August 1995, Vol. 2, No. 4. Supplement The Journal of the American Association of Gynecologic Laparoscopists

hysterectomy, and the cervical cylinders after laparo- scopic CISH. Histologic findings show that some of the endocervical mucosa remains in most cases and is not completely removed by electrocoagulation. Serial cuts show that this tissue is localized in the endocervical part of the cervix, but the isthmocervi- cal region is free of mucosal tissue. Depending on the diameter of the ectocervix compared with the isth- mocervical region, a classic conization before per- forming the intracervical resection can be very helpful in removing this tissue. Women should be screened reg- ularly for cervical cancer after supravaginal hyster- ectomy. We believe that in those with cellular dysplasia of the cervix or cervical intraepithelial neoplasia, supracervical hysterectomy is not indicated.

Comparison of Laparoscopic-Assisted Vaginal Hysterectomy Performed With the Contact Nd:YAG Laser versus the Harmonic Scalpel KM Kumar, CB Fleet Jr. Virginia Institute for Laparoscopic and Laser Surgery, Richmond, VA.

We compared outcomes including operating time, blood loss, length of stay, and cost of performing lap- aroscopic-assisted vaginal hysterectomy with the con- tact neodymium:yttrium-aluminum-garnet (Nd:YAG) laser and the harmonic scalpel. This was a retrospec- tive review of the last 22 LAVHs performed by the author at one hospital between July 1992 and September 1994. The technique included the use of automatic sta- pling devices and either the contact Nd:YAG laser or the harmonic scalpel for vesicouterine visceral peri- toneal fold dissection. Data averages for the laser and harmonic scalpel, respectively, were operating room time 103 and 83 minutes, blood loss 203 and 186 ml, and length of stay 1.15 and 1.2 days. An average cost savings of $640 per case was realized with the harmonic scalpel, which resulted from reduced cost of dispos- able instruments, equipment use fee, and decreased operating time. No complications related to either instrument occurred in any patient. We believe that both the contact Nd:YAG laser and the harmonic scalpel can be used safely in performing LAVH. However, the har- monic scalpel, with its significantly lower purchase price, is less expensive and equally effective, and does not compromise surgical technique.

Office Hysterectomy With Liquid Distention Medium and the 3.1-mm Hysteroscope KM Kumar, CB Fleet Jr. Virginia Institute for LaparoscopJc and Laser Surgery, Richmond, VA.

We evaluated procedure time, fluid absorption, and patient acceptance of office hysteroscopy performed with the Optimis TM 601 narrow-caliber (3. l-ram) hys- teroscope. Between August 3, 1994, and January 11, 1995, 22 hysteroscopies were performed in a private office setting. Patients were counseled preoperatively regarding the procedure and were given an oral non- steroidal anti-inflammatory drug 20 minutes before the procedure. Lactated Ringer's solution was the dis- tention medium and was delivered from a 60-ml syringe through irrigation tubing attached to the hysteroscope. The hysteroscope was advanced under direct visualization and fluid was collected for mea- surement. Hysteroscopy was performed successfully in 21 of 22 women. It was deferred in one patient due to extreme cervical stenosis. The data averages for pro- cedure time, fluid absorption, and patient acceptance, respectively, were 5 minutes, 20 ml, and 90%. The qual- ity and resolution of the image were considered sat- isfactory. We conclude that office hysteroscopy can be performed safely and effectively with the Optimis TM 601 hysteroscope.

Cost-Effectiveness Analysis of Laparoscopic and Abdominal Burch Procedures R Kung, KI Lie, HP Drutz. Department of Obstetrics and Gynaecology, Women's College Hospital, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.

We assessed the cost effectiveness of laparoscopic and abdominal Burch procedures in a cohort of 62 women (31 abdominal Burch, 31 laparoscopic Burch) with stress incontinence. To determine direct costs, we checked physician fees (surgeon, surgical assistant, anaesthetist) nursing costs (operating room nurses, technicians, ward nurses), and expenses associated with capital equipment, disposable equipment, drugs, and laboratory investigations (blood work, radiographs, urodynamics, cystoscopy). The average costs for lap- aroscopic Burch were $2855.91 without the carbon dioxide (CO2) laser and $2977.60 with the CO2 laser. The average cost for abdominal Burch was $5692.30. The cure rates for the two were 97% and 90%, respec- tively. Based on this preliminary study, we conclude

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