scholarly journals Analysis of Applicator Insertion Related Acute Side Effects for Cervical Cancer Treated With Brachytherapy

2021 ◽  
Vol 11 ◽  
Author(s):  
Jiajun Chen ◽  
Ning Zhang ◽  
Ying Liu ◽  
Dongmei Han ◽  
Zhuang Mao ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Side Effects ◽  
Waiting Time ◽  
Vaginal Bleeding ◽  
Procedure Time ◽  
Removal Time ◽  
Total Procedure Time ◽  
Acute Side Effects ◽  
The Mean ◽  
Total Procedure

PurposeTo report applicator insertion-related acute side effects during brachytherapy (BT) procedure for cervical cancer patients.Materials and MethodsBetween November 2017 and December 2019, 407 BT fractions were performed in 125 patients with locally advanced cervical cancer. Acute side effects recorded comprised anesthesia-related side effects, mechanical-related side effects and infection, whose frequency and degree were recorded. Pain was assessed using numeric rating scale; vaginal bleeding volume was counted by weighing gauze pieces used in packing. The BT procedure comprised eight stages: anesthesia, applicator insertion, image acquisition, transport, waiting for treatment, dose delivery, applicator removal, and removed which denoted 0.5–12.0 h period after removal, with time of each stage recorded. Factors influencing acute side effects were assessed by Spearman correlation and Mann–Whitney U test.ResultsThe most common acute side effect was pain, followed by vaginal bleeding. The mean scores for pain were highest during removal time, 4.9 ± 1.6 points. The mean vaginal bleeding volume was 44.4 ml during removal time. Mean total procedure time was 218.8 (175–336) min, having positive relationship with frequency of acute side effects. The total procedure time with acute side effects was longer than that without acute side effects. The longest procedure time was waiting time, 113.0 (91.0–132.0) min. More needles generated higher pain scores and larger volume of vaginal bleeding.ConclusionPain and vaginal bleeding were the most common acute side effects, especially during removal time, which physicians should focus on. Shortening patients’ waiting time helps to reduce the total procedure time, thus, reduce acute side effects. While meeting dose requirement, less needles are helpful to reduce acute side effects.

scholarly journals P338 The road to zero-fluoroscopy catheter ablation in recurrent paroxysmal atrial fibrillation using ICE: training, learning, getting closer

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I A Minciuna ◽  
M Puiu ◽  
G Cismaru ◽  
S Istratoaie ◽  
G Simu ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiation Exposure ◽  
Radiofrequency Catheter Ablation ◽  
Procedure Time ◽  
Total Procedure Time ◽  
The Mean ◽  
Group 2 ◽  
Total Procedure ◽  
Zero Fluoroscopy ◽  
Group 1

Abstract INTRODUCTION Catheter ablation is the treatment of choice for patients with recurrent paroxysmal atrial fibrillation (AF) in which antiarrhythmic drug therapy has failed to maintain sinus rhythm. Since its first introduction, intracardiac echocardiography (ICE) has proved to increase the efficacy and reduce complications in AF catheter ablation. One of the main advantages of ICE in the electrophysiology laboratory is the reduction of radiation exposure, for both the patient and the physician. Multiple recent studies have shown the feasibility and safety of zero or near-zero fluoroscopy AF ablation, including transseptal puncture, and outlined the importance of using ICE under the support of 3D mapping systems in reducing radiation exposure. PURPOSE The aim of this study was to show whether the use of ICE reduced the radiation exposure and total procedure time in recurrent paroxysmal AF patients undergoing radiofrequency catheter ablation. METHODS Forty patients that undergone radiofrequency catheter ablation for recurrent paroxysmal AF between January 2018 and May 2019 were included. They were divided in two groups: Group 1 – 20 patients in which ICE was performed and Group 2 – 20 patients in which ablation was performed without ICE guidance. We compared the total ablation time and fluoroscopy dose and time between the two groups. The total ablation time was defined as the time from the groin puncture until the withdrawal of all catheters. RESULTS Among the 40 patients included, 28 were men (70%) and the mean age was 57 years old. The mean procedure time was similar between the two groups (175 ± 52.0 for group 1 and 193 ± 49.9 for group 2, p = 0.33). The difference between the two groups was observed in fluoroscopy dose (9914.13 ± 5018.14 vs. 14561.43 ± 7446.1, p = 0.02) and time (26.04 ± 12.5 vs. 40.52 ± 12.6, p = 0.001). We found that in both groups higher fluoroscopy dose was correlated with higher fluoroscopy time (R = 0.74, p = 0.0001 vs. R = 0.57, p = 0.008) and higher total procedure time (R = 0.63, p = 0.002 vs. R = 0.46, p = 0.03). Furthermore, there was also a correlation between higher fluoroscopy dose and time (R = 0.59, p = 0.005 vs. R = 0.58, p = 0.006). No severe procedure-related complications were recorded. CONCLUSIONS This study shows that the use of ICE for recurrent paroxysmal AF catheter ablation reduces radiation exposure by lowering the fluoroscopy dose and the time of exposure. As a result, by increasing the training and learning curve in low-experienced centers it may finally get us closer to the ideal zero or near-zero fluoroscopy ablation. Abstract P338 Figure. ICE-guided transseptal puncture

scholarly journals Diagnostic Performance of Endoscopic Ultrasound-Guided Tissue Acquisition by EUS-FNA versus EUS-FNB for Solid Pancreatic Mass Without ROSE: A Retrospective Study.

2021 ◽  
Author(s):  
Thanawin Wong ◽  
Tanawat Pattarapuntakul ◽  
Nisa Netinatsuton ◽  
Bancha Ovartlarnporn ◽  
Jaksin Sottisuporn ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Diagnostic Performance ◽  
Diagnostic Yield ◽  
Pancreatic Mass ◽  
Procedure Time ◽  
Ultrasound Guided ◽  
Total Procedure Time ◽  
Tissue Acquisition ◽  
The Mean ◽  
Total Procedure

Abstract Background: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is an established diagnostic procedure for solid pancreatic mass. However, the diagnostic yield between fineneedle aspiration (FNA) and fine-needle biopsy (FNB) remains unclear. Thus, we aimed to evaluate and compare the diagnostic yields between FNA and FNB using conventional FNA and Franseen needles of the same size (22 gauge), respectively, in patients with solid pancreatic mass who underwent EUS-TA without rapid onsite cytopathology evaluation (ROSE). Methods: All cases of EUS-TA by FNA or FNB for solid pancreatic mass between January 2017 and October 2020 in a single center university hospital were retrospectively reviewed. The procedure was performed without an onsite cytologist. After macroscopic onsite evaluation (MOSE), the endoscopist finished the procedure. The diagnostic yield and the average number of needle passes between FNB and FNA were then compared. Results: A total of 151 patients (FNA, n = 77; FNB, n = 74) with solid pancreatic mass detected by cross-sectional imaging underwent EUS-TA. The mean age was 62.3 ± 12.8 years, with 88 (58.3%) males. Age, gender, mass location, tumour size and disease stage from imaging were not significantly different. The diagnostic performance was dramatically higher in EUS-FNB (100%) than in EUS-FNA (89.6%). The mean number of needle passes was clearly fewer in FNB than FNA (2.8 vs. 3.8, p < 0.001). The total procedure time was less in FNB (34.7 minutes) than in FNA (41 minutes). The adverse event rate between FNB and FNA was not significantly different. Conclusions: The diagnostic performance for solid pancreatic mass without ROSE was significantly higher in FNB than in FNA. The number of needle passes and the total procedure time was also lesser in FNB.

Abstract 98: Higher Volume Endovascular Stroke Centers Have Decreased Times to Treatment

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Rishi Gupta ◽  
Anat Horev ◽  
Thanh N Nguyen ◽  
Raphael Y Gershon ◽  
Dheeraj Gandhi ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
High Volume ◽  
Arterial Puncture ◽  
Procedure Time ◽  
Total Procedure Time ◽  
Lower Volume ◽  
The Mean ◽  
Mean Time ◽  
Total Procedure

Background: Currently, no metric exists for door to arterial puncture time for endovascular treatment in acute ischemic stroke. The aim of this study was to determine the timings of each step of endovascular stroke intervention stratified by the volume of procedures at each center. Methods: We retrospectively reviewed patients from seven institutions undergoing endovascular reperfusion therapies for acute ischemic stroke. Patients with anterior circulation strokes treated less than 8 hours from symptoms onset were included. Demographic, radiographic, angiographic and clinical outcomes were collected. The time interval at each milestone from CT acquisition to reperfusion was recorded. Successful reperfusion was defined as achieving a TICI 2B or 3 score as graded by the operator. Symptomatic hemorrhage was defined as a parenchymal hemorrhage type 2 as defined by ECASScriteria. Centers that performed more than 50 intra-arterial stroke interventions annually were considered high volume (HV) centers. A univariate analysis was performed with the Fisher’s exact test for categorical variables and students t-test for continuous variables to compare HV to lower volume (LV) centers. Variables with a p-value < 0.20 were placed in a binary logistic regression model to determine if there were differences in time to treatment between the two groups. Results: A total of 338 patients with a mean age of 67±14 years and mean NIHSS of 18±5 were included. The mean time from CT imaging to groin puncture was 108±73 minutes. The mean time from groin puncture to the placement of a microcatheter in the thrombus was 41±21 minutes and total procedure time 104±55 minutes. There were no differences in demographics, site of vascular occlusion and hemorrhage rates between high volume and lower volume centers. In univariate analysis, HV centers had a lower time from CT imaging to groin puncture (89±57 minutes vs. 154±84 minutes, p<0.001), procedure time (93±46 minutes vs. 129±65 minutes, p<0.001), final infarct volume (79±82 cm 3 vs. 94±106 cm 3 , p<0.03) and higher reperfusion rates (73% vs. 59%, p<0.01). In binary logistic regression modeling HV centers were found to have a shorter CT acquisition to arterial puncture time [OR 0.991, 95%CI (0.986-0.996), p<0.001] and higher reperfusion rates [OR 1.79, 95% CI (1.04-3.12), p<0.03]. Conclusions: Currently there is variability in the time from CT to arterial puncture and total procedure time across institutions, but HV centers appear to have lower times to treatment. Further study is required to determine how to reduce times to treatment and develop a metric for centers to target.

scholarly journals A Decade of Marketing Authorization Applications of Anticancer Drugs in the European Union: An Analysis of Procedural Timelines

2021 ◽  
Author(s):  
Marjolein Garsen ◽  
Maaike Steenhof ◽  
Alex Zwiers
Keyword(s):  
Anticancer Drugs ◽  
Marketing Authorization ◽  
European Medicines Agency ◽  
Company Size ◽  
Scientific Advice ◽  
The European Union ◽  
Small Companies ◽  
Procedure Time ◽  
Total Procedure Time ◽  
Total Procedure

Abstract Background Cancer is a serious global health problem and a major cause of death. The European Medicines Agency (EMA) has established several regulatory initiatives to expedite the development and authorization of drugs to ensure timely access of patients. In this study, we analyzed the procedural timelines of marketing authorization applications for anticancer drugs in the EU, with a specific focus to special regulatory programs, scientific advice and company size. Methods Anticancer drugs that received an opinion from the EMA between January 2010 and December 2019 were included in the study. Public assessment reports were used to obtain publicly available information of the drugs. Results We identified 96 applications for new anticancer drugs. 34 applications were granted access to at least one expedited program offered by the EMA. Total procedure time was reduced from average 370 to 200–215 days when accelerated assessment was granted. Granting of a conditional marketing authorization or an orphan designation, as well as having scientific advice, only mildly affected total procedure time. Average total procedure time of small companies was much longer compared with medium-sized and large companies (483 versus 356 days), which was caused by an increased clock stop time. Conclusion Total procedure time for anticancer is mainly affected by the granting of accelerated assessment, which reduced the total procedure time, and company size, where total procedure time is much longer for small companies. Small companies are advised to have, and especially adhere to scientific advice to reduce procedure time and increase the chance of success.

The endovascular management of splenic artery aneurysms and pseudoaneurysms

Vascular ◽  
2011 ◽  
Vol 19 (5) ◽  
pp. 257-261 ◽  
Author(s):  
Jia Xin ◽  
Liu Xiao-ping ◽  
Guo Wei ◽  
Xiong Jiang ◽  
Zhang Hong-peng ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Splenic Artery ◽  
Endovascular Procedures ◽  
Endovascular Management ◽  
Total Procedure Time ◽  
The Mean ◽  
Postembolization Syndrome ◽  
Mid Term Results ◽  
Total Procedure

The purpose of this study was to evaluate outcomes of the endovascular treatment of splenic artery aneurysms (SAAs) and pseudoaneurysms (SAPAs). From April 2003 to December 2009, 12 patients (mean age 46.8 years, range 29–58) with SAAs ( n = 9) or SAPAs ( n = 3) underwent endovascular treatment. Four patients were asymptomatic and three had ruptured aneurysms. Lesions were in the proximal splenic artery ( n = 3), intermediate splenic artery ( n = 3) and distal splenic artery ( n = 6). Endovascular procedures included embolization by sac packing ( n = 5), sandwich occlusion of the splenic artery ( n = 4) or stent graft deployment ( n = 3). Computed tomography (CT) was done before the operation, 3 and 12 months after the operation, then yearly. Endovascular treatment was successful at the first attempt in all 12 (100%) patients, with complete angiographic exclusion of the aneurysm at the end of the operation. The mean amount of contrast medium used was 165 mL (range 100–230), and the mean total procedure time was 92 minutes (range 55–160). No major complications occurred. Postoperational CT scans showed splenic multisegmental infarcts in eight patients (66.7%, 8/12) and among them postembolization syndrome developed in six patients, manifesting as abdominal pain and fever. The mean follow-up was 32 months (range 9–51). No patient demonstrated gross evidence of aneurysm sac growth, and no significant decrease in aneurysm sac size postintervention was noted on follow-up. The endovascular management of SAAs and SAPAs is safe and effective and may induce less mortality than open surgery. Regardless of the etiology, endovascular treatment can provide excellent mid-term results.

scholarly journals Two electrosurgical endo-knives for endoscopic submucosal dissection of colorectal superficial neoplasms: a prospective randomized study

2017 ◽  
Vol 05 (08) ◽  
pp. E729-E735 ◽  
Author(s):  
Yuusaku Sugihara ◽  
Keita Harada ◽  
Yoshiro Kawahara ◽  
Daisuke Takei ◽  
Shiho Takashima ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Controlled Trial ◽  
Randomized Study ◽  
Procedure Time ◽  
Related Factors ◽  
Submucosal Dissection ◽  
Total Procedure Time ◽  
Mucosal Incision ◽  
The Difference ◽  
Total Procedure

Abstract Background and study aims Few studies have directly compared endo-knives for endoscopic submucosal dissection (ESD) in humans. We compared the performances of the Mucosectom2 and SB knife Jr. Patients and methods Two trainee endoscopists performed ESD of 36 lesions in this prospective, randomized controlled trial. Mucosal incision with a 1.5-mm Dual knife and submucosal dissection using the Mucosectom2 were performed in 1 group. Mucosal incision with a 1.5-mm Dual knife and submucosal dissection with a SB knife Jr. were performed in the other group. The primary outcome was the ESD procedure time. Secondary outcomes were total procedure time, self-completion rates, and adverse events. Results ESD time in Mucosectom2 patients was not significantly shorter than in SB knife Jr. patients (57 ± 32 min vs. 61 ± 44 min, respectively; P = 0.94). Total procedure time in Mucosectom2 patients was not significantly shorter than in SB knife Jr. patients (81 ± 42 min vs. 82 ± 51 min, respectively; P = 0.85). The trainee self-completion rate was slightly higher in SB knife Jr. patients than in Mucosectom2 patients, although the difference was not significant (94 % vs. 100 %, respectively; P = 0.959). Fewer hemostatic procedures using the Coagrasper were performed in Mucosectom2 patients than in SB knife Jr. patients, although the difference was not significant (0.62 vs. 0.7, respectively; P = 0.432). Conclusions Mucosectom2 and SB knife Jr. did not significantly differ in performance for colorectal ESD to safely and reliably enhance ESD. Knife selection is not as important for learning colorectal ESD as patient- and lesion-related factors.

scholarly journals Whitacre Needle Reduces the Incidence of Intravascular Uptake in Lumbar Transforaminal Epidural Steroid Injections

2015 ◽  
Vol 18;4 (4;18) ◽  
pp. 325-331
Author(s):  
JiHee Hong
Keyword(s):  
Steroid Injection ◽  
Leg Pain ◽  
Digital Subtraction ◽  
Procedure Time ◽  
Intravascular Injection ◽  
Total Procedure Time ◽  
Transforaminal Epidural Steroid Injection ◽  
Interventional Pain Management ◽  
Epidural Steroid ◽  
Total Procedure

Background: Transforaminal epidural steroid injection (TFESI) is a commonly used interventional pain management procedures to treat radicular leg pain. Although most reported complications of TFESI are minor, serious morbidity has also been demonstrated including spinal cord infarction, paraplegia, and quadriparesis. Suggested mechanisms include direct vascular injury or intravascular injection of particulate steroid. Objective: We compared 2 different needle types, Whitacre and Quincke type needles, with regard to intravascular injection rate with total procedure time and the amount of radiation during lumbar TFESI. Study Design: Prospective, randomized trial. Setting: An interventional pain management practice in South Korea. Methods: After Institutional Review Board approval, 149 patients undergoing lumbar TFESI for radicular leg pain were randomly assigned to one of 2 needle groups (Whitacre needle or Quincke type needle). After final confirmation of intravascular injection with digital subtraction angiography, total procedure time and amount of radiation exposure during TFESI were measured. Results: The overall incidence of intravascular injection was 10.4% (28/269). We analyzed the overall incidence of intravascular injection according to the 2 different needle types. The incidence of intravascular injection of the Whitacre needle was 5.4% (8/146), whereas the incidence of intravascular injection of the Quincke needle was 16.2% (20/123). Total procedure time and amount of radiation required to complete the TFESI in the Whitacre and Quincke needle groups was 168.4 ± 57.9 (seconds) and 33.4 ± 15.9 (cGy/cm2 ), 131.9 ± 46.0 (seconds) and 33.2 ± 15.8 (cGy/cm2 ), respectively. Limitations: The physician who performed the TFESI was not blinded to the type of needle for detecting intravascular injection. This study was focused on lumbar TFESI, however, most TFESIs are performed at the L4-5 or L5-S1 level. Conclusion: The Whitacre needle had the benefit of reducing the incidence of intravascular injection with minimal differences in technical difficulties and the amount of radiation exposure during lumbar TFESI. Key words: Transforaminal epidural steroid injection, complication, intravascular injection, Whitacre needle, Quincke needle, procedure time, radiation, digital subtraction angiography

scholarly journals The role of intracardiac echocardiography in reducing radiation exposure during atrial fibrillation ablation

2021 ◽  
Author(s):  
Ioan-Alexandru Minciuna ◽  
Mihai Puiu ◽  
Gabriel Cismaru ◽  
Radu Roșu ◽  
Raluca Tomoaia ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Learning Curve ◽  
Radiation Exposure ◽  
Intracardiac Echocardiography ◽  
Procedure Time ◽  
Af Ablation ◽  
Total Procedure Time ◽  
The Mean

Aims: Intracardiac echocardiography (ICE) is a relatively young technique used during complex electrophysiology proce-dures, such as atrial fibrillation (AF) ablation. The aim of this study was to assess whether the use of ICE modifies the radia-tion exposure at the beginning of the learning curve in AF ablation. Materials and methods: In this retrospective study, 52 patients, in which catheter ablation for paroxysmal or persistent AF was performed, were included. For 26 patients we used ICE guidance together with fluoroscopy, whereas for the remaining 26 patients we used fluoroscopy alone, all supported by electroanatomical mapping. We compared total procedure time and radiation exposure, including fluoroscopy dose and time between the two groups and along the learning curve. Results: Most of the patients included were suffering from paroxysmal AF (40, 76%), pulmonary vein isolation being performed in all patients, without secondary ablation sites. The use of ICE was associated with a lower fluoroscopy dose (11839.60±6100.6 vs. 16260.43±8264.5 mGy, p=0.041) and time (28.00±12.5 vs. 42.93±12.7 minutes, p=0.001), whereas the mean procedure time was similar between the two groups (181.54±50.3 vs 197.31±49.8 minutes, p=0.348). Radiation exposure was lower in the last 9 months compared to the first 9 months of the study (p<0.01), decreasing gradually along the learning curve. Conclusions: The use of ICE lowers radiation exposure in AF catheter ablation from the beginning of the learning curve, without any difference in terms of acute safety or efficacy. Aware-ness towards closest to zero radiation exposure during electrophysiology procedures should increase in order to achieve better protection for both patient and medical staff.

scholarly journals Comparison of Standard Technique, Ultrasonography, and Near-Infrared Light in Difficult Peripheral Vascular Access: A Randomized Controlled Trial

2021 ◽  
pp. 1-6
Author(s):  
Sercan Yalçınlı ◽  
Funda Karbek Akarca ◽  
Özge Can ◽  
İlhan Uz ◽  
Gülbin Konakçı
Keyword(s):  
Vascular Access ◽  
Near Infrared ◽  
Standard Technique ◽  
Infrared Light ◽  
Controlled Study ◽  
Procedure Time ◽  
Near Infrared Light ◽  
Randomized Controlled ◽  
Total Procedure Time ◽  
Total Procedure

Abstract Objectives: Successful placement of a peripheral intravenous catheter (PIVC) on the first attempt is an important outcome for difficult vascular access (DVA) patients. This study compared standard technique, ultrasonography (USG), and near-infrared light (NIR) in terms of success in the first attempt in patients with DVA. Methods: This was a prospective, randomized controlled study. The study was conducted in a tertiary care hospital. Emergency department patients who describe DVA history, have no visible or palpable veins, and were assessed by the nurse to have a difficult PIVC were included to study. The PIVC procedure was performed on patients by standard, USG, or NIR device techniques. For all approaches, the success of the first attempt was the primary aim. Total procedure time, the total number of attempts, and the need for rescue intervention were secondary aims. Results: This study evaluated 270 patients. The first attempt success rates for USG, standard, and NIR methods were 78.9%, 62.2%, and 58.9%, respectively. The rate of first attempt success was higher in patients who underwent USG (USG versus standard, P = .014; USG versus NIR, P = .004; standard versus NIR, P = .648). The total median (IQR) procedure time for USG, standard, and NIR methods was 107 (69-228), 72 (47-134), and 82 (61-163) seconds, respectively. The total procedure time was longer in patients undergoing USG (standard versus USG, P <.001; NIR versus USG, P = .035; standard versus NIR, P = .055). The total median (IQR) number of attempts of USG, standard, and NIR methods were 1 (1-1), 1 (1-2), and 1 (1-2), respectively. A difference was found among the groups regarding the total number of attempts (USG versus NIR, P = .015; USG versus standard P = .108; standard versus NIR, P = .307). No difference was found among groups in terms of the need for rescue methods. Conclusion: It was found that USG increases the success of the first attempt compared with the standard method and NIR in patients with DVA.

Mifepristone and misoprostol compared to osmotic dilators for cervical preparation prior to surgical abortion at 15–18 weeks' gestation: a randomised controlled non-inferiority trial

2019 ◽  
Vol 46 (1) ◽  
pp. 67-72 ◽  
Author(s):  
Amy E Paris ◽  
Olivera Vragovic ◽  
Sarita Sonalkar ◽  
Molly Finneseth ◽  
Lynn Borgatta
Keyword(s):  
Operative Time ◽  
Effective Means ◽  
Procedure Time ◽  
Medication Group ◽  
Total Procedure Time ◽  
The Future ◽  
Cervical Preparation ◽  
Randomised Controlled ◽  
Surgical Abortion ◽  
Total Procedure

ObjectiveCervical preparation is recommended prior to second-trimester surgical abortion. Osmotic dilators are an effective means to prepare the cervix, but require an additional procedure and may cause discomfort. We compared cervical preparation with mifepristone and misoprostol to preparation with osmotic dilators.Study designA randomised, controlled, non-inferiority trial was performed to compare cervical preparation with mifepristone and misoprostol to preparation with osmotic dilators in women undergoing surgical abortion between 15 and 18 weeks gestation. The medication group (n=29) received mifepristone 200 mg orally 24 hours prior to uterine evacuation and misoprostol 400 μg buccally 2 hours before the procedure. The dilator group (n=20) underwent osmotic dilator insertion 24 hours prior to the procedure. The primary outcome was total procedure time, from insertion to removal of the speculum. Secondary outcomes included operative time (from intrauterine instrumentation to speculum removal), initial cervical dilation, nausea, pain, ease of procedure, and whether participants would choose the same modality in the future.ResultsFor mean total procedure time, medication preparation (14.0 min, 95% CI 12.0–16.1) was not inferior to dilators (14.3 min, 95% CI 11.7 to 16.8, p<0.001). Mean operative time and ease of procedure were also similar between groups. More women in the medication group than the dilator group would prefer to use the same method in the future (86% vs 30%, p=0.003).ConclusionPrior to surgical abortion at 15–18 weeks, use of mifepristone and misoprostol did not result in longer procedure times than overnight osmotic dilators.Trial registration numberNCT01462.

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