Uterine artery embolization for uterine arteriovenous malformation in five women desiring fertility: pregnancy outcomes.

Uterine arteriovenous malformations (AVM) are rare and can be classified as either congenital or acquired. Acquired AVMs may result from trauma, uterine instrumentation, infection or gestational trophoblastic disease. The majority of acquired AVMs are encountered in women of reproductive age with a history of at least one pregnancy.

Post-uterine artery embolization pain and clinical outcomes for symptomatic myomas using gelfoam pledgets alone versus embospheres plus gelfoam pledgets: a comparative pilot study.

Background: To evaluate the efficacy and post-procedural pain associated with uterine artery embolization (UAE) using Gelfoam alone versus Embospheres plus Gelfoam in women with symptomatic uterine fibroids.

Method: We conducted a prospective, non-randomized pilot study. Fluoroscopy-guided trans-femoral artery UAE was performed using Gelfoam pledgets alone or Embospheres (500 to 700 mg) plus Gelfoam under conscious sedation and local anaesthesia.

Resolution of catamenial epilepsy after goserelin therapy and oophorectomy: case report of presumed cerebral endometriosis.

Endometriosis can develop in every organ and tissue in the female body except perhaps the spleen. The mechanism of distal metastasis is thought to be hematogenous or lymphatic spread from the uterus. Endometriotic lesions in the central nervous system are rare.

Transvaginal Doppler-guided uterine artery occlusion for the treatment of symptomatic fibroids: summary results from two pilot studies.

Objective: To evaluate the feasibility, safety, and short-term efficacy of bilateral uterine artery occlusion, using a transvaginal Doppler-guided vascular clamp as a minimally invasive therapy for symptomatic uterine leiomyomas.

Methods: We conducted two prospective, non-randomized, phase I pilot studies (Canadian Task Force Classification II-2) at a university-affiliated teaching hospital. Between June 2004 and May 2005, 30 premenopausal women with symptomatic uterine leiomyomas underwent bilateral uterine artery occlusion using a transvaginal Doppler-guided vascular clamp.

Comparison of clinical outcomes with low-voltage (cut) versus high-voltage (coag) waveforms during hysteroscopic endometrial ablation with the rollerball: a pilot study.

Study Objective: To compare efficacy of rollerball endometrial ablation with low-voltage (cut) versus high-voltage (coag) waveforms.

Design: Pilot comparative clinical study (Canadian Task Force Classification II-1).

Setting: University-affiliated teaching hospital.

Miscellaneous uterine malignant neoplasms detected during hysteroscopic surgery.

Study Objectives: To estimate the incidence of incidental miscellaneous uterine malignant neoplasms other than endometrioid adenocarcinoma detected during routine resectoscopic surgery in women with abnormal uterine bleeding (AUB) and to examine the effect of hysteroscopic surgery on long-term clinical outcome.

Design: Prospective cohort study (Canadian Task Force classification II-3).

Setting: University-affiliated teaching hospital.

Three simple steps during closed laparoscopic entry may minimize major injuries.

Objectives: To describe three steps: (1) the initial Veress pressure (VIP-Pressure), (2) transient high-pressure pneumoperitoneum (HIP-Entry) prior to trocar/cannula insertion, and (3) visual entry with a trocarless cannula during closed laparoscopic entry, which may reduce major injuries.

Design: Prospective observational cohort study (Canadian Task Force Classification II-2).

Setting: University-affiliated teaching hospital.

Leiomyosarcoma diagnosed six years after laparoscopic electromyolysis.

Background: Making a histologic diagnosis of leiomyosarcoma in the specimen from a hysterectomy performed for suspected benign fibroids is rare. Currently, there are no reliable diagnostic tools to diagnose uterine sarcomas preoperatively.

Case: A 38-year-old woman presented with menorrhagia and a uterine fibroid measuring 6.

Hysteroscopic surgery does not adversely affect the long-term prognosis of women with endometrial adenocarcinoma.

Study Objective: To determine the effect of hysteroscopic surgery on the long-term clinical outcome of women diagnosed with endometrial cancer.

Design: Prospective cohort study (Canadian Task Force classification II-3).

Setting: University-affiliated teaching hospital.

Endometrioid adenocarcinoma treated by hysteroscopic endomyometrial resection.

A 53-year-old multiparous woman, with no identifiable risk factor for endometrial cancer, presented with menorrhagia. She had been treated with oral contraceptives for 3 years. Office endometrial biopsy indicated well-differentiated villoglandular adenocarcinoma of the endometrium.

Resectoscopic surgery may be an alternative to hysterectomy in high-risk women with atypical endometrial hyperplasia.

Study Objective: Endometrial hyperplasia is found in 2% to 10% of women with abnormal uterine bleeding (AUB). Up to 43% of patients with cytologic atypia harbor coexisting adenocarcinoma, and approximately 20% to 52% of atypical hyperplasias, if untreated, progress to cancer. The objective of this study was to estimate the incidence of atypical endometrial hyperplasia encountered during routine resectoscopic surgery in women with AUB and to evaluate the role of resectoscopic surgery in the management of women with AUB and atypical endometrial hyperplasia who refused and/or were at high risk for hysterectomy.

Uterine artery occlusion: what is the evidence?

Symptomatic uterine fibroids are a relatively common gynecologic condition. In the past, fibroids were exclusively treated by myomectomy and/or hysterectomy. With the advent of uterine artery embolization or uterine artery occlusion, there now exist minimally invasive approaches to fibroid therapy especially for women in whom surgery is contraindicated or for those who wish to retain their uterus and possibly fertility.

Laparoscopic findings, histopathologic evaluation, and clinical outcomes in women with chronic pelvic pain after hysterectomy and bilateral salpingo-oophorectomy.

Study Objective: To laparoscopically evaluate the pelvis of patients with chronic pelvic pain after hysterectomy and bilateral salpingo-oophorectomy, to determine any associated factors to the pain.

Design: Retrospective cohort of patients with chronic pelvic pain after hysterectomy and bilateral salpingo-oophorectomy (Canadian Task Force Classification II-2).

Setting: University-affiliated teaching hospital.

Effect of body habitus and parity on insufflated CO2 volume at various intraabdominal pressures during laparoscopic access in women.

Study Objective: To determine height, weight, body mass index (BMI), parity, and age effect on the volume of CO2 pneumoperitoneum during laparoscopic access in women.

Design: Prospective observational cohort study (Canadian Task Force classification II-1).

Setting: University-affiliated teaching hospital.

Fertility and pregnancy outcomes following hysteroscopic septum division.

Objectives: We sought to evaluate retrospectively the efficacy of hysteroscopic metroplasty in a population of women with a history of recurrent pregnancy loss or infertility who were also known to have a uterine septum.

Methods: Hysteroscopic metroplasty was performed on 26 women with a uterine septum and a history of either recurrent pregnancy loss or infertility. The metroplasty was performed using a Versapoint bipolar needle device (in 23% of cases) or a resectoscopic knife electrode with cutting current (in 77% of cases).

Effect of body habitus and parity on the initial Veres intraperitoneal CO2 insufflation pressure during laparoscopic access in women.

Study Objectives: Since most gynecologists use the Veres/trocar entry, and because the Veres intraperitoneal (VIP) pressure appears to be the most reliable indicator of correct Veres needle placement, the objective of this study was to determine the effect of height, weight, body mass index (BMI), parity, and age on the initial Veres intraperitoneal CO2 insufflation pressure during laparoscopic access in women.

Design: Prospective observational cohort study (Canadian Task Force classification II-1).

Setting: University affiliated teaching hospital.

High-pressure laparoscopic entry does not adversely affect cardiopulmonary function in healthy women.

Study Objective: To determine hemodynamic and pulmonary compliance changes during laparoscopic entry using transient hyperinsufflated pneumoperitoneum.

Design: Prospective observational cohort study (Canadian Task Force classification II-1).

Setting: University-affiliated teaching hospital.

Laparoscopic mobilization of the rectosigmoid and excision of the obliterated cul-de-sac.

Study Objective: To evaluate the feasibility and surgical and clinical outcomes of laparoscopic excision of anterior recto-sigmoid wall endometriosis and en bloc dissection of the obliterated cul-de-sac.

Design: Retrospective cohort (Canadian Task Force classification II-2).

Setting: University-affiliated teaching hospital.