This document discusses alternatives to hysterectomy for various gynecological conditions such as abnormal uterine bleeding, fibroids, endometriosis, and prolapse. It outlines newer minimally invasive treatments like endometrial ablation, uterine fibroid embolization, and laparoscopic excision of endometriosis that can avoid the risks and long recovery of traditional hysterectomy. These newer options are often as effective as hysterectomy but allow for a shorter hospital stay and faster recovery time. The document emphasizes that treatment should be tailored to the individual patient's condition and that in many cases, a hysterectomy is not always necessary to successfully treat the underlying problem.

1.
Alterna)ves
to
Hysterectomy
DR.
KAWITA
BAPAT

3. HYSTERECTOMY
600,000
per
year
in
USA
35%
chance
by
60
Tradi)onal
Surgery
3
days
in
hospital
6
weeks
of
recovery
Total
Cost:
$15,000
+
loss
of
produc)vity

4. TOPICS
Alterna)ves
to
Hysterectomy
Alterna)ves
to
Tradi)onal
Hysterectomy
Why?
New
Treatments
New
Surgeries
You
Have
A
Choice

5. Defini)ons
Hysterectomy
Removal
of
Uterus,
With/Without
Ovaries
Subtotal
Hysterectomy
Removal
of
Uterus
Without
Cervix,
With/Without
Ovaries
Approaches
Abdominal
(Laparotomy)
Vaginal
Endoscopic
(Laparoscopic)

6. The
Uterus

7. Defini)ons
Endoscopy:
Looking
through
a
narrow
tube
Types
of
Endoscopy
Hysteroscopy
-­‐
into
uterus
via
vagina
Laparoscopy
-­‐
into
the
abdomen
Cystoscopy
-­‐
into
bladder
Others

8. Cost
of
laparotomy
$5,000
-­‐
$15,000
3
Days
in
Hospital
Significant
Pain
6
Weeks
of
Recovery

9. Cost
of
laparoscopy
$4,000
-­‐
$15,000
Outpa)ent
or
Inpa)ent
3
Hours
to
2
Days
in
Hospital
3
Days
to
3
Weeks
Recovery

10. Cost
of
hysteroscopy
$2000
Outpa)ent
<3
Hours
in
Surgery
Center
1-­‐2
Days
of
Recovery

11. The
Condi)ons
Abnormal
Uterine
bleeding
Fibroids
Endometriosis
Prolapse
Chronic
Pelvic
Pain
Cancer
and
Precancerous
Condi)ons

12. ABNORMAL
UTERINE
BLEEDING
Prolonged,
Irregular
or
Heavy
Bleeding
30%
of
Hysterectomies
200,000
a
Year

13. Causes
of
A.U.B.
Hormonal
Irregularity
Growths
in
Uterus
Cancer
and
Precancerous
Condi)ons
Bleeding
Disorders

14. Inves)ga)on
and
Treatment
Nothing
Ultrasound
and
Biopsy
to
Rule
Out
Cancer
or
Precancerous
Condi)ons
Hormonal
Therapy
D
and
C
Hysteroscopic
Therapy
Hysterectomy

15. Hormonal
Therapy
for
A.U.B.
Birth
Control
Pill
Adjustment
of
Current
Therapy
Other
Hormones

16. D
and
C
for
A.U.B.
Tradi)onal
Treatment
Blind
Procedure
Good
for
Biopsy
No
Evidence
of
Therapeu)c
Benefit

17. Hysteroscopic
Treatment
of
A.U.B.
Visual
Procedure
Removal
of
Growth
Good
for
Biopsy
Very
Accurate
Endometrial
Abla)on
Destruc)on
of
Lining
Tissue
by
Laser
Electricity
Hot
Water
Balloon

18. Thermachoice

19. Thermachoice
VS
Electrocautery
Improvement
at
12
months
85%
vs
89%
Hysterectomies
by
12
months
2%
=
Repeat
Abla)ons
by
12
months
<1%
=
Complica)ons
4%
vs
6%

20. Benefits
of
Thermachoice
Effec)ve
Simple
Safe
Short
Procedure
Local
or
General
Anesthe)c
85%
Successful

21. Hysterectomy
for
A.U.B.
Tradi)onal
Laparoscopic
With
or
Without
Ovaries
or
Cervix
100%
Successful

22. Fibroids
Non-­‐cancerous
Growths
of
Uterine
Muscle
35%
of
Women
30%
of
Hysterectomies
Can
Cause:
Bleeding
Pain
Pressure
or
Nothing

23. Treatment
of
Fibroids
Nothing
Hormonal
Therapy
Destruc)on
Removal
Hysterectomy

24. Hormonal
Therapy
for
Fibroids
Side
Effects
Temporary
Expense
Can
be
U)lized
Before
Surgery

25. Destruc)on
of
Fibroids
Blocking
Blood
Supply
(EMBOLIZATION)
SURGERY
Laser
Electricity
Freezing

26. Removal
of
Fibroids
Individual
-­‐
Tradi)onal
or
Endoscopic
Hysteroscopic
or
Laparoscopic
Total
-­‐
Hysterectomy
Subtotal
Hysterectomy
Tradi)onal
or
Laparoscopic

27. Endometriosis
Endometrial
Tissue
in
Abnormal
Places:
On
Ovaries,
Uterus,
Bowel
Can
Cause:
Pain
Infer)lity
Growths

28. Treatment
of
Endometriosis
Nothing
Hormonal
Excision
Cukng
of
Nerve
Supply
Hysterectomy

29. Hormonal
Therapy
for
Endometriosis
Birth
Control
Pills
Progesterone
Danazol
Lupron
Side
Effects
Expensive

30. Excision
of
Endometriosis
Tradi)onal
Surgery
Laparoscopic
Surgery
Beler
Visualiza)on
More
Precise
Surgery
Nerve
Supply
May
Be
Cut
Hysterectomy
May
Not
Be
Necessary

31. PROLAPSE
Loss
of
Support
of:
Uterus
Bladder
Vagina
Rectum
Because
of:
Childbirth
Gene)cs
Chronic
Increase
in
Pressure

32. PROLAPSE
Resul)ng
in:
Protrusion
of
Structures
Pain
and
Pressure
Urinary
Incon)nence
Urinary
Reten)on

33. Non-­‐Surgical
Treatment
of
Prolapse
Pessary
Kegel
Exercises
Weights
Electrical
S)mula)on
Biofeedback
Therapy

34. Surgical
Treatment
of
Prolapse
Vaginal
Abdominal
Laparoscopic
Does
not
Have
To
Include
HYSTERECTOMY

35. CHRONIC
PELVIC
PAIN
Debilita)ng
Pain
-­‐
Chronic
No
Obvious
Cause
Pain
With
Intercourse
Pain
With
Periods

36. Treatment
of
Chronic
Pain
Hormones
Pain
Killers
Diagnos)c/Therapeu)c
Surgery
Microlaparoscopy
Smaller
Instruments
Quicker
Recovery
Tradi)onal
Surgery

37.
PRECANCEROUS
CONDITIONS
of
UTERUS
Hormonal
Therapy
Observa)on
Hysterectomy

38. PRECANCEROUS
CONDITIONS
of
the
CERVIX
Freezing
Coniza)on
Office
of
Out
Pa)ent
Surgery
Center
Hysterectomy
-­‐
Tradi)onal
or
Laparoscopic

39.
CONCERNS
REGARDING
MANAGED
CARE
Underu)liza)on
vs
Overu)liza)on
Diminished
Freedom
to
Choose

40. SUMMARY
Alterna)ves
Exist
Treatment
Should
be
Suited
to
the
Individual
A
Minimally
Invasive
Approach
is
Almost
Always
Available
Be
Part
of
the
Decision
Making
Process