www.minimalinvazivjinekolojikcerrahi.org
21 - 25 Şubat 2018
Wyndham Grand İstanbul Levent • İstanbul
MİNİMAL İNVAZİV JİNEKOLOJİK
CERRAHİ KONGRESİ
SS-03
A new method used in laparoscopic hysterectomy for uterine manipulation: “Uterine Rein
Technique’’
Abdullah Boztosun
1
, Remzi Atılgan
2
,
Şehmus Pala
2
, Şafak Olgan
1
1
Department of Obstetrics and Gynecology, Akdeniz University, Antalya, Turkey
2
Department of Obstetrics and Gynecology, Firat University, Elazig, Turkey
OBJECTIVE: The current study aimed to describe a novel technique allowing abdominal
manipulation of the uterus during laparoscopic hysterectomy.
MATERIALS-METHODS: Total laparoscopic hysterectomy with newly defined technique was
performed in 29 patients between July 2016 and July 2017. Preparation of polyester tape was
described in Figure 1. The pre-operatively prepared tape was inserted
into the intraabdominal
cavity after ligation of infundibulopelvic and round ligaments (before ligating uterine arteries).
After being wrapped around uterus at a location just above corpus-isthmus level, both ends of
tape A were tied anteriorly. Subsequently, one of the free ends of tape A was passed through
the ring of tape B at uterine fundus level and tied with the other free end of tape A. Finally,
after being checked for the position and tightness, the remaining free ends of tape A were cut
and taken out through port site.
After this stage, manipulation of the uterus was performed by
grasping of the polyester tape (Figure 1-3).
RESULTS: Technique was successfully performed in a single attempt in 93.1% of cases. Uterine
tape released in two cases (6.9%) with myoma uteri and thus the procedure had to be repeated.
The mean application time was 11.2 minutes (min-max, 7-25 minutes). The mean operation
duration was 120 minutes (min-max, 40-200 minutes). Vaginal manipulator was not required in
any of the cases. There were no intraoperative or postoperative major complications within the
mean follow-up period of 6 months.
CONCLUSION: Our technique has several advantages including no need for any vaginal
manipulator, reduced number of assistants required during operation, allowing near maximum
manipulation of
uterus in all three dimensions, and enable the surgeons to control the
manipulations directly. Finally, our preliminary results on the use of uterine rein technique are
promising and justify further investigation in larger prospective studies.
Keywords: laparoscopic hysterectomy, uterine manipulator, uterine rein technique
21 - 25 Şubat 2018
Wyndham Grand İstanbul Levent • İstanbul
MİNİMAL İNVAZİV JİNEKOLOJİK
CERRAHİ KONGRESİ
www.minimalinvazivjinekolojikcerrahi.org
figure 1
Two pieces of a polyester tape, 50 cm (A) and 25 cm (B), were used for this procedure.
Both ends of
the tape B were tied to the middle of the tape A within 2 cm distance. Then, by tying a simple knot on
the unbound free end of tape B, an additional circle (C) was generated (1-2 cm diameter) which was
going to be used to restrain the uterus.
figure2
Manipulation of uterus by grasping the polyester tape
figure3
Manipulation of uterus by grasping the polyester tape
www.minimalinvazivjinekolojikcerrahi.org
21 - 25 Şubat 2018
Wyndham Grand İstanbul Levent • İstanbul
MİNİMAL İNVAZİV JİNEKOLOJİK
CERRAHİ KONGRESİ
SS-04
The effect of the levonorgestrel-releasing intrauterine device used in the abnormal
uterine bleeding treatment related to uterine leiomyomas on uterine artery blood flows,
leiomyoma size and uterine volume
Hatice Kansu Çelik
Zekai Tahir Burak Woman’s Health, Education and Research Hospital, Health Science University,
Ankara, Turkey
OBJECTIVES: A prospective cohort study was carried out to evaluate uterine volume, uterine
leiomyoma size, uterine artery blood flows in women using the
levonorgestrel intrauterine
system (LNG-IUS) to treat abnormal uterine bleeding related to leiomyomas.
MATERIALS-METHODS: 30 premenopausal women attending our gynecology clinic due
to abnormal uterine bleeding related to uterine myomas were enrolled into the study. The
age, gravidity, body mass index (BMI) and menstrual flow pattern using a Pictorial Blood Loss
Assessment Chart (PBAC) score were recorded. All women were assessed by ultrasonography
at the preinsertion period and 6 months after insertion. The pulsatility and resistance indices (PI
and RI, respectively) of the uterine artery, endometrial thickness, uterine volume, and leiomyoma
size were evaluated in the preinsertion and postinsertion periods.
RESULTS: 2 patients underwent spontaneous expulsion of the device after 1 and 2 months
of follow-up. The mean age of the patients was 47.36+/-2.16 years. At 6
months follow-up, 2
women had a hysterectomy. 3 patients were amenorrheic (Tabel 1). The PBAC score and
the mean endometrial thickness were decreased 6 months after insertion; these decreases
were statistically significant (p<0.001). Also, the hemoglobin level was increased (p=0.001). A
reduction in mean uterine volume and leiomyoma size, and an increase in mean uterine artery PI
were observed, but these changes did not reach statistical significance (p = 0.654, p=0.509 and
p = 0.07, respectively) (Table 2).
CONCLUSIONS: LNG-IUS seems
to reduce menstrual blood loss, endometrial thickness with
no change in the blood flow in the uterine artery. Also, it increases hemoglobin levels in the
premenopausal women with uterine leiomyomas even in the absence of reduction of uterine
and leiomyoma volume.
Keywords: Levonorgestrel intrauterine system, Doppler flow, Leiomyoma,
Abnormal uterine
bleeding, Ultrasonography