Types of Hysterectomies

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Presentation transcript:

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

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

Long-Term Patient Outcomes Comparison Supracervical Long-term Abdominal OPERA Procedure SMART Procedure Experience Hysterectomy Hysterectomy Complete / 100% 100% 85% Reproductive Near Complete Potential Absence of Maintained Bleeding Subsequent 10% 15% 10% Procedures Risk of 40% Increase No No Incontinence

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 Derman et al. Obstet Gynecol 1991:59-77.

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

Global Ablation: Technique & Equipment Thermal Balloon: 170-190°F for 8-10 min ThermaChoice® (Gynecare) Cavaterm Cryo-ablation Soprano™ (Gynecare) Bipolar:  2 min exposure Novacept® Heated fluid: 70°C for 3-4 min (local anesthesia) EnAbl® (Innerdyne/U.S. Surgical) Radiofrequency balloon Vesta/DUB (Vesta Medical) Photodynamic Therapy Photofrin II Microwaves: 8mm probe: 2 min 12 sec 17

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 Ruptured uterus