Objective: This study was conducted to evaluate the use of non-crosslinked acellular dermal matrix (ADM) in laparoscopic sacrocolpopexy by analyzing clinical outcomes and patient-satisfaction surveys. Materials and Methods: Two hundred and eleven patients underwent laparoscopic sacrocolpopexy for pelvic organ prolapse (POP) between January 6, 2012, and December 31, 2017. Each patient had her pelvic-floor measurements diagrammed with the POP-Q [Quantification] system using the interactive tool provided by the American Urogynecologic Society. The Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7), used to make comprehensive assessments of women with urogynecologic problems, were mailed to all patients. If responses were not received, the patients were contacted by telephone. Patients who were not reached by either mail or telephone had their charts individually reviewed to extract the information. Trained surveyors scored the PFDI-20 and the PFIQ-7 questionnaires. The de-identified data were analyzed for patient satisfaction and outcomes. This information was obtained by a review of patient charts at 4-week postoperative and annual examinations; any phone calls with complaints and/or problem office visits were noted. Biopsies from the sacrocolpopexy area were taken if a patient had another incidental gynecologic procedure unrelated to the prolapse or at the time of repeat sacrocolpopexy for POP and the paraffin cell block was sent to McGowan Institute for Tissue Regeneration. Results: One hundred and five patients responded to the survey. Charts were completed for 106. The majority of interviewed patients stated that they were doing a ''little better'' or ''much better'' (77/88; 87.5%). The thirdquartile PFDI-20 score was 93 with a median of 60 and the PFIQ-7 score was 43 with a median of 29. Five patients underwent reoperations (4.76%). The most-common postoperative complaint was overactive bladder symptoms, followed by vaginal discharge. Histology showed either a lack of regenerative healing tissue at the failure site or good results showing neovascularization and a presence of connective and ligamentous tissue around the matrix. No intense fibrosis or neoplastic formation was reported. Conclusions: A non-crosslinked ADM patch can be a good alternative to synthetic polypropylene mesh in patients undergoing sacrocolpopexy for POP. ( J GYNECOL SURG 35:337)

INTRODUCTION: Despite alternative methods such as embolization or leuprolide injections, myomectomy remains the “gold standard” for removing uterine fibroids, especially in younger women desiring pregnancy. Laparoscopic myomectomy offers a minimally invasive approach with the best chances for conception. However, post-operative adhesions and defects within the endometrial lining are still a risk. Thus, an ideal adjunct would promote endogenous regeneration of the tissue defect created by the surgery, minimize adhesions, and improve blood flow for future embryo implantation. We present for the first time use of viable, cryopreserved umbilical tissue (vCUT*, Stravix, Osiris Therapeutics, Inc.) in myomectomy. vCUT is ideal for prevention of adhesions and strengthening of the incised uterus due to its pro-regenerative, anti-fibrotic, angiogenic, and anti-inflammatory properties. vCUT contains all endogenous neonatal extracellular matrix proteins, growth factors, and tissue viable cells, including mesenchymal stem cells, in their native state. METHODS: Ten women underwent laparoscopic myomectomy. After fibroid removal the endometrium was closed with a monofilament suture, and vCUT was incorporated into the closure layer. Patients will be assessed at 3mo and 6mo post-op by 3D Doppler sonography for endometrial thickness and followed until time of conception and mandatory Cesarean delivery. At delivery, uterine anatomy and scarring will be assessed and, when possible, biopsies taken. RESULTS: Preliminary data show all patients are healing well with minimal pain, no complaints, and no abnormal bleeding. Data collection is on-going for 3mo (n=5) and 6mo (n=5) outcomes. CONCLUSION: Viable, cryopreserved umbilical tissue shows promise as a novel adjunct to support endometrial regeneration following laparoscopic myomectomy.

The inability of the uterine cervix to retain a pregnancy in the second trimester is referred to as cervical insufficiency. The most common intervention for such cervical insufficiency to prevent preterm birth is a McDonald cerclage. However, the rate of success ranges from 40-90%. This 3 patient case series is the first report of supplemental use of a dehydrated amniotic membrane allograft (DAMA; BioDRestore®) at the cerclage suture sites as a means to improve success, measured by prevention of pre-term birth, reduction in complications of neonatal prematurity, and decreased length of hospitalization for mother and neonates.

INTRODUCTION: Endometriosis, in particular endometriomas, can cause impairments in folliculogenesis or other damage to ovarian tissue in patients trying to achieve pregnancy. These patients are often tested for levels of anti-Mullerian hormone (AMH), follicle stimulating hormone, and antral follicle counts to assess “ovarian reserve” and fertility potential. Here we present use of a fluid neonatal allograft in laparoscopy to improve AMH levels and chances of conception. The allograft has a multi-specialty indication for the correction of soft tissue defects, and current research suggests it may have the potential to aid in restoration of ovarian function. METHODS: Three patients with moderate to severe endometriosis underwent laparoscopic resection of endometriosis and ovariolysis. Patients’ fallopian tubes were patent and fimbria intact. An amniotic fluid allograft was injected in the areas of tissue defects. Patients had blood work tested pre-operatively and 1 and 3mo post-operatively. Ultrasound was also performed pre- and post-operatively to assess antral follicle count in the beginning and middle of menstruation cycle. RESULTS: One patient had a rise of AMH level from 0.5ng/ml (pre-op) to 1.5ng/ml (post-op). This patient also had mature follicle on day 12 of her cycle whereas pre-operatively there was no evidence of folliculogenesis by ultrasound even with Clomid therapy. Assessments of two other patients are on-going. CONCLUSION: Preliminary findings show an improvement in AMH levels and folliculogenesis after ovarian treatment with a neonatal-derived fluid allograft, suggesting that this treatment may aid in restoration of ovarian function and achievement of a successful pregnancy.