ABSTRACT
To verify the technical feasibility and safety of endometrial ablation with a vaporizing electrode (Vaportrode), we performed operative hysteroscopy in a consecutive series of 40 women (mean ± SD age 45.3 ± 4.7 yrs) with established menorrhagia and uterine volume less than 12 weeks' gestation. The results in 26 women with a regular uterine cavity were compared with those in 14 patients who had submucous myomas with less than 50% intramural extension. Surgery was undertaken after 2-month treatment with a depot gonadotropin-releasing hormone agonist. Pure cutting current was set at 200 W. Mean ± SD operating time was 8.6 ± 2.4 minutes in women with a regular cavity and 14.4 ± 5.2 in those with submucous myomas (mean difference 5.8 minutes, 95% CI 3.4-8.3). Corresponding values for distention fluid absorption were, respectively, 76 ± 103 and 227 ± 138 ml (mean difference 151 ml, 95% CI 73-229). A significant correlation was observed between operating time and distention fluid deficit (Spearman r = 0.47, p = 0.002). No complications occurred and all the procedures were performed as day surgery. After a mean follow-up of 4 months, no recurrence of menorrhagia was reported. Endometrial ablation with the Vaportrode is rapid, effective, and safe. Fluid deficit, although significantly greater in women with submucous myomas than in those with regular cavities, always remained within safety limits and below the usual values observed after resection with the wire loop.
ABSTRACT
To ascertain whether treatment with a gonadotropin-releasing hormone agonist before endometrial resection reduces absorption of distention fluid and operating time, facilitates the procedure, and improves long-term bleeding pattern, 71 menorrhagic women were allocated to 8 weeks of goserelin depot treatment before operative hysteroscopy or immediate surgery in the early proliferative phase of the cycle. Eight patients withdrew from the study after randomization, leaving 33 in the goserelin arm and 30 in the immediate surgery arm. Mean (SD) operating time was 15.1 (9.0) minutes in the goserelin group versus 16.9 (9.5) minutes in the controls (mean difference 1.8 min, 95% CI -2.9-6.4). Mean (SD) distention medium deficit was, respectively, 422 (287 ml) and 564 ml (291 ml; mean difference 142 ml, 95% CI -4-288). Considering only the 29 women with adenomyosis, the mean (SD) fluid deficit was considerably less in the 19 goserelin-treated group than in the 10 controls, 299 (206) versus 597 (135) ml (mean difference 298 ml, 95% CI 149-447). The surgeons classified intraoperative difficulties as none in 6, minimal in 20, moderate in 7, and severe in no cases in the goserelin group; corresponding figures in the group without pretreatment were 2, 14, 13, and 1 (p = 0.02). At 12-month follow-up 35% of women in the goserelin group were amenorrheic, 23% hypomenorrheic, 42% eumenorrheic, and none hypermenorrheic. Corresponding figures in the immediate surgery group were, respectively, 20%, 30%, 37%, and 13%. Goserelin administration before endometrial resection may reduce absorption of fluid at surgery in some patients and may facilitate intrauterine operating conditions. Effects on long-term bleeding patterns were limited.
ABSTRACT
Serum and cystic fluid levels of CA 125, CA 19.9, carcinoembryonic antigen (CEA), and alpha-fetoprotein (AFP) were assayed in 74 consecutive women of median age 30 years (range 15 to 74 years) undergoing surgery for adnexal cysts of presumed benign nature. Median (range) serum levels of CA 125, CA 19.9, CEA and AFP were 46.5 IU/ml (4.3-406), 28.5 IU/ml (1-96.3), 1.4 ng/ml (0.5-3.5) and 2.4 ng/ml (1-9.9) in 44 endometriotic cysts; 22.5 (4.7-82), 4.9 (1-226),1.3 (0.7-4.8) and 4 (0.5-10.5) in 11 dermoid cysts, 14 (8.6-25.1), 3.2 (1-6), 1 (0.3-2.8) and 3.7 (1.9-6) in 9 mucinous cysts, and 6.9 (0.5-104), 18 (1-132), 0.8 (0.1-1.9) and 2.1(1-5.4) in 10 cases with mixed histotypes. Corresponding cystic fluid levels were 342,864 (1,418-3,404,682), 228,000 (117-2,500,000), 106 (0.5-2,908) and 1.3 (0.4-51) in endometriomas; 843,895 (10,842-1,676,948), 740,039 (77-1,280,000), 470 (61-880) and 2.5 (1-4) in dermoids; 3,485 (27.2-149,804), 9,007 (36.4-153,475), 1,631 (402-11,096) and 1 (0.5-2.5) in mucinous cysts, and 13,068 (5,300-43,767), 412 (1-142,700), 0.8 (0.4-5.3) and 2.3 (1-4) in the mixed histotype group. No significant between group differences were detected in serum marker levels. Patients in the mucinous cyst group had significantly lower CA 125 cystic fluid levels compared with women with endometriomas and dermoids (P<0.05). Fluid aspirate tumor marker measurements did not aid in the differential diagnosis of benign ovarian cysts, mainly due to the extremely wide scattering of values.
