WOMEN'S HEALTH
December 11, 2007

Women Should Demand Less Invasive Surgery

Modern medicine has been revolutionized by the use of endoscopes, which allow surgeons to see, in great detail, inside the body. Repairs are done from within the body, sometimes with no incision needed.

Yet most hysterectomies are still done the old-fashioned way — with a surgeon making a rather large incision in a woman's lower abdomen. Why have gynecologists been slower than doctors in other specialties to adopt new endoscopic surgical techniques such as laparoscopy and hysteroscopy when they are far safer and far less invasive than traditional surgery?

...[n]ot only reduced health care costs, but also less trauma and anxiety for patients "When you reduce the stress level with any procedure, you have a better outcome,"...

Laparoscopic gall bladder surgery is only ten years old, yet it is used in 80% of all gall bladder removal operations. Laparoscopic hysterectomy, on the other hand, is used in only 15% of the 600,000 hysterectomies done in the United States each year.

The discrepancy is explained by lack of patient education, lack of physician training, reimbursement issues, and the reluctance of women to question their doctors, according to experts at the 36th Annual Global Congress of Minimally Invasive Gynecology (AAGL).

At the meeting, Keith Isaacson, MD, of Harvard Medical School described three procedures that once required several hours in an operating room, general anesthesia and days of recovery, but which now can be done safely with just a small incision and without anesthesia in a doctor's office: hysteroscopy, (a procedure used to diagnose or treat various problems in the womb); permanent sterilization, (an operation that makes a person unable to father children or to become pregnant); and endometrial ablation, a treatment to stop bleeding from the uterus.

This means not only reduced health care costs, but also less trauma and anxiety for patients "When you reduce the stress level with any procedure, you have a better outcome," said Dr. Isaacson.

According to Javier F. Magrina, MD, of the Mayo Clinic in Scottsdale, AZ, the use of robotics for gynecologic procedures is giving increased precision and control 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 include less blood loss, less trauma to tissue and quicker recovery.

Despite the availability of many new, less invasive treatments for gynecological problems, many women do not benefit from them. For example, using existing minimally invasive techniques for the treatment of fibroids might make a significant percentage of the U.S.'s 600,000 annual hysterectomies unnecessary. In addition, half of these hysterectomies remove more tissue than is necessary, according to William Parker, MD, of the UCLA 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.

"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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