Journal of The American Association of Gynecologic Laparoscopists 

About: Journal of The American Association of Gynecologic Laparoscopists is an academic journal. The journal publishes majorly in the area(s): Laparoscopy & Hysterectomy. It has an ISSN identifier of 1074-3804. Over the lifetime, 1634 publications have been published receiving 28317 citations.

Selective uterine artery embolization as primary treatment for symptomatic leiomyomata uteri.

Abstract: Study Objective. To analyze initial experience with uterine artery embolization for treatment of symptomatic leiomyomata. Design. Prospective, longitudinal study (Canadian Task Force classification II-2). Setting. Private practice, university-affiliated hospital. Patients. Three hundred five women (age 26–52 yrs). Interventions. Uterine artery embolization, performed over 2 years by a single radiologist working in collaboration with a single gynecology practice. Measurements and Main Results. Embolization was technically successful in 96% of patients. No major complications occurred. Average reduction in uterine volume was 48%. Control of menorrhagia was reported by 86% of patients at 3 months, 85% at 6 months, and 92% at 12 months after the procedure. Bulk symptoms were satisfactorily controlled in 64% of patients at 3 months, 77% at 6 months, and 92% at 12 months. Six women subsequently underwent hysterectomy and five had myomectomy. Conclusion. Uterine artery embolization appears to be a highly effective treatment for symptomatic uterine leiomyomata. Its impact on fertility and pregnancy remain to be investigated fully.

The learning curve of total laparoscopic hysterectomy: comparative analysis of 1647 cases.

Abstract: Study Objective To compare the frequency of complications of total laparoscopic hysterectomy performed in the first and more recent years of our experience, and based on that, offer ways to prevent them. Design Retrospective, comparative study (Canadian Task Force classification II-2). Setting University tertiary referral center for endoscopic surgery. Patients During 1989–1995 and 1996–1999, 695 and 952 women, respectively, with benign pathology. Intervention Total laparoscopic hysterectomy. Measurements and Main Results differences in patient characteristics were found between 1989–1995 and 1996–1999. Substantial decreases in major complication rates were noted, 5.6% and 1.3%, respectively. No major vessel injury occurred. Excessive hemorrhage (1.9%) and need for blood transfusion (2.2%) during the first period were statistically higher than in the second period (both 0.1%, p Conclusion Laparoscopic hysterectomy was safe, effective, and reproducible after training, and with current technique, had a low rate of complications.

A Vaginoscopic Approach to Reduce the Pain of Office Hysteroscopy

Abstract: We developed a new approach to diagnostic hysteroscopy that reduces patient discomfort and increases the possible applications of hysteroscopy. Between February 1992 and March 1996, 1200 hysteroscopies were performed at our institution. Of these, the last 680 were done using the vaginoscopic approach without preselection. Discomfort was reduced in all patients, including those with moderate stenosis of the internal cervical os. Vaginoscopy is easy to perform and incurs no additional cost for the patient. It is ideal for office hysteroscopy and in patients who otherwise might require general anesthesia, such as virgins and older women with somewhat stenotic vaginas.

Correlation between endometriosis and pelvic pain.

Abstract: Study Objective. To evaluate the relationship between prevalence and severity of chronic pelvic pain (CPP) and stage, site, and type of endometriosis. Design. Prospective, observational study (Canadian Task Force classification II-2). Setting. University Hospital. Patients. Of 90 consecutive women with biopsy-proved endometriosis, laparoscopy was performed in 69 for pelvic pain and in 21 for infertility or clinical and ultrasonographic suspicion of ovarian endometriosis. Intervention. Preoperatively, using a 10-point visual analog scale, the severity of dysmenorrhea, CPP, and deepdyspareunia was assessed. During laparoscopy all visible endometriotic lesions were recorded and treated. Measurements and Main Results. Ten women (11.1%) had no pain; 72 had dysmenorrhea (mild in 13, moderatein 37, severe in 22); 55 had CPP (mild in 11, moderate in 25, severe in 19); and 39 deep dyspareunia (mild in 5, moderate in 31, severe in 3). The severity of dysmenorrhea significantly correlated with the presence and extent of pelvic adhesions (p=0.004); the severity of CPP correlated with deep endometriosis on the uterosacral ligaments (p=0.0001) and extent of pelvic adhesions (p=0.02); and deep dyspareunia correlated with deep endometriosis on the uterosacral ligaments (p=0.04). Total pain score significantly correlated with deep endometriosis on the uterosacral ligaments (p=0.0001), peritoneal adhesions (p=0.01), and extent of adnexal adhesions (p=0.01). No significant correlation was found among revised American Fertility Society stage of endometriosis; presence and size of ovarian endometriomas; extent, type, and site of peritoneal lesions; and pain scores. By logistic regresion analysis, the presence and intensity of total pain could be predicted simultaneously by the presence of deep endometriosis (p=0.0001) and presence and extent of adnexal adhesions without cystic endometriosis (p=0.01), and by the presence of ovarian endometrioma with periovarian adhesions (p=0.03). Chronic pelvic pain was predicted by both deep endometriosis (p=0.0001) and ovarian endometriomas with adnexal adhesions (p=0.03). Deep dyspareunia was predicted simultaneously by deep endometriosis (p=0.01) and an ovarian endometrioma with periovarian adhesions (p=0.008). Conclusion. Deep endometriosis, pelvic adhesions, and ovarian cystic endometriosis were independent predictors of pelvic pain. These data strongly suggest that it is not the size of ovarian cystic endometriosis but the association with adhesions that causes pelvic pain.

Operative office hysteroscopy without anesthesia: analysis of 4863 cases performed with mechanical instruments.

Abstract: Study Objective To evaluate the efficacy of, and patients' satisfaction with, office hysteroscopic treatment of benign intrauterine pathologies using 5F hysteroscopic instruments. Design Observational clinical study (Canadian Task Force classification II). Setting University center. Patients Four thousand eight hundred sixty-three (4863) women. Intervention Office hysteroscopy without analgesia or anesthesia. Measurements and Main Results We used 5F mechanical instruments (scissors, grasping forceps) to treat cervical and endometrial polyps ranging between 0.2 and 3.7 cm, as well as intrauterine adhesions and anatomic impediments. From 71.9% to 93.5% of women underwent the procedure without discomfort for all pathologies treated except endometrial polyps larger than the internal cervical os, for which 63.6% experienced low or moderate pain. At 3-month follow-up, pathology persisted in 364 patients (5.6%). Conclusion Simple instruments enable us to perform many operative procedures in an office setting with excellent patient satisfaction, provided that the indications are correct.