alternatives to hysterectomy
TRANSCRIPT
![Page 1: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/1.jpg)
Alternatives to Hysterectomy
Duncan Turner MD, MBBS, FACOG,
October 28th 1998
Santa Barbara,California
![Page 2: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/2.jpg)
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
![Page 3: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/3.jpg)
TOPICS
• Alternatives to Hysterectomy
• Alternatives to Traditional Hysterectomy
• Why?– New Treatments
– New Surgeries
– You Have A Choice
![Page 4: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/4.jpg)
Definitions
• Hysterectomy– Removal of Uterus, With/Without Ovaries
• Subtotal Hysterectomy– Removal of Uterus Without Cervix, With/Without Ovaries
• Approaches– Abdominal (Laparotomy)
– Vaginal
– Endoscopic (Laparoscopic)
![Page 5: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/5.jpg)
The Uterus
![Page 6: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/6.jpg)
Definitions
• Endoscopy: Looking through a narrow tube
• Types of Endoscopy– Hysteroscopy - into uterus via vagina
– Laparoscopy - into the abdomen
– Cystoscopy - into bladder
– Others
![Page 7: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/7.jpg)
Cost of laparotomy
• $5,000 - $15,000
• 3 Days in Hospital
• Significant Pain
• 6 Weeks of Recovery
![Page 8: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/8.jpg)
Cost of laparoscopy
• $4,000 - $15,000
• Outpatient or Inpatient
• 3 Hours to 2 Days in Hospital
• 3 Days to 3 Weeks Recovery
![Page 9: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/9.jpg)
Cost of hysteroscopy
• $2000
• Outpatient
• <3 Hours in Surgery Center
• 1-2 Days of Recovery
![Page 10: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/10.jpg)
The Conditions
• Abnormal Uterine bleeding
• Fibroids
• Endometriosis
• Prolapse
• Chronic Pelvic Pain
• Cancer and Precancerous Conditions
![Page 11: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/11.jpg)
ABNORMAL UTERINE BLEEDING
• Prolonged, Irregular or Heavy Bleeding
• 30% of Hysterectomies
• 200,000 a Year
![Page 12: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/12.jpg)
Causes of A.U.B.
• Hormonal Irregularity
• Growths in Uterus
• Cancer and Precancerous Conditions
• Bleeding Disorders
![Page 13: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/13.jpg)
Investigation and Treatment
• Nothing
• Ultrasound and Biopsy to Rule Out Cancer or Precancerous Conditions
• Hormonal Therapy
• D and C
• Hysteroscopic Therapy
• Hysterectomy
![Page 14: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/14.jpg)
Hormonal Therapy for A.U.B.
• Birth Control Pill
• Adjustment of Current Therapy
• Other Hormones
![Page 15: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/15.jpg)
D and C for A.U.B.
• Traditional Treatment
• Blind Procedure
• Good for Biopsy
• No Evidence of Therapeutic Benefit
![Page 16: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/16.jpg)
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
![Page 17: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/17.jpg)
Thermachoice
![Page 18: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/18.jpg)
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%
![Page 19: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/19.jpg)
Benefits of Thermachoice
• Effective
• Simple
• Safe
• Short Procedure
• Local or General Anesthetic
• 85% Successful
![Page 20: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/20.jpg)
Hysterectomy for A.U.B.
• Traditional
• Laparoscopic
• With or Without Ovaries or Cervix
• 100% Successful
![Page 21: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/21.jpg)
Fibroids
• Non-cancerous Growths of Uterine Muscle
• 35% of Women
• 30% of Hysterectomies
• Can Cause:– Bleeding
– Pain
– Pressure
– or Nothing
![Page 22: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/22.jpg)
Treatment of Fibroids
• Nothing
• Hormonal Therapy
• Destruction
• Removal
• Hysterectomy
![Page 23: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/23.jpg)
Hormonal Therapy for Fibroids
• Side Effects
• Temporary
• Expense
• Can be Utilized Before Surgery
![Page 24: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/24.jpg)
Destruction of Fibroids
• Blocking Blood Supply– (EMBOLIZATION)
• SURGERY– Laser
– Electricity
– Freezing
![Page 25: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/25.jpg)
Removal of Fibroids
• Individual -– Traditional or Endoscopic
– Hysteroscopic or Laparoscopic
• Total - – Hysterectomy
– Subtotal Hysterectomy
– Traditional or Laparoscopic
![Page 26: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/26.jpg)
Endometriosis
• Endometrial Tissue in Abnormal Places:
• On Ovaries, Uterus, Bowel
• Can Cause:
• Pain
• Infertility
• Growths
![Page 27: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/27.jpg)
Treatment of Endometriosis
• Nothing
• Hormonal
• Excision
• Cutting of Nerve Supply
• Hysterectomy
![Page 28: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/28.jpg)
Hormonal Therapy for Endometriosis
• Birth Control Pills
• Progesterone
• Danazol
• Lupron
• Side Effects
• Expensive
![Page 29: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/29.jpg)
Excision of Endometriosis
• Traditional Surgery
• Laparoscopic Surgery
• Better Visualization
• More Precise Surgery
• Nerve Supply May Be Cut
• Hysterectomy May Not Be Necessary
![Page 30: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/30.jpg)
PROLAPSE
• Loss of Support of:• Uterus• Bladder• Vagina• Rectum• Because of:• Childbirth• Genetics• Chronic Increase in Pressure
![Page 31: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/31.jpg)
PROLAPSE
• Resulting in:
• Protrusion of Structures
• Pain and Pressure
• Urinary Incontinence
• Urinary Retention
![Page 32: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/32.jpg)
Non-Surgical Treatment of Prolapse
• Pessary
• Kegel Exercises
• Weights
• Electrical Stimulation
• Biofeedback Therapy
![Page 33: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/33.jpg)
Surgical Treatment of Prolapse
• Vaginal
• Abdominal
• Laparoscopic
• Does not Have To Include
HYSTERECTOMY
![Page 34: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/34.jpg)
CHRONIC PELVIC PAIN
• Debilitating Pain - Chronic
• No Obvious Cause
• Pain With Intercourse
• Pain With Periods
![Page 35: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/35.jpg)
Treatment of Chronic Pain
• Hormones
• Pain Killers
• Diagnostic/Therapeutic Surgery– Microlaparoscopy
– Smaller Instruments
– Quicker Recovery
• Traditional Surgery
![Page 36: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/36.jpg)
PRECANCEROUS CONDITIONS of UTERUS
• Hormonal Therapy
• Observation
• Hysterectomy
![Page 37: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/37.jpg)
PRECANCEROUS CONDITIONS of the CERVIX
• Freezing
• Conization– Office of Out Patient Surgery Center
• Hysterectomy - Traditional or Laparoscopic
![Page 38: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/38.jpg)
CONCERNS REGARDING MANAGED CARE
• Underutilization vs Overutilization
• Diminished Freedom to Choose
![Page 39: alternatives to hysterectomy](https://reader036.vdocuments.site/reader036/viewer/2022081502/554b70bfb4c90564168b5098/html5/thumbnails/39.jpg)
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