Arteriovenous malformations of the uterus: long-term follow-up.

BACKGROUND/AIM: Arteriovenous malformations (AVMs) of the uterus have various clinical presentations. With the advancement of and accessibility to imaging, the diagnosis of the lesions in association with less severe clinical presentations is becoming more common. Contrary to cases with severe hemorrhage, the management of these cases is not clear. The purpose of this study was to describe our experience with diagnosis, management and long-term follow-up of cases with different clinical presentations of uterine AVMs. METHODS: The clinical and sonographic presentations of 8 cases diagnosed between July 2000 and July 2003 in our medical center are described. Annual sonographic follow-up was performed for a period of at least 42 months. RESULTS: Only 3 of the 8 cases presented with heavy vaginal bleeding and 2 of them required selective embolization. Two patients had hysterectomy during the study period which was not related to a severe bleeding event. Long-term follow-up for all other cases was significant for sonographic resolution of the uterine AVM. CONCLUSION: Management of uterine AVMs should be influenced by the clinical and not by the sonographic findings. If clinically feasible, conservative management should be considered as the primary approach, since most of these lesions tend to spontaneously resolve.

Does a surgical simulator improve resident operative performance of laparoscopic tubal ligation?

OBJECTIVE: The purpose of this study was to assess whether a surgical skills simulator laboratory improves resident knowledge and operative performance of laparoscopic tubal ligation. STUDY DESIGN: Twenty postgraduate year 1 residents were assigned randomly to either a surgical simulator laboratory on laparoscopic tubal ligation together with apprenticeship teaching in the operating room or to apprenticeship teaching alone. Tests that were given before and after the training assessed basic knowledge. Attending physicians who were blinded to resident randomization status evaluated postgraduate year 1 performance on a laparoscopic tubal ligation in the operating room with 3 validated tools: a task-specific checklist, global rating scale, and pass/fail grade. RESULTS: Postgraduate year 1 residents who were assigned randomly to the surgical simulator laboratory performed significantly better than control subjects on all 3 surgical assessment tools (the checklist, the global score, and the pass/fail analysis) and scored significantly better on the knowledge posttest (all P < .0005). CONCLUSION: Compared with apprenticeship teaching alone, a surgical simulator laboratory on laparoscopic tubal ligation improved resident knowledge and performance in the operating room.