Journal of Gynecologic Surgery

Objective: The aim of this study was to determine the number and types of complications associated with the use of minimally invasive nonhysteroscopic methods of endometrial ablation. Method: The Food and Drug Administration (FDA) website was searched and complications associated with the Hydrothermablator, Thermachoice, Novasure, and Microwave ablation devices were tabulated. Additionally, complications associated with the Hydrothermablator were tabulated within a single hospital system to compare with national data recorded by the FDA. Results: Each device was associated with a number of serious complications. Similarly, each device was observed to have particular complications, which uniquely footprinted a given instrument. The Hydrothermablator had 16 adverse events. The single hospital system compiled 6 Hydrothermablator-associated complications alone. None of the latter were included in the FDA data. The Novasure device had 32 adverse events. The Thermachoice had 22 events and 1 death. The Microwave had 20 events, among which 13 were intestinal burn injuries. Conclusions: Nonhysteroscopic ablation devices are associated with a variety of serious complications. The FDA database is incomplete and underreports these adverse events. (J. GYNECOL SURG 23:7)

Purpose: The aim of this study was to evaluate the effect of uterine artery embolization (UFE) on ovarian function. Methods: Sixty (60) patients with ultrasonographic diagnosis of uterine leiomyomata were subjected to UFE with polyvinyl alcohol particles. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E₂) levels were determined directly before, and subsequently 3 and 12 months after, the procedure between days 2 and 5 of the menstrual cycle. Results: The mean age of the participants was 43.1 years (age range, 32–51). There was no statistically significant difference in FSH, LH, and E 2 levels before and 3 and 12 months after UFE in patients with an age range of 30–44 (Group 1). FSH and LH levels were significantly increased, and E₂ levels were significantly decreased, at 3 and 12 months after UFE in patients older than 45 (Group 2). Ovarian failure occurred in 19 patients (31%). Among those 19 patients, 14 (74%) developed permanent ovarian failure, and these patients were women older than 45 years. All statistical analyses were completed with the use of the Friedman test, and p-values less than 5% were considered statistically significant. Conclusions: Ovarian function may be compromised following UFE, especially in women older than 45. (J GYNECOL SURG 23:13)

Objective: The aim of this study was to determine whether benign uterine leiomyomata results in an elevation of serum CA-125, and whether the weight of the uterine specimen affects CA-125 levels. Study Design: This study was an institutional review board–approved retrospective chart review. The patients ages ranged from 18 to 75 years, and patients were identified as they presented with a large pelvic mass. A serum CA-125 level was drawn as part of the preoperative workup for this study. A Pearson's linear correlation coefficient was calculated for the uterine weight versus the CA-125 level. Results: Forty-five (45) of 77 patients had only leiomyomata at surgery and pathologic exam, and they were the subjects who participated in this study. The patients′ mean uterine weight was 928 g (standard deviation [SD]±691), the mean CA-125 was 17.7 (SD±11.0), and mean patient age was 43 years (SD±8.3). Four (4) of 45 women (8.9%) had an elevated CA-125. The correlation coefficient for uterine weight versus CA-125 level was not significant (R=0.23). Conclusions: Serum CA-125 does not correlate with uterine weight. Few patients with leiomyomata and no other pathology would have an elevated CA-125. An abnormal CA-125 should alert the treating clinician to the potential for a pathology other than leiomyomata. (J GYNECOL SURG 23:19).

Introduction: Uterine arteriovenous malformations (AVMs) are very rare vascular lesions that can be fatal if left untreated. Early radiologic detection and optimal treatment by an accomplished surgeon is essential to maximize patient survival. Case Report: In this paper, the authors present the case of a 49-year-old patient with a significant history of menorrhagia, anemia, and pelvic mass. She had a pelvic ultrasound that revealed a distended uterus, which was suggestive of multiple enlarged uterine and infundibular pelvic AVMs. The patient underwent a complicated abdominal hysterectomy and bilateral-salpingo oophorectomy with right ureteral ligation. The patient has done well postoperatively. Conclusions: Arteriovenous malformations in the uterus are often undetected in patients with menorrhagia or anemia. Therefore, clinical diagnosis may be delayed, adversely affecting patient prognosis. Comprehensive imaging, multispecialty invasive radiology, and surgical management are needed to treat these patients. (J GYNECOL SURG 23:23)

Introduction: Laparoscopic retrieval of an ovarian cyst should aim at an intact removal, with minimal or no content spillage into the peritoneal cavity. By using the bag-retrieval technique, cystic ovarian masses can be collected, aspirated, and decompressed inside a closed system upon retrieval. However, laparoscopic retrieval of a solid ovarian mass is difficult and often has to be removed piece by piece, using an electric morcellator. It is not uncommon for specimen fragments to be spilled out into the abdomen during morcellation, requiring searching and individual removal afterward. Some of these fragments may still be left inside the abdominal cavity, and this will cause a major problem in cases of unexpected malignancy. Case Report: In this paper, the authors describe a new approach to prevent specimen spillage during laparoscopic removal of a large, solid ovarian mass. By cutting one side of a zipper bag, a pouch was created to shield off and protect the pelvic organs as well as the bowels in the lower abdomen. By morcellating the solid ovarian tumor over this pouch, we can collect the spilled-out fragments to minimize the risk of contamination. Conclusions: Our technique is simple and inexpensive, easy to perform, and minimizes the risk of bag perforation during morcellation. (J GYNECOL SURG 23:31)

Aggressive angiomyxoma is an uncommon neoplasm of undetermined origin that predominantly involves the pelvis and perineum of young females. The tumor is slow growing, locally infiltrative, and highly recurrent yet is biologically benign. In this paper, the authors report on the occurrence of aggressive angiomyxoma of the vulva in a 30-year-old female, which became aggravated in two subsequent pregnancies and required repeated excision. The presence of estrogen receptors in the tumor and its enlargement in pregnancy suggest the possibility of hormone dependence of this neoplasm. (J GYNECOL SURG 23:37)

Carcinoma of the fallopian tube is a rare occurrence. In this paper, the authors report on a case of endometrioid adenocarcinoma of the fallopian tube that was initially misdiagnosed as endometrial carcinoma. The diagnostic dilemma and implications are discussed. (J GYNECOL SURG 23:41)