Life-table analysis of the success of thermal balloon endometrial ablation in the treatment of menorrhagia.

OBJECTIVE: To evaluate the change in intrauterine pressure during thermal balloon endometrial ablation and to identify risk factors associated with treatment failure. DESIGN: Prospective observational study. SETTING: University-affiliated teaching hospital. PATIENT(S): Seventy two consecutive patients with idiopathic menorrhagia refractory to medical treatment. INTERVENTION(S): Thermal balloon endometrial ablation under patient-controlled sedation. MAIN OUTCOME MEASURE(S): Change in intrauterine pressure during the treatment cycle and risk factors associated with treatment failure. RESULT(S): A spontaneous decrease in intrauterine pressure occurred in most patients (93%). The mean (+/-SD) decrease was 34.1 +/- 14.9 mm Hg, or 19.5% +/- 9.1%. The treatment failed in 10 patients (13.9%), and the mean end pressure was significantly lower in this group (131.1 +/- 14.1 mm Hg vs. 145.1 +/- 18.0 mm Hg; P=.02). The chance of success of treatment was significantly lower when the end pressure was <140 mm Hg (odds ratio, 0.42 [95% CI, 0.27 to 0.68]; P=.01), the intrauterine volume was >10 mL (odds ratio, 0.43 [95% CI, 0.22 to 0.83]; P=.058) and the uterus was retroverted (odds ratio, 0.36 [95% CI, 0.20 to 0.65]; P=.008). CONCLUSION(S): Maintaining high intrauterine pressure during the treatment cycle and correction of the retroversion may help to improve treatment success in thermal balloon endometrial ablation.

Preference on the treatments for menorrhagia in Hong Kong chinese women.

BACKGROUND: Menorrhagia is a common gynecological problem and its management options vary from medical to surgical treatment. With the development of the new minimally invasive therapies, there is a paucity of data in the preference and acceptance on these treatment options, especially in the Chinese population. METHODS: An anonymous survey using a self-constructed questionnaire was undertaken on women with heavy menstrual bleeding referred to the specialty clinic in a university teaching hospital. The aim was to elicit women's knowledge and preferences for the treatment options for menorrhagia. RESULTS: A total of 200 Chinese women returned their questionnaire with a response rate of 62%. Over 90% of them were unaware of other alternative treatment options for menorrhagia. Eumenorrhea was the desired treatment outcome in 173 (86.5%) women while only 15 (7.5%) and 12 (6%) wished to have oligomenorrhea and amenorrhea respectively. Drug therapy was the preferred first-line treatment in 87% and none preferred to undergo hysterectomy. When the medical treatment failed, 16% of women would not accept any other forms of treatment. For the rest of them, an L-norgestrel-releasing intrauterine device was the preferred option in 53.6%, endometrial ablation in 19%, while only 5.4% would prefer hysterectomy. CONCLUSION: The awareness of alternative treatment options for menorrhagia in Hong Kong Chinese women is very deficient and eumenorrhea is the desired treatment outcome, rather than oligomenorrhea or amenorrhea.

Measurement of trocar insertion force using a piezoelectric transducer.

We attempted to establish a model to measure the force required for trocar insertion at laparoscopy. A 3-cm, circular transducer was constructed from piezoresistive material that changes its impedance as force is exerted on its surface. The transducer is connected by an interface box to a personal computer to record surface contact pressure digitally (pressure = force/area) profile continuously during trocar insertion. Each subject had three trocars inserted: a 10-mm trocar at the umbilicus after creation of pneumoperitoneum, and 5-mm trocars at corresponding sites on the left and right sides of the lower abdomen. All insertions were performed by the same operator using reusable trocar with a conical tip. Each subject acted as her own control. Recordings were successfully obtained from eight women. There was no instance of transducer failure. The mean (SE) peak contact surface pressure for the 10-mm and 5-mm left and right trocars were 5.3 (0.32), 6.4 (0.51), and 6.81 (0.27) pounds/square inch, respectively. Placement of the 10-mm trocar required less insertion force than placement of the 5-mm trocars. There was a strong negative correlation (r = -0.97, p < 0.001) between body weight and peak insertion force for the 10-mm trocar.

Comparison of peritoneal oxidative stress during laparoscopy and laparotomy.

STUDY OBJECTIVE: To identify oxidative stress in peritoneum during laparoscopic and open surgery by measuring products of lipid peroxidation, and to determine whether surgical approach influences the type of oxidative metabolite synthesized. DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Twenty-eight consecutive women with uterine myomas or ovarian cysts. INTERVENTION: Laparoscopic or open surgery (14 patients each). MEASUREMENTS AND MAIN RESULTS: We obtained 1 x 1-cm squares of peritoneum at the beginning and end of surgical procedures away from sites of surgery. 8-Isoprostaglandin F(2alpha), hydroxyeicosatetranoic acids (HETEs), and malondyaldehyde (MDA) were measured by enzyme-immunoassay, high-performance liquid chromatography, and thiobarbituric acid adduction method, respectively. Comparisons showed significant increases in 5-HETE and 8-prostane in the laparoscopy group, which were correlated with duration of pneumoperitoneum and volume of carbon dioxide (CO(2)) insufflated, respectively. In the laparotomy group only MDA rose significantly related to duration of surgery. CONCLUSIONS: Lipid peroxidation was observed in peripheral peritoneum during laparoscopic surgery, mediated through noncyclooxygenase and lipoxygenase pathways, and appears to be due to effects of CO(2) pneumoperitoneum. Biochemical reactions were also observed in the laparotomy group, but are thought to be related to mechanisms other than lipid peroxidation.