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  • 17

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  • 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
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  • 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
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  • 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
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