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Hysterectomy

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  • 17
  • Transcript

    • 1. Types of Hysterectomies
      • Total abdominal hysterectomy
      • Total vaginal hysterectomy
      • Laparoscopic assisted vaginal hysterectomy
      • Laparoscopic hysterectomy
      • Laparoscopic Supracervical hysterectomy
      www.freelivedoctor.com
    • 2. www.freelivedoctor.com
    • 3. Outcomes Comparison 90% of AUB patients prefer treatments that are painless, require no large incision and allow a quick recovery . 4 1 Brumsted JR, Blackman JA, et.al., Fertility and Sterility, Vol. 65:2, 1996 2 Dwyer, ibid 3 Brooks, PG, et.al., Journal of Reproductive Medicine, Vol. 39, No. 10, October 1994, Rand Corporation 4 RAND Institute, AAGL 9/97 www.freelivedoctor.com
    • 4. Long-Term Patient Outcomes Comparison Long-term Experience Abdominal Hysterectomy Supracervical Hysterectomy SMART Procedure Complete / Near Complete Absence of Bleeding 100% 100% 85% Reproductive Potential Maintained Subsequent Procedures 10% 10% 15% Risk of Incontinence 40% Increase No No OPERA Procedure www.freelivedoctor.com
    • 5. AUB: Life-Table Analysis (N=62)
      • FU (menopause) N No further surgery (%)
      • 1 49 25 100 Global
      • 2 48 16 100 Global
      • 3 47 14 91.3 R/A(?cryo)
      • 4 46 3 91.3 R/A(?cryo)
      • 5 45 1 91.3 R/A F ib/Adeno
      • 6 44 0 91.3 R/A SCH
      • 7 43 2 73.0 SCH SCH
      • 8 42 2 48.6 SCH SCH
      Derman et al. Obstet Gynecol 1991:59-77. www.freelivedoctor.com
    • 6. Alternatives to hysterectomy
      • Supracervical hysterectomy
      • Ablation of the endometrium
          • Resection/ablation in Operating room
              • Versa Point
              • Electric loop, any instrument company
              • Cryoablation
              • Gynecare: tri-wire loop with morcellator
              • Yag Laser
      • Pre-menopause: GnRH analog therapy + add-back
      www.freelivedoctor.com
    • 7. Global Ablation: Technique & Equipment
      • Thermal Balloon: 170-190°F for 8-10 min
        • ThermaChoice ® (Gynecare)
        • Cavaterm
      • Cryo-ablation
        • Soprano™ (Gynecare)
      • Bipolar:  2 min exposure
        • Novacept ®
      • Heated fluid: 70°C for 3-4 min (local anesthesia)
        • EnAbl ® (Innerdyne/U.S. Surgical)
      • Radiofrequency balloon
        • Vesta/DUB (Vesta Medical)
      • Photodynamic Therapy
        • Photofrin II
      • Microwaves: 8mm probe: 2 min 12 sec
      www.freelivedoctor.com
    • 8. Indications for hysterectomy
      • Endometriosis
      • Abnormal uterine bleeding
      • Fibroids
      • Pelvic inflammatory disease
      • Cancer of uterus, tubes or ovaries
      • Severe pelvic adhesions
      • Bilateral ovarian pathology
      • Adenomyosis
      • Pelvic congestion syndrome
      • Intractable, recurrent dysmenorrhea or metrorrhagia
      • Uterine anomalies
      • Uterine prolapse
      • Recurrent intrauterine polyps
      • Uterine perforation
      • Mentally retarded patient with no hygiene control
      • Pregnancy
        • Placenta increta, percreta, or acreta
        • Atonic uterus
        • Uterine perforation
        • Ruptured uterus
      www.freelivedoctor.com