Hysterectomy

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  • 17
  • Hysterectomy

    1. 1. Types of Hysterectomies <ul><li>Total abdominal hysterectomy </li></ul><ul><li>Total vaginal hysterectomy </li></ul><ul><li>Laparoscopic assisted vaginal hysterectomy </li></ul><ul><li>Laparoscopic hysterectomy </li></ul><ul><li>Laparoscopic Supracervical hysterectomy </li></ul>
    2. 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
    3. 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
    4. 5. AUB: Life-Table Analysis (N=62) <ul><li>FU (menopause) N No further surgery (%) </li></ul><ul><li>1 49 25 100 Global </li></ul><ul><li>2 48 16 100 Global </li></ul><ul><li>3 47 14 91.3 R/A(?cryo) </li></ul><ul><li>4 46 3 91.3 R/A(?cryo) </li></ul><ul><li>5 45 1 91.3 R/A F ib/Adeno </li></ul><ul><li>6 44 0 91.3 R/A SCH </li></ul><ul><li>7 43 2 73.0 SCH SCH </li></ul><ul><li>8 42 2 48.6 SCH SCH </li></ul>Derman et al. Obstet Gynecol 1991:59-77.
    5. 6. Alternatives to hysterectomy <ul><li>Supracervical hysterectomy </li></ul><ul><li>Ablation of the endometrium </li></ul><ul><ul><ul><li>Resection/ablation in Operating room </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Versa Point </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Electric loop, any instrument company </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Cryoablation </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Gynecare: tri-wire loop with morcellator </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Yag Laser </li></ul></ul></ul></ul></ul><ul><li>Pre-menopause: GnRH analog therapy + add-back </li></ul>
    6. 7. Global Ablation: Technique & Equipment <ul><li>Thermal Balloon: 170-190°F for 8-10 min </li></ul><ul><ul><li>ThermaChoice ® (Gynecare) </li></ul></ul><ul><ul><li>Cavaterm </li></ul></ul><ul><li>Cryo-ablation </li></ul><ul><ul><li>Soprano™ (Gynecare) </li></ul></ul><ul><li>Bipolar:  2 min exposure </li></ul><ul><ul><li>Novacept ® </li></ul></ul><ul><li>Heated fluid: 70°C for 3-4 min (local anesthesia) </li></ul><ul><ul><li>EnAbl ® (Innerdyne/U.S. Surgical) </li></ul></ul><ul><li>Radiofrequency balloon </li></ul><ul><ul><li>Vesta/DUB (Vesta Medical) </li></ul></ul><ul><li>Photodynamic Therapy </li></ul><ul><ul><li>Photofrin II </li></ul></ul><ul><li>Microwaves: 8mm probe: 2 min 12 sec </li></ul>
    7. 8. Indications for hysterectomy <ul><li>Endometriosis </li></ul><ul><li>Abnormal uterine bleeding </li></ul><ul><li>Fibroids </li></ul><ul><li>Pelvic inflammatory disease </li></ul><ul><li>Cancer of uterus, tubes or ovaries </li></ul><ul><li>Severe pelvic adhesions </li></ul><ul><li>Bilateral ovarian pathology </li></ul><ul><li>Adenomyosis </li></ul><ul><li>Pelvic congestion syndrome </li></ul><ul><li>Intractable, recurrent dysmenorrhea or metrorrhagia </li></ul><ul><li>Uterine anomalies </li></ul><ul><li>Uterine prolapse </li></ul><ul><li>Recurrent intrauterine polyps </li></ul><ul><li>Uterine perforation </li></ul><ul><li>Mentally retarded patient with no hygiene control </li></ul><ul><li>Pregnancy </li></ul><ul><ul><li>Placenta increta, percreta, or acreta </li></ul></ul><ul><ul><li>Atonic uterus </li></ul></ul><ul><ul><li>Uterine perforation </li></ul></ul><ul><ul><li>Ruptured uterus </li></ul></ul>

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