alternatives to hysterectomy

1. Alternatives to Hysterectomy Duncan Turner MD, MBBS, FACOG, October 28th 1998 Santa Barbara,California

3. TOPICS Alternatives to Hysterectomy Alternatives to Traditional Hysterectomy Why? New Treatments New Surgeries You Have A Choice

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)

5. The Uterus

6. Definitions Endoscopy: Looking through a narrow tube Types of Endoscopy Hysteroscopy - into uterus via vagina Laparoscopy - into the abdomen Cystoscopy - into bladder Others

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

8. Cost of laparoscopy $4,000 - $15,000 Outpatient or Inpatient 3 Hours to 2 Days in Hospital 3 Days to 3 Weeks Recovery

9. Cost of hysteroscopy $2000 Outpatient <3 Hours in Surgery Center 1-2 Days of Recovery

10. The Conditions Abnormal Uterine bleeding Fibroids Endometriosis Prolapse Chronic Pelvic Pain Cancer and Precancerous Conditions

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

12. Causes of A.U.B. Hormonal Irregularity Growths in Uterus Cancer and Precancerous Conditions Bleeding Disorders

13. Investigation and Treatment Nothing Ultrasound and Biopsy to Rule Out Cancer or Precancerous Conditions Hormonal Therapy D and C Hysteroscopic Therapy Hysterectomy

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

15. D and C for A.U.B. Traditional Treatment Blind Procedure Good for Biopsy No Evidence of Therapeutic Benefit

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

17. Thermachoice

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%

19. Benefits of Thermachoice Effective Simple Safe Short Procedure Local or General Anesthetic 85% Successful

20. Hysterectomy for A.U.B. Traditional Laparoscopic With or Without Ovaries or Cervix 100% Successful

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

22. Treatment of Fibroids Nothing Hormonal Therapy Destruction Removal Hysterectomy

23. Hormonal Therapy for Fibroids Side Effects Temporary Expense Can be Utilized Before Surgery

24. Destruction of Fibroids Blocking Blood Supply (EMBOLIZATION) SURGERY Laser Electricity Freezing

25. Removal of Fibroids Individual - Traditional or Endoscopic Hysteroscopic or Laparoscopic Total - Hysterectomy Subtotal Hysterectomy Traditional or Laparoscopic

26. Endometriosis Endometrial Tissue in Abnormal Places: On Ovaries, Uterus, Bowel Can Cause: Pain Infertility Growths

27. Treatment of Endometriosis Nothing Hormonal Excision Cutting of Nerve Supply Hysterectomy

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

29. Excision of Endometriosis Traditional Surgery Laparoscopic Surgery Better Visualization More Precise Surgery Nerve Supply May Be Cut Hysterectomy May Not Be Necessary

30. PROLAPSE Loss of Support of: Uterus Bladder Vagina Rectum Because of: Childbirth Genetics Chronic Increase in Pressure

31. PROLAPSE Resulting in: Protrusion of Structures Pain and Pressure Urinary Incontinence Urinary Retention

32. Non-Surgical Treatment of Prolapse Pessary Kegel Exercises Weights Electrical Stimulation Biofeedback Therapy

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

34. CHRONIC PELVIC PAIN Debilitating Pain - Chronic No Obvious Cause Pain With Intercourse Pain With Periods

35. Treatment of Chronic Pain Hormones Pain Killers Diagnostic/Therapeutic Surgery Microlaparoscopy Smaller Instruments Quicker Recovery Traditional Surgery

36. PRECANCEROUS CONDITIONS of UTERUS Hormonal Therapy Observation Hysterectomy

37. PRECANCEROUS CONDITIONS of the CERVIX Freezing Conization Office of Out Patient Surgery Center Hysterectomy - Traditional or Laparoscopic

38. CONCERNS REGARDING MANAGED CARE Underutilization vs Overutilization Diminished Freedom to Choose

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