Minimally invasive surgery

0008 Is laparoscopic myomectomy a good practice to perform a diagnostic hysteroscopy before laparoscopic myomectomy? Case report Christos Spyroulis, Mohammed El-Mouslemanny, Magdy Nawar London North West Healthcare Trust, Harrow, UK Introducton: Myomectomy is the removal of a fibroid, either abdominally, or endoscopically (laparoscopy/ hysteroscopy). There is evidence that, myomectomy can improve the pregnancy success rate, especially if the fibroids are obstructing the uterine cavity, like in case of subserous fibroids. Case report: We present a 42 year old woman, P2, nonsmoker, no medical history, with a large subserous fibroid measuring 75x75x72mm and a 28x22x28 submucous fibroid who attended the outpatient clinic of Northwick Park hospital with menorrhagia in May. Her periods before attending the clinic were normal and not heavy. She attended A&E department of NPH in February due to severe menorrhagia who lasted for 20 consecutive days, with large clots. Since February was on Tranexamic acidwhich improved her symptoms. The gynaecologist prescribed Esmya 5 mg OD for 3 months and booked her for theatre. She attended preoperative assessment in September and the Hb:106. In October had the laparoscopic myomectomy. Before laparoscopy, we performed a hysteroscopy which shown 1 submucous and 1intramural fibroid. The submuscous fibroid was attached to the endometrium. The ultrasound scan didn’t specify this and overestimated the subserous fibroid. Also, didn’t peak the intramural fibroid, which was around 3 cm. We performed first the transcervical resection of the intramural and subserous fibroids via hysteroscopy guidance and then we completed the laparoscopic myomectomy of the subserous fibroid using Harmonic scissors and morcelator. The EBL was 300 ml and the patient went home 2 days after the operation. Postoperative Hbwas 105. Histology confirmed the presence of a subserous, intramural and submucous fibroid. Conclusion:x As we can see, by doing a hysteroscopy we can avoid to miss a fibroid which can be missed by the ultrasound due to distortion of the uterine cavity, leading to improvement of symptoms and patient satisfaction. So, we believe is a good practice hysteroscopy before laparoscopic myomectomy. 0046 Changes in antimullerian hormone levels as a biomarker of ovarian reserve after ultrasound-guided high-intensity focused ultrasound treatment of adenomyosis and uterine fibroid Jae-Seong Lee, Gi-Youn Hong, Kye-Hwa Lee, Tae-Eung Kim Aegis-Roen Obstetrics and Gynecology Clinic, Seoul, Republic of Korea, Biomedical Informatics ADND Systems, Biomedical Informatics Research Center, Seoul National University, Seoul, Republic of Korea, Green Cross Medical Clinic, Incheon, Republic of Korea, Department of Obstetrics and Gynecology, The Catholic University, Incheon, Republic of Korea This study aimed to assess the change in antimullerian hormone (AMH) levels after ablation for symptomatic uterine fibroids and adenomyosis using ultrasoundguided high-intensity focused ultrasound (USgHIFU). Seventy-nine women with symptomatic uterine fibroids and adenomyosis who met the inclusion criteria were enrolled in our study from January 2014 to December 2014. Each patient was examined before treatment, and at 6 and 12 months post-treatment by T2-weighted MRI imaging (T2WI) and T1-weighted MRI imaging (T1WI) with gadolinium injection. Assessments included symptom severity scores (SSS), Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire subscales, and reduction of treated volume. AMH levels before and 6 months after HIFU ablation were assessed to determine whether USgHIFU ablation affected ovarian reserve. Ultrasound-guided high-intensity focused ultrasound ablation for uterine fibroid and adenomyosis showed effective therapeutic results. AMH levels before and 6 months after HIFU ablation of fibroid were 1.94 μg/l (SD = 2.7) and 1.72 μg/l (SD = 2.31), respectively (P > 0.05). Mean AMH levels before and 6months afterHIFU ablation of adenomyosis were 2.34 μg/l (SD = 2.64) and 2.00 μg/l (SD = 2.91), respectively (P > 0.05). In our study, USgHIFU ablation for the treatment of uterine fibroid and adenomyosis was effective and might not affect ovarian reserve.