Alice Goodman

NEW YORK – Uterine size does not appear to increase the risk of surgical complications in patients who undergo type VII total laparoscopic hysterectomy, but both uterine size and the number of prior pelvic surgeries increased surgical time in a linear manner, according to a retrospective case-control analysis.

“There is insufficient evidence to determine a statistical correlation between uterine size and presence of surgical complications. Therefore, type VII [total laparoscopic hysterectomy] seems to be a feasible and safe surgical procedure, resulting in a short hospital stay, minimal blood loss, minimal operating time, and a low complication rate regardless of uterine weight,” Dr. Carlos Hernández Nieto said at the annual Minimally Invasive Surgery Week.

Type VII total laparoscopic hysterectomy consists of completing all surgical dissection, ligations, and sutures through trocars, including vaginal closure.

©Thinkstock.com

The study was based on 235 consecutive patients undergoing type VII total laparoscopic hysterectomy at two hospitals between January 2008 and December 2014. Sufficient information was available on 211 patients.

The mean age of women in the study was 45 years, with a mean body mass index of 25.3 kg/m². The mean number of prior births was two; the mean number of prior pelvic surgeries was two; the mean number of days in hospital was three; the mean surgical time was 140 minutes; and the mean uterine weight was 142 grams. Mean blood loss during surgery was 100 cc.

Surgical complications occurred in 14 patients (6.6%); two had bleeding which led to conversion to laparotomy and 12 had fever. The mean uterine weight in the group with complications was 161.8 grams, according to Dr. Hernández Nieto of TEC Salud Health Care System, Monterrey, Mexico.

A logistical regression analysis showed that the only factor significantly related to complications was the mean surgical time (170 minutes in this group of patients; P = .003). Uterine weight was not significantly related to complications.

Uterine weight was, however, significantly associated with increased surgical time. Surgical time increased from 0.02 to 1 minute for each additional gram of weight (P = .002), Dr. Hernández Nieto said. The number of prior pelvic surgeries also significantly increased surgical time. For each prior pelvic surgery, surgical time increased from 1.62 to 8.72 minutes (P = .006).

Dr. Hernández Nieto reported having no financial disclosures.

NEW YORK – Uterine size does not appear to increase the risk of surgical complications in patients who undergo type VII total laparoscopic hysterectomy, but both uterine size and the number of prior pelvic surgeries increased surgical time in a linear manner, according to a retrospective case-control analysis.

“There is insufficient evidence to determine a statistical correlation between uterine size and presence of surgical complications. Therefore, type VII [total laparoscopic hysterectomy] seems to be a feasible and safe surgical procedure, resulting in a short hospital stay, minimal blood loss, minimal operating time, and a low complication rate regardless of uterine weight,” Dr. Carlos Hernández Nieto said at the annual Minimally Invasive Surgery Week.

Type VII total laparoscopic hysterectomy consists of completing all surgical dissection, ligations, and sutures through trocars, including vaginal closure.

©Thinkstock.com

The study was based on 235 consecutive patients undergoing type VII total laparoscopic hysterectomy at two hospitals between January 2008 and December 2014. Sufficient information was available on 211 patients.

The mean age of women in the study was 45 years, with a mean body mass index of 25.3 kg/m². The mean number of prior births was two; the mean number of prior pelvic surgeries was two; the mean number of days in hospital was three; the mean surgical time was 140 minutes; and the mean uterine weight was 142 grams. Mean blood loss during surgery was 100 cc.

Surgical complications occurred in 14 patients (6.6%); two had bleeding which led to conversion to laparotomy and 12 had fever. The mean uterine weight in the group with complications was 161.8 grams, according to Dr. Hernández Nieto of TEC Salud Health Care System, Monterrey, Mexico.

A logistical regression analysis showed that the only factor significantly related to complications was the mean surgical time (170 minutes in this group of patients; P = .003). Uterine weight was not significantly related to complications.

Uterine weight was, however, significantly associated with increased surgical time. Surgical time increased from 0.02 to 1 minute for each additional gram of weight (P = .002), Dr. Hernández Nieto said. The number of prior pelvic surgeries also significantly increased surgical time. For each prior pelvic surgery, surgical time increased from 1.62 to 8.72 minutes (P = .006).

Dr. Hernández Nieto reported having no financial disclosures.

NEW YORK – Uterine size does not appear to increase the risk of surgical complications in patients who undergo type VII total laparoscopic hysterectomy, but both uterine size and the number of prior pelvic surgeries increased surgical time in a linear manner, according to a retrospective case-control analysis.

“There is insufficient evidence to determine a statistical correlation between uterine size and presence of surgical complications. Therefore, type VII [total laparoscopic hysterectomy] seems to be a feasible and safe surgical procedure, resulting in a short hospital stay, minimal blood loss, minimal operating time, and a low complication rate regardless of uterine weight,” Dr. Carlos Hernández Nieto said at the annual Minimally Invasive Surgery Week.

Type VII total laparoscopic hysterectomy consists of completing all surgical dissection, ligations, and sutures through trocars, including vaginal closure.

©Thinkstock.com

The study was based on 235 consecutive patients undergoing type VII total laparoscopic hysterectomy at two hospitals between January 2008 and December 2014. Sufficient information was available on 211 patients.

The mean age of women in the study was 45 years, with a mean body mass index of 25.3 kg/m². The mean number of prior births was two; the mean number of prior pelvic surgeries was two; the mean number of days in hospital was three; the mean surgical time was 140 minutes; and the mean uterine weight was 142 grams. Mean blood loss during surgery was 100 cc.

Surgical complications occurred in 14 patients (6.6%); two had bleeding which led to conversion to laparotomy and 12 had fever. The mean uterine weight in the group with complications was 161.8 grams, according to Dr. Hernández Nieto of TEC Salud Health Care System, Monterrey, Mexico.

A logistical regression analysis showed that the only factor significantly related to complications was the mean surgical time (170 minutes in this group of patients; P = .003). Uterine weight was not significantly related to complications.

Uterine weight was, however, significantly associated with increased surgical time. Surgical time increased from 0.02 to 1 minute for each additional gram of weight (P = .002), Dr. Hernández Nieto said. The number of prior pelvic surgeries also significantly increased surgical time. For each prior pelvic surgery, surgical time increased from 1.62 to 8.72 minutes (P = .006).

Dr. Hernández Nieto reported having no financial disclosures.

NEW YORK – More than a year after the Food and Drug Administration first warned physicians and patients about the risks of disseminating unsuspected cancer with electric power morcellation, most minimally invasive gynecologic surgeons are not using the technology.

But rather than convert to open laparotomy for fibroid removal, many surgeons are using conventional and robotic-assisted laparoscopic techniques, Dr. Farr Nezhat said at the annual Minimally Invasive Surgery Week.

“The controversy over electric power morcellation demonstrates the difficulty with surgical innovation. The risks and balances of morcellation must be balanced. The current debate demonstrates the power of public opinion,” said Dr. Nezhat, who is director of minimally invasive surgery and gynecologic robotics at Mount Sinai Roosevelt and Mount Sinai St. Luke’s hospitals, New York. “The good news is that the majority of respondents have not converted to laparotomy.”

Dr. Nezhat and his colleagues sent a survey to 3,505 members of the Society of Laparoendoscopic Surgeons and received 518 responses. Surgeons were queried on their beliefs about morcellation and current practices for fibroid removal.

Sixty-one percent of respondents said they do not currently use a power morcellator. Of those who do not use the device, nearly half said it was because power morcellation was banned by their hospital, while others responded that they were not comfortable using it or that their hospital didn’t have power morcellation equipment.

A total of 60% said they believe morcellation affects survival, and 66% said that morcellation also disseminates benign pathology. Additionally, 48% reported that they have encountered a diagnosis of unsuspected uterine carcinoma in their practices.

So what are surgeons doing instead of power morcellation? About three-quarters of respondents currently perform open laparotomy in fewer than 25% of their cases. Their responses indicated that they mostly use laparoscopic and robotic procedures.

“It is encouraging that they did not go back to open laparotomy and that they have obviously found alternatives,” Dr. Nezhat said at the meeting sponsored by the Society of Laparoendoscopic Surgeons and affiliated societies.

Dr. Nezhat and his colleagues are planning a second survey to get details on the type of approaches that ob.gyns. are now using: vaginal morcellation, minilaparoscopy, or posterior colostomy, as well as and whether they perform morcellation in a bag.

“I have stopped using electric morcellation, and now we use a bag,” he said.

Dr. Nezhat reported having no relevant financial disclosures.

NEW YORK – More than a year after the Food and Drug Administration first warned physicians and patients about the risks of disseminating unsuspected cancer with electric power morcellation, most minimally invasive gynecologic surgeons are not using the technology.

But rather than convert to open laparotomy for fibroid removal, many surgeons are using conventional and robotic-assisted laparoscopic techniques, Dr. Farr Nezhat said at the annual Minimally Invasive Surgery Week.

“The controversy over electric power morcellation demonstrates the difficulty with surgical innovation. The risks and balances of morcellation must be balanced. The current debate demonstrates the power of public opinion,” said Dr. Nezhat, who is director of minimally invasive surgery and gynecologic robotics at Mount Sinai Roosevelt and Mount Sinai St. Luke’s hospitals, New York. “The good news is that the majority of respondents have not converted to laparotomy.”

Dr. Nezhat and his colleagues sent a survey to 3,505 members of the Society of Laparoendoscopic Surgeons and received 518 responses. Surgeons were queried on their beliefs about morcellation and current practices for fibroid removal.

Sixty-one percent of respondents said they do not currently use a power morcellator. Of those who do not use the device, nearly half said it was because power morcellation was banned by their hospital, while others responded that they were not comfortable using it or that their hospital didn’t have power morcellation equipment.

A total of 60% said they believe morcellation affects survival, and 66% said that morcellation also disseminates benign pathology. Additionally, 48% reported that they have encountered a diagnosis of unsuspected uterine carcinoma in their practices.

So what are surgeons doing instead of power morcellation? About three-quarters of respondents currently perform open laparotomy in fewer than 25% of their cases. Their responses indicated that they mostly use laparoscopic and robotic procedures.

“It is encouraging that they did not go back to open laparotomy and that they have obviously found alternatives,” Dr. Nezhat said at the meeting sponsored by the Society of Laparoendoscopic Surgeons and affiliated societies.

Dr. Nezhat and his colleagues are planning a second survey to get details on the type of approaches that ob.gyns. are now using: vaginal morcellation, minilaparoscopy, or posterior colostomy, as well as and whether they perform morcellation in a bag.

“I have stopped using electric morcellation, and now we use a bag,” he said.

Dr. Nezhat reported having no relevant financial disclosures.

NEW YORK – More than a year after the Food and Drug Administration first warned physicians and patients about the risks of disseminating unsuspected cancer with electric power morcellation, most minimally invasive gynecologic surgeons are not using the technology.

But rather than convert to open laparotomy for fibroid removal, many surgeons are using conventional and robotic-assisted laparoscopic techniques, Dr. Farr Nezhat said at the annual Minimally Invasive Surgery Week.

“The controversy over electric power morcellation demonstrates the difficulty with surgical innovation. The risks and balances of morcellation must be balanced. The current debate demonstrates the power of public opinion,” said Dr. Nezhat, who is director of minimally invasive surgery and gynecologic robotics at Mount Sinai Roosevelt and Mount Sinai St. Luke’s hospitals, New York. “The good news is that the majority of respondents have not converted to laparotomy.”

Dr. Nezhat and his colleagues sent a survey to 3,505 members of the Society of Laparoendoscopic Surgeons and received 518 responses. Surgeons were queried on their beliefs about morcellation and current practices for fibroid removal.

Sixty-one percent of respondents said they do not currently use a power morcellator. Of those who do not use the device, nearly half said it was because power morcellation was banned by their hospital, while others responded that they were not comfortable using it or that their hospital didn’t have power morcellation equipment.

A total of 60% said they believe morcellation affects survival, and 66% said that morcellation also disseminates benign pathology. Additionally, 48% reported that they have encountered a diagnosis of unsuspected uterine carcinoma in their practices.

So what are surgeons doing instead of power morcellation? About three-quarters of respondents currently perform open laparotomy in fewer than 25% of their cases. Their responses indicated that they mostly use laparoscopic and robotic procedures.

“It is encouraging that they did not go back to open laparotomy and that they have obviously found alternatives,” Dr. Nezhat said at the meeting sponsored by the Society of Laparoendoscopic Surgeons and affiliated societies.

Dr. Nezhat and his colleagues are planning a second survey to get details on the type of approaches that ob.gyns. are now using: vaginal morcellation, minilaparoscopy, or posterior colostomy, as well as and whether they perform morcellation in a bag.

“I have stopped using electric morcellation, and now we use a bag,” he said.

Dr. Nezhat reported having no relevant financial disclosures.

NEW YORK – While some evidence in the surgical literature suggests that intraperitoneal bupivacaine reduces postoperative pain scores and narcotic use, a new randomized controlled trial shows no significant improvement in patients undergoing robot-assisted total laparoscopic hysterectomy.

“Despite evidence of benefit in laparoscopic surgery, there does not appear to be a benefit for using intraperitoneal bupivacaine. We need a larger sample size to study this,” Dr. Allan Klapper said at the annual Minimally Invasive Surgery Week.

The uptake of robot-assisted total laparoscopic hysterectomy increased by 9.5% in the United States, and hospitals with robotic capabilities perform 22.4% of hysterectomies with this technique, according to Dr. Klapper, an ob.gyn. at West Pennsylvania Allegheny Health System in Pittsburgh. Minimally invasive surgery, however, does not completely eliminate postoperative pain, and between one-third and two-thirds of patients report pain following such surgery.

Intraperitoneal bupivacaine (IB) was selected for the study because of positive reports in small studies of patients undergoing laparoscopic cholecystectomy and gynecologic procedures, Dr. Klapper explained. He noted that the positive studies were of poor quality, but other studies – also of poor quality – had negative results.

To investigate the role of IB in reducing postoperative pain and narcotic requirements in patients undergoing robot-assisted total laparoscopic hysterectomy, Dr. Klapper and his colleagues launched a prospective, double-blind, randomized, placebo-controlled trial comparing IB to normal saline in 41 patients managed with a standardized postoperative analgesic regimen.

Baseline characteristics showed no differences between the two groups in surgical indications, body mass index, operating room time, number of previous surgeries, and the percentage of patients undergoing lymph node dissection. Patients were excluded from the analysis if they converted to laparotomy, were allergic to IB, or were currently on treatment for chronic pain.

Complete data on pain response, as assessed by the visual analog scale, was available for 29 of the 41 patients. No significant differences in postoperative pain scores were observed between the two groups at 1, 16, 18, and 24 hours. Further, there was no significant difference in morphine dose between the IB and normal saline groups.

“One finding was the opposite of what I would have expected. Patients who underwent lymph node dissection used significantly less narcotic analgesic [P = .03],” Dr. Klapper told the audience.

Study strengths were the prospective, randomized design, and its being adequately powered to detect a significant difference between the two groups. But the study was conducted at a single institution and did not include data beyond 24 hours. Also, Dr. Klapper said that perhaps results should have been stratified according to indications for surgery.

“There is more and more pressure on us to achieve higher patient satisfaction scores. Soon down the line, patient satisfaction will become a metric for compensation. We need to focus on what we can do to improve patient satisfaction scores and experience,” Dr. Klapper said. “A larger sample of gynecologic oncology patients is needed to further support these conclusions, and we need to fine tune to avoid the problems in this study.”

The meeting was presented by the Society of Laparoendoscopic Surgeons and affiliated societies. Dr. Klapper reported that he is on the speakers bureau for Astellas.

NEW YORK – While some evidence in the surgical literature suggests that intraperitoneal bupivacaine reduces postoperative pain scores and narcotic use, a new randomized controlled trial shows no significant improvement in patients undergoing robot-assisted total laparoscopic hysterectomy.

“Despite evidence of benefit in laparoscopic surgery, there does not appear to be a benefit for using intraperitoneal bupivacaine. We need a larger sample size to study this,” Dr. Allan Klapper said at the annual Minimally Invasive Surgery Week.

The uptake of robot-assisted total laparoscopic hysterectomy increased by 9.5% in the United States, and hospitals with robotic capabilities perform 22.4% of hysterectomies with this technique, according to Dr. Klapper, an ob.gyn. at West Pennsylvania Allegheny Health System in Pittsburgh. Minimally invasive surgery, however, does not completely eliminate postoperative pain, and between one-third and two-thirds of patients report pain following such surgery.

Intraperitoneal bupivacaine (IB) was selected for the study because of positive reports in small studies of patients undergoing laparoscopic cholecystectomy and gynecologic procedures, Dr. Klapper explained. He noted that the positive studies were of poor quality, but other studies – also of poor quality – had negative results.

To investigate the role of IB in reducing postoperative pain and narcotic requirements in patients undergoing robot-assisted total laparoscopic hysterectomy, Dr. Klapper and his colleagues launched a prospective, double-blind, randomized, placebo-controlled trial comparing IB to normal saline in 41 patients managed with a standardized postoperative analgesic regimen.

Baseline characteristics showed no differences between the two groups in surgical indications, body mass index, operating room time, number of previous surgeries, and the percentage of patients undergoing lymph node dissection. Patients were excluded from the analysis if they converted to laparotomy, were allergic to IB, or were currently on treatment for chronic pain.

Complete data on pain response, as assessed by the visual analog scale, was available for 29 of the 41 patients. No significant differences in postoperative pain scores were observed between the two groups at 1, 16, 18, and 24 hours. Further, there was no significant difference in morphine dose between the IB and normal saline groups.

“One finding was the opposite of what I would have expected. Patients who underwent lymph node dissection used significantly less narcotic analgesic [P = .03],” Dr. Klapper told the audience.

Study strengths were the prospective, randomized design, and its being adequately powered to detect a significant difference between the two groups. But the study was conducted at a single institution and did not include data beyond 24 hours. Also, Dr. Klapper said that perhaps results should have been stratified according to indications for surgery.

“There is more and more pressure on us to achieve higher patient satisfaction scores. Soon down the line, patient satisfaction will become a metric for compensation. We need to focus on what we can do to improve patient satisfaction scores and experience,” Dr. Klapper said. “A larger sample of gynecologic oncology patients is needed to further support these conclusions, and we need to fine tune to avoid the problems in this study.”

The meeting was presented by the Society of Laparoendoscopic Surgeons and affiliated societies. Dr. Klapper reported that he is on the speakers bureau for Astellas.

NEW YORK – While some evidence in the surgical literature suggests that intraperitoneal bupivacaine reduces postoperative pain scores and narcotic use, a new randomized controlled trial shows no significant improvement in patients undergoing robot-assisted total laparoscopic hysterectomy.

“Despite evidence of benefit in laparoscopic surgery, there does not appear to be a benefit for using intraperitoneal bupivacaine. We need a larger sample size to study this,” Dr. Allan Klapper said at the annual Minimally Invasive Surgery Week.

The uptake of robot-assisted total laparoscopic hysterectomy increased by 9.5% in the United States, and hospitals with robotic capabilities perform 22.4% of hysterectomies with this technique, according to Dr. Klapper, an ob.gyn. at West Pennsylvania Allegheny Health System in Pittsburgh. Minimally invasive surgery, however, does not completely eliminate postoperative pain, and between one-third and two-thirds of patients report pain following such surgery.

Intraperitoneal bupivacaine (IB) was selected for the study because of positive reports in small studies of patients undergoing laparoscopic cholecystectomy and gynecologic procedures, Dr. Klapper explained. He noted that the positive studies were of poor quality, but other studies – also of poor quality – had negative results.

To investigate the role of IB in reducing postoperative pain and narcotic requirements in patients undergoing robot-assisted total laparoscopic hysterectomy, Dr. Klapper and his colleagues launched a prospective, double-blind, randomized, placebo-controlled trial comparing IB to normal saline in 41 patients managed with a standardized postoperative analgesic regimen.

Baseline characteristics showed no differences between the two groups in surgical indications, body mass index, operating room time, number of previous surgeries, and the percentage of patients undergoing lymph node dissection. Patients were excluded from the analysis if they converted to laparotomy, were allergic to IB, or were currently on treatment for chronic pain.

Complete data on pain response, as assessed by the visual analog scale, was available for 29 of the 41 patients. No significant differences in postoperative pain scores were observed between the two groups at 1, 16, 18, and 24 hours. Further, there was no significant difference in morphine dose between the IB and normal saline groups.

“One finding was the opposite of what I would have expected. Patients who underwent lymph node dissection used significantly less narcotic analgesic [P = .03],” Dr. Klapper told the audience.

Study strengths were the prospective, randomized design, and its being adequately powered to detect a significant difference between the two groups. But the study was conducted at a single institution and did not include data beyond 24 hours. Also, Dr. Klapper said that perhaps results should have been stratified according to indications for surgery.

“There is more and more pressure on us to achieve higher patient satisfaction scores. Soon down the line, patient satisfaction will become a metric for compensation. We need to focus on what we can do to improve patient satisfaction scores and experience,” Dr. Klapper said. “A larger sample of gynecologic oncology patients is needed to further support these conclusions, and we need to fine tune to avoid the problems in this study.”

The meeting was presented by the Society of Laparoendoscopic Surgeons and affiliated societies. Dr. Klapper reported that he is on the speakers bureau for Astellas.

NEW YORK – Cryoablation of the endometrium is a safe and effective office-based procedure for the treatment of menorrhagia, resulting in few operative complications, according to a chart review of 100 consecutive cases over a 3-year period.

“Abnormal uterine bleeding is the most common reason for referral to a gynecologist, and it is associated with an adverse impact on quality of life, health care use, and cost. Hysterectomy cures abnormal uterine bleeding, but surgery has risks,” study author Dr. Radha Syed said at the annual Minimally Invasive Surgery Week.

Between 2012 and 2015, Dr. Syed treated women aged 37-51 years with cryoablation of the endometrium under ultrasound guidance in her office. Anesthesia was provided by intravenous conscious sedation and paracervical blocks. Manufacturer’s guidelines were followed for the procedure, with voice prompts from the generator device, said Dr. Syed of the North Shore LIJ Health System, Staten Island, N.Y.

Indications for cryoablation included refractory menorrhagia or menorrhagia affecting quality of life with benign etiology; patients who did not want hysterectomy were not operative candidates.

Patient-based outcome measures were used to assess results of cryoablation. In the recovery room, pain scores were between 2 and 3, as assessed by a visual analog scale ranging from 0 to 10, with 10 signifying the most severe pain. Patients were able to return to work on the first or second postoperative day.

There were no intraoperative or immediate postoperative complications among the 100 consecutive cases reviewed. The maximum follow-up time was 36 months.

The most pressing postoperative symptom was excess watery discharge lasting 2-3 weeks, which was sometimes bloody, Dr. Syed said at the meeting, which was presented by the Society of Laparoendoscopic Surgeons and affiliated societies.

Delayed complications included two hematometra due to cervical cicatrix 4-6 weeks from surgery, which was managed by dilation under ultrasound guidance. One to two years after surgery, two patients underwent hysterectomy for recurrence of menorrhagia; both were associated with fibroids.

Patient satisfaction was 90%, as assessed over the phone using patient-based outcome measures. Most patients achieved hypomenorrhea or eumenorrhea. The rate of amenorrhea was less than 30%.

“Other minimally invasive procedures are available, but it is difficult to compare these procedures due to the subjective nature of complaints and variable symptoms,” Dr. Syed said. “I find cryoablation useful. There is less pain than with hysterectomy, and patient satisfaction is high. Even though the equipment is expensive, cryoablation avoids hysterectomy and all its attendant risks.”

Dr. Syed reported having no financial disclosures.

NEW YORK – Cryoablation of the endometrium is a safe and effective office-based procedure for the treatment of menorrhagia, resulting in few operative complications, according to a chart review of 100 consecutive cases over a 3-year period.

“Abnormal uterine bleeding is the most common reason for referral to a gynecologist, and it is associated with an adverse impact on quality of life, health care use, and cost. Hysterectomy cures abnormal uterine bleeding, but surgery has risks,” study author Dr. Radha Syed said at the annual Minimally Invasive Surgery Week.

Between 2012 and 2015, Dr. Syed treated women aged 37-51 years with cryoablation of the endometrium under ultrasound guidance in her office. Anesthesia was provided by intravenous conscious sedation and paracervical blocks. Manufacturer’s guidelines were followed for the procedure, with voice prompts from the generator device, said Dr. Syed of the North Shore LIJ Health System, Staten Island, N.Y.

Indications for cryoablation included refractory menorrhagia or menorrhagia affecting quality of life with benign etiology; patients who did not want hysterectomy were not operative candidates.

Patient-based outcome measures were used to assess results of cryoablation. In the recovery room, pain scores were between 2 and 3, as assessed by a visual analog scale ranging from 0 to 10, with 10 signifying the most severe pain. Patients were able to return to work on the first or second postoperative day.

There were no intraoperative or immediate postoperative complications among the 100 consecutive cases reviewed. The maximum follow-up time was 36 months.

The most pressing postoperative symptom was excess watery discharge lasting 2-3 weeks, which was sometimes bloody, Dr. Syed said at the meeting, which was presented by the Society of Laparoendoscopic Surgeons and affiliated societies.

Delayed complications included two hematometra due to cervical cicatrix 4-6 weeks from surgery, which was managed by dilation under ultrasound guidance. One to two years after surgery, two patients underwent hysterectomy for recurrence of menorrhagia; both were associated with fibroids.

Patient satisfaction was 90%, as assessed over the phone using patient-based outcome measures. Most patients achieved hypomenorrhea or eumenorrhea. The rate of amenorrhea was less than 30%.

“Other minimally invasive procedures are available, but it is difficult to compare these procedures due to the subjective nature of complaints and variable symptoms,” Dr. Syed said. “I find cryoablation useful. There is less pain than with hysterectomy, and patient satisfaction is high. Even though the equipment is expensive, cryoablation avoids hysterectomy and all its attendant risks.”

Dr. Syed reported having no financial disclosures.

NEW YORK – Cryoablation of the endometrium is a safe and effective office-based procedure for the treatment of menorrhagia, resulting in few operative complications, according to a chart review of 100 consecutive cases over a 3-year period.

“Abnormal uterine bleeding is the most common reason for referral to a gynecologist, and it is associated with an adverse impact on quality of life, health care use, and cost. Hysterectomy cures abnormal uterine bleeding, but surgery has risks,” study author Dr. Radha Syed said at the annual Minimally Invasive Surgery Week.

Between 2012 and 2015, Dr. Syed treated women aged 37-51 years with cryoablation of the endometrium under ultrasound guidance in her office. Anesthesia was provided by intravenous conscious sedation and paracervical blocks. Manufacturer’s guidelines were followed for the procedure, with voice prompts from the generator device, said Dr. Syed of the North Shore LIJ Health System, Staten Island, N.Y.

Indications for cryoablation included refractory menorrhagia or menorrhagia affecting quality of life with benign etiology; patients who did not want hysterectomy were not operative candidates.

Patient-based outcome measures were used to assess results of cryoablation. In the recovery room, pain scores were between 2 and 3, as assessed by a visual analog scale ranging from 0 to 10, with 10 signifying the most severe pain. Patients were able to return to work on the first or second postoperative day.

There were no intraoperative or immediate postoperative complications among the 100 consecutive cases reviewed. The maximum follow-up time was 36 months.

The most pressing postoperative symptom was excess watery discharge lasting 2-3 weeks, which was sometimes bloody, Dr. Syed said at the meeting, which was presented by the Society of Laparoendoscopic Surgeons and affiliated societies.

Delayed complications included two hematometra due to cervical cicatrix 4-6 weeks from surgery, which was managed by dilation under ultrasound guidance. One to two years after surgery, two patients underwent hysterectomy for recurrence of menorrhagia; both were associated with fibroids.

Patient satisfaction was 90%, as assessed over the phone using patient-based outcome measures. Most patients achieved hypomenorrhea or eumenorrhea. The rate of amenorrhea was less than 30%.

“Other minimally invasive procedures are available, but it is difficult to compare these procedures due to the subjective nature of complaints and variable symptoms,” Dr. Syed said. “I find cryoablation useful. There is less pain than with hysterectomy, and patient satisfaction is high. Even though the equipment is expensive, cryoablation avoids hysterectomy and all its attendant risks.”

Dr. Syed reported having no financial disclosures.

NEW YORK – Displaying a low-tech, low-cost white board in the operating room during the “time out” before surgery can significantly improve memory retention among members of the surgical team, a new study suggests.

“We found that providing a white board that you can buy at any office supply store gives a visual stimulus on top of the verbal stimulus [that] improves retention of important information,” Dr. Aryan Meknat, the study author, said at the annual Minimally Invasive Surgery Week.

A surgical pause or “time out” performed before any operative procedure is a major component of the Joint Commission’s Universal Protocol to prevent wrong site, wrong procedure, and wrong person surgery. Retention of information presented during the surgical pause is essential, at the beginning of the case and for the duration of the procedure, he said.

During the study, surgical teams were randomly divided into two groups: in the first group, 30 team members were given information verbally during the surgical pause; while a second group of 29 team members was provided with verbal information that was read from the white board. The white board was displayed in the operating room throughout the surgical procedure for the second group.

After the conclusion of the procedure, the white board was removed and both groups were given a short written questionnaire. Each team was tested only once in order to keep the study blinded. Also, participants had no prior knowledge that they would be tested after the procedure.

Study participants were asked to recall several facts about the patient, including the patient’s first and last name, age, sex, weight, site of IV placement, allergies, medications, relation of accompanying guardian, and the signature on the consent form.

Team members in the first study group answered a total of 300 questions, and 200 questions (66.7%) were correctly answered. Participants in the second group – which used the white board – answered 290 questions, and 239 (82.4%) were correctly answered. The white board group had a 23.6% overall increase in correctly answered questions. The difference between retention in the two groups was statistically significant (P less than .05) in every category tested.

“These findings apply to operating rooms everywhere, especially in cases where there may be long delays before starting the procedure, changes in anesthesia midcase, situations where two procedures are scheduled in one patient, or in intraoperative emergency situations. We need to be sure that the surgical team retains information, as well as [listens] to verbal instructions,” said Dr. Meknat of MobiSurg, a mobile surgical unit based in Laguna Hills, Calif.

Dr. Meknat reported having no financial disclosures.

NEW YORK – Displaying a low-tech, low-cost white board in the operating room during the “time out” before surgery can significantly improve memory retention among members of the surgical team, a new study suggests.

“We found that providing a white board that you can buy at any office supply store gives a visual stimulus on top of the verbal stimulus [that] improves retention of important information,” Dr. Aryan Meknat, the study author, said at the annual Minimally Invasive Surgery Week.

A surgical pause or “time out” performed before any operative procedure is a major component of the Joint Commission’s Universal Protocol to prevent wrong site, wrong procedure, and wrong person surgery. Retention of information presented during the surgical pause is essential, at the beginning of the case and for the duration of the procedure, he said.

During the study, surgical teams were randomly divided into two groups: in the first group, 30 team members were given information verbally during the surgical pause; while a second group of 29 team members was provided with verbal information that was read from the white board. The white board was displayed in the operating room throughout the surgical procedure for the second group.

After the conclusion of the procedure, the white board was removed and both groups were given a short written questionnaire. Each team was tested only once in order to keep the study blinded. Also, participants had no prior knowledge that they would be tested after the procedure.

Study participants were asked to recall several facts about the patient, including the patient’s first and last name, age, sex, weight, site of IV placement, allergies, medications, relation of accompanying guardian, and the signature on the consent form.

Team members in the first study group answered a total of 300 questions, and 200 questions (66.7%) were correctly answered. Participants in the second group – which used the white board – answered 290 questions, and 239 (82.4%) were correctly answered. The white board group had a 23.6% overall increase in correctly answered questions. The difference between retention in the two groups was statistically significant (P less than .05) in every category tested.

“These findings apply to operating rooms everywhere, especially in cases where there may be long delays before starting the procedure, changes in anesthesia midcase, situations where two procedures are scheduled in one patient, or in intraoperative emergency situations. We need to be sure that the surgical team retains information, as well as [listens] to verbal instructions,” said Dr. Meknat of MobiSurg, a mobile surgical unit based in Laguna Hills, Calif.

Dr. Meknat reported having no financial disclosures.

NEW YORK – Displaying a low-tech, low-cost white board in the operating room during the “time out” before surgery can significantly improve memory retention among members of the surgical team, a new study suggests.

“We found that providing a white board that you can buy at any office supply store gives a visual stimulus on top of the verbal stimulus [that] improves retention of important information,” Dr. Aryan Meknat, the study author, said at the annual Minimally Invasive Surgery Week.

A surgical pause or “time out” performed before any operative procedure is a major component of the Joint Commission’s Universal Protocol to prevent wrong site, wrong procedure, and wrong person surgery. Retention of information presented during the surgical pause is essential, at the beginning of the case and for the duration of the procedure, he said.

During the study, surgical teams were randomly divided into two groups: in the first group, 30 team members were given information verbally during the surgical pause; while a second group of 29 team members was provided with verbal information that was read from the white board. The white board was displayed in the operating room throughout the surgical procedure for the second group.

After the conclusion of the procedure, the white board was removed and both groups were given a short written questionnaire. Each team was tested only once in order to keep the study blinded. Also, participants had no prior knowledge that they would be tested after the procedure.

Study participants were asked to recall several facts about the patient, including the patient’s first and last name, age, sex, weight, site of IV placement, allergies, medications, relation of accompanying guardian, and the signature on the consent form.

Team members in the first study group answered a total of 300 questions, and 200 questions (66.7%) were correctly answered. Participants in the second group – which used the white board – answered 290 questions, and 239 (82.4%) were correctly answered. The white board group had a 23.6% overall increase in correctly answered questions. The difference between retention in the two groups was statistically significant (P less than .05) in every category tested.

“These findings apply to operating rooms everywhere, especially in cases where there may be long delays before starting the procedure, changes in anesthesia midcase, situations where two procedures are scheduled in one patient, or in intraoperative emergency situations. We need to be sure that the surgical team retains information, as well as [listens] to verbal instructions,” said Dr. Meknat of MobiSurg, a mobile surgical unit based in Laguna Hills, Calif.

Dr. Meknat reported having no financial disclosures.

NEW YORK – Virtual learning of laparoscopic surgical skills is now possible and appears to be as successful as direct mentoring through an in-person teaching course, according to a pilot study of 16 medical students and residents naive to laparoscopy.

Suturing skills were equivalent in the group mentored directly, compared with those who learned how to suture in a virtual course using a telementoring program called Top Gun Surgeon. Suturing was evaluated based on time, skill, and errors.

“Our preliminary data suggest there is no difference between in-person transferring of suturing skills versus telementoring. Top Gun Surgeon is a new, cost-effective telementoring program, using telecommunications to guide surgeons and teach them skills from afar. It is a great extender, expanding access to available mentors, and increasing access to surgical training,” said Dr. James C. Rosser Jr., a surgeon at Celebration Hospital in Florida and developer of the original Top Gun Surgeon training program, which recently added a telementoring component.

Future studies are planned with a group of 75 surgeons to validate telementoring as an effective method of teaching laparoscopic surgical skills. Participants will go through a series of drills based on the Top Gun Surgeons to increase their speed and competence.

Improving skills such as suturing is critical for the field, according to Dr. Rosser.

“Adoption of advanced laparoscopic procedures has been abysmal in the U.S.,” he said at the annual Minimally Invasive Surgery Week. “Surgeons need to adopt advanced skills required for minimally invasive surgery, starting with suturing.”

“Our data show that only 18% of self-proclaimed advanced laparoscopy surgeons can tie a knot in 10 minutes. You can take the Top Gun course and learn how to do this in 12 hours with telementoring, or teach yourself in 350 hours,” he said in an interview.

The standard setup for telementoring involves a downloadable iBook, two webcams, two tripods, a headset, and a USB extender. This platform costs about $322 to acquire, according to Dr. Rosser.

“A robot costs $100,000,” he said. “It’s not feasible to buy a robot for every training station.”

The suturing training course is $1,500 per physician and can be ordered through stealthlearningcompany.com.

The potential advantages of telementoring include expanded access to available mentors, increased access to surgical training, multiplication of the workforce, and improved novice performance, according to Dr. Rosser. Another potential benefit is the cost effectiveness of the program, provided the transfer of skills is proven to be equally effective to in-person training in larger studies. With the virtual program, a single mentor can monitor multiple positions.

More than 7,500 surgeons have gone through the Top Gun Surgeon training program since its launch in 1992. The telementoring component is new.

“This is the first time we have done a study at a high academic level where skills are transferred virtually by telementoring. We saw equivalent transfer of skills using the direct mentoring method and telementoring,” Dr. Rosser said. “We believe that this technology can be transferred to other industries. It’s groundbreaking to learn new skills without traveling.”

Dr. Paul Wetter, chairman of the Society of Laparoendoscopic Surgeons, said the virtual course has a lot of appeal.

“In this era of time constraints for the medical profession, being able to take a course and practice on a simulator where you are, instead of having to travel to meetings, and the opportunity to learn at your own pace and go back to review specifics you may be unsure of, will allow laparoscopic surgeons to ‘warm up’ their skill set,” Dr. Wetter said. “Many studies show improved surgical outcomes with ‘warming up.’ ”

The Society of Laparoendoscopic Surgeons – in collaboration with Dr. Rosser – developed the new iBook teaching platform. The Society is currently developing a CME course for accreditation using the new platform.

“This program will help solve the difficulties related to time and logistics and improve laparoscopic surgery skill sets, which is linked to patient safety and outcomes,” Dr. Wetter said.

The pilot study was sponsored by Karl Storz, a medical device manufacturer.

NEW YORK – Virtual learning of laparoscopic surgical skills is now possible and appears to be as successful as direct mentoring through an in-person teaching course, according to a pilot study of 16 medical students and residents naive to laparoscopy.

Suturing skills were equivalent in the group mentored directly, compared with those who learned how to suture in a virtual course using a telementoring program called Top Gun Surgeon. Suturing was evaluated based on time, skill, and errors.

“Our preliminary data suggest there is no difference between in-person transferring of suturing skills versus telementoring. Top Gun Surgeon is a new, cost-effective telementoring program, using telecommunications to guide surgeons and teach them skills from afar. It is a great extender, expanding access to available mentors, and increasing access to surgical training,” said Dr. James C. Rosser Jr., a surgeon at Celebration Hospital in Florida and developer of the original Top Gun Surgeon training program, which recently added a telementoring component.

Future studies are planned with a group of 75 surgeons to validate telementoring as an effective method of teaching laparoscopic surgical skills. Participants will go through a series of drills based on the Top Gun Surgeons to increase their speed and competence.

Improving skills such as suturing is critical for the field, according to Dr. Rosser.

“Adoption of advanced laparoscopic procedures has been abysmal in the U.S.,” he said at the annual Minimally Invasive Surgery Week. “Surgeons need to adopt advanced skills required for minimally invasive surgery, starting with suturing.”

“Our data show that only 18% of self-proclaimed advanced laparoscopy surgeons can tie a knot in 10 minutes. You can take the Top Gun course and learn how to do this in 12 hours with telementoring, or teach yourself in 350 hours,” he said in an interview.

The standard setup for telementoring involves a downloadable iBook, two webcams, two tripods, a headset, and a USB extender. This platform costs about $322 to acquire, according to Dr. Rosser.

“A robot costs $100,000,” he said. “It’s not feasible to buy a robot for every training station.”

The suturing training course is $1,500 per physician and can be ordered through stealthlearningcompany.com.

The potential advantages of telementoring include expanded access to available mentors, increased access to surgical training, multiplication of the workforce, and improved novice performance, according to Dr. Rosser. Another potential benefit is the cost effectiveness of the program, provided the transfer of skills is proven to be equally effective to in-person training in larger studies. With the virtual program, a single mentor can monitor multiple positions.

More than 7,500 surgeons have gone through the Top Gun Surgeon training program since its launch in 1992. The telementoring component is new.

“This is the first time we have done a study at a high academic level where skills are transferred virtually by telementoring. We saw equivalent transfer of skills using the direct mentoring method and telementoring,” Dr. Rosser said. “We believe that this technology can be transferred to other industries. It’s groundbreaking to learn new skills without traveling.”

Dr. Paul Wetter, chairman of the Society of Laparoendoscopic Surgeons, said the virtual course has a lot of appeal.

“In this era of time constraints for the medical profession, being able to take a course and practice on a simulator where you are, instead of having to travel to meetings, and the opportunity to learn at your own pace and go back to review specifics you may be unsure of, will allow laparoscopic surgeons to ‘warm up’ their skill set,” Dr. Wetter said. “Many studies show improved surgical outcomes with ‘warming up.’ ”

The Society of Laparoendoscopic Surgeons – in collaboration with Dr. Rosser – developed the new iBook teaching platform. The Society is currently developing a CME course for accreditation using the new platform.

“This program will help solve the difficulties related to time and logistics and improve laparoscopic surgery skill sets, which is linked to patient safety and outcomes,” Dr. Wetter said.

The pilot study was sponsored by Karl Storz, a medical device manufacturer.

NEW YORK – Virtual learning of laparoscopic surgical skills is now possible and appears to be as successful as direct mentoring through an in-person teaching course, according to a pilot study of 16 medical students and residents naive to laparoscopy.

Suturing skills were equivalent in the group mentored directly, compared with those who learned how to suture in a virtual course using a telementoring program called Top Gun Surgeon. Suturing was evaluated based on time, skill, and errors.

“Our preliminary data suggest there is no difference between in-person transferring of suturing skills versus telementoring. Top Gun Surgeon is a new, cost-effective telementoring program, using telecommunications to guide surgeons and teach them skills from afar. It is a great extender, expanding access to available mentors, and increasing access to surgical training,” said Dr. James C. Rosser Jr., a surgeon at Celebration Hospital in Florida and developer of the original Top Gun Surgeon training program, which recently added a telementoring component.

Future studies are planned with a group of 75 surgeons to validate telementoring as an effective method of teaching laparoscopic surgical skills. Participants will go through a series of drills based on the Top Gun Surgeons to increase their speed and competence.

Improving skills such as suturing is critical for the field, according to Dr. Rosser.

“Adoption of advanced laparoscopic procedures has been abysmal in the U.S.,” he said at the annual Minimally Invasive Surgery Week. “Surgeons need to adopt advanced skills required for minimally invasive surgery, starting with suturing.”

“Our data show that only 18% of self-proclaimed advanced laparoscopy surgeons can tie a knot in 10 minutes. You can take the Top Gun course and learn how to do this in 12 hours with telementoring, or teach yourself in 350 hours,” he said in an interview.

The standard setup for telementoring involves a downloadable iBook, two webcams, two tripods, a headset, and a USB extender. This platform costs about $322 to acquire, according to Dr. Rosser.

“A robot costs $100,000,” he said. “It’s not feasible to buy a robot for every training station.”

The suturing training course is $1,500 per physician and can be ordered through stealthlearningcompany.com.

The potential advantages of telementoring include expanded access to available mentors, increased access to surgical training, multiplication of the workforce, and improved novice performance, according to Dr. Rosser. Another potential benefit is the cost effectiveness of the program, provided the transfer of skills is proven to be equally effective to in-person training in larger studies. With the virtual program, a single mentor can monitor multiple positions.

More than 7,500 surgeons have gone through the Top Gun Surgeon training program since its launch in 1992. The telementoring component is new.

“This is the first time we have done a study at a high academic level where skills are transferred virtually by telementoring. We saw equivalent transfer of skills using the direct mentoring method and telementoring,” Dr. Rosser said. “We believe that this technology can be transferred to other industries. It’s groundbreaking to learn new skills without traveling.”

Dr. Paul Wetter, chairman of the Society of Laparoendoscopic Surgeons, said the virtual course has a lot of appeal.

“In this era of time constraints for the medical profession, being able to take a course and practice on a simulator where you are, instead of having to travel to meetings, and the opportunity to learn at your own pace and go back to review specifics you may be unsure of, will allow laparoscopic surgeons to ‘warm up’ their skill set,” Dr. Wetter said. “Many studies show improved surgical outcomes with ‘warming up.’ ”

The Society of Laparoendoscopic Surgeons – in collaboration with Dr. Rosser – developed the new iBook teaching platform. The Society is currently developing a CME course for accreditation using the new platform.

“This program will help solve the difficulties related to time and logistics and improve laparoscopic surgery skill sets, which is linked to patient safety and outcomes,” Dr. Wetter said.

The pilot study was sponsored by Karl Storz, a medical device manufacturer.

Major Finding: Seventy-one percent of the females with PCOS had acanthosis nigricans, 75% had a family history of type 2 diabetes, 71% had a family history of cardiovascular disease, and 87% had a BMI greater than 26 kg/m

Data Source: A retrospective case series of 24 PCOS patients aged 9-19 years.

Disclosures: Dr. Green and Dr. Broomfield said they had no relevant financial disclosures.

WASHINGTON – Girls and young women with polycystic ovary syndrome appear to share common features that include obesity, a strong family history of type 2 diabetes, cardiovascular disease, and acanthosis nigricans, according to a retrospective case series from researchers at Howard University Hospital in Washington.

“These findings are not new, but they are striking, considering how common they were,” said lead author Dr. Lisa Green.

“For example, more than two-thirds of adolescents with PCOS [polycystic ovary syndrome] were found to have acanthosis nigricans, which is a marker of hyperinsulinemia.”

If uncorrected, hyperinsulinemia may leads to type 2 diabetes in these patients, said Dr. Green.

“The findings underline the importance of recognizing and treating PCOS in adolescents, who are predisposed to developing type 2 diabetes, cardiovascular disease, endometrial hyperplasia, and cancer,” Dr. Green said at the meeting.

“Parents of adolescents known to have PCOS should be counseled appropriately regarding these risks,” she added.

PCOS is a common disorder, occurring in 5%-10% of all females aged 12-45 years, she noted, but the causes are unknown, and the diagnosis is based on clinical findings.

“The diagnosis of polycystic ovary syndrome is more difficult or delayed in the adolescent population because clinical findings, such as irregular menstrual cycles and acne, are normal among this population,” Dr. Green said in an interview.

The study identified 24 females aged 9-19 years who were diagnosed with PCOS between 2007 and 2009 using the Rotterdam criteria: 71% had acanthosis nigricans, 75% had a family history of type 2 diabetes mellitus, 71% had a family history of cardiovascular disease, and 87% had body mass index greater than 26 kg/m

The study is limited by its size and lack of control group. Dr. Green and her colleagues plan to conduct future studies to validate the strength of their observations.

“Knowing that adolescents with PCOS have significant underlying risk factors for type 2 diabetes mellitus and cardiovascular disease makes it imperative that we conduct additional studies to ascertain if treatment with insulin-sensitizing agents and the like will decrease their risk of subsequently developing diabetes,” according to senior author Dr. Diana Broomfield.

“If so, then it would be more prudent to treat them with these drugs, rather than simply to put then on oral contraceptive pills for menstrual cycle management,” she said.

Major Finding: Seventy-one percent of the females with PCOS had acanthosis nigricans, 75% had a family history of type 2 diabetes, 71% had a family history of cardiovascular disease, and 87% had a BMI greater than 26 kg/m

Data Source: A retrospective case series of 24 PCOS patients aged 9-19 years.

Disclosures: Dr. Green and Dr. Broomfield said they had no relevant financial disclosures.

WASHINGTON – Girls and young women with polycystic ovary syndrome appear to share common features that include obesity, a strong family history of type 2 diabetes, cardiovascular disease, and acanthosis nigricans, according to a retrospective case series from researchers at Howard University Hospital in Washington.

“These findings are not new, but they are striking, considering how common they were,” said lead author Dr. Lisa Green.

“For example, more than two-thirds of adolescents with PCOS [polycystic ovary syndrome] were found to have acanthosis nigricans, which is a marker of hyperinsulinemia.”

If uncorrected, hyperinsulinemia may leads to type 2 diabetes in these patients, said Dr. Green.

“The findings underline the importance of recognizing and treating PCOS in adolescents, who are predisposed to developing type 2 diabetes, cardiovascular disease, endometrial hyperplasia, and cancer,” Dr. Green said at the meeting.

“Parents of adolescents known to have PCOS should be counseled appropriately regarding these risks,” she added.

PCOS is a common disorder, occurring in 5%-10% of all females aged 12-45 years, she noted, but the causes are unknown, and the diagnosis is based on clinical findings.

“The diagnosis of polycystic ovary syndrome is more difficult or delayed in the adolescent population because clinical findings, such as irregular menstrual cycles and acne, are normal among this population,” Dr. Green said in an interview.

The study identified 24 females aged 9-19 years who were diagnosed with PCOS between 2007 and 2009 using the Rotterdam criteria: 71% had acanthosis nigricans, 75% had a family history of type 2 diabetes mellitus, 71% had a family history of cardiovascular disease, and 87% had body mass index greater than 26 kg/m

The study is limited by its size and lack of control group. Dr. Green and her colleagues plan to conduct future studies to validate the strength of their observations.

“Knowing that adolescents with PCOS have significant underlying risk factors for type 2 diabetes mellitus and cardiovascular disease makes it imperative that we conduct additional studies to ascertain if treatment with insulin-sensitizing agents and the like will decrease their risk of subsequently developing diabetes,” according to senior author Dr. Diana Broomfield.

“If so, then it would be more prudent to treat them with these drugs, rather than simply to put then on oral contraceptive pills for menstrual cycle management,” she said.

Major Finding: Seventy-one percent of the females with PCOS had acanthosis nigricans, 75% had a family history of type 2 diabetes, 71% had a family history of cardiovascular disease, and 87% had a BMI greater than 26 kg/m

Data Source: A retrospective case series of 24 PCOS patients aged 9-19 years.

Disclosures: Dr. Green and Dr. Broomfield said they had no relevant financial disclosures.

WASHINGTON – Girls and young women with polycystic ovary syndrome appear to share common features that include obesity, a strong family history of type 2 diabetes, cardiovascular disease, and acanthosis nigricans, according to a retrospective case series from researchers at Howard University Hospital in Washington.

“These findings are not new, but they are striking, considering how common they were,” said lead author Dr. Lisa Green.

“For example, more than two-thirds of adolescents with PCOS [polycystic ovary syndrome] were found to have acanthosis nigricans, which is a marker of hyperinsulinemia.”

If uncorrected, hyperinsulinemia may leads to type 2 diabetes in these patients, said Dr. Green.

“The findings underline the importance of recognizing and treating PCOS in adolescents, who are predisposed to developing type 2 diabetes, cardiovascular disease, endometrial hyperplasia, and cancer,” Dr. Green said at the meeting.

“Parents of adolescents known to have PCOS should be counseled appropriately regarding these risks,” she added.

PCOS is a common disorder, occurring in 5%-10% of all females aged 12-45 years, she noted, but the causes are unknown, and the diagnosis is based on clinical findings.

“The diagnosis of polycystic ovary syndrome is more difficult or delayed in the adolescent population because clinical findings, such as irregular menstrual cycles and acne, are normal among this population,” Dr. Green said in an interview.

The study identified 24 females aged 9-19 years who were diagnosed with PCOS between 2007 and 2009 using the Rotterdam criteria: 71% had acanthosis nigricans, 75% had a family history of type 2 diabetes mellitus, 71% had a family history of cardiovascular disease, and 87% had body mass index greater than 26 kg/m

The study is limited by its size and lack of control group. Dr. Green and her colleagues plan to conduct future studies to validate the strength of their observations.

“Knowing that adolescents with PCOS have significant underlying risk factors for type 2 diabetes mellitus and cardiovascular disease makes it imperative that we conduct additional studies to ascertain if treatment with insulin-sensitizing agents and the like will decrease their risk of subsequently developing diabetes,” according to senior author Dr. Diana Broomfield.

“If so, then it would be more prudent to treat them with these drugs, rather than simply to put then on oral contraceptive pills for menstrual cycle management,” she said.

Major Finding: Polyps were suspected in 101 (6.7%) of these patients based on the ultrasound appearance of the endometrial lining.

Data Source: A prospective study of 1,500 consecutive asymptomatic women.

Disclosures: Dr. Hartman said that he had no relevant financial disclosures.

WASHINGTON – A small but important percentage of postmenopausal women not taking hormone replacement therapy have an endometrial lining that is suspicious for polyps, according to a prospective study of 1,500 consecutive asymptomatic women.

“We found no suspicion of polyps in the vast majority of asymptomatic postmenopausal women not taking HRT [hormone replacement therapy]; but we did find a suspicion of polyps in 6.7% of all patients. The appearance of a nonhomogeneous endometrial lining on ultrasound increased our suspicion of polyp,” Dr. Michael Hartman of Memorial University of Newfoundland, St. John's, Canada, said in a poster presentation at the meeting. “The number of women with suspicion of polyps was higher than expected and indicates there are a large number of asymptomatic postmenopausal women with endometrial polyps.”

Dr. Hartman explained in an interview: “Any woman can develop polyps, whether or not she is on exogenous hormones. Estrogen can affect the lining of the uterus after menopause since it is produced in fat cells and not just the ovaries.”

In a study of women aged 45–95 years (mean age, 62.7 years) who underwent transvaginal ultrasound from January to August 2010, 77.1% had an endometrial thickness of less than or equal to 4 mm, and 92% had an endometrial thickness of less than 5 mm. Polyps were suspected in 101 (6.7%) of these patients based on the ultrasound appearance of the endometrial lining.

Independent t-tests of age and endometrial thickening were performed, comparing the patients with a normal-appearing endometrium with those whose endometrial thickening was suspicious for polyps. A significant difference was observed between the groups, with older age and mean endometrial thickness having a significant association with suspicion of polyps. Polyps were significantly more likely to be found in older patients, with a mean age of 67.7 years, than in younger patients (mean age of 62 years). Patients with a lining suspicious for polyps had a thicker endometrium (mean of 8.02 mm) than did patients who did not have a lining suspicious for a polyp (mean of 3.40 mm).

These findings do not support routine ultrasound screening of older asymptomatic women. “In fact, I would say that the finding of polyps in 6.7% of women does not necessarily signal the presence of cancerous or precancerous growths. Further clinical investigation is required to determine the natural history of these polyps,” Dr. Hartman stated.

Major Finding: Polyps were suspected in 101 (6.7%) of these patients based on the ultrasound appearance of the endometrial lining.

Data Source: A prospective study of 1,500 consecutive asymptomatic women.

Disclosures: Dr. Hartman said that he had no relevant financial disclosures.

WASHINGTON – A small but important percentage of postmenopausal women not taking hormone replacement therapy have an endometrial lining that is suspicious for polyps, according to a prospective study of 1,500 consecutive asymptomatic women.

“We found no suspicion of polyps in the vast majority of asymptomatic postmenopausal women not taking HRT [hormone replacement therapy]; but we did find a suspicion of polyps in 6.7% of all patients. The appearance of a nonhomogeneous endometrial lining on ultrasound increased our suspicion of polyp,” Dr. Michael Hartman of Memorial University of Newfoundland, St. John's, Canada, said in a poster presentation at the meeting. “The number of women with suspicion of polyps was higher than expected and indicates there are a large number of asymptomatic postmenopausal women with endometrial polyps.”

Dr. Hartman explained in an interview: “Any woman can develop polyps, whether or not she is on exogenous hormones. Estrogen can affect the lining of the uterus after menopause since it is produced in fat cells and not just the ovaries.”

In a study of women aged 45–95 years (mean age, 62.7 years) who underwent transvaginal ultrasound from January to August 2010, 77.1% had an endometrial thickness of less than or equal to 4 mm, and 92% had an endometrial thickness of less than 5 mm. Polyps were suspected in 101 (6.7%) of these patients based on the ultrasound appearance of the endometrial lining.

Independent t-tests of age and endometrial thickening were performed, comparing the patients with a normal-appearing endometrium with those whose endometrial thickening was suspicious for polyps. A significant difference was observed between the groups, with older age and mean endometrial thickness having a significant association with suspicion of polyps. Polyps were significantly more likely to be found in older patients, with a mean age of 67.7 years, than in younger patients (mean age of 62 years). Patients with a lining suspicious for polyps had a thicker endometrium (mean of 8.02 mm) than did patients who did not have a lining suspicious for a polyp (mean of 3.40 mm).

These findings do not support routine ultrasound screening of older asymptomatic women. “In fact, I would say that the finding of polyps in 6.7% of women does not necessarily signal the presence of cancerous or precancerous growths. Further clinical investigation is required to determine the natural history of these polyps,” Dr. Hartman stated.

Major Finding: Polyps were suspected in 101 (6.7%) of these patients based on the ultrasound appearance of the endometrial lining.

Data Source: A prospective study of 1,500 consecutive asymptomatic women.

Disclosures: Dr. Hartman said that he had no relevant financial disclosures.

WASHINGTON – A small but important percentage of postmenopausal women not taking hormone replacement therapy have an endometrial lining that is suspicious for polyps, according to a prospective study of 1,500 consecutive asymptomatic women.

“We found no suspicion of polyps in the vast majority of asymptomatic postmenopausal women not taking HRT [hormone replacement therapy]; but we did find a suspicion of polyps in 6.7% of all patients. The appearance of a nonhomogeneous endometrial lining on ultrasound increased our suspicion of polyp,” Dr. Michael Hartman of Memorial University of Newfoundland, St. John's, Canada, said in a poster presentation at the meeting. “The number of women with suspicion of polyps was higher than expected and indicates there are a large number of asymptomatic postmenopausal women with endometrial polyps.”

Dr. Hartman explained in an interview: “Any woman can develop polyps, whether or not she is on exogenous hormones. Estrogen can affect the lining of the uterus after menopause since it is produced in fat cells and not just the ovaries.”

In a study of women aged 45–95 years (mean age, 62.7 years) who underwent transvaginal ultrasound from January to August 2010, 77.1% had an endometrial thickness of less than or equal to 4 mm, and 92% had an endometrial thickness of less than 5 mm. Polyps were suspected in 101 (6.7%) of these patients based on the ultrasound appearance of the endometrial lining.

Independent t-tests of age and endometrial thickening were performed, comparing the patients with a normal-appearing endometrium with those whose endometrial thickening was suspicious for polyps. A significant difference was observed between the groups, with older age and mean endometrial thickness having a significant association with suspicion of polyps. Polyps were significantly more likely to be found in older patients, with a mean age of 67.7 years, than in younger patients (mean age of 62 years). Patients with a lining suspicious for polyps had a thicker endometrium (mean of 8.02 mm) than did patients who did not have a lining suspicious for a polyp (mean of 3.40 mm).

These findings do not support routine ultrasound screening of older asymptomatic women. “In fact, I would say that the finding of polyps in 6.7% of women does not necessarily signal the presence of cancerous or precancerous growths. Further clinical investigation is required to determine the natural history of these polyps,” Dr. Hartman stated.

Major Finding: Results showed that 34% of polyps decreased in size, 42% had no significant change from time of diagnosis, and 24% showed an increase in size.

Data Source: A study of 300 consecutive patients aged 22–78 years who underwent sonohysterography from January to July of 2010.

Disclosures: Dr. Hartman said he had no relevant financial disclosures.

WASHINGTON – A longitudinal study of patients with previously diagnosed endometrial polyps found that about 75% of the polyps either decreased in size or remained the same size, while about one-quarter increased with up to 3.5 years of follow-up, leading the authors to suggest that the practice of automatic treatment of benign-appearing endometrial polyps should be reevaluated.

“The current practice is to treat endometrial polyps that are found, especially if the patient is undergoing fertility procedures or is postmenopausal. This study shows that routine treatment of endometrial polyps may not always be necessary. Polyps should be triaged based on their appearance, size, patient's age, and whether there is increased blood flow in the polyp,” Dr. Michael Hartman of Memorial University of Newfoundland, St. John's, Canada, said at the meeting.

The study included 300 consecutive patients aged 22–78 years who underwent sonohysterography from January to July of 2010. All patients were diagnosed with polyps from 1 to 43 months previously, and none had an intervention for the polyps.

Results showed that 34% of the polyps decreased in size (41 resolved [14%], and 61 [20%] decreased more than 1 mm); 41.7% had no significant change from time of diagnosis, and 24.3% showed an increase in size (16% showed an increase of more than 1 mm, and 8% had an increase of greater than or equal to 50%).

Independent t-tests showed that the change in polyp size was significantly associated with menopausal status and blood flow, but failed to find an association between increased size and polyp location and abnormal uterine bleeding. Univariate linear regression found no association between change in polyp size and patient age, time between scans, and endometrial thickness.

Dr. Hartman said in an interview: “In common practice, polyps found in a postmenopausal woman that cause bleeding and polyps with increased vascularity should be treated. Treatment of all polyps without these features should be reevaluated.”

He noted that his impression is that smaller polyps and those in women of reproductive age may not require treatment and may instead be monitored.

Major Finding: Results showed that 34% of polyps decreased in size, 42% had no significant change from time of diagnosis, and 24% showed an increase in size.

Data Source: A study of 300 consecutive patients aged 22–78 years who underwent sonohysterography from January to July of 2010.

Disclosures: Dr. Hartman said he had no relevant financial disclosures.

WASHINGTON – A longitudinal study of patients with previously diagnosed endometrial polyps found that about 75% of the polyps either decreased in size or remained the same size, while about one-quarter increased with up to 3.5 years of follow-up, leading the authors to suggest that the practice of automatic treatment of benign-appearing endometrial polyps should be reevaluated.

“The current practice is to treat endometrial polyps that are found, especially if the patient is undergoing fertility procedures or is postmenopausal. This study shows that routine treatment of endometrial polyps may not always be necessary. Polyps should be triaged based on their appearance, size, patient's age, and whether there is increased blood flow in the polyp,” Dr. Michael Hartman of Memorial University of Newfoundland, St. John's, Canada, said at the meeting.

The study included 300 consecutive patients aged 22–78 years who underwent sonohysterography from January to July of 2010. All patients were diagnosed with polyps from 1 to 43 months previously, and none had an intervention for the polyps.

Results showed that 34% of the polyps decreased in size (41 resolved [14%], and 61 [20%] decreased more than 1 mm); 41.7% had no significant change from time of diagnosis, and 24.3% showed an increase in size (16% showed an increase of more than 1 mm, and 8% had an increase of greater than or equal to 50%).

Independent t-tests showed that the change in polyp size was significantly associated with menopausal status and blood flow, but failed to find an association between increased size and polyp location and abnormal uterine bleeding. Univariate linear regression found no association between change in polyp size and patient age, time between scans, and endometrial thickness.

Dr. Hartman said in an interview: “In common practice, polyps found in a postmenopausal woman that cause bleeding and polyps with increased vascularity should be treated. Treatment of all polyps without these features should be reevaluated.”

He noted that his impression is that smaller polyps and those in women of reproductive age may not require treatment and may instead be monitored.

Major Finding: Results showed that 34% of polyps decreased in size, 42% had no significant change from time of diagnosis, and 24% showed an increase in size.

Data Source: A study of 300 consecutive patients aged 22–78 years who underwent sonohysterography from January to July of 2010.

Disclosures: Dr. Hartman said he had no relevant financial disclosures.

WASHINGTON – A longitudinal study of patients with previously diagnosed endometrial polyps found that about 75% of the polyps either decreased in size or remained the same size, while about one-quarter increased with up to 3.5 years of follow-up, leading the authors to suggest that the practice of automatic treatment of benign-appearing endometrial polyps should be reevaluated.

“The current practice is to treat endometrial polyps that are found, especially if the patient is undergoing fertility procedures or is postmenopausal. This study shows that routine treatment of endometrial polyps may not always be necessary. Polyps should be triaged based on their appearance, size, patient's age, and whether there is increased blood flow in the polyp,” Dr. Michael Hartman of Memorial University of Newfoundland, St. John's, Canada, said at the meeting.

The study included 300 consecutive patients aged 22–78 years who underwent sonohysterography from January to July of 2010. All patients were diagnosed with polyps from 1 to 43 months previously, and none had an intervention for the polyps.

Results showed that 34% of the polyps decreased in size (41 resolved [14%], and 61 [20%] decreased more than 1 mm); 41.7% had no significant change from time of diagnosis, and 24.3% showed an increase in size (16% showed an increase of more than 1 mm, and 8% had an increase of greater than or equal to 50%).

Independent t-tests showed that the change in polyp size was significantly associated with menopausal status and blood flow, but failed to find an association between increased size and polyp location and abnormal uterine bleeding. Univariate linear regression found no association between change in polyp size and patient age, time between scans, and endometrial thickness.

Dr. Hartman said in an interview: “In common practice, polyps found in a postmenopausal woman that cause bleeding and polyps with increased vascularity should be treated. Treatment of all polyps without these features should be reevaluated.”

He noted that his impression is that smaller polyps and those in women of reproductive age may not require treatment and may instead be monitored.

WASHINGTON – A longitudinal study of patients with previously diagnosed endometrial polyps found that about 75% of the polyps either decreased in size or remained the same size, while about one-quarter increased with up to 3.5 years of follow-up, leading the authors to suggest that the practice of automatic treatment of benign-appearing endometrial polyps should be re-evaluated.

"The current practice is to treat endometrial polyps that are found, especially if the patient is undergoing fertility procedures or is postmenopausal. This study shows that routine treatment of endometrial polyps may not always be necessary. Polyps should be triaged based on their appearance, size, patient’s age, and whether there is increased blood flow in the polyp," Dr. Michael Hartman of Memorial University of Newfoundland, St. John’s, said at the annual meeting of the American College of Obstetricians and Gynecologists.

The study included 300 consecutive patients aged 22-78 years who underwent sonohysterography from January to July of 2010. All patients were diagnosed with polyps from 1 to 43 months previously, and none had an intervention for the polyps.

Results showed that 34% of the polyps decreased in size (41 resolved [14%], and 61 [20%] decreased more than 1 mm); 41.7% had no significant change from time of diagnosis, and 24.3% showed an increase in size (16% showed an increase of more than 1 mm, and 8% had an increase of greater than or equal to 50%). Independent t-tests showed that the change in polyp size was significantly associated with menopausal status and blood flow, but failed to find an association between increased size and polyp location and abnormal uterine bleeding. Univariate linear regression found no association between change in polyp size and patient age, time between scans, and endometrial thickness.

Dr. Hartman said in an interview: "In common practice, polyps found in a postmenopausal woman that cause bleeding and polyps with increased vascularity should be treated. Treatment of all polyps without these features should be re-evaluated." He noted that his impression is that smaller polyps and those in women of reproductive age may not require treatment and may instead be monitored.

Dr. Hartman said he had no relevant financial disclosures.

WASHINGTON – A longitudinal study of patients with previously diagnosed endometrial polyps found that about 75% of the polyps either decreased in size or remained the same size, while about one-quarter increased with up to 3.5 years of follow-up, leading the authors to suggest that the practice of automatic treatment of benign-appearing endometrial polyps should be re-evaluated.

"The current practice is to treat endometrial polyps that are found, especially if the patient is undergoing fertility procedures or is postmenopausal. This study shows that routine treatment of endometrial polyps may not always be necessary. Polyps should be triaged based on their appearance, size, patient’s age, and whether there is increased blood flow in the polyp," Dr. Michael Hartman of Memorial University of Newfoundland, St. John’s, said at the annual meeting of the American College of Obstetricians and Gynecologists.

The study included 300 consecutive patients aged 22-78 years who underwent sonohysterography from January to July of 2010. All patients were diagnosed with polyps from 1 to 43 months previously, and none had an intervention for the polyps.

Results showed that 34% of the polyps decreased in size (41 resolved [14%], and 61 [20%] decreased more than 1 mm); 41.7% had no significant change from time of diagnosis, and 24.3% showed an increase in size (16% showed an increase of more than 1 mm, and 8% had an increase of greater than or equal to 50%). Independent t-tests showed that the change in polyp size was significantly associated with menopausal status and blood flow, but failed to find an association between increased size and polyp location and abnormal uterine bleeding. Univariate linear regression found no association between change in polyp size and patient age, time between scans, and endometrial thickness.

Dr. Hartman said in an interview: "In common practice, polyps found in a postmenopausal woman that cause bleeding and polyps with increased vascularity should be treated. Treatment of all polyps without these features should be re-evaluated." He noted that his impression is that smaller polyps and those in women of reproductive age may not require treatment and may instead be monitored.

Dr. Hartman said he had no relevant financial disclosures.

WASHINGTON – A longitudinal study of patients with previously diagnosed endometrial polyps found that about 75% of the polyps either decreased in size or remained the same size, while about one-quarter increased with up to 3.5 years of follow-up, leading the authors to suggest that the practice of automatic treatment of benign-appearing endometrial polyps should be re-evaluated.

"The current practice is to treat endometrial polyps that are found, especially if the patient is undergoing fertility procedures or is postmenopausal. This study shows that routine treatment of endometrial polyps may not always be necessary. Polyps should be triaged based on their appearance, size, patient’s age, and whether there is increased blood flow in the polyp," Dr. Michael Hartman of Memorial University of Newfoundland, St. John’s, said at the annual meeting of the American College of Obstetricians and Gynecologists.

The study included 300 consecutive patients aged 22-78 years who underwent sonohysterography from January to July of 2010. All patients were diagnosed with polyps from 1 to 43 months previously, and none had an intervention for the polyps.

Results showed that 34% of the polyps decreased in size (41 resolved [14%], and 61 [20%] decreased more than 1 mm); 41.7% had no significant change from time of diagnosis, and 24.3% showed an increase in size (16% showed an increase of more than 1 mm, and 8% had an increase of greater than or equal to 50%). Independent t-tests showed that the change in polyp size was significantly associated with menopausal status and blood flow, but failed to find an association between increased size and polyp location and abnormal uterine bleeding. Univariate linear regression found no association between change in polyp size and patient age, time between scans, and endometrial thickness.

Dr. Hartman said in an interview: "In common practice, polyps found in a postmenopausal woman that cause bleeding and polyps with increased vascularity should be treated. Treatment of all polyps without these features should be re-evaluated." He noted that his impression is that smaller polyps and those in women of reproductive age may not require treatment and may instead be monitored.

Dr. Hartman said he had no relevant financial disclosures.