at risk.”

Dr. Moulder and her colleagues analyzed data on 28,487 women who underwent an abdominal, vaginal, or laparoscopic hysterectomy from 2014 to 2015. The data came from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database.

Patients were excluded if they had cancer, their surgery was not performed by a gynecologist, or their BMI data was missing.

A majority of patients (13,000) had a BMI of 30 kg/m² or greater.

Compared with patients with a normal BMI of 24 kg/m², patients with a BMI of 39 kg/m² had the lowest odds of reoperation (adjusted odds ratio, 0.73; P = .02). Patients with BMIs of 29 kg/m² and 34 kg/m² were also at lower odds of reoperation, with adjusted odds ratios of 0.83 (P = .003) and 0.75 (P = .005), respectively.

Patients with a low normal BMI of 18.5 kg/m² were at a higher risk of reoperation (aOR = 1.33; P = .001).

Researchers were unable to comment on women with a BMI of 45 kg/m² or greater, due to the limited number of women in this group.

Researchers did not have access to the reason for reoperation, which may have limited the scope of the study.

“The next thing to be evaluated is what is the protective effect of the increasing BMI on reoperation and also look at variables that may put low normal BMI women at risk for reoperation,” Dr. Moulder said.

The researchers reported having no relevant financial disclosures.

ezimmerman@frontlinemedcom.com

On Twitter @eaztweets

NATIONAL HARBOR, MD. – Women with a greater body mass index (BMI) were less likely to need reoperation after hysterectomy, according to findings presented at the AAGL Global Congress.

“What’s unusual is women who are considered overweight or obese are generally thought to be at higher risk of any complication, including reoperation,” Janelle Moulder, MD, of the department of ob.gyn. at the University of Tennessee, Knoxville, said in an interview prior to the meeting. “We don’t have enough data to say what exactly might be protective. And to see that women who are at normal or below normal BMI were at increased risk makes you pause as to what could potentially put them at risk.”

Dr. Moulder and her colleagues analyzed data on 28,487 women who underwent an abdominal, vaginal, or laparoscopic hysterectomy from 2014 to 2015. The data came from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database.

Patients were excluded if they had cancer, their surgery was not performed by a gynecologist, or their BMI data was missing.

A majority of patients (13,000) had a BMI of 30 kg/m² or greater.

Compared with patients with a normal BMI of 24 kg/m², patients with a BMI of 39 kg/m² had the lowest odds of reoperation (adjusted odds ratio, 0.73; P = .02). Patients with BMIs of 29 kg/m² and 34 kg/m² were also at lower odds of reoperation, with adjusted odds ratios of 0.83 (P = .003) and 0.75 (P = .005), respectively.

Patients with a low normal BMI of 18.5 kg/m² were at a higher risk of reoperation (aOR = 1.33; P = .001).

Researchers were unable to comment on women with a BMI of 45 kg/m² or greater, due to the limited number of women in this group.

Researchers did not have access to the reason for reoperation, which may have limited the scope of the study.

“The next thing to be evaluated is what is the protective effect of the increasing BMI on reoperation and also look at variables that may put low normal BMI women at risk for reoperation,” Dr. Moulder said.

The researchers reported having no relevant financial disclosures.

ezimmerman@frontlinemedcom.com

On Twitter @eaztweets

NATIONAL HARBOR, MD – Patients who experience chronic pelvic pain have higher rates of adenomyosis than previously thought, suggest new findings presented at the AAGL Global Congress.

Samantha P. Nadella, MD, and her associates conducted a retrospective cohort study analyzing 101 women with chronic pelvic pain who underwent hysterectomy between April 2014 and December 2016. In total, 51 patients (50.5%) were found to have adenomyosis. Previous studies of adenomyosis had suggested an overall incidence rate of 20%-35%. Dr. Nadella, currently of Kaiser Permanente South Bay Medical Center in Harbor City, Calif., conducted the study during her fellowship in minimally invasive gynecology surgery at St. Joseph’s Hospital and Medical Center in Phoenix.

“Anytime women have pelvic pain, or abdominal pain, they are always sent to their gynecologist,” Dr. Nadella said in an interview. However, there are many disorders that may present with pelvic pain but are not related to uterine pathology, including pelvic floor muscle dysfunction, interstitial cystitis, and irritable bowel syndrome. As suggested in this study, pelvic pain is frequently present in patients with IBS, both with and without adenomyosis.

“When we’re talking about hysterectomy and surgical management for pelvic pain, we need to do our due diligence to make sure we are not missing more treatable disorders, especially those with conservative treatments,” Dr. Nadella said. “It is important to counsel patients who are undergoing surgery for pelvic pain by explaining what will happen and what they can expect, including postsurgical pain and need for ongoing treatments. Additionally, cross-disciplinary communication is key in delivering more effective and personalized treatment of pelvic pain.”

Dr. Nadella reported having no financial disclosures.

ilacy@frontlinemedcom.com

NATIONAL HARBOR, MD – Patients who experience chronic pelvic pain have higher rates of adenomyosis than previously thought, suggest new findings presented at the AAGL Global Congress.

Samantha P. Nadella, MD, and her associates conducted a retrospective cohort study analyzing 101 women with chronic pelvic pain who underwent hysterectomy between April 2014 and December 2016. In total, 51 patients (50.5%) were found to have adenomyosis. Previous studies of adenomyosis had suggested an overall incidence rate of 20%-35%. Dr. Nadella, currently of Kaiser Permanente South Bay Medical Center in Harbor City, Calif., conducted the study during her fellowship in minimally invasive gynecology surgery at St. Joseph’s Hospital and Medical Center in Phoenix.

“Anytime women have pelvic pain, or abdominal pain, they are always sent to their gynecologist,” Dr. Nadella said in an interview. However, there are many disorders that may present with pelvic pain but are not related to uterine pathology, including pelvic floor muscle dysfunction, interstitial cystitis, and irritable bowel syndrome. As suggested in this study, pelvic pain is frequently present in patients with IBS, both with and without adenomyosis.

“When we’re talking about hysterectomy and surgical management for pelvic pain, we need to do our due diligence to make sure we are not missing more treatable disorders, especially those with conservative treatments,” Dr. Nadella said. “It is important to counsel patients who are undergoing surgery for pelvic pain by explaining what will happen and what they can expect, including postsurgical pain and need for ongoing treatments. Additionally, cross-disciplinary communication is key in delivering more effective and personalized treatment of pelvic pain.”

Dr. Nadella reported having no financial disclosures.

ilacy@frontlinemedcom.com

NATIONAL HARBOR, MD – Patients who experience chronic pelvic pain have higher rates of adenomyosis than previously thought, suggest new findings presented at the AAGL Global Congress.

Samantha P. Nadella, MD, and her associates conducted a retrospective cohort study analyzing 101 women with chronic pelvic pain who underwent hysterectomy between April 2014 and December 2016. In total, 51 patients (50.5%) were found to have adenomyosis. Previous studies of adenomyosis had suggested an overall incidence rate of 20%-35%. Dr. Nadella, currently of Kaiser Permanente South Bay Medical Center in Harbor City, Calif., conducted the study during her fellowship in minimally invasive gynecology surgery at St. Joseph’s Hospital and Medical Center in Phoenix.

“Anytime women have pelvic pain, or abdominal pain, they are always sent to their gynecologist,” Dr. Nadella said in an interview. However, there are many disorders that may present with pelvic pain but are not related to uterine pathology, including pelvic floor muscle dysfunction, interstitial cystitis, and irritable bowel syndrome. As suggested in this study, pelvic pain is frequently present in patients with IBS, both with and without adenomyosis.

“When we’re talking about hysterectomy and surgical management for pelvic pain, we need to do our due diligence to make sure we are not missing more treatable disorders, especially those with conservative treatments,” Dr. Nadella said. “It is important to counsel patients who are undergoing surgery for pelvic pain by explaining what will happen and what they can expect, including postsurgical pain and need for ongoing treatments. Additionally, cross-disciplinary communication is key in delivering more effective and personalized treatment of pelvic pain.”

Dr. Nadella reported having no financial disclosures.

ilacy@frontlinemedcom.com

NATIONAL HARBOR, MD. – Elagolix, an oral gonadotropin-releasing hormone antagonist, improved dysmenorrhea and nonmenstrual pelvic pain for a year or more in women with surgically-diagnosed endometriosis in two extension studies.

Women who had participated in two pivotal, 6-month studies of elagolix were given the option to continue in an extension trial for another 6 months, Sukhbir S. Singh, MD, said at the AAGL Global Congress. He noted that “all my patients who completed the 6-month trial continued out to a year.”

Patients tracked their dysmenorrhea and nonmenstrual pelvic pain scores on a 4-point scale daily using an electronic pain impact diary. They were classified as being responders if they experienced reduced dysmenorrhea and nonmenstrual pelvic pain equal to or better than they had during the original trial (much or very much improved on the Patient Global Impression of Change scale).

For each dose of elagolix, rates of response seen at 6 months in the original trial were maintained at a year or longer of continuous treatment, demonstrating long-term efficacy, Dr. Singh said. The average number of analgesic pills taken per month decreased 46%-77% from baseline for all doses in the extension studies.

The most common adverse events were hot flushes, experienced by just over half (52%-55%) of women in the high-dose group and about 25%-30% of women in the lower-dose group. Severity was mild to moderate across the studies.

“The higher the dose you give, the more hot flushes you get,” said Dr. Singh, vice chair of gynecology at the University of Ottawa, Ontario. “But overall, patients often did not complain of this because they were getting pain relief as well.”

Other adverse events included headache in about 25%-30% of high-dose patients and 20% of low-dose patients, as well as nausea in about one-fifth of patients overall. Some decreases from baseline in bone mineral density were seen but there was progressive improvement upon discontinuation of elagolix, Dr. Singh noted.

Importantly, “these were patients who had endometriosis and pain, similar in makeup to groups studied by others. These studies did provide two dosing options to offer individualized approaches and pain results were controlled for use of rescue analgesia. But as extension trials, the studies are limited by having no placebo control and we did not know whether they had deep endometriosis or other pain issues,” Dr. Singh said.

Elagolix represents another treatment option for patients with endometriosis, Dr. Singh said. “One of the objections to taking currently approved [gonadotropin-releasing hormone] antagonists is that they are subcutaneous injections. Patients don’t like that – this is an oral option. It is quick to act and is rapidly reversible as well.”

Dr. Singh serves as a principal investigator and speaker for Allergan, AbbVie, and Bayer. The studies were sponsored by AbbVie.
 

dfulton@frontlinemedcom.com

On Twitter @denisefulton

NATIONAL HARBOR, MD. – Elagolix, an oral gonadotropin-releasing hormone antagonist, improved dysmenorrhea and nonmenstrual pelvic pain for a year or more in women with surgically-diagnosed endometriosis in two extension studies.

Women who had participated in two pivotal, 6-month studies of elagolix were given the option to continue in an extension trial for another 6 months, Sukhbir S. Singh, MD, said at the AAGL Global Congress. He noted that “all my patients who completed the 6-month trial continued out to a year.”

Patients tracked their dysmenorrhea and nonmenstrual pelvic pain scores on a 4-point scale daily using an electronic pain impact diary. They were classified as being responders if they experienced reduced dysmenorrhea and nonmenstrual pelvic pain equal to or better than they had during the original trial (much or very much improved on the Patient Global Impression of Change scale).

For each dose of elagolix, rates of response seen at 6 months in the original trial were maintained at a year or longer of continuous treatment, demonstrating long-term efficacy, Dr. Singh said. The average number of analgesic pills taken per month decreased 46%-77% from baseline for all doses in the extension studies.

The most common adverse events were hot flushes, experienced by just over half (52%-55%) of women in the high-dose group and about 25%-30% of women in the lower-dose group. Severity was mild to moderate across the studies.

“The higher the dose you give, the more hot flushes you get,” said Dr. Singh, vice chair of gynecology at the University of Ottawa, Ontario. “But overall, patients often did not complain of this because they were getting pain relief as well.”

Other adverse events included headache in about 25%-30% of high-dose patients and 20% of low-dose patients, as well as nausea in about one-fifth of patients overall. Some decreases from baseline in bone mineral density were seen but there was progressive improvement upon discontinuation of elagolix, Dr. Singh noted.

Importantly, “these were patients who had endometriosis and pain, similar in makeup to groups studied by others. These studies did provide two dosing options to offer individualized approaches and pain results were controlled for use of rescue analgesia. But as extension trials, the studies are limited by having no placebo control and we did not know whether they had deep endometriosis or other pain issues,” Dr. Singh said.

Elagolix represents another treatment option for patients with endometriosis, Dr. Singh said. “One of the objections to taking currently approved [gonadotropin-releasing hormone] antagonists is that they are subcutaneous injections. Patients don’t like that – this is an oral option. It is quick to act and is rapidly reversible as well.”

Dr. Singh serves as a principal investigator and speaker for Allergan, AbbVie, and Bayer. The studies were sponsored by AbbVie.
 

dfulton@frontlinemedcom.com

On Twitter @denisefulton

NATIONAL HARBOR, MD. – Elagolix, an oral gonadotropin-releasing hormone antagonist, improved dysmenorrhea and nonmenstrual pelvic pain for a year or more in women with surgically-diagnosed endometriosis in two extension studies.

Women who had participated in two pivotal, 6-month studies of elagolix were given the option to continue in an extension trial for another 6 months, Sukhbir S. Singh, MD, said at the AAGL Global Congress. He noted that “all my patients who completed the 6-month trial continued out to a year.”

Patients tracked their dysmenorrhea and nonmenstrual pelvic pain scores on a 4-point scale daily using an electronic pain impact diary. They were classified as being responders if they experienced reduced dysmenorrhea and nonmenstrual pelvic pain equal to or better than they had during the original trial (much or very much improved on the Patient Global Impression of Change scale).

For each dose of elagolix, rates of response seen at 6 months in the original trial were maintained at a year or longer of continuous treatment, demonstrating long-term efficacy, Dr. Singh said. The average number of analgesic pills taken per month decreased 46%-77% from baseline for all doses in the extension studies.

The most common adverse events were hot flushes, experienced by just over half (52%-55%) of women in the high-dose group and about 25%-30% of women in the lower-dose group. Severity was mild to moderate across the studies.

“The higher the dose you give, the more hot flushes you get,” said Dr. Singh, vice chair of gynecology at the University of Ottawa, Ontario. “But overall, patients often did not complain of this because they were getting pain relief as well.”

Other adverse events included headache in about 25%-30% of high-dose patients and 20% of low-dose patients, as well as nausea in about one-fifth of patients overall. Some decreases from baseline in bone mineral density were seen but there was progressive improvement upon discontinuation of elagolix, Dr. Singh noted.

Importantly, “these were patients who had endometriosis and pain, similar in makeup to groups studied by others. These studies did provide two dosing options to offer individualized approaches and pain results were controlled for use of rescue analgesia. But as extension trials, the studies are limited by having no placebo control and we did not know whether they had deep endometriosis or other pain issues,” Dr. Singh said.

Elagolix represents another treatment option for patients with endometriosis, Dr. Singh said. “One of the objections to taking currently approved [gonadotropin-releasing hormone] antagonists is that they are subcutaneous injections. Patients don’t like that – this is an oral option. It is quick to act and is rapidly reversible as well.”

Dr. Singh serves as a principal investigator and speaker for Allergan, AbbVie, and Bayer. The studies were sponsored by AbbVie.
 

dfulton@frontlinemedcom.com

On Twitter @denisefulton