Alternatives to-hysterectomy

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