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

3. 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

4. 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

5. AUB: Life-Table Analysis (N=62)
FU (menopause)N No further surgery (%)
Global
Global
R/A(?cryo)
R/A(?cryo)
R/A Fib/Adeno
R/A SCH
SCH SCH
SCH SCH
Derman et al. Obstet Gynecol 1991:59-77.

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: °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

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
Ruptured uterus