Induction of labor in women with a history of fast labor.

OBJECTIVE: History of fast labor is currently subjectively defined and inductions for non-medical indications are becoming restricted. We hypothesized that women induced for a history of fast labor do not have faster previous labors and do not deliver more quickly. METHODS: A retrospective case-control cohort design studied multiparas undergoing elective induction at one high risk center. Outcomes of dyads electively induced for a history of previous fast labor indication (PFast) were compared to controls with a psychosocial indication. RESULTS: A total of 612 elective inductions with 1074 previous deliveries were evaluated: 81 (13%) PFast and 531 (87%) control. PFast had faster previous labors (median 5.5 h, IQR: 4.5-6) versus. control (10 h, IQR: 9-10.5; p < 0.001). Subsequent delivery time from start to expulsion was shorter for PFast (median 7 h, IQR: 5-9, p < 0.001) than controls with and without a previous labor <5.5 h (8.6 h, IQR: 6-14 and 9.5 h, IQR: 7-15, respectively). PFast were less likely to have a serious maternal complication. Neonatal complications were similar. CONCLUSIONS: Patients induced for a history of fast labor do have faster previous labors, suggesting a significant history of fast labor can be defined as <5.5 h. These women deliver more quickly and with lower morbidity than controls when subsequently induced, therefore the benefit may warrant the risk for a select number of women with a history of a prior labor length <5.5 h.

Classifying Patients with Chronic Pelvic Pain into Levels of Biopsychosocial Dysfunction Using Latent Class Modeling of Patient Reported Outcome Measures.

Chronic pelvic pain affects multiple aspects of a patient's physical, social, and emotional functioning. Latent class analysis (LCA) of Patient Reported Outcome Measures Information System (PROMIS) domains has the potential to improve clinical insight into these patients' pain. Based on the 11 PROMIS domains applied to n=613 patients referred for evaluation in a chronic pelvic pain specialty center, exploratory factor analysis (EFA) was used to identify unidimensional superdomains. Latent profile analysis (LPA) was performed to identify the number of homogeneous classes present and to further define the pain classification system. The EFA combined the 11 PROMIS domains into four unidimensional superdomains of biopsychosocial dysfunction: Pain, Negative Affect, Fatigue, and Social Function. Based on multiple fit criteria, a latent class model revealed four distinct classes of CPP: No dysfunction (3.2%); Low Dysfunction (17.8%); Moderate Dysfunction (53.2%); and High Dysfunction (25.8%). This study is the first description of a novel approach to the complex disease process such as chronic pelvic pain and was validated by demographic, medical, and psychosocial variables. In addition to an essentially normal class, three classes of increasing biopsychosocial dysfunction were identified. The LCA approach has the potential for application to other complex multifactorial disease processes.

The neurobiology of pain perception in normal and persistent pain.

Pain is a significant national burden in terms of patient suffering, expenditure and lost productivity. Understanding pain is fundamental to improving evaluation, treatment and innovation in the management of acute and persistent pain syndromes. Pain perception begins in the periphery, and then ascends in several tracts, relaying at different levels. Pain signals arrive in the thalamus and midbrain structures which form the pain neuromatrix, a constantly shifting set of networks and connections that determine conscious perception. Several cortical regions become active simultaneously during pain perception; activity in the cortical pain matrix evolves over time to produce a complex pain perception network. Dysfunction at any level has the potential to produce unregulated, persistent pain.

Interstitial Cystitis - Elucidation of Psychophysiologic and Autonomic Characteristics (the ICEPAC Study): design and methods.

BACKGROUND AND PURPOSE: Interstitial cystitis/bladder pain syndrome (IC/BPS) is relatively common and associated with severe pain, yet effective treatment remains elusive. Research typically emphasized the bladder's role, but given the high presence of systemic comorbidities, the authors hypothesized a pathophysiologic nervous system role. This paper reports the methodology and approach to study the nervous system in women with IC/BPS. The study compares neurologic, urologic, gynecologic, autonomic, gastrointestinal, and psychological features of women with IC/BPS, their female relatives, women with myofascial pelvic pain (MPP), and healthy controls to elucidate the role of central and peripheral processing. METHODS AND RESULTS: In total, 228 women (76 IC/BPS, 76 MPP, 38 family members, and 38 healthy controls) will be recruited. Subjects undergo detailed screening, structured neurologic examination of limbs and pelvis, tender point examination, autonomic testing, electrogastrography, and assessment of comorbid functional dysautonomias. Interpreters are blinded to subject classification. Psychological and stress response characteristics are examined with assessments of stress, trauma history, general psychological function, and stress response quantification. As of December 2012, data collection is completed for 25 healthy controls, 33 IC/BPS ± MPP, eight MPP, and three family members. Recruitment rate is accelerating and strategies emphasize maintaining and encouraging investigator participation in study science, internet advertising, and presentations to pelvic pain support groups. CONCLUSION: The study represents a comprehensive, interdisciplinary approach to sampling autonomic and psychophysiologic characteristics of women with IC/BPS. Despite divergent opinions on study methodologies based on specialty experiences, the study has proven feasible to date and different perspectives have proved to be one of the greatest study strengths.

Does enhanced "bundling" criteria improve outcomes? A comparative study of elective inductions.

OBJECTIVE: To assess outcomes and costs of dyads achieving elective induction bundle criteria with a favorable Bishop score. STUDY DESIGN: In a historical automated records-based cohort study, 180 dyads undergoing elective induction bundling at a single institution from 2009 to 2010 were compared to a pre-introduction of bundling cohort. The bundled cohort was then compared by Bishop score. RESULTS: The bundled cohort (n = 180) had a lower cesarean delivery rate (12% vs. 21%, p = 0.01), but neonatal special or intensive care admissions were not statistically significant compared to the pre-introduction of bundling cohort (n = 473). Ninety-six percent (n = 173) of the bundled cohort achieved bundle criteria. Those with a Bishop score > 6 (52%, n = 90) had fewer cesarean deliveries (4% vs. 19%, p = 0.003), fewer neonatal special or intensive care admissions (1% vs. 10%, p = 0.015), shorter induction time to vaginal delivery (8.8 vs. 17 hrs, p < 0.001), fewer cesareans for dystocia (75% vs. 94%, p = 0.002) or fetal heart rate abnormalities (25% vs. 50%, p = 0.015), and had one-sixth the average net income lost ($423 vs. $2,600, p < 0.001) compared to bundle achievers with a Bishop score of < or = 6. CONCLUSION: The elective induction bundle does not guarantee quality and should require favorable cervix instead of documented Bishop score to proceed with induction.

Cost analysis of prophylactic intraoperative cystoscopic ureteral stents in gynecologic surgery.

CONTEXT: Prophylactic intraoperative ureteral stent placement is performed to decrease operative ureteric injury, though few data are available on the effectiveness of this procedure, and no data are available on its cost. OBJECTIVE: To analyze the cost of prophylactic intraoperative cystoscopic ureteral stents in gynecologic surgery. METHODS: All cases of prophylactic ureteral stent placement performed in gynecologic surgery during a 1-year period were identified and retrospectively reviewed through the electronic medical records database of Summa Health System. Costs were obtained through the Healthcare Cost Accounting System. The principles of cost-effective analysis were used (ie, explicit and detailed descriptions of costs and cost-effectiveness statistics). Importantly, we evaluated cost and not charges or financial model estimates. In addition, we obtained the contribution margins (ie, the hospital's net profit or loss) for prophylactic ureteral stent placement. Other gynecologic procedures were also analyzed. RESULTS: Among 792 major inpatient gynecologic procedures, 18 cases of prophylactic intraoperative ureteral stents were identified. Median costs were as follows: additional cost of prophylactic intraoperative ureteral stenting, $1580; additional cost of surgical resources, $770; cost of ureteral catheters, $427; cost of surgeons, $383. The contribution margins per case for various gynecologic surgical procedures were as follows: oophorectomy, $2804 profit; abdominal hysterectomy, $2649 profit; laparoscopically assisted vaginal hysterectomy (LAVH), $1760 profit. When intraoperative ureteral stenting was added, the contribution margins changed to the following: oophorectomy, $782 profit; abdominal hysterectomy, $627 profit; LAVH, $262 loss. Overall, the contribution margin profit was decreased by about 85%, from $2400 to $380. CONCLUSION: Prophylactic intraoperative ureteral stenting in gynecologic surgery decreases a hospital's contribution margin. Because of the expense of this procedure, as well as scientific data suggesting a lack of effectiveness, the authors argue that prophylactic intraoperative ureteral stenting should not be used in gynecologic surgery to decrease operative ureteric injury.

Reduced-force closed trocar entry technique: analysis of trocar insertion force using a mechanical force gauge.

BACKGROUND AND OBJECTIVES: Trocar insertion injury has a high morbidity, mortality, and cost. The purpose of this study was to compare standard trocar entry with our reduced-force closed trocar entry technique by measuring trocar insertion force using a mechanical force gauge. METHODS: In the operating room, the force gauge was inserted into a sterile glove and connected to the proximal portion of the trocar to measure insertion force. Through one incision, we used a standard closed trocar entry, while through the other incision, we used our reduced-force closed trocar entry technique. After making the skin incision and before trocar entry, we spread and dilated the skin, subcutaneous tissue, fascia, and muscle with a hemostat. RESULTS: Twenty-five patients entered the trial and none were excluded. Median trocar insertion force was 3.3lb (range, 1.6 to 5.4) with our reduced-force trocar entry technique versus 6.5lb (range, 2.0 to 14.0) with the standard trocar entry (P=.001). No complications occurred with the reduced-force trocar entry technique. CONCLUSION: Our reduced-force trocar entry technique decreases trocar insertion force by 50%, requires no additional instruments or cost and is fast and safe. Reduced-entry force pressure may decrease the risk of trocar insertion injury.

Application of Patient-Reported Outcomes Measurement Information System to chronic pelvic pain.

STUDY OBJECTIVES: To apply the Patient-Reported Outcomes Measurement Information System (PROMIS) recently developed by the National Institutes of Health in patients with chronic pelvic pain. Secondary objectives included evaluation of individual pain categories and of the effect of the occurrence of myofascial abdominal wall and pelvic floor muscle pain. DESIGN: Retrospective study (Canadian Task Force classification III). SETTING: Chronic pelvic pain multidisciplinary referral center. PATIENTS: A total of 149 consecutive patients with chronic pelvic pain provided evaluable results. INTERVENTIONS: As part of a comprehensive evaluation, patients were assigned diagnoses based on standard criteria, and completed the 96-item short-form PROMIS. MEASUREMENTS AND MAIN RESULTS: Pain-related and global PROMIS scores were significantly worse than in the reference population (p <.05). The presence of myofascial pain was also associated with worse PROMIS scores. CONCLUSION: Chronic pelvic pain is associated with impaired quality of life regardless of the diagnosis, including myofascial pain.

Comparison of teenaged video gamers vs PGY-I residents in obstetrics and gynecology on a laparoscopic simulator.

STUDY OBJECTIVE: To compare the performance of teenaged video gamers verses postgraduate year I (PGY-I) residents in obstetrics and gynecology (Ob/Gyn) on our video trainer laparoscopic simulator. DESIGN: Randomized controlled trial (Canadian Task Force Classification I). SETTING: Medical school university. PARTICIPANTS: Teenaged video gamers and PGYI Ob/Gyn Residents. INTERVENTION: Laparoscopic simulator. MEASUREMENTS AND MAIN RESULTS: Fifteen teenaged experienced video gamers and 15 PGYI Ob/Gyn residents without video gaming experience were timed performing 3 laparoscopic simulator assessment procedures. Each drill was timed using a stopwatch. Pretest instructions were given as to how to perform each task. No warm-up was allowed, and each participant was tested during his or her initial performance of each assessment drill. Compared with the PGYI Ob/Gyn residents, the teenaged experienced video gamers completed the Bean and Pom-Pom Drop 27% faster (p = .05), the Checkerboard Drill 41% faster (p = .03), and the Bead Manipulation 31% faster (p = .43). CONCLUSION: Virtual reality skills of teenaged video gamers seem to translate into improved video trainer laparoscopic skills. Previous teenage video gaming experience may favorably affect future residents' ability to develop laparoscopic skills.

Transvaginal application of a laparoscopic bipolar cutting forceps to assist vaginal hysterectomy in extremely obese endometrial cancer patients.

INTRODUCTION: The purpose of this report is to evaluate our experience with transvaginal application of a laparoscopic bipolar cutting forceps to assist vaginal hysterectomy in extremely obese women with endometrial cancer in whom obesity precluded LAVH/BSO and lymphadenectomy and vaginal obesity limited visualization and exposure. MATERIALS AND METHODS: We performed a retrospective review and identified 6 consecutive cases. No cases were excluded. A laparoscopic 33-cm Plasma Kinctic (PK) cutting forceps with a 5-mm diameter was applied transvaginally to coagulate and cut the uterosacral and cardinal ligaments, uterine vasculature, and ovarian ligaments. The uterus was delivered vaginally. Staging lymphadenectomy was not performed. RESULTS: Median age was 51 years, median weight was 405 lbs, and median BMI was 66 kg/m². Five of 6 cases were successfully performed vaginally (83%). Median operative time was 1 hour 10 minutes, median blood loss was 500 mL, and pain was only discomforting. All patients were discharged the day after surgery. There were no complications. At median follow-up of 1 year, all patients were alive with no evidence of disease. CONCLUSION: It is our opinion that the transvaginal application of a laparoscopic bipolar cutting forceps can successfully assist vaginal hysterectomy in extremely obese endometrial cancer patients who cannot tolerate LAVH/BSO and lymphadenectomy and vaginal obesity limits visualization and exposure.

Laparoscopic cytoreduction for primary advanced ovarian cancer.

INTRODUCTION: We evaluated the feasibility of laparoscopic cytoreduction for primary advanced ovarian cancer. METHODS: All patients with presumed stage 3/4 primary ovarian cancer underwent attempted laparoscopic cytoreduction. All patients had CT evidence of omental metastasis and ascites. A 5-port (5-mm) transperitoneal approach was used. A bilateral salpingo-oophorectomy, supracervical hysterectomy, and omentectomy were performed with PlasmaKinetic (PK) cutting forceps. A laparoscopic 5-mm Argon-Beam Coagulator was used to coagulate tumor in the pelvis, abdominal peritoneum, intestinal mesentery, and diaphragm. RESULTS: Nine of 11 cases (82%) were successfully debulked laparoscopically without conversion to laparotomy. Median operative time was 2.5 hours, and median blood loss was 275 mL. All tumors were debulked to <2 cm and 45% had no residual disease. Stages were 1-3B, 7-3C, and 1-4. Median length of stay was one day. Median VAS pain score was 4 (discomforting). Two of 11 patients (18%) had postoperative complications. CONCLUSION: Laparoscopic cytoreduction was successful and resulted in minimal morbidity. Because of our small sample size, additional studies are needed.

Quantification of abdominal wall pain using pain pressure threshold algometry in patients with chronic pelvic pain.

OBJECTIVE: Chronic pelvic pain (CPP) is a syndrome involving 1 or more pain generating organs in the pelvis, which includes pain from the lower anterior abdominal wall. This entity has been termed myofascial pain syndrome (MFPS), but its characteristics, definition, and quantification have not been well described. In this study, pain pressure threshold (PPT) testing of the lower anterior abdominal wall in CPP patients was performed to determine the range and distribution of values at each site, and the clinical utility of using PPT in a definition of MFPS. METHODS: Fifty-six patients evaluated in a CPP specialty clinic underwent PPT algometry of 14 sites on the lower anterior abdominal wall. These values were described and evaluated before and after treatment. PPT values were also evaluated in patients found to be drug seeking. RESULTS: Twenty percent of the PPT tests reached the threshold of 3 kgf/cm2. The abnormal tests usually formed a normal distribution. PPT testing had a weak but appropriate correlation with other pain symptom measures. After trigger point injection there was a 75% improvement in PPT, and response to medical therapy resulted in a 60% improvement. A composite measure was able to distinguish drug-seeking patients with statistical accuracy. DISCUSSION: PPT testing can be used to evaluate MFPS in CPP patients. One suggested definition would exclude patients with low scores in the upper abdomen while including patients with low scores in the lower abdomen.

A method for the consistent creation and quantitative testing of postoperative pelvic adhesions in a porcine model.

INTRODUCTION: The assessment of methods for the prevention of postoperative pelvic adhesions is hampered by the lack of a quantifiable adhesion measurement technique. Currently available methods for adhesion model assessment rely on qualitative grading scales; a quantitative method would have many attendant benefits, including standardized reporting. METHODS: A technique was developed to generate consistent and significant adhesions in a swine model that are suitable for quantitative assessment using a Material Testing System (MTS) machine platform. In this method, the uterine horns are cannulated and then attached to the pelvic sidewall using loose silk sutures. The underlying sidewall and adjacent uterine serosa are injured with electrocautery. Following a two-week survival the entire complex of uterine horn and sidewall are excised en bloc and prepared for MTS testing. RESULTS: Extrication of the adhesion, as measured by the MTS platform, generates a quantitative assessment of adhesion strength that can be scaled and analyzed to produce several continuous variable descriptions. DISCUSSION: This technique represents a novel quantitative method for adhesion assessment in an animal model. This quantitative technique may then be applied to accurately assess a range of adhesion prevention techniques, producing results which can be standardized for comparison.

A preliminary study of transcranial direct current stimulation for the treatment of refractory chronic pelvic pain.

BACKGROUND: The modulatory effects of transcranial direct current stimulation (tDCS) appear beneficial for different chronic pain syndromes; however, it is unclear whether this method can be used to treat refractory chronic pelvic pain. OBJECTIVE: The objective of this preliminary study was to determine the efficacy and safety of tDCS for the management of refractory chronic pelvic pain. METHODS: Seven patients with chronic pelvic pain having failed standard medical or surgical therapy underwent a crossover, double-blind sham controlled tDCS treatment protocol consisting of 1 mA applied for 20 minutes on two consecutive days with 2 weeks of follow-up symptom recording. Symptoms were recorded using multiple scoring systems, including visual analog scales for different pains, as well as organ-specific symptom scales. Comparison between active and sham treatment was performed by using paired t tests. RESULTS: Overall and pelvic pain scores were significantly lower after active compared with sham treatment, as were disability and traumatic stress scores. No patient discontinued the study because of side effects, which were infrequent. CONCLUSIONS: Active tDCS treatment induces a modest pain reduction in refractory chronic pelvic pain patients as compared with sham tDCS treatment. These results can guide the design and implementation of further studies investigating this method of neuromodulation for the treatment of refractory chronic pelvic pain.

Receiver operating characteristic curves of symptom scores in the diagnosis of interstitial cystitis/painful bladder syndrome.

STUDY OBJECTIVE: Chronic pelvic pain is often a manifestation of interstitial cystitis (IC), for which several symptom scoring measures exist. However, the receiver operating characteristic (ROC) curves for these scores have not been described, even though such analysis could identify an optimal noninvasive test and suggest diagnostic test thresholds. The objective of this study was to develop ROC curves for IC symptom scores based on the standard of pain relief after cystoscopy with hydrodistention (HD). DESIGN: This is a retrospective analysis of IC symptom index (ICSI) and visual analog scale (VAS) bladder pain (VASb) scores recorded at initial patient visit. Patients underwent a diagnostic algorithm leading to selected HD. The ROC curves were calculated based on the presence of diagnostic criteria for IC found at HD (Canadian Task Force classification III). SETTING: A multidisciplinary chronic pelvic pain referral center. PATIENTS: A total of 277 women with chronic pelvic pain were evaluated. The mean duration of pain was 54 months; mean pelvic pain VAS score was 7.5. Those proved to have IC had a VASb score of 7 and an ICSI score of 11. INTERVENTIONS: Initial symptom score tabulation followed by a symptom-based diagnostic algorithm consisting of alkalinized lidocaine instillation with HD offered to responders. MEASUREMENTS AND MAIN RESULTS: The ROC curve for the VASb was shifted to the upper left compared with the ICSI, which was closer to the diagonal. Area under the curve was significantly greater for VASb (0.860) than ICSI (0.773) (p=.045). The maximum diagnostic accuracy for the ICSI was at a value of 14 or more (0.88) and for the VASb at a value of 7 or more (0.94). CONCLUSION: The most accurate symptom score for detecting IC based on this analysis was the VASb with a threshold of 7. Although the ICSI may have use, in this setting it is not as useful as the VAS for identifying patients who eventually prove to have IC.

Robotic radical hysterectomy.

OBJECTIVE: Advanced laparoscopic procedures are increasing being used in gynecologic surgery. The da Vinci robotic system (Intuitive Surgical Corporation, Sunnyvale, CA) can further augment laparoscopic surgery. We describe our initial experience using the da Vinci robotic system to perform radical hysterectomy. STUDY DESIGN: Twenty consecutive patients with primary stage IB-IIA cervical carcinoma underwent class 3 radical hysterectomy with the use of the da Vinci robotic system. Median age was 44 years, median weight was 69.9 kg, 65% of patients had medical comorbidity, and 40% had prior abdominal surgery. RESULTS: All 20 patients successfully underwent robotic radical hysterectomy. Median operative time was 6.5 hours (3.5-8.5 hours) and median blood loss was 300 mL. All patients were discharged on the first day after surgery. At median follow-up of 2 years (0.6-3 years), 90% of patients are alive and disease free. CONCLUSION: We report the first series of robotic radical hysterectomy for early stage cervical cancer. All cases were successfully performed robotically with minimal complications and all patients were discharged on postoperative day 1.

Frequency and distribution of multiple diagnoses in chronic pelvic pain related to previous abuse or drug-seeking behavior.

BACKGROUND: The objective of this study was to describe the nature and number of pain diagnoses in a chronic pelvic pain population, and to determine the relationship between these and a patient's history of abuse, drug-seeking behavior, or initial symptom scores. METHODS: 175 consecutive patients were evaluated at the Summa Chronic Pelvic Pain Center and assigned diagnoses. These diagnoses included gynecologic pain, interstitial cystitis (IC), irritable bowel syndrome (IBS), pelvic floor tension myalgia, abdominal wall myalgia, and vulvodynia. The diagnosis of drug seeking was based upon a patient's refusal of non-narcotic management. RESULTS: Multiple diagnoses were common, occurring in 58% of all patients, and in up to 96% of those diagnosed with non-gynecologic pain. A history of abuse was present in 55% of all patients. Drug seeking was diagnosed in 13% of all patients. Significantly elevated IC, IBS, and myalgia scores were associated with previous abuse and multiple pain diagnoses. CONCLUSION: Patients with chronic pelvic pain frequently have multiple pain diagnoses, and non-gynecologic pain in particular is common. Multiple pain diagnoses and a history of abuse have similar symptom patterns, suggesting a relationship which can be used to distinguish these patients from those with drug-seeking behavior.

Laparoscopic-assisted vaginal hysterectomy for uteri weighing 1000 grams or more.

INTRODUCTION: Prospective randomized trials have proven the benefits of laparoscopic-assisted vaginal hysterectomy (LAVH) compared with abdominal hysterectomy. The purpose of this study was to evaluate the safety and efficacy of LAVH performed for uteri weighing > or =1000 grams. METHODS: Fifteen patients underwent attempted LAVH for uteri >1000g. Median age was 45 years old (range, 31 to 57), and median weight was 170 pounds (range, 130 to 236); 64% had medical comorbidities, and 43% had prior pelvic surgery. Five ports (5 mm) were used to allow maximum uterine manipulation. Uterine vessels were doubly coagulated. RESULTS: Fourteen of 15 cases (93%) were successfully completed laparoscopically. Median uterine weight was 1090 grams (range, 1000 to 1650). Median operative time was 3.5 hours (range, 2 to 4.6), and median blood loss was 400 mL (range, 100 to 1200). All patients were discharged on postoperative day one, and no patients developed a postoperative complication. CONCLUSION: We believe that LAVH is a safe and effective approach for uteri larger than 1000 g. It is our opinion that 3 surgical techniques are required; maximum Trendelenburg position, adequate number of ports, and double coagulations of the uterine vessels.

Phase I/II prospective trial of autologous platelet tissue graft in gynecologic surgery.

STUDY OBJECTIVE: To perform the original phase I/II trial of autologous platelet tissue graft in gynecologic surgery to evaluate toxicity and efficacy on decreasing pain. DESIGN: Prospective nonrandomized trial (Canadian Task Force classification II-A). SETTING: Teaching hospital. PATIENTS: Fifty-five consecutive patients undergoing major gynecologic surgery were entered into this prospective phase I/II trial and were matched with 55 patients from the previous 6 months. INTERVENTION: After anesthesia was induced, peripheral venous blood (55 mL) was obtained from the patient producing, autologous platelet tissue graft (20 mL). At completion of surgery, autologous platelet tissue graft was directly applied to the surgical site. MEASUREMENTS AND MAIN RESULTS: Median pain on the day of surgery was 2.7 (mild) in the autologous platelet tissue graft group vs 6.7 (severe) in the control group, p <.001. Likewise, pain on postoperative day 1 was 2.1 (mild) in the autologous platelet tissue graft group vs 5.5 (moderate) in the control group, p < or =.001. Median of morphine per hospital stay for the autologous platelet tissue graft group was 17 mg (range 1-98 mg) vs 26 mg (range 3-90 mg) in the control group, which was statistically significant at p = .02. There were no adverse effects associated with autologous platelet tissue graft. CONCLUSIONS: In the original phase I/II prospective trial of autologous platelet tissue graft in gynecologic surgery, there were no apparent adverse effects, and pain was significantly reduced.