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types of hysterectomies

. . . 90% of AUB patients prefer treatments that are painless, require no large incision and allow a quick recovery. 4. 1Brumsted JR, Blackman JA, et.al., Fertility and Sterility, Vol. 65:2, 19962Dwyer, ibid3Brooks, PG, et.al., Journal of Reproductive Medicine, Vol. 39, No. 10, October 1994, Rand Corporation4RAND Institute, AAGL 9/97.

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types of hysterectomies

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    1. Types of Hysterectomies Total abdominal hysterectomy Total vaginal hysterectomy Laparoscopic assisted vaginal hysterectomy Laparoscopic hysterectomy Laparoscopic Supracervical hysterectomy

    3. Outcomes Comparison

    4. Long-Term Patient Outcomes Comparison

    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 Fib/Adeno 6 44 0 91.3 R/A SCH 7 43 2 73.0 SCH SCH 8 42 2 48.6 SCH SCH

    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

    7. Global Ablation: Technique & Equipment Thermal Balloon: 170-190°F for 8-10 min ThermaChoiceŽ (Gynecare) Cavaterm Cryo-ablation Soprano™ (Gynecare) Bipolar: ? 2 min exposure NovaceptŽ Heated fluid: 70°C for 3-4 min (local anesthesia) EnAblŽ (Innerdyne/U.S. Surgical) Radiofrequency balloon Vesta/DUB (Vesta Medical) Photodynamic Therapy Photofrin II Microwaves: 8mm probe: 2 min 12 sec

    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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