Effect of undiagnosed deep adenomyosis after failed NovaSure endometrial ablation.

STUDY OBJECTIVE: To determine the prevalence of adenomyosis and deep adenomyosis after NovaSure (Hologic Inc., Newark, DE) endometrial ablation in hysterectomy specimens after NovaSure endometrial ablation failure. DESIGN: Prospective observational study (Canadian Task Force classification II-2). SETTING: The TweeSteden Hospital, a teaching hospital in the south of the Netherlands. PATIENTS: All women who underwent hysterectomy for menorrhagia and/or dysmenorrhea after failure of NovaSure endometrial ablation between November 2007 and January 2011. INTERVENTIONS: All patients who underwent hysterectomy between January 2005 and April 2009 for the same indication but did not undergo prior endometrial ablation from choice or the lack of availability of the endometrial ablation procedure. MEASUREMENTS AND MAIN RESULTS: Of 213 patients who underwent NovaSure therapy, 22 (10.3%) underwent a hysterectomy because NovaSure failed. Of these, 10 (45.5%) exhibited adenomyosis in their hysterectomy specimens. The control group patients had a similar adenomyosis prevalence (74/173, 42.8%). However, the NovaSure failure group had a significantly higher prevalence of deep adenomyosis (>2.5 mm endometrial penetration) (9/22, 40.9%) than the control group (37/173, 21.4%, p < .05). CONCLUSION: Deep adenomyosis after failed NovaSure endometrial ablation was present in a significant number of patients. It is not clear whether adenomyosis is induced by endometrial ablation or whether it causes endometrial ablation failure.

Innovations in surgery: the role of residents in the implementation of laparoscopic hysterectomy.

BACKGROUND: Laparoscopic hysterectomy (LH) is poorly adopted by general gynecologists. The aim of this study was to assess the differences between residents, general gynecologists, and laparoscopic-orientated gynecologists in the choice of surgical route in patients planned for hysterectomy. METHODS: An observational study was carried out at a teaching hospital in south of The Netherlands. All patients who were planned for a hysterectomy for benign or premalignant indications between January 2005 and April 2009 were included. All performed hysterectomies were evaluated for the planned surgical route: vaginal, abdominal, or LH. Surgeons were divided into three categories: residents, general gynecologists, and laparoscopic-orientated gynecologists. RESULTS: One hundred thirty-nine (35.8%) patients were planned for a vaginal approach, 151 (38.9%) for an abdominal approach, and 98 (25.2%) for a laparoscopic approach. The percentage of planned vaginal hysterectomies was comparable for all surgeons. There was a significant difference between the percentage of planned LHs by residents (30%) and that by general gynecologists (6%). As expected, laparoscopic-orientated gynecologists planned a laparoscopic approach in 53% of their cases. CONCLUSIONS: LH as alternative to abdominal hysterectomy is rarely planned by general gynecologists. Residents could play a role in the implementation of LH.

Extensive cellulitis as the first symptom of ureter lesion after laparoscopic hysterectomy.

Laparoscopic hysterectomy as an alternative to abdominal hysterectomy is frequently performed for benign uterine pathology. Although laparoscopic hysterectomy is associated with less pain, quicker recovery, and better short-term quality of life, it is associated with an increased risk of ureter lesions compared with the open procedure. We point out the case of a woman who underwent a total laparoscopic hysterectomy and presented postoperatively with a cellulitis at the right side of the body expanding over the abdomen and the pelvis, and subsequently problems with micturition. Computed tomography demonstrated a lesion of the left ureter nearby the ureterovesical junction. Cellulitis was treated with clindamycin, and a nephrostomy catheter was placed since the placement of a Double-J stent was not possible. Six weeks after surgery, a ureter re-anastomosis was performed by laparotomy. Urine leakage into the abdomen combined with urinary tract infection or infection of the wounds can lead to rapid extension of cellulitis and is therefore an important additional symptom for urological complications after a laparoscopic hysterectomy.