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PURPOSE: To determine the effectiveness, safety, and participant satisfaction with endometrial ablation by bipolar energy (NovaSure®) in the treatment of heavy menstrual bleeding (HMB), and to investigate factors associated with poorer outcomes. METHODS: Multicenter retrospective observational study based on medical record review of the outcomes related to endometrial ablation by the bipolar-energy technique procedure to treat HMB in the setting of three university teaching hospitals in Spain. RESULTS: A total of 333 women were included in the study. Most bipolar-energy ablations were successful (85.12%; n = 269 out of 316), with amenorrhea the most frequent outcome (39.6%, n = 131 out of 316). The majority of participants had no complications (95.5%; n = 317 out of 332), and of those who did, only 2.1% were related to the technique. No further treatment was required for HMB in 82.8% of women (n = 274 out of 331), and surgery was avoided in 91.8%; only 5.9% of women underwent ablation-related hysterectomy. In women with previous transverse cesarean sections (CS), 91.0% avoided subsequent surgical treatment. Eighty-six percent of women (n = 221 out of 257) were satisfied with the procedure. CONCLUSION: Bipolar-energy ablation is very effective and safe for the treatment of HMB and yielded a high rate of participant satisfaction in our setting. The presence of comorbidities or previous CS may slightly reduce the effectiveness of the method, while performing concomitant surgery (mainly curettage) increases the rate of complications. Notably, despite the known increased risk of hysterectomy, most participants with previous CSs who underwent ablation avoided major surgery.

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BACKGROUND AND OBJECTIVES: To analyze the frequency of complications during laparoscopic gynecologic surgery and identify associated risk factors. METHODS: A descriptive observational study was performed between January 2000 and December 2012 and included all gynecologic laparoscopies performed at our center. Variables were recorded for patient characteristics, indication for surgery, length of hospital stay (in days), major and minor complications, and conversions to laparotomy. To identify risk factors and variables associated with complications, crude and adjusted odds ratios were calculated with unconditional logistic regression. RESULTS: Of all 2888 laparoscopies included, most were procedures of moderate difficulty (adnexal surgery) (54.2%). The overall frequency of major complications was 1.93%, and that of minor complications was 4.29%. The level of technical difficulty and existence of prior abdominal surgery were associated with a higher risk of major complications and conversions to laparotomy. CONCLUSION: Laparoscopic gynecologic surgery is associated with a low frequency of complications but is a procedure that is not without risk. Greater technical difficulty and prior surgery were factors associated with a higher frequency of complications.

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Objetivo. Analizar las peculiaridades quirúrgicas asociadas al tratamiento por vía laparoscópica del quiste dermoide ovárico. Se estudian, igualmente, los factores asociados a la rotura intraoperatoria del quiste y su trascendencia clínica. Material y métodos. Se realizó un estudio retrospectivo de 131 quistes dermoides intervenidos por vía laparoscópica en el Hospital Universitario Virgen de las Nieves desde enero de 2000 hasta diciembre de 2008. Resultados. La edad media de las pacientes fue de 32,4 años. El tamaño medio del quiste fue de 63,8mm. En el 62,6% de los casos se pudo realizar cirugía conservadora (quistectomía). Sólo 2 pacientes precisaron reintervención por problemas hemorrágicos. La estancia media fue de 1,6 días. La rotura intraoperatoria del quiste ocurrió con más frecuencia cuando se practicó quistectomía. No hubo ningún caso de peritonitis. Conclusiones. La laparoscopia es la técnica de elección en el tratamiento quirúrgico del quiste dermoide de ovario. Las complicaciones son mínimas y la recuperación rápida. Si se produce la rotura intraoperatoria del quiste no suele tener trascendencia clínica alguna (AU)

Objective. To analyze the surgical characteristics of laparoscopic treatment of dermoid cyst and the factors associated with intraoperative spillage and its clinical importance. Material and methods. A retrospective research was performed of 131 dermoid cysts treated by laparoscopy at the Virgen de las Nieves University Hospital from January 2000 to December 2008. Results. The mean age of the patients was 32.4 years. The mean size of the cysts was 63.8mm. In 62.6% of the patients, conservative surgery (cystectomy) was feasible. Only two patients needed reintervention due to bleeding complications. The mean length of hospital stay was 1.6 days. Intraoperative spillage was more common when cystectomy was performed. There were no cases of peritonitis. Conclusions. Laparoscopic surgery is the first treatment option in the management of ovarian dermoid cysts. There are few complications and healing is rapid. Spillage is usually clinically unimportant (AU)

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