Jackie Hollett-caines - Academia.edu (original) (raw)

Papers by Jackie Hollett-caines

Research paper thumbnail of Uterine artery embolization for uterine arteriovenous malformation in five women desiring fertility: pregnancy outcomes

Human Reproduction, 2015

Uterine arteriovenous malformations (AVM) are rare and can be classified as either congenital or ... more Uterine arteriovenous malformations (AVM) are rare and can be classified as either congenital or acquired. Acquired AVMs may result from trauma, uterine instrumentation, infection or gestational trophoblastic disease. The majority of acquired AVMs are encountered in women of reproductive age with a history of at least one pregnancy. Traditional therapies of AVMs include medical management of symptomatic bleeding, blood transfusions, uterine artery embolization (UAE) or hysterectomy. In this retrospective case series, we report our experience with AVM and UAE in five symptomatic women of reproductive age who wished to preserve fertility. Patients were 18-32 years old, and had 1-3 previous pregnancies prior to initial presentation. All patients were followed until their deliveries. All five patients delivered live births. Three of the five patients required two embolization procedures and one of these women required a subsequent hysterectomy. Two deliveries were at term and had normal weight babies and normal placenta. One woman had cerclage placed and developed chorioamnionitis at 34 weeks but had a normal placenta. Two pregnancies were induced <37 weeks for pre-eclampsia/b intrauterine growth restriction ± abnormal umbilical artery dopplers. The low birthweight were both <2000 g. Both placentas showed accelerated maturity and infarcts. All estimated blood losses were recorded as <500 cc. In conclusion, UAE may not be as effective at managing AVM as previously thought and should be questioned as an initial therapy in symptomatic women of reproductive age desiring fertility preservation.

Research paper thumbnail of Post-uterine artery embolization pain and clinical outcomes for symptomatic myomas using gelfoam pledgets alone versus embospheres plus gelfoam pledgets: a comparative pilot study

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2014

To evaluate the efficacy and post-procedural pain associated with uterine artery embolization (UA... more To evaluate the efficacy and post-procedural pain associated with uterine artery embolization (UAE) using Gelfoam alone versus Embospheres plus Gelfoam in women with symptomatic uterine fibroids. We conducted a prospective, non-randomized pilot study. Fluoroscopy-guided trans-femoral artery UAE was performed using Gelfoam pledgets alone or Embospheres (500 to 700 mg) plus Gelfoam under conscious sedation and local anaesthesia. This was followed by patient-controlled analgesia (PCA) using a morphine pump overnight. Post-procedural pain was assessed by the mean amount of self-administered morphine delivered by PCA pump (mL) from 0 to 19 hours in each group. The mean volumes of the uterus and the dominant fibroid were calculated by ultrasound at baseline, three months, six months, and 12 months. A total of 17 women participated in the study. Bilateral uterine artery occlusion was performed in eight women using Gelfoam alone, and in nine women using Embosphere + Gelfoam. One woman in th...

Research paper thumbnail of Transvaginal Doppler-guided uterine artery occlusion for the treatment of symptomatic fibroids: summary results from two pilot studies

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2010

To evaluate the feasibility, safety, and short-term efficacy of bilateral uterine artery occlusio... more To evaluate the feasibility, safety, and short-term efficacy of bilateral uterine artery occlusion, using a transvaginal Doppler-guided vascular clamp as a minimally invasive therapy for symptomatic uterine leiomyomas. We conducted two prospective, non-randomized, phase I pilot studies (Canadian Task Force Classification II-2) at a university-affiliated teaching hospital. Between June 2004 and May 2005, 30 premenopausal women with symptomatic uterine leiomyomas underwent bilateral uterine artery occlusion using a transvaginal Doppler-guided vascular clamp. Bilateral uterine artery occlusion was performed for 5.8 +/- 1.4 hours in the first 17 patients (Group 1) and from 6 to 9 hours (mean 7.05 +/- 1.0 hours) in the latter 13 patients (Group 2). Outcome measures included dominant fibroid volume (cm(3)), uterine volume (cm(3)), and improvement of menorrhagia at one, three, and six months. Bilateral occlusion of the uterine arteries was achieved in all 30 patients. In Group 1, the Ruta ...

Research paper thumbnail of Leiomyosarcoma diagnosed six years after laparoscopic electromyolysis

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2008

Making a histologic diagnosis of leiomyosarcoma in the specimen from a hysterectomy performed for... more Making a histologic diagnosis of leiomyosarcoma in the specimen from a hysterectomy performed for suspected benign fibroids is rare. Currently, there are no reliable diagnostic tools to diagnose uterine sarcomas preoperatively. A 38-year-old woman presented with menorrhagia and a uterine fibroid measuring 6.0 cm x 8.1 cm x 6.2 cm on ultrasonography. The patient underwent a laparoscopic myolysis with 50% shrinkage of the fibroid volume at follow-up after six months. Six years after myolysis, the patient presented with right lower quadrant pain and a rapidly enlarging uterus. Hysterectomy and bilateral salpingo-oophorectomy was performed and a diagnosis of leiomyosarcoma was histologically confirmed. CT scan was performed biannually after hysterectomy. One year after surgery, the patient presented with radiologic evidence of a right pulmonary nodule. The nodule was excised thoracoscopically and histologic examination demonstrated metastatic leiomyosarcoma. One year later, another pulm...

Research paper thumbnail of Three simple steps during closed laparoscopic entry may minimize major injuries

Surgical Endoscopy, 2008

To describe three steps: (1) the initial Veress pressure (VIP-Pressure), (2) transient high-press... more To describe three steps: (1) the initial Veress pressure (VIP-Pressure), (2) transient high-pressure pneumoperitoneum (HIP-Entry) prior to trocar/cannula insertion, and (3) visual entry with a trocarless cannula during closed laparoscopic entry, which may reduce major injuries. Prospective observational cohort study (Canadian Task Force Classification II-2). University-affiliated teaching hospital. VIP-Pressure. During laparoscopic entry, the initial VIP pressure was measured and correlated against the body habitus and parity of 365 consecutive women. HIP-Entry was performed in 2,498 consecutive cases. In 100 women, the CO(2) volume, heart rate, blood pressure, oxygen saturation, and pulmonary compliance were recorded at pressures of 10, 15, 20, 25, and 30 mmHg. Visual entry with a trocarless blunt cannula was performed in 776 women. The cannula, housing a 0 degrees laparoscope, was rotated clockwise applying minimal downward force. VIP-Pressure. Pneumoperitoneum was established after one, two or three Veress needle attempts at the umbilicus in 82.4%, 10.9%, and 4.0% of women, respectively. In seven (2.2%), pneumoperitoneum was established at the left upper quadrant (LUQ) during the fourth attempt, and in two (0.6%) entry was abandoned. Median initial Veress pressure was 4 mmHg (range 2-10 mmHg). The VIP pressure correlated positively with women's weight (r = 0.518, p < 0.001) and body mass index (BMI) (r=0.545, p<0.001), and negatively with parity (r= -0.179, p<0.001). HIP-Entry. The abdomen was insufflated to 25-30 mmHg prior to primary trocar/cannula insertion. There were no changes in cardiovascular parameters between 15 and 30 mmHg. A 21% decrease in pulmonary compliance from 15 to 30 mmHg was of no clinical significance. No injury has been experienced with the visual cannula in 776 cases. (1) A VIP-Pressure (<10 mmHg) indicates intraperitoneal placement of the Veress needle. (2) The use of transient HIP-Entry does not adversely affect cardiopulmonary function in healthy women. (3) Visual cannula offers an additional step towards safer entry.

Research paper thumbnail of High-pressure laparoscopic entry does not adversely affect cardiopulmonary function in healthy women

Journal of Minimally Invasive Gynecology, 2005

To determine hemodynamic and pulmonary compliance changes during laparoscopic entry using transie... more To determine hemodynamic and pulmonary compliance changes during laparoscopic entry using transient hyperinsufflated pneumoperitoneum.

Research paper thumbnail of Effect of body habitus and parity on insufflated CO2 volume at various intraabdominal pressures during laparoscopic access in women

Journal of Minimally Invasive Gynecology, 2006

STUDY OBJECTIVE: To determine height, weight, body mass index (BMI), parity, and age effect on th... more STUDY OBJECTIVE: To determine height, weight, body mass index (BMI), parity, and age effect on the volume of CO 2 pneumoperitoneum during laparoscopic access in women.

Research paper thumbnail of Resolution of Catamenial Epilepsy after Goserelin Therapy and Oophorectomy: Case Report of Presumed Cerebral Endometriosis

Journal of Minimally Invasive Gynecology, 2011

Endometriosis can develop in every organ and tissue in the female body except perhaps the spleen.... more Endometriosis can develop in every organ and tissue in the female body except perhaps the spleen. The mechanism of distal metastasis is thought to be hematogenous or lymphatic spread from the uterus. Endometriotic lesions in the central nervous system are rare. Herein, we report the case of a woman with abnormal uterine bleeding who developed catamenial neurologic signs and symptoms. Computed tomography scans and magnetic resonance images demonstrated a circumscribed lesion in the left centrum semiovale of the brain. All neurologic symptoms resolved completely after treatment with gonadotropinreleasing hormone agonist for 3 months and subsequent laparoscopic bilateral oophorectomy. The patient was thought to have cerebral endometriosis, a rare phenomenon, although several cases have been reported in the literature. Temporal association of neurologic signs and symptoms with menstruation that resolves with medical or surgical menopause is highly suggestive of cerebral endometriosis.

Research paper thumbnail of Hysteroscopic surgery does not adversely affect the long-term prognosis of women with endometrial adenocarcinoma

Journal of Minimally Invasive Gynecology, 2007

To determine the effect of hysteroscopic surgery on the long-term clinical outcome of women diagn... more To determine the effect of hysteroscopic surgery on the long-term clinical outcome of women diagnosed with endometrial cancer.

Research paper thumbnail of Resectoscopic surgery may be an alternative to hysterectomy in high-risk women with atypical endometrial hyperplasia

Journal of Minimally Invasive Gynecology, 2007

STUDY OBJECTIVE: Endometrial hyperplasia is found in 2% to 10% of women with abnormal uterine ble... more STUDY OBJECTIVE: Endometrial hyperplasia is found in 2% to 10% of women with abnormal uterine bleeding (AUB). Up to 43% of patients with cytologic atypia harbor coexisting adenocarcinoma, and approximately 20% to 52% of atypical hyperplasias, if untreated, progress to cancer. The objective of this study was to estimate the incidence of atypical endometrial hyperplasia encountered during routine resectoscopic surgery in women with AUB and to evaluate the role of resectoscopic surgery in the management of women with AUB and atypical endometrial hyperplasia who refused and/or were at high risk for hysterectomy.

Research paper thumbnail of Endometrioid adenocarcinoma treated by hysteroscopic endomyometrial resection

Journal of Minimally Invasive Gynecology, 2007

A 53-year-old multiparous woman, with no identifiable risk factor for endometrial cancer, present... more A 53-year-old multiparous woman, with no identifiable risk factor for endometrial cancer, presented with menorrhagia. She had been treated with oral contraceptives for 3 years. Office endometrial biopsy indicated well-differentiated villoglandular adenocarcinoma of the endometrium. The patient refused hysterectomy and would consent only to hysteroscopic resection. She remains alive and well, with no clinical evidence of recurrence 5 years after resection. We propose that skillful resectoscopic surgery, under specific circumstance, may be an appropriate alternative treatment to hysterectomy for some early uterine malignancies.

Research paper thumbnail of Effect of body habitus and parity on the initial Veres intraperitoneal CO2 insufflation pressure during laparoscopic access in women

Journal of Minimally Invasive Gynecology, 2006

STUDY OBJECTIVES: Since most gynecologists use the Veres/trocar entry, and because the Veres intr... more STUDY OBJECTIVES: Since most gynecologists use the Veres/trocar entry, and because the Veres intraperitoneal (VIP) pressure appears to be the most reliable indicator of correct Veres needle placement, the objective of this study was to determine the effect of height, weight, body mass index (BMI), parity, and age on the initial Veres intraperitoneal CO 2 insufflation pressure during laparoscopic access in women.

Research paper thumbnail of Laparoscopic findings, histopathologic evaluation, and clinical outcomes in women with chronic pelvic pain after hysterectomy and bilateral salpingo-oophorectomy

Journal of Minimally Invasive Gynecology, 2006

STUDY OBJECTIVE: To laparoscopically evaluate the pelvis of patients with chronic pelvic pain aft... more STUDY OBJECTIVE: To laparoscopically evaluate the pelvis of patients with chronic pelvic pain after hysterectomy and bilateral salpingo-oophorectomy, to determine any associated factors to the pain.

Research paper thumbnail of Miscellaneous Uterine Malignant Neoplasms Detected during Hysteroscopic Surgery

Journal of Minimally Invasive Gynecology, 2009

Study Objectives: To estimate the incidence of incidental miscellaneous uterine malignant neoplas... more Study Objectives: To estimate the incidence of incidental miscellaneous uterine malignant neoplasms other than endometrioid adenocarcinoma detected during routine resectoscopic surgery in women with abnormal uterine bleeding (AUB) and to examine the effect of hysteroscopic surgery on long-term clinical outcome. Design: Prospective cohort study (Canadian Task Force classification II-3). Setting: University-affiliated teaching hospital. Patients: Women with AUB. Intervention: From January 1, 1990, through December 31, 2008, one of the authors (G.A.V.) and several fellows performed primary hysteroscopic surgery at St. Joseph's Health Care in 3892 women with AUB. Of the 7 with malignant disease, one underwent hysteroscopic partial (n 5 1) or complete (n 5 6) rollerball electrocoagulation or endomyometrial resection. After diagnosis of uterine cancer, the women were counseled about the disease and management in accord with established clinical practice guidelines. Follow-up with office visits and telephone interviews ranged from 2 to 8 years (median, 6 years). Measurements and Main Results: Of the 3892 women, 4 had undiagnosed and 3 had suspected miscellaneous uterine malignant neoplasms including 1 endometrial stromal sarcoma, 2 carcinosarcomas, 2 atypical polypoid adenomyomas of the endometrium, 1 minimal deviation adenocarcinoma of the cervix, and 1 smooth-muscle tumor of uncertain malignant potential. At 2 to 8 years of follow-up, 1 patient died accidentally after 1 year, 1 died of carcinomatosis of either coexisting breast cancer or a carcinosarcoma (postmortem examination was declined) after 1 year, and 5 were alive and well. Conclusion: Resectoscopic surgery in women with miscellaneous uterine malignant lesions not adversely affect 5-year survival and long-term prognosis.

Research paper thumbnail of Fertility and Pregnancy Outcomes Following Hysteroscopic Septum Division with and without Intrauterine Balloon Stenting: A Randomized Comparison

Journal of Minimally Invasive Gynecology, 2009

We sought to evaluate retrospectively the efficacy of hysteroscopic metroplasty in a population o... more We sought to evaluate retrospectively the efficacy of hysteroscopic metroplasty in a population of women with a history of recurrent pregnancy loss or infertility who were also known to have a uterine septum.

Research paper thumbnail of Laparoscopic mobilization of the rectosigmoid and excision of the obliterated cul-de-sac

The Journal of the American Association of Gynecologic Laparoscopists, 2002

To evaluate the feasibility and surgical and clinical outcomes of laparoscopic excision of anteri... more To evaluate the feasibility and surgical and clinical outcomes of laparoscopic excision of anterior recto-sigmoid wall endometriosis and en bloc dissection of the obliterated cul-de-sac. Retrospective cohort (Canadian Task Force classification II-2). University-affiliated teaching hospital. Eighty-one women with infertility and/or chronic pelvic pain. Intervention. Laparoscopic excision of all endometrial implants and uterosacral ligaments, and dissection of the cul-de-sac using a horseshoe-shaped approach to mobilize, but not resect, the rectosigmoid. Eleven women (24%) had endometriomas. Cumulative pregnancy rates in 34 women with primary infertility and 12 with secondary infertility were 62% and 42%, respectively. Eighty-eight percent of 61 women with pain reported significant improvement of symptoms. Laparoscopic excision of cul-de-sac and rectovaginal endometriosis by this approach is feasible and safe when performed by an experienced surgeon, and results in high rates of cumulative pregnancy and relief of pain. Some patient variables may give higher rates of success for pregnancy than others.

Research paper thumbnail of Gonadotropin Dose Step-up in Women With an Initial Low Response to Ovarian Stimulation for In Vitro Fertilization (IVF)

Fertility and Sterility, 2005

Research paper thumbnail of Uterine Artery Occlusion: What Is the Evidence?

Clinical Obstetrics and Gynecology, 2006

Symptomatic uterine fibroids are a relatively common gynecologic condition. In the past, fibroids... more Symptomatic uterine fibroids are a relatively common gynecologic condition. In the past, fibroids were exclusively treated by myomectomy and/or hysterectomy. With the advent of uterine artery embolization or uterine artery occlusion, there now exist minimally invasive approaches to fibroid therapy especially for women in whom surgery is contraindicated or for those who wish to retain their uterus and possibly fertility. Fertility and pregnancy outcomes after these minimally invasive therapies are currently being evaluated.

Research paper thumbnail of Comparison of Clinical Outcomes Using Low-Voltage (Cut) Versus High-Voltage (Coag) Waveforms during Hysteroscopic Endometrial Ablation with the Rollerball

J Minim Invasive Gynecol, 2008

Research paper thumbnail of Uterine artery embolization for uterine arteriovenous malformation in five women desiring fertility: pregnancy outcomes

Human Reproduction, 2015

Uterine arteriovenous malformations (AVM) are rare and can be classified as either congenital or ... more Uterine arteriovenous malformations (AVM) are rare and can be classified as either congenital or acquired. Acquired AVMs may result from trauma, uterine instrumentation, infection or gestational trophoblastic disease. The majority of acquired AVMs are encountered in women of reproductive age with a history of at least one pregnancy. Traditional therapies of AVMs include medical management of symptomatic bleeding, blood transfusions, uterine artery embolization (UAE) or hysterectomy. In this retrospective case series, we report our experience with AVM and UAE in five symptomatic women of reproductive age who wished to preserve fertility. Patients were 18-32 years old, and had 1-3 previous pregnancies prior to initial presentation. All patients were followed until their deliveries. All five patients delivered live births. Three of the five patients required two embolization procedures and one of these women required a subsequent hysterectomy. Two deliveries were at term and had normal weight babies and normal placenta. One woman had cerclage placed and developed chorioamnionitis at 34 weeks but had a normal placenta. Two pregnancies were induced <37 weeks for pre-eclampsia/b intrauterine growth restriction ± abnormal umbilical artery dopplers. The low birthweight were both <2000 g. Both placentas showed accelerated maturity and infarcts. All estimated blood losses were recorded as <500 cc. In conclusion, UAE may not be as effective at managing AVM as previously thought and should be questioned as an initial therapy in symptomatic women of reproductive age desiring fertility preservation.

Research paper thumbnail of Post-uterine artery embolization pain and clinical outcomes for symptomatic myomas using gelfoam pledgets alone versus embospheres plus gelfoam pledgets: a comparative pilot study

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2014

To evaluate the efficacy and post-procedural pain associated with uterine artery embolization (UA... more To evaluate the efficacy and post-procedural pain associated with uterine artery embolization (UAE) using Gelfoam alone versus Embospheres plus Gelfoam in women with symptomatic uterine fibroids. We conducted a prospective, non-randomized pilot study. Fluoroscopy-guided trans-femoral artery UAE was performed using Gelfoam pledgets alone or Embospheres (500 to 700 mg) plus Gelfoam under conscious sedation and local anaesthesia. This was followed by patient-controlled analgesia (PCA) using a morphine pump overnight. Post-procedural pain was assessed by the mean amount of self-administered morphine delivered by PCA pump (mL) from 0 to 19 hours in each group. The mean volumes of the uterus and the dominant fibroid were calculated by ultrasound at baseline, three months, six months, and 12 months. A total of 17 women participated in the study. Bilateral uterine artery occlusion was performed in eight women using Gelfoam alone, and in nine women using Embosphere + Gelfoam. One woman in th...

Research paper thumbnail of Transvaginal Doppler-guided uterine artery occlusion for the treatment of symptomatic fibroids: summary results from two pilot studies

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2010

To evaluate the feasibility, safety, and short-term efficacy of bilateral uterine artery occlusio... more To evaluate the feasibility, safety, and short-term efficacy of bilateral uterine artery occlusion, using a transvaginal Doppler-guided vascular clamp as a minimally invasive therapy for symptomatic uterine leiomyomas. We conducted two prospective, non-randomized, phase I pilot studies (Canadian Task Force Classification II-2) at a university-affiliated teaching hospital. Between June 2004 and May 2005, 30 premenopausal women with symptomatic uterine leiomyomas underwent bilateral uterine artery occlusion using a transvaginal Doppler-guided vascular clamp. Bilateral uterine artery occlusion was performed for 5.8 +/- 1.4 hours in the first 17 patients (Group 1) and from 6 to 9 hours (mean 7.05 +/- 1.0 hours) in the latter 13 patients (Group 2). Outcome measures included dominant fibroid volume (cm(3)), uterine volume (cm(3)), and improvement of menorrhagia at one, three, and six months. Bilateral occlusion of the uterine arteries was achieved in all 30 patients. In Group 1, the Ruta ...

Research paper thumbnail of Leiomyosarcoma diagnosed six years after laparoscopic electromyolysis

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2008

Making a histologic diagnosis of leiomyosarcoma in the specimen from a hysterectomy performed for... more Making a histologic diagnosis of leiomyosarcoma in the specimen from a hysterectomy performed for suspected benign fibroids is rare. Currently, there are no reliable diagnostic tools to diagnose uterine sarcomas preoperatively. A 38-year-old woman presented with menorrhagia and a uterine fibroid measuring 6.0 cm x 8.1 cm x 6.2 cm on ultrasonography. The patient underwent a laparoscopic myolysis with 50% shrinkage of the fibroid volume at follow-up after six months. Six years after myolysis, the patient presented with right lower quadrant pain and a rapidly enlarging uterus. Hysterectomy and bilateral salpingo-oophorectomy was performed and a diagnosis of leiomyosarcoma was histologically confirmed. CT scan was performed biannually after hysterectomy. One year after surgery, the patient presented with radiologic evidence of a right pulmonary nodule. The nodule was excised thoracoscopically and histologic examination demonstrated metastatic leiomyosarcoma. One year later, another pulm...

Research paper thumbnail of Three simple steps during closed laparoscopic entry may minimize major injuries

Surgical Endoscopy, 2008

To describe three steps: (1) the initial Veress pressure (VIP-Pressure), (2) transient high-press... more To describe three steps: (1) the initial Veress pressure (VIP-Pressure), (2) transient high-pressure pneumoperitoneum (HIP-Entry) prior to trocar/cannula insertion, and (3) visual entry with a trocarless cannula during closed laparoscopic entry, which may reduce major injuries. Prospective observational cohort study (Canadian Task Force Classification II-2). University-affiliated teaching hospital. VIP-Pressure. During laparoscopic entry, the initial VIP pressure was measured and correlated against the body habitus and parity of 365 consecutive women. HIP-Entry was performed in 2,498 consecutive cases. In 100 women, the CO(2) volume, heart rate, blood pressure, oxygen saturation, and pulmonary compliance were recorded at pressures of 10, 15, 20, 25, and 30 mmHg. Visual entry with a trocarless blunt cannula was performed in 776 women. The cannula, housing a 0 degrees laparoscope, was rotated clockwise applying minimal downward force. VIP-Pressure. Pneumoperitoneum was established after one, two or three Veress needle attempts at the umbilicus in 82.4%, 10.9%, and 4.0% of women, respectively. In seven (2.2%), pneumoperitoneum was established at the left upper quadrant (LUQ) during the fourth attempt, and in two (0.6%) entry was abandoned. Median initial Veress pressure was 4 mmHg (range 2-10 mmHg). The VIP pressure correlated positively with women's weight (r = 0.518, p < 0.001) and body mass index (BMI) (r=0.545, p<0.001), and negatively with parity (r= -0.179, p<0.001). HIP-Entry. The abdomen was insufflated to 25-30 mmHg prior to primary trocar/cannula insertion. There were no changes in cardiovascular parameters between 15 and 30 mmHg. A 21% decrease in pulmonary compliance from 15 to 30 mmHg was of no clinical significance. No injury has been experienced with the visual cannula in 776 cases. (1) A VIP-Pressure (<10 mmHg) indicates intraperitoneal placement of the Veress needle. (2) The use of transient HIP-Entry does not adversely affect cardiopulmonary function in healthy women. (3) Visual cannula offers an additional step towards safer entry.

Research paper thumbnail of High-pressure laparoscopic entry does not adversely affect cardiopulmonary function in healthy women

Journal of Minimally Invasive Gynecology, 2005

To determine hemodynamic and pulmonary compliance changes during laparoscopic entry using transie... more To determine hemodynamic and pulmonary compliance changes during laparoscopic entry using transient hyperinsufflated pneumoperitoneum.

Research paper thumbnail of Effect of body habitus and parity on insufflated CO2 volume at various intraabdominal pressures during laparoscopic access in women

Journal of Minimally Invasive Gynecology, 2006

STUDY OBJECTIVE: To determine height, weight, body mass index (BMI), parity, and age effect on th... more STUDY OBJECTIVE: To determine height, weight, body mass index (BMI), parity, and age effect on the volume of CO 2 pneumoperitoneum during laparoscopic access in women.

Research paper thumbnail of Resolution of Catamenial Epilepsy after Goserelin Therapy and Oophorectomy: Case Report of Presumed Cerebral Endometriosis

Journal of Minimally Invasive Gynecology, 2011

Endometriosis can develop in every organ and tissue in the female body except perhaps the spleen.... more Endometriosis can develop in every organ and tissue in the female body except perhaps the spleen. The mechanism of distal metastasis is thought to be hematogenous or lymphatic spread from the uterus. Endometriotic lesions in the central nervous system are rare. Herein, we report the case of a woman with abnormal uterine bleeding who developed catamenial neurologic signs and symptoms. Computed tomography scans and magnetic resonance images demonstrated a circumscribed lesion in the left centrum semiovale of the brain. All neurologic symptoms resolved completely after treatment with gonadotropinreleasing hormone agonist for 3 months and subsequent laparoscopic bilateral oophorectomy. The patient was thought to have cerebral endometriosis, a rare phenomenon, although several cases have been reported in the literature. Temporal association of neurologic signs and symptoms with menstruation that resolves with medical or surgical menopause is highly suggestive of cerebral endometriosis.

Research paper thumbnail of Hysteroscopic surgery does not adversely affect the long-term prognosis of women with endometrial adenocarcinoma

Journal of Minimally Invasive Gynecology, 2007

To determine the effect of hysteroscopic surgery on the long-term clinical outcome of women diagn... more To determine the effect of hysteroscopic surgery on the long-term clinical outcome of women diagnosed with endometrial cancer.

Research paper thumbnail of Resectoscopic surgery may be an alternative to hysterectomy in high-risk women with atypical endometrial hyperplasia

Journal of Minimally Invasive Gynecology, 2007

STUDY OBJECTIVE: Endometrial hyperplasia is found in 2% to 10% of women with abnormal uterine ble... more STUDY OBJECTIVE: Endometrial hyperplasia is found in 2% to 10% of women with abnormal uterine bleeding (AUB). Up to 43% of patients with cytologic atypia harbor coexisting adenocarcinoma, and approximately 20% to 52% of atypical hyperplasias, if untreated, progress to cancer. The objective of this study was to estimate the incidence of atypical endometrial hyperplasia encountered during routine resectoscopic surgery in women with AUB and to evaluate the role of resectoscopic surgery in the management of women with AUB and atypical endometrial hyperplasia who refused and/or were at high risk for hysterectomy.

Research paper thumbnail of Endometrioid adenocarcinoma treated by hysteroscopic endomyometrial resection

Journal of Minimally Invasive Gynecology, 2007

A 53-year-old multiparous woman, with no identifiable risk factor for endometrial cancer, present... more A 53-year-old multiparous woman, with no identifiable risk factor for endometrial cancer, presented with menorrhagia. She had been treated with oral contraceptives for 3 years. Office endometrial biopsy indicated well-differentiated villoglandular adenocarcinoma of the endometrium. The patient refused hysterectomy and would consent only to hysteroscopic resection. She remains alive and well, with no clinical evidence of recurrence 5 years after resection. We propose that skillful resectoscopic surgery, under specific circumstance, may be an appropriate alternative treatment to hysterectomy for some early uterine malignancies.

Research paper thumbnail of Effect of body habitus and parity on the initial Veres intraperitoneal CO2 insufflation pressure during laparoscopic access in women

Journal of Minimally Invasive Gynecology, 2006

STUDY OBJECTIVES: Since most gynecologists use the Veres/trocar entry, and because the Veres intr... more STUDY OBJECTIVES: Since most gynecologists use the Veres/trocar entry, and because the Veres intraperitoneal (VIP) pressure appears to be the most reliable indicator of correct Veres needle placement, the objective of this study was to determine the effect of height, weight, body mass index (BMI), parity, and age on the initial Veres intraperitoneal CO 2 insufflation pressure during laparoscopic access in women.

Research paper thumbnail of Laparoscopic findings, histopathologic evaluation, and clinical outcomes in women with chronic pelvic pain after hysterectomy and bilateral salpingo-oophorectomy

Journal of Minimally Invasive Gynecology, 2006

STUDY OBJECTIVE: To laparoscopically evaluate the pelvis of patients with chronic pelvic pain aft... more STUDY OBJECTIVE: To laparoscopically evaluate the pelvis of patients with chronic pelvic pain after hysterectomy and bilateral salpingo-oophorectomy, to determine any associated factors to the pain.

Research paper thumbnail of Miscellaneous Uterine Malignant Neoplasms Detected during Hysteroscopic Surgery

Journal of Minimally Invasive Gynecology, 2009

Study Objectives: To estimate the incidence of incidental miscellaneous uterine malignant neoplas... more Study Objectives: To estimate the incidence of incidental miscellaneous uterine malignant neoplasms other than endometrioid adenocarcinoma detected during routine resectoscopic surgery in women with abnormal uterine bleeding (AUB) and to examine the effect of hysteroscopic surgery on long-term clinical outcome. Design: Prospective cohort study (Canadian Task Force classification II-3). Setting: University-affiliated teaching hospital. Patients: Women with AUB. Intervention: From January 1, 1990, through December 31, 2008, one of the authors (G.A.V.) and several fellows performed primary hysteroscopic surgery at St. Joseph's Health Care in 3892 women with AUB. Of the 7 with malignant disease, one underwent hysteroscopic partial (n 5 1) or complete (n 5 6) rollerball electrocoagulation or endomyometrial resection. After diagnosis of uterine cancer, the women were counseled about the disease and management in accord with established clinical practice guidelines. Follow-up with office visits and telephone interviews ranged from 2 to 8 years (median, 6 years). Measurements and Main Results: Of the 3892 women, 4 had undiagnosed and 3 had suspected miscellaneous uterine malignant neoplasms including 1 endometrial stromal sarcoma, 2 carcinosarcomas, 2 atypical polypoid adenomyomas of the endometrium, 1 minimal deviation adenocarcinoma of the cervix, and 1 smooth-muscle tumor of uncertain malignant potential. At 2 to 8 years of follow-up, 1 patient died accidentally after 1 year, 1 died of carcinomatosis of either coexisting breast cancer or a carcinosarcoma (postmortem examination was declined) after 1 year, and 5 were alive and well. Conclusion: Resectoscopic surgery in women with miscellaneous uterine malignant lesions not adversely affect 5-year survival and long-term prognosis.

Research paper thumbnail of Fertility and Pregnancy Outcomes Following Hysteroscopic Septum Division with and without Intrauterine Balloon Stenting: A Randomized Comparison

Journal of Minimally Invasive Gynecology, 2009

We sought to evaluate retrospectively the efficacy of hysteroscopic metroplasty in a population o... more We sought to evaluate retrospectively the efficacy of hysteroscopic metroplasty in a population of women with a history of recurrent pregnancy loss or infertility who were also known to have a uterine septum.

Research paper thumbnail of Laparoscopic mobilization of the rectosigmoid and excision of the obliterated cul-de-sac

The Journal of the American Association of Gynecologic Laparoscopists, 2002

To evaluate the feasibility and surgical and clinical outcomes of laparoscopic excision of anteri... more To evaluate the feasibility and surgical and clinical outcomes of laparoscopic excision of anterior recto-sigmoid wall endometriosis and en bloc dissection of the obliterated cul-de-sac. Retrospective cohort (Canadian Task Force classification II-2). University-affiliated teaching hospital. Eighty-one women with infertility and/or chronic pelvic pain. Intervention. Laparoscopic excision of all endometrial implants and uterosacral ligaments, and dissection of the cul-de-sac using a horseshoe-shaped approach to mobilize, but not resect, the rectosigmoid. Eleven women (24%) had endometriomas. Cumulative pregnancy rates in 34 women with primary infertility and 12 with secondary infertility were 62% and 42%, respectively. Eighty-eight percent of 61 women with pain reported significant improvement of symptoms. Laparoscopic excision of cul-de-sac and rectovaginal endometriosis by this approach is feasible and safe when performed by an experienced surgeon, and results in high rates of cumulative pregnancy and relief of pain. Some patient variables may give higher rates of success for pregnancy than others.

Research paper thumbnail of Gonadotropin Dose Step-up in Women With an Initial Low Response to Ovarian Stimulation for In Vitro Fertilization (IVF)

Fertility and Sterility, 2005

Research paper thumbnail of Uterine Artery Occlusion: What Is the Evidence?

Clinical Obstetrics and Gynecology, 2006

Symptomatic uterine fibroids are a relatively common gynecologic condition. In the past, fibroids... more Symptomatic uterine fibroids are a relatively common gynecologic condition. In the past, fibroids were exclusively treated by myomectomy and/or hysterectomy. With the advent of uterine artery embolization or uterine artery occlusion, there now exist minimally invasive approaches to fibroid therapy especially for women in whom surgery is contraindicated or for those who wish to retain their uterus and possibly fertility. Fertility and pregnancy outcomes after these minimally invasive therapies are currently being evaluated.

Research paper thumbnail of Comparison of Clinical Outcomes Using Low-Voltage (Cut) Versus High-Voltage (Coag) Waveforms during Hysteroscopic Endometrial Ablation with the Rollerball

J Minim Invasive Gynecol, 2008