ABSTRACT: To determine whether performing uterine artery embolization (UAE) immediately before laparoscopic myomectomy can facilitate a minimally invasive surgical approach for larger uterine fibroids.
In a retrospective case-control study, laparoscopic myomectomy with and without preoperative UAE was examined. Data were analyzed from 26 laparoscopic myomectomies performed by a single surgeon at Northwestern University Feinberg School of Medicine between 2004 and 2010. Controls were matched for age, calendar year, surgeon, and number of fibroids removed. Surgical outcomes included preoperative clinical uterine size, operative time, operative blood loss, and postoperative myoma specimen weight. Data were analyzed via 2-tailed Student t test.
Twelve women underwent laparoscopic myomectomy within 169 ± 16minutes (mean ± SEM) of preoperative UAE. Fourteen control patients underwent laparoscopic myomectomy alone. The UAE group had a greater mean preoperative clinical uterine size (19.7 versus 12.4 weeks, P<0.001) and a greater mean myoma specimen weight measured postoperatively (595.3 versus 153.6 grams, P<0.05). There were no significant differences in operative time or blood loss, and there were no intra-operative complications.
UAE performed immediately before laparoscopic myomectomy facilitated minimally invasive surgery for larger uteri and larger uterine myomas, with no differences in operative time or blood loss.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 11/2011; 116(2):105-8. · 1.41 Impact Factor
Fertility and sterility 09/2011; · 3.97 Impact Factor
ABSTRACT: To evaluate the use of an aromatase inhibitor for the treatment of endometriosis-related chronic pelvic pain.
Academic medical center outpatient reproductive endocrinology clinic.
Sixteen patients with endometriosis and chronic pelvic pain who previously failed conventional medical and/or surgical therapy.
Treatment with the aromatase inhibitor letrozole (2.5 mg/d) plus a gonadotropin suppressor (norethindrone acetate, 2.5 mg/d, or a combination oral contraceptive [OC]) for an average of 6 months.
Pain scores were reported at each visit using a visual analogue scale from 0 to 10 (0: no pain, 10: maximum pain).
Sixteen patients were treated with an aromatase inhibitor for 180 ± 31 days. The median pain score at the start of therapy was 7, and at the end of therapy it was 1.5. In the nine patients who were evaluated after discontinuing therapy, pain scores returned to pretreatment levels. We did not find any correlation between the length of treatment and the overall improvement in pain score.
Letrozole plus a gonadotropin suppressor substantially improved pain symptoms in patients with endometriosis refractory to conventional therapies; however, pain recurred after treatment was completed.
Fertility and sterility 08/2011; 96(4):939-42. · 3.97 Impact Factor
ABSTRACT: To determine a minimum number of procedures required for proficiency in oocyte retrieval and to characterize skill acquisition.
Reproductive endocrinology and infertility fellowship training program.
Fellows in training from 2005 to 2007 and 2008 to 2010.
Proficiency scores were calculated by dividing the number of oocytes retrieved by oocytes expected. The 2005 to 2007 trainees were grouped and proficiency scores calculated as an average during specific points in their training. The 2008 to 2010 trainees were compared individually to determine differences in individual skill acquisition.
A greater number of oocytes were retrieved than expected, 8.6 versus 7.6. A relatively lower proficiency score was noted during the first 10 trainee aspirations (proficiency score=1.1) compared with subsequent aspirations (proficiency score=1.25 for retrievals 11-20, proficiency score=1.21 for retrievals 21-30 and >31). When individual fellows' scores were calculated, the majority achieved proficiency by 20 aspirations, and all but one trainee achieved the mean staff proficiency score by 50 retrievals.
Regardless of a trainee's initial proficiency in oocyte retrieval, there were no statistically significant differences in the learning curve between trainees. The majority of individual fellows in training demonstrate proficiency in follicular aspirations within 20 procedures; however, a minority may require 50 procedures to achieve the proficiency of an attending physician.
Fertility and sterility 03/2011; 95(7):2279-82. · 3.97 Impact Factor