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Posted Nov 30 2008 12:20pm
TWSHF was recently sent the below press release and more than likely, most women have not had an opportunity to educate themselves on the recent advances in the procedures that we have highlighted below. TWSHF firmly believes that your knowledge is your power. This release will add to your power base.

WASHINGTON, DC (November 19, 2007) -- Endoscopic techniques are transforming the practice of surgery, yet their adoption in certain specialties, particularly gynecology, lags far behind that of other specialties. For example, laparoscopic surgery for gall bladder removal reached an 80% adoption rate over the ten years since it was introduced, while laparoscopic hysterectomy is still used for less than 15% of the 600,000 hysterectomies annually performed in the United States. Reasons for the discrepancy include lack of patient education, lack of physician training, reimbursement issues, and reluctance of women to question their doctors, said experts at the 36th Annual Global Congress of Minimally Invasive Gynecology.

“Historically the AAGL has been devoted to introducing and testing new surgical techniques and educating surgeons how to perform endoscopic and laparoscopic procedures,” said Charles E. Miller, MD, President-Elect of AAGL. “Today we are broadening our mission to include education and empowerment of our patients.”

Highlighted at the meeting were new in-office procedures that replace the need for a woman to spend hours in a hospital operating room; the coming transformation of surgery through the use of robotics; and the miniaturization of surgical techniques in general as the medical profession leverages technological advances made by NASA, the military and the communications industry.

Procedures Move from Hospital to Office

Keith Isaacson, MD of Harvard Medical School and a surgeon at Newton Wellesley Hospital, MA, described three examples of procedures that once required several hours in an operating room, general anesthesia and days of recovery, but now can be done safely, effectively and without anesthesia in the physician’s office: hysteroscopy; permanent sterilization; and endometrial ablation.

Hysteroscopy is a diagnostic technique in which the physician uses a miniature “telescope” to view the inside of the uterus, frequently used to diagnose the cause of abnormal uterine bleeding (AUB), a condition responsible for 30% of all visits to the gynecologist. Today a woman can have this procedure in the comfortable and familiar surroundings of her gynecologist’s office and return to her work or other activities immediately thereafter. Similarly, one of the treatments for AUB – a procedure called endometrial ablation – now can be done in the doctor’s office, as can tubal occlusion, a treatment for permanent sterilization. This translates not only into health cost savings, but also reduced trauma and anxiety for patients. “When you reduce the stress level with any procedure, you have a better outcome,” said Dr. Isaacson.

Robotic-Assisted Laparoscopy Will Create “No-fly Zone”

According to Javier F. Magrina, MD of the Mayo Clinic in Scottsdale, AZ, the use of robotics in minimally-invasive techniques for gynecologic procedures is a major advance because of the increased precision and control it provides to the surgeon. “For the first time, the surgeon can sit comfortably at a console, become immersed in the patient via a 3-D image, and control the most minute and complex operations using robotic arms,” said Dr. Magrina. “In the future, the patient will be next to you in the room or thousands of miles away. All this is possible because of robotic-assisted laparoscopy.”

Advantages to the patient may include less blood loss, less trauma to tissue, quicker recovery with less pain, and less risk of damage to adjacent organs. According to Dr. Magrina, “Virtual biopsy is already being done and all of you in the room have contributed to the development of the instrument by NASA. It’s a little 18 gauge needle that has five different sensors on the tip of the needle. You can put it directly into a breast tumor without taking a biopsy and it will give you a curve of probability of whether that tumor is benign or not without taking an open biopsy.” In the future, Dr. Magrina said, robotic-assisted surgery will enable the creation of a “no-fly zone” – a designated area where the instruments simply will not go -- thus providing even greater protection of surrounding organs and tissues.

Miniaturization Heralds the Future

Marie Fidela-Paraiso, MD of the Cleveland Clinic, OH, described new, miniaturized techniques for the laparoscopic treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). SUI affects as many as one in nine American women and is often caused by POP, the “dropping” of the uterus after pelvic floor muscles become weakened by childbirth and age.

“Just as tension-free vaginal tape (TVT) revolutionized the treatment of SUI in the mid-1990s, the new mini-sling is a major treatment advance today, requiring only one tiny incision in place of three. With a 90% success rate, this procedure is comparable to earlier ‘gold standard’ methods,” said Dr. Fidela-Paraiso.

“The reduction in time and trauma means that the mini-sling procedure may soon move into the physician’s office. Like the prolapse repair kits, these miniaturized devices are helping more doctors transition to the use of newer procedures, improving patient care and the quality of life for many more women,” she added.

Miniaturization is changing the way medicine is practiced today and will continue to do so into the future, according to Steven Palter, MD of the North Shore University Hospital, NY. Dr. Palter described exciting potentials such as micro-invasive and non-invasive surgery, the use of microchip, miniaturized devices and autofluorescents to diagnose “invisible” conditions, and surgeons being trained on simulators just as astronauts are.

“In the past year we have seen as much innovation as we did in the previous ten years,” said Dr. Palter. “The field of medicine is undergoing the same kind of exponential progress as computer technology, which means that in ten years or less, the way we provide care to our patients will be radically different. Instead of a doctor standing in an operating room making a big incision and working with his hands, he will be more like a NASA commander on a Mars mission – remotely controlling a rover that travels through the body.”

Message to Women: “Ask”

Despite the availability of many new, less invasive treatments for gynecological problems, the majority of women do not benefit from these advances. For example, a significant percentage of the 600,000 hysterectomies done annually in the U.S. may be avoidable through the use of minimally invasive techniques for the treatment of fibroids, AUB and other common conditions.

In addition, half of these hysterectomies remove more than is necessary and perhaps more than is healthy, according to William Parker, MD of the University of California, Los Angeles, School of Medicine. “Half of all hysterectomies remove the ovaries, even when there is no cancer involved. We now know that after menopause, the ovaries continue to secrete hormones that help keep bones strong and hearts healthy.” said Dr. Parker. Dr. Parker believes that women should keep their ovaries whenever possible and if not should consider hormone replacement therapy.

Prior to the introduction of laparoscopic gynecologic surgery, it was also common to remove the cervix during a hysterectomy. “Now, however, we know that if we do a laparoscopic supracervical hysterectomy or LSH, we can leave the healthy cervix intact and thereby preserve the integrity of the pelvic floor,” Dr. Parker said.

“Women’s treatment choices should always include minimally invasive options,” Dr. Parker continued. “Women should not be afraid to ask for what they want or hesitate to pursue a second opinion.”
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