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27 Knot integrity of sutures used for may choose suture based on other characteristics and personal
reconstructive pelvic floor procedures comfort.
O. F. Duenas1,2, G. T. Sullivan1, D. Healy3, K. Leung1, K. Billiar3,
M. K. Flynn1
1
Obstetrics and Gynecology, University of Massachusetts, Holden, MA,
2
Obstetrics and Gynecology, University of West Virginia, Morgantown, WV,
3
Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA
OBJECTIVES: To determine the integrity of flat square and slip knots
tied by hand and robotically in 6 different sutures used in pelvic
surgery.
MATERIALS AND METHODS: Knots were tied by two fellows in female
pelvic medicine and reconstructive surgery using the following
suture materials: polyester coated with polybutyrate (Ethibond;
Ethicon), polypropylene (Prolene; Ethicon), polydioxanone (PDS;
Ethicon), polyglyconate (Maxon; Covidien/Medtronic) and poly-
tetrafluoroethylene (Gore-Tex; Gore & Associates). Instrumental
knot tying technique was employed to tie square and slip knots
using the using a DaVinci Si robot and by hand around a 1/2 inch
dowel. For the hand knots, double-handed and single-handed
techniques were employed for both the slip and square knots. The
tied suture was transferred to a uniaxial mechanical test machine
(Instron 5544), where each loop was subjected to tensile elonga-
tion. Force and elongation at suture failure or knot slippage
(whichever came first) were measured as well as force at 3 mm
displacement and elongation at 30 Newtons (N) based on previous
literature.
RESULTS: Four hundred thirty-two knots were tied in total. One
unraveled before the analysis and 431 knots were tested. Three
hundred and ninety-two knots reached and surpassed a tensile
strength of 30 N, the force where the tissue itself will fail. Of the 39
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS:
knots that failed to reach the 30 N, 27 were robotically tied and 12
Omar F. Duenas: Nothing to disclose; Gina T. Sullivan: Nothing to
were hand tied. Eleven of these 39 knots were tied with polyester (8
disclose; Danielle Healy: Nothing to disclose; Katherine Leung:
robotically and 3 by hand). Because of the low failures rate, none of
Nothing to disclose; Kristen Billiar: Nothing to disclose; Michael K.
these differences was statistically significant. Overall, knots tied by
Flynn: Nothing to disclose.
surgeon A were stronger than those tied by surgeon B (79.72N vs
74.05N, p 0.012). Polyglyconate (Maxon) suture achieved the 28 Administration of methotrexate to patients with
greatest tensile strength (93.29N) and knots tied with intrauterine pregnancies misdiagnosed as ectopic
OO-Polydioxanone had the lowest tensile strength (61.37N) but also D. Fridman1, W. Chong2, O. Rotenberg1, P. Dar1, S. Mehta1,
the greatest elongation. Table 1 shows that robotic knots were E. Hawkins1, S. Chudnoff1, M. Levie1
significantly weaker than hand tied knots regardless the type of knot 1
Obstetrics, Gynecology and Women’s Health, Albert Einstein College of
and the method (p < 0.001) but they had lower elongation sug- Medicine/Montefiore Medical Center, Bronx, NY, 2Obstetrics, Gynecology
gesting they are tighter. There were no significant differences be- and Reproductive Science, Icahn School of Medicine at Mount Sinai, New
tween flat square knots and slipknots regardless of the tying method, York, NY
and there were no differences in one-handed or the two-handed OBJECTIVES: Proportion of patients treated medically for ectopic
hand tied knots. In an adjusted linear regression model adjusting for pregnancy (EP) is increasing. One of rarely reported complications is
material, robot or hand tied, and square or slipknot, hand tied knots administration of methotrexate to patients with intrauterine preg-
were stronger than robotic tied knots (p ¼ 0.001). Importantly, none nancies (IUP) misdiagnosed as ectopic. Our study objective is to
of the sutures and knots failed below the recognized physiologic report the rate of inadvertent methotrexate administration to pa-
maximum threshold of 30N. tients with IUP originally misdiagnosed as EP.
CONCLUSION: In this study, hand tied knots, regardless of the tech- MATERIALS AND METHODS: A retrospective cohort, descriptive study
nique and suture material, had greater tensile strength, but greater was conducted. All patients who were medically treated for suspected
elongation than robotically tied knots and its clinical significance is ectopic pregnancy (EP) from January 2000 to January 2014 were
likely minimal. The decision to use a specific type of suture based on included. Manual review of medical records to retrieve demographic
strength is not supported by our results, suggesting that surgeons and clinical information was performed.

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ajog.org
RESULTS: A total of 632 patients received medical treatment for
suspected EP. Three hundred sixty-nine patients were treated with
methotrexate for pregnancy of unknown location (PUL) of who 12
were eventually diagnosed with IUP (3.3%). Four of the 12 patients
with IUP (33.3%) had viable or potentially viable pregnancies at the
time of administration of methotrexate. Also, 4 out of the 12 pa-
tients with IUP (33.3%) were initially diagnosed as probable EP
based on sonographic finding of adnexal mass. No demographic
factors, past medical history, clinical and laboratory findings
distinguished patients with IUP from women treated with metho-
trexate for PUL. There were several sonographic findings charac-
teristic for patients with IUP; presence of adnexal mass (41.7 vs
72.4%, p ¼ 0.02), presence of intrauterine fluid (41.6 vs 8.4%, p <
0.001), and thicker endometrium (13.8  5.8 vs 10.1  6.2, p ¼
0.02).
CONCLUSION: Presumptive medical management of PUL leads to
inadvertent administration of methotrexate to patient with IUP.
Caution should be advised interpreting adnexal mass with no clear
structures diagnostic of EP.
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS:
Dmitry Fridman: Nothing to disclose; Woojin Chong: Nothing to
disclose; Ohad Rotenberg: Nothing to disclose; Pe’er Dar: Nothing to
disclose; Sukrant Mehta: Nothing to disclose; Eleanor Hawkins:
Nothing to disclose; Scott Chudnoff: Nothing to disclose; Mark
Levie: Nothing to disclose.
29 Implementation of the pelvic organ prolapse
quantification system in peer-reviewed journals
S. S. Boyd1, D. M. O’Sullivan2, P. Tulikangas1
1
Division of FPMRS, Hartford Hospital, Hartford, CT, 2Research Program,
Hartford Hospital, Hartford, CT
OBJECTIVES: To determine the use of the pelvic organ prolapse
quantification (POPQ) system in published articles of specialized
journals.
MATERIALS AND METHODS: Articles published in nine journals
representative of urogynecology were reviewed for articles describing
staging of pelvic organ prolapse (POP). Journals were reviewed from
January to December of 2012 and 2015. Publications were included
if a grading or staging system was used to describe pelvic organ
prolapse. Review articles, editorials, letters, and articles with re-
tractions or not in manuscript form were excluded. All articles were
reviewed by an independent reviewer with expertise in urogynecol-
ogy. The primary outcome was frequency of POPQ use. Secondary
outcomes included POPQ use by specialty of journal, specialty of
primary author and country of origin, as well as presence of an
anatomic definition of failure and how failure was defined. Data was
evaluated using chi-square tests. Results yielding p < 0.05 were
deemed statistically significant.
RESULTS: Two hundred nineteen articles were reviewed. POPQ was
used in 88.4% of articles in 2012 and in 80% of articles in 2015. Use
of the Baden and Walker (BW) grading system was 2.3% in 2012 and
5.6% in 2015. There was no significant change in the use of POPQ
from 2012 to 2015 (p ¼ 0.296). POPQ was used least frequently by
urologists and urology journals; however, usage by urologists
increased from 50% in 2012 to 63.6% in 2015. The United States
used POPQ more frequently than other countries. In 2012, a defi-
nition for anatomic failure was present in 27% of articles. When
using POPQ to define anatomic failure, 23% of all articles in 2012
used the POPQ stage and 17.8% used a specific POPQ point. From
Supplement to MARCH 2017 American Journal of Obstetrics & Gynecology
Non-Oral Posters
2012 to 2015 the use of specific POPQ point significantly decreased
(7.78%, p ¼ 0.033).
CONCLUSION: POPQ is the most common staging system used in
published articles across all studied specialties and subgroups. In
studies where POPQ is used as an outcome measure, more authors
report data using the recommended staging system rather than
specific points.
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS:
Sarah S. Boyd: Nothing to disclose; David M. O’Sullivan: Nothing to
disclose; Paul Tulikangas: Nothing to disclose.
30 The curious case of the uterine cyst
A. Carpenter2, D. Rush2,3, N. S. Moawad1,2
1
Minimally Invasive Gynecologic Surgery, Department of Obstetrics and
Gynecology, University of Florida, Gainesville, FL, 2College of Medicine,
University of Florida, Gainesville, FL, 3Gynecologic Pathology, Department of
Pathology, Laboratory Medicine and Immunology, University of Florida,
Gainesville, FL
OBJECTIVES: To present a case in which a serous cystadenoma orig-
inated from the serosal surface of the uterus, to describe the surgical
procedure, and to discuss the pathology of cystic structures arising
from the uterus.
MATERIALS AND METHODS: A 40-year-old woman presented with
pelvic pain, heavy menstrual bleeding, and radiculopathy affecting
the right lower extremity. Ultrasound revealed a normal-sized
uterus with a large, simple-appearing adnexal cyst, presumably
originating from the right ovary, along with small fibroids.
Endometrial biopsy was benign. A preoperative MRI visualized a
non-enhancing, fluid-filled structure. No septations, debris, or
nodular enhancement was identified, and the cyst was once again
presumed to be of ovarian origin. The patient underwent laparo-
scopic removal of the mass. Surprisingly, the 8 cm cyst was found
to arise from the serosal surface of the posterior uterine wall
rather than the right ovary. The pedunculated, cystic mass was
excised without rupture and retrieved in a specimen containment
bag. Subsequent pathological evaluation revealed a thin-walled
uterine serous cystadenoma without papillary excrescences. Bilat-
eral salpingectomy revealed normal fallopian tubes with small
paratubal cysts. Both ovaries were visualized and did not appear to
have any associated abnormalities. Interestingly, the patient’s back
pain and radiculopathy resolved after removal of the uterine
cystadenoma.
RESULTS: The case described herein is an unusual occurrence of a
uterine serous cystadenoma. Cystic tumors of the uterus previously
described in the literature have been largely of the intramyometrial
type, including degenerated submucosal leiomyomata, unicornuate
uteri with obstructed rudimentary horns, and cystic variants of
adenomyosis. Cystic structures arising from the serosal surfaces of
the uterus are even less common, such that only a few case reports
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