Highlights from 41st Annual Association of Gynecologic Laparoscopists Meeting in
Las Vegas

November 9, 2012

New data: Consider the robot a safe and effective option for gynecologic surgery

LAS VEGAS—In a presentation of recent findings on various aspects of the robotic approach to gynecologic surgery, researchers offered data that largely confirmed the safety and efficacy of robot-assisted surgeries. For example, Ruhee K. Sidhu, MD, of Providence Hospital in Southfield, Michigan, described a comparison of robot-assisted laparoscopic hysterectomy and abdominal hysterectomy for benign indications. Although the robot was associated with longer surgical time, the rate of complications was lower among women who underwent robot-assisted laparoscopic hysterectomy, compared with those who had abdominal hysterectomy.

And in a look at long-term outcomes and patient satisfaction in women undergoing myomectomy via laparotomy versus two minimally invasive approaches (mini-laparotomy and robot-assisted laparoscopy), investigators found no significant differences in long-term outcomes or patient satisfaction between the approaches, according to Mark Hoffman, MD, of the University of Michigan.

Surgery should be the last option for heavy menstrual bleeding

LAS VEGAS—Linda D. Bradley, MD, of the Cleveland Clinic described optimal assessment and medical management of heavy menstrual bleeding. For example, she noted that thorough evaluation of the endometrium via hysteroscopy or saline-infusion sonography can aid the clinician in determining the most effective treatment approach, as can liberal use of endometrial biopsy. Don’t overlook the possibility of inherited coagulation disorders, Dr. Bradley advised. In many cases, the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena) can greatly reduce or eliminate heavy menstrual bleeding, and tranexamic acid (Lysteda) is a valuable and effective alternative. Either approach can avert the need for surgery in many women.

Approach the adnexal mass systematically to ensure optimal outcomes

LAS VEGAS—Robert W. Holloway, MD, from the Florida Hospital Cancer Institute in Orlando, Florida, and Yukio Sonoda, MD, from Memorial Sloan-Kettering Cancer Center in New York City, described evaluation and surgical criteria, and presented surgical tutorials on the laparoscopic and robot-assisted laparoscopic management of adnexal masses.

Among their recommendations:

• Even when the physical examination, radiographic findings, and tumor markers suggest that a mass is benign, evaluate the interior of the tumor in the operative suite to determine whether frozen section analysis is warranted.

• Take steps to avoid intraoperative rupture of the lesion, which can increase the risk of recurrence and death if malignancy is present, by placing the mass in an endobag and rupturing it only after it has been removed from the body.

• Reserve the robotic approach for cases that have no ascites or upper abdominal metastatic disease and for cysts smaller than 12 to 14 cm—and then only with careful preoperative analysis and informed consent.

Essure^® Insert Expulsion After 3-Month Confirmatory HSG

LAS VEGAS—Amy Garcia, MD, and colleagues from Center for Women’s Surgery in Albuquerque, New Mexico, report the first case of Essure insert expulsion after 3-month hysterosalpinogram (HSG) confirmation of bilateral tubal occlusion and bilateral correct placement. The insert was expelled during withdrawal bleeding the patient experienced after discontinuing her oral contraceptive. Although reports of expulsion of an Essure insert occurring before 3-month HSG have been published, Dr. Garcia and colleagues’ documented case informs practitioners of this rare occurrence, and prompts further investigation into the cause of such an event.

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