Video-Assisted Thoracic Surgery Lobectomy for Non-Small Cell Lung Cancer – A Propensity Score Analysis Based on a Multi-institutional Registry
Jianxing He, MD, PhD, FACS
Authors: Tristan D. Yan1#, Zhi-hua Zhu2#, Christopher Cao1#, Qun Wang3#, Gening Jiang4#, Lunxu Liu5#, Deruo Liu6#, Zheng Wang7, David M. Jablons8, Wenlong Shao9,10, Deborah Black11, Jianhua Fu2, Xinguo Xiong9,10, Daoyuan Wang9,10, Michael Mann8, Weiqiang Yin9,10, Xin Xu9,10, Hanzhang Chen9,10, Dongrong Situ2, Xu Zhang2, Peng Lin2, Yuming Zhu3, Wentao Li3, Yi Zhang3, Lin Yang7, Jasleen Kukreja8, Tie-hua Rong2, Jianxing He9,10
Institutions: 1. The Systematic Review Group, The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia.
2. Department of Thoracic Oncology, Cancer Center of Sun Yat-Sen University, Guangzhou, China.
3 Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai, China.
4 Department of Thoracic Surgery, Shanghai Pulmonary Hospital of Tongji University, Shanghai, China.
5. Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
6. Department of Thoracic Surgery, China and Japan Friendship Hospital, Beijing, China.
7. Department of Thoracic Surgery, Shenzhen People’s Hospital, Shenzhen, China.
8. UCSF Department of Surgery, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, CA, USA.
9. Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China.
10. Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.
11. The University of Sydney, Faculty of Health Sciences and Biostatistics, Sydney, NSW, Australia.
Background: We conducted a multi-institutional propensitymatched study comparing video-assisted thoracic surgery (VATS) with conventional open lobectomy for patients with nonsmall cell lung cancer (NSCLC) in an attempt to stratify potential differences in long-term survival outcomes.
Methods: We established a multi-institutional registry for 4138 patients with NSCLC who underwent lobectomy between January 2000 and December 2007 from eight institutions in the People’s Republic of China. Age, gender, histological type and tumor staging based on the latest TNM classification were entered into a non-parsimonious multivariable logistic regression model. The predicted probability derived from the logistic equation was used as the propensity score for each individual. Based on similar propensity scores, we matched 1356 of the 1584 patients who underwent VATS lobectomy with 1356 of the 2554 patients who underwent open lobectomy and compared their long-term survival outcomes.
Findings: The mean age of the 2712 matched patients was 59 (S.D. = 11) years. After propensity-matching, VATS and open lobectomy patients were similar in regards to important prognostic variables. Four prognostic factors were independently associated with improved survival in the multivariate analysis: gender (p = 0.001), histological type (p < 0.001), pathological staging (p < 0.001) and operation type (lobectomy/sleeve resection versus pneumonectomy (p = 0.044). Patients who underwent VATS versus open lobectomy had similar long-term survival (p = 0.101).
Interpretation: The current propensity score analysis suggests that well-matched patients with NSCLC who underwent VATS lobectomy did not have inferior long-term survival outcomes when compared to those who underwent open lobectomy.
Needlescopic Surgery for Gallstone, Appendicitis, and Other Diseases
Akiko Umezawa MD, Tsuyoshi Yamaguchi MD, Yosuke Seki MD, Kazunori Kasama MD, FACS, Yoshimochi Kurokawa MD.
Minimally invasive surgery center, Yotsuya Medical Cube, Japan
Safeness, less-invasiveness, and cosmetic satisfaction are some of the expectations to be fulfilled for the patients who submit to laparoscopic surgery. Laparoscopic cholecystectomy (LC) have been the most common procedure worldwide. The same is equally true of appendectomy (LA) and other procedures. In an effort to pursue those expectations, needlescopic surgery has been introduced.
Our conventional needlescopic LC is performed with 2 puncture and 2 incisions. 2 punctures are applied through thin caliber trocar with needle forceps with a diameter of 2.1mm. The puncture sites were below the right costal margin on the midclavicular line and on the anterior axillary line of the navel level. Other incisions were 12mm trocar at umbilical site for 10mm laparoscope and 5mm trocar below the left costal margin. We performed intraoperative cholangiography routinely during cholecystectomy. LA was performed with 3mm laparoscope at the lower abdomen, needle forceps at the right lower abdomen, and 5mm forceps at umbilical site.
During single incision laparoscopic surgery (TANKO), needle forceps are useful as adjunctive ports, and those scars with needle forceps will fade away in a few months. It has incited considerable controversy for some surgeons considering that needlescopic surgery is more troublesome and time consuming. In our series, more than 90% of LC cases have been performed successfully with needle forceps. One of the limitations was inflammation, but even in biliary inflammatory cases, 60% has been completed. The cosmetic advantage was evident, and there were no complications caused by using the needle forceps.
Laparoscopic Liver Resection Updates
Ho-Seong Han MD PhD
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University, College of Medicine
The applications and indications of LLR have been changed significantly recently. In the early stages, only tumorectomy was possible. With encouraging postoperative outcomes after LLR, there have been pioneering attempts to apply this procedure to more difficult cases. Previous limitations of the laparoscopic approach to posterior and superior parts of the liver have been overcome with the recent accumulation of experience as well. Liver resection in the vicinity of major vascular structures, such as the hilum, major hepatic veins and IVC, is still not indicated in laparoscopic procedure, as there is high risk of injury to these vessels, which may cause massive bleeding. Control of bleeding is difficult due to limitation of freedom which is inherent in laparoscopic procedure.
One way to minimize unwanted bleeding is to perform anatomical liver resection as possible. In anatomical liver resection, the liver parenchyma is straightly transected under the guidance of the ischemia line after selective ligation of a portal pedicle supplying the section or segment where the tumor is located. In several series, anatomical liver resection has been shown to be more advantageous in performing parenchymal transection and reducing bleeding. In addition, it has theoretical advantages of high survival outcomes after resection of HCC by eradicating all portions of liver supplied by portal pedicles. In conclusion, the limitation of LLR for HCC will be overcome as advanced techniques of LLR will be more widely applicable and more experiences accumulates.
Clinical Effect of Laparoscopic Roux-en-Y Choledochojejunostomy in Treating Biliary Tract Diseases
Zhu An-Dong Prof Doc Med,Chen De-Xing, Prof Doc Med
Qianwei Hospital of Jilin Province, Jilin, China.
Objective: To investigate the value of laparoscopic Roux-en-Y choledochojejunostomy in treating biliary tract diseases.
Methods: Laparoscopic Roux-en-Y cholangiojejunostomy was performed in 103 cases.
Results: All of the operations were performed successfully. The operation time was 120-240 minutes, average 107.1±59.3 minutes. The blood loss was 52-210 ml, average 48.2±87.6 ml. The postoperative hospital stays were 4-6 days, average 5.5 days. The follow up period of 95 patients ranged from 493 months, average 48.3 months. Among the 49 patients with malignant tumor, 41 patients had lived over 2 years. Other 8 patients died 8-11 months after the operations. No recurrent calculus or other complications were found in other patients.
Conclusions: Roux-en-Y anastomosis under the laparoscope is the best surgery procedure in treating biliary tract diseases that need choledochojejunostomy, although it is essential that the surgeon is rich in laparoscopic surgery experience.
The Evolution of Laparoscopic Hepatectomy: The Role of Laparoscopy in Liver Disease, with Special Emphasis on Hepatocellular Carcinoma
Georgios Tsoulfas MD, PhD, FACS
Aristoteleion University of Thessaloniki, Greece
The clinical application of laparoscopic surgery has grown rapidly over the last several years, as a less invasive method that is capable of achieving results similar to those of open surgery.
The goal of this presentation is to review the various applications of laparoscopic surgery in the treatment of liver diseases, with a special emphasis in hepatocellular carcinoma (HCC). The open and laparoscopic techniques will be compared with regards to efficacy and safety. The types, techniques and results of laparoscopic hepatectomy in the management of HCC will be analyzed, as well as the future prospects and potential including the use of robotic surgery and NOTES.
Robotic Hysterectomy Advantages and Applicability to the Large Uterus
Mona E. Orady MD, FACOG
Division of Minimally Invasive Gynecology and Robotic Surgery, Women’s Health Services, Henry Ford Health System
Hysterectomy is one of the most common gynecologic procedures performed for benign indications. Unfortunately, to date, most hysterectomies are still performed via laparotomy because laparoscopic and vaginal hysterectomy procedures were limited by uterine size, complex pathology, patient BMI and history of previous surgeries. The advent of robotic surgery using the daVinci Surgical System, has given laparoscopic surgeons the ability to approach more complex cases, such as in patients with the large uterus in a minimally invasive fashion. Since its approval by the US FDA for use in gynecology in 2005, the adoption of this procedure has been exponential.
This presentation provides an overview of the robotic hysterectomy procedure, the risk and benefits of this approach, and
evaluation of possible advantages or disadvantages of its adoption as compared to traditional approaches to hysterectomy as well as its application to the large uterus. DaVinci Hysterectomy has been shown to be safe and effective with low morbidity and fewer conversions to laparotomy than the traditional laparoscopic approach to hysterectomy. Blood loss and length of hospital stay are comparable to laparoscopic hysterectomy. Although operative time is initially increased, this decreases significantly with increasing surgeon experience and becomes comparable to laparoscopic hysterectomy towards the end of the learning curve. Robotic assisted Hysterectomy with the DaVinci surgical system has allowed the performance of complex hysterectomies with the same advantages of traditional laparoscopic surgeries without increasing complication rates or conversions to laparotomy. Thus, its continued adoption and expansion of usage in hysterectomy is likely.
Transvaginal Notes for Infertility
Hugo C. Verhoeven, M.D.
The Private Center for Endocrinology, Reproductive and Preventive Medicine, Dusseldorf, Germany
Transvaginal NOTES or TVE represents a culdoscopic approach of the pelvic cavity, takes advantage of micro-endoscopic technology without grasping or manipulation, uses saline for distension, and is an outpatient procedure.
Tubal factors are estimated to account for 10-20% of infertility. Evaluation of tubal function is largely restricted to the appraisal of its patency. Treatment of tubal infertility is primarily focused on the restoration of tubal patency. But, in spite of restored patency, infertility frequently persists and tubal pregnancy frequently occurs, as underlying disease is not diagnosed. It is increasingly evident that evaluation of peritubal adhesions and tubal patency is an incomplete evaluation of tubal function. Patients with patent tubes could be infertile because of tubal mucosal damage, not screened during traditional laparoscopy or HSG.
Changes of the major mucosal folds, adhesions, epithelial desquamation and reduced percentage of ciliated mucosal surface could be a reason for infertility, even in patients with patent tubes. Endoscopic evaluation of the tubal mucosa and tubal adhesions appears to be the most important prognostic tool for evaluating the outcome of pregnancy. TVE offers the optimal axis to enter into the tube without grasping or manipulation. Distension of the ampulla is obtained by water pressure, no additional scope is required, no additional instruments. Microsalpingoscopy allows examining the number of dyestained nuclei on the tubal epithelium, which are either intermediary cells on the surface of the epithelium or inflammatory cells residing inside the tubal folds.
It can be stated that the identification of tubal pathology during TVE, salpingoscopy or microsalpingoscopy is of great importance when deciding whether IVF or expectant treatment is the better option for infertile patients.
Influence of Surgical Stress from Laparoscopy and Laparotomy on Ovarian Carcinoma in an Animal Model
Jeong-Won Lee, MD, PhD, Tae-Joong Kim, MD, Byoung-Gie Kim, MD, PhD, and Duk-Soo Bae, MD, PhD
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Background. Recently, surgical stress was found to promote tumor growth and angiogenesis in a mouse model of ovarian carcinoma. The influences of surgical stress from minimally invasive surgery have not been thoroughly examined. We examined the effects of surgical stress from laparoscopy compared to laparotomy on ovarian cancer growth, including investigation of underlying mechanisms.
Methods. To mimic surgery effects, we performed laparoscopy or laparotomy on athymic nude mice under isoflurane inhalation at 4 days after i.p. tumor cell injection. Laparotomy was a 4 cm midline abdominal incision followed by externalization of intestines for 4 min. For the laparoscopy model, we performed pneumoperitoneum with CO2, inserting three cannulars.
Results. When either HeyA8 or SKOV3ip1 ovarian cancer cells were introduced, mice in the laparoscopy group had significantly lower tumor weight and fewer nodules compared to mice in the laparotomy group (P < 0.05). The level of VEGF in tissues, assessed by ELISA, significantly decreased in the laparoscopy group compared to the laparotomy group, but MMP2 and MMP9 levels showed no differences. In the immediate postoperative period, serum levels of VEGF and MMP2 were significantly decreased in the laparoscopy group. NK cell activity significantly decreased at postoperative 2 days in the laparotomy group, but showed no differences in the laparoscopy or control groups.
Conclusions. These results indicate that laparoscopy had little effect on enhancing tumor growth compared to laparotomy in an ovarian cancer animal model, possibly because it minimally influences angiogenesis, NK cell suppression, and induction of adhesion molecules.
Keywords: Surgical stress, Ovarian carcinoma, Laparoscopy, Mouse model
Endoscopic Surgery of Uterine Anomalies: A Review
Xiaoyan Shi, MD ,Sumin Wang, MD
Nanjing Maternal & Child Health Hospital Affiliated Hospital with Nanjing Medical University
Background: The prevalence of uterine anomalies is rare. Although it is classified into main types, Septate uterus is the most common uterine malformation and need to be return the cavity into normal form. At present, TCRS has been replaced the traditional open abdominal surgery and called gold standard therapy. The aim of this review is to evaluate feasibility and clinical value of endoscopic surgery of uterine anomalies associated with septate uterus.
Methods: 97 women with different degrees of septate uterus underwent transcervical resection of septa(TCRS) in our department between March, 2006, and August, 2010. All patients were followed up for more than 12 months. With the help of medical records, operation reports, as well as telephone contact, we analyzed the intraoperative and postoperative complications, postoperative anatomic identification of the uterus, and reproductive outcome.
Results: There were no complications, such as uterine perforation or bleeding, during or after any of the procedures. 74 second hysteroscopic examinations were taken after two to three months. Only 4 patients (5.4%) required a second operation to resect the postoperative intrauterine adhesion. The preoperative reproductive performance included 176pregnancies, of which 7 live deliveries (4%). Post-operation, there are 63 pregnancies, of which 54(85.7%) pregnancies have resulted in a living infant.
Single Incisional Laparoscopic Splenectomy with Pericardial Devascularization for the Treatment of Hypersplenism Due to Portal Hypertension
Jun Xu, MD, Zhifei Wang, MD, Yinghui Guan, MD, Bo Zhai, MD, Lei Zhao, MD and Heliang Yin, MD
Department of General Surgery, The Fourth Hospital of Harbin Medical University, Harbin, China.
Introduction: Single incisional laparoscopic splenectomy with pericardial devascularization for the treatment of hypersplenism due to portal hypertension has not been reported. This may be partly due to the high risk of bleeding and technically demanding of this procedure.
Objective: To explore the feasibility and safety of this technique.
Methods: From Jan, 2011 to Sept, 2011, we performed single incision laparoscopic splenectomy in 6 cases of hypersplenism due to portal hypertension. Pericardial devascularization was also performed in 4 of them. Autologous blood transfusion was applied in all the cases.
Results: The operations were successful in all the 6 cases. The mean operative time was 214 min (ranging from 120 min to 270 min). The mean blood loss was 383 ml (ranging from 50 to 1000 ml). All the patients have been followed to date and they all have gone on well postoperatively. This video shows the crucial steps of this operation.
Conclusions: This technique is safe and feasible in experienced hands of surgeons.
Retroperitoneal Laparoscopic Donor Nephrectomy: A Single Centre Experience with 160 Cases Report in China
Ma Lulin, Ye J, Huang Y, Hou X, Zhao L, Wang G.
Department of Urology, Peking University Third Hospital, Beijing, China.
Objective: To evaluate the efficacy and the learning-curve period of our modified retroperitoneoscopic live-donor nephrectomy.
Methods: From December 2003 to May 2009, 160 consecutive retroperitoneoscopic live-donor nephrectomies were carried out at our institution. Donors were separated into four groups in consecutive sequence in order to determine the learning-curve period. Groups 1-3 included forty consecutive cases each, whereas group 4 included the last eighteen cases. The renal artery and vein were controlled with two plastic locking clips at proximal ends without any clips on the kidney side. The kidney was manually retrieved through lumbar incision.
Results: Mean operative times were 160.5, 116.9, 101.4 and 109.2 min in groups 1-4, respectively (group 1 vs group 2, 3 or 4, P < 0.01). Mean warm ischemic time was 3.5 min. Mean estimated blood loss was 88.8, 73.0, 69.3 and 43.9 mL in groups 1-4, respectively (group 1 vs group 4, P < 0.01). No blood transfusion or open conversion was required. Mean hospital stay was 7.8, 6.9, 6.6 and 5.8 days in groups 1-4, respectively (group 1 vs group 4, P < 0.05). Eight donors and seven grafts suffered from complications. Complication rates were 22.5%, 7.5%, 5.0% and 6.0% in groups 1-4, respectively (group 1 vs group 3, P < 0.05).
Conculsion: Our modified retroperitoneoscopic live-donor nephrectomy can be carried out safely with a learning-curve period of about 40 cases.
Therapeutic Strategy of Hepatocellular Carcinoma by Laparoscopic Hepatetomy
Hironori Kaneko M.D. PhD. F.A.C.S.
Professor, Chairman, Department of Surgery, School of Medicine, Toho University
Due to the specific characteristics of hepatocellular carcinoma (HCC) such as the high recurrence rates accompanied by underlying cirrhosis caused by hepatitis B or C, the most important aspects of HCC treatment are curability and minimizing invasiveness. However, these two issues sometimes may not be adequately addressed by the available treatment options. We have pursued laparoscopic hepatectomy as a means of surgical therapy for HCC.
We outline the indications, evaluate the degree of invasiveness and analyze the outcomes of laparoscopic hepatectomy. Regarding the operative method, laparoscopic hepatectomy involving either partial hepatectomy or left lateral segmentectomy is a less invasive procedure.
We have accumulated laparoscopic hepatectomy cases, and the operative time has been shortened with less bleeding in recent cases. Laparoscopic hepatectomy was found to be less invasive than conventional hepatectomy. The patients were given more rapid recoveries, which consequently allowed shorter hospitalizations. Both the five-year survival rate and the survival rate without recurrences for HCC were nearly identical to those of open conventional hepatectomy, although further analysis will be necessary to reach definitive conclusions.
Recently, we have had successful experiences with laparoscopic hemihepatectomy, hepatectomy of giant HCC, tumor located upper segment or recurrence tumor. Laparoscopic hepatectomy avoids the disadvantages of standard hepatectomy for HCC in properly selected cirrhotic patients and is beneficial for patient quality of life because it is a minimally invasive procedure.
Comparative Clinical Evaluation of Single Incision Laparoscopic Cholecystectomy with Single and Multiport Access versus Conventional Multi-Port Laparoscopic Cholecystectomy
Bhupinder Singh Pathania Prof Dr Med
Postgraduate Department of Surgery, Medical College, Jammu, J&K, India
Introduction: Data that can prove single incision laparoscopic cholecystectomy (SILC) has superiority over the conventional multi-port cholecystectomy (MPLC), which is scant.
Aims and objectives: To compare safety, efficacy, and overall morbidity in these two methods of laparoscopic cholecystectomy.
Methods: Eighty patients were randomly and equally divided into two groups of 40 patients each. In one group, we performed single incision laparoscopic cholecystectomy whereas conventional MPLC was performed in the other group.
Results: Mean operating time of SILC was 70 minutes compared to 52 minutes in conventional MPLC. There was no conversion but an extra umbilical rescue device Allegator, minilaparoscopic instrument was necessary in 6 patients. One 5mm port was required in 2 cases of Empyema gall bladder and two 5mm ports, were essential to suture 1 to 2mm common bile duct injury in sixth case of SILC. No analgesics were needed even on demand in any patient beyond one week in SILC as compared to MPLC. Cosmetic appearance and satisfaction with body image was found very good in SILC.
Conclusion: SILS is a feasible and a promising method for cholecystectomy. Compared to MPLC, it is patient demanding with less postoperative pain, earlier return to work, excellent cosmesis and is cost effective when SILC is performed with standard equipment and instruments.
Transumbilical Single-Incision Laparoscopic Splenectomy Using Conventional Instruments
Shuo-Dong Wu, MD, PhD
Sheng Jing Hospital of China Medical University
Background: We share our ten cases to demonstrate the feasibility of transumbilical single-incision laparoscopic splenectomy using conventional instruments.
Methods: Ten patients were recruited: eight men and two women with a median age of 44 (range, 17–73) years, and body mass index of 22.3 (range, 18.6–22.6). Preoperative diagnosis was traumatic rupture (n = 1), splenic artery aneurysm (n = 1), ITP (n = 1), hypersplenism secondary to portal hypertension (n = 3), gastric cardia cancer with invasiveness to the spleen (n = 1), congenital hemolytic anemia with gallbladder stone (n = 1), and splenic hemangioma (n = 2). The procedure was attempted transumbilically by using three trocars (one of 12 mm and two of 5 mm) inserted through the umbilicus. Conventional laparoscopic instruments were used. Visualization of the spleen and standard dissection of attachments was accomplished, and splenectomy was completed by stapling of the splenic hilum. The spleen was extracted through the umbilical incision.
Results: All ten operations were successful with operative duration 115~360min,estimated blood loss 20~400ml and hospital stay 6~10days. One splenic hemangioma patient had postoperative bleeding and was reoperated by laparoscopic exploration revealing splenic hilum bleeding, which was controlled by suturing and ligation.
Conclusions: Transumbilical single-incision laparoscopic splenectomy appears to be a technically feasible alternative to standard endoscopic procedure and can be performed using conventional instruments by experienced hands.
Laparoscopic Major Liver Resection
Go Wakabayashi, MD, PhD, FACS
Department of Surgery, Iwate Medical University School of Medicine
Background: The trend in laparoscopic liver resections (LLR) has been moving from limited resections toward major hepatectomies. The surgical techniques for a laparoscopic major hepatectomy (LMH) include pure laparoscopic (PLMH), hand-assisted laparoscopic (HALMH), and laparoscopy-assisted (LAMH) methods. We discuss these techniques and the current role of LAMH method in LMH.
Method: Our literature review was conducted with Medline and articles written in English containing more than 10 cases of LMH were selected. Our previous results with LAMH were compared with the other series using PLMH or HALMH.
Results: Twenty-five articles, including our previous publication, were selected for this review. Those series containing PLMH or HALMH were published within highly-centralized centers and showed an apparent learning curve effect. As compared to the other articles focused on PLMH or HALMH, our previous results with LAMH showed an acceptable peri-operative outcome, while encompassing more hepatocellular carcinoma patients and more resections on laparoscopically unfavorable locations (right posterior and anterior sectionectomies). The LAMH method could also be utilized in living donor right hepatectomy without interfering with the donor safety and recipient outcomes.
Conclusion: We suggest that LAMH can be safely adopted by more surgeons with little laparoscopic experience for use in a wider population, while PLMH and HALMH should be reserved for the high volume experienced centers.
The Clinical Value of Endoscopy in Treatment of Female Infertility: 992 Cases Analysis
Dong LIU, Yong Song, Wei Huang*, Li Xiao, Guimei FENG, Licong SHEN, Jie RUAN
Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu Sichuan, P.R. China
Objectives: Endoscopy is increasingly important in the management of female infertility. The objective of this study is to analyze the outcomes of endoscopic procedures in the treatment of infertile patients.
Methods: This is a retrospective study about 1135 infertile women who underwent laparoscopy alone or with hysteroscopy in the department of Obstetrics and Gynecology in West China Second University Hospital, Sichuan University. Their clinical features and further pregnancy outcomes were retrospectively analyzed.
Results: A total of 1135 patients aged 20-40 were admitted at our hospital for infertility from January 2010 to December 2010. 992 cases of them were well followed up while the other 143 cases were lost; the mean follow-up period was (16.3±3.4) months, ranged from 11 to 22 months. According to the patients’ informed consent, 438 of them had both laparoscopy and hysteroscopy performed, and the other 554 patients had laparoscopy only. The baseline(age,duration of infertility,infertility type)of the two groups were similar(P> 0.05). In the combined group from which we could get extraneous information of the uterus, we found and treated endometrial polyps in 128 cases, intrauterine adhesions in 157, and uterine anomaly in 18(14 with septate uterus, 2 with saddle uterus, and 2 with bicornuate uterus). In additon, for the combined group,112 patients conceived 114 times,the pregnancy rate (PR) was 25.6%(112/438)and the live birth rate was 20.55% ( 90/438). For laparoscopy alone group, 160 patients conceived 168 times,the PR was 28.9%( 160/554)and the live birth rate was 21.48% (119/554). There was no significant difference in PR and live birth rate (P>0.05) between the two groups.
Conclusions: PR has no significant difference in laparoscopy alone and combination of hysteroscopy and laparoscopy, the latter way should result more live birth in infertile women as no abnormal uterine endometrium or uterine cavity.
Laparoscopic and Medical Management of Severe Endometriosis in Young Patients
Rolando Alvarez-Valero, MD, FACOG, Constanza M. Riquelme-Mc Loughlin, MD
It is estimated that more than 10 million women have endometriosis, affecting 6-10% of reproductive aged women. It is the third leading cause of gynecologic hospitalizations in the Un