alternatives to-hysterectomy
TRANSCRIPT
Alternatives to Hysterectomy
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HYSTERECTOMY
• 600,000 per year in USA
• 35% chance by 60
• Traditional Surgery– 3 days in hospital
– 6 weeks of recovery
• Total Cost: $15,000 + loss of productivity
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TOPICS
• Alternatives to Hysterectomy
• Alternatives to Traditional Hysterectomy
• Why?– New Treatments
– New Surgeries
– You Have A Choice
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Definitions
• Hysterectomy– Removal of Uterus, With/Without Ovaries
• Subtotal Hysterectomy– Removal of Uterus Without Cervix, With/Without Ovaries
• Approaches– Abdominal (Laparotomy)
– Vaginal
– Endoscopic (Laparoscopic)
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The Uterus
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Definitions
• Endoscopy: Looking through a narrow tube
• Types of Endoscopy– Hysteroscopy - into uterus via vagina
– Laparoscopy - into the abdomen
– Cystoscopy - into bladder
– Others
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Cost of laparotomy
• $5,000 - $15,000
• 3 Days in Hospital
• Significant Pain
• 6 Weeks of Recovery
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Cost of laparoscopy
• $4,000 - $15,000
• Outpatient or Inpatient
• 3 Hours to 2 Days in Hospital
• 3 Days to 3 Weeks Recovery
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Cost of hysteroscopy
• $2000
• Outpatient
• <3 Hours in Surgery Center
• 1-2 Days of Recovery
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The Conditions
• Abnormal Uterine bleeding
• Fibroids
• Endometriosis
• Prolapse
• Chronic Pelvic Pain
• Cancer and Precancerous Conditions
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ABNORMAL UTERINE BLEEDING
• Prolonged, Irregular or Heavy Bleeding
• 30% of Hysterectomies
• 200,000 a Year
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Causes of A.U.B.
• Hormonal Irregularity
• Growths in Uterus
• Cancer and Precancerous Conditions
• Bleeding Disorders
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Investigation and Treatment
• Nothing
• Ultrasound and Biopsy to Rule Out Cancer or Precancerous Conditions
• Hormonal Therapy
• D and C
• Hysteroscopic Therapy
• Hysterectomy
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Hormonal Therapy for A.U.B.
• Birth Control Pill
• Adjustment of Current Therapy
• Other Hormones
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D and C for A.U.B.
• Traditional Treatment
• Blind Procedure
• Good for Biopsy
• No Evidence of Therapeutic Benefit
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Hysteroscopic Treatment of A.U.B.
• Visual Procedure• Removal of Growth
– Good for Biopsy– Very Accurate
• Endometrial Ablation– Destruction of Lining Tissue by
• Laser• Electricity• Hot Water Balloon
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Thermachoice
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Thermachoice VS Electrocautery
• Improvement at 12 months– 85% vs 89%
• Hysterectomies by 12 months– 2% =
• Repeat Ablations by 12 months– <1% =
• Complications– 4% vs 6%
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Benefits of Thermachoice
• Effective
• Simple
• Safe
• Short Procedure
• Local or General Anesthetic
• 85% Successful
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Hysterectomy for A.U.B.
• Traditional
• Laparoscopic
• With or Without Ovaries or Cervix
• 100% Successful
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Fibroids
• Non-cancerous Growths of Uterine Muscle
• 35% of Women
• 30% of Hysterectomies
• Can Cause:– Bleeding
– Pain
– Pressure
– or Nothing
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Treatment of Fibroids
• Nothing
• Hormonal Therapy
• Destruction
• Removal
• Hysterectomy
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Hormonal Therapy for Fibroids
• Side Effects
• Temporary
• Expense
• Can be Utilized Before Surgery
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Destruction of Fibroids
• Blocking Blood Supply– (EMBOLIZATION)
• SURGERY– Laser
– Electricity
– Freezing
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Removal of Fibroids
• Individual -– Traditional or Endoscopic
– Hysteroscopic or Laparoscopic
• Total - – Hysterectomy
– Subtotal Hysterectomy
– Traditional or Laparoscopic
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Endometriosis
• Endometrial Tissue in Abnormal Places:
• On Ovaries, Uterus, Bowel
• Can Cause:
• Pain
• Infertility
• Growths
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Treatment of Endometriosis
• Nothing
• Hormonal
• Excision
• Cutting of Nerve Supply
• Hysterectomy
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Hormonal Therapy for Endometriosis
• Birth Control Pills
• Progesterone
• Danazol
• Lupron
• Side Effects
• Expensive
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Excision of Endometriosis
• Traditional Surgery
• Laparoscopic Surgery
• Better Visualization
• More Precise Surgery
• Nerve Supply May Be Cut
• Hysterectomy May Not Be Necessary
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PROLAPSE
• Loss of Support of:• Uterus• Bladder• Vagina• Rectum• Because of:• Childbirth• Genetics• Chronic Increase in Pressure
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PROLAPSE
• Resulting in:
• Protrusion of Structures
• Pain and Pressure
• Urinary Incontinence
• Urinary Retention
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Non-Surgical Treatment of Prolapse
• Pessary
• Kegel Exercises
• Weights
• Electrical Stimulation
• Biofeedback Therapy
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Surgical Treatment of Prolapse
• Vaginal
• Abdominal
• Laparoscopic
• Does not Have To Include
HYSTERECTOMY
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CHRONIC PELVIC PAIN
• Debilitating Pain - Chronic
• No Obvious Cause
• Pain With Intercourse
• Pain With Periods
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Treatment of Chronic Pain
• Hormones
• Pain Killers
• Diagnostic/Therapeutic Surgery– Microlaparoscopy
– Smaller Instruments
– Quicker Recovery
• Traditional Surgery
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PRECANCEROUS CONDITIONS of UTERUS
• Hormonal Therapy
• Observation
• Hysterectomy
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PRECANCEROUS CONDITIONS of the CERVIX
• Freezing
• Conization– Office of Out Patient Surgery Center
• Hysterectomy - Traditional or Laparoscopic
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CONCERNS REGARDING MANAGED CARE
• Underutilization vs Overutilization
• Diminished Freedom to Choose
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SUMMARY
• Alternatives Exist
• Treatment Should be Suited to the Individual
• A Minimally Invasive Approach is Almost Always Available
• Be Part of the Decision Making Process
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