“Say it ain’t so Smalls”

Charles Miller, MD

Sunday, 14 March 2010

sandlot charles miller is a famous quote from the movie Sandlot; when it comes to minimally invasive gynecologic surgery, that’s exactly the case. How can it be that the specialty of medicine that introduced laparoscopic surgery now trails in innovation, acceptance and adoption? You say I’m wrong, well let’s examine these facts….. According to industry estimates prior to 2004, and more recently Thomson Reuters, between the years 1998 and 2007, the number of laparoscopic cholecystectomies rose from 90 percent to 95 percent, and laparoscopic bariatric surgeries increased from 30 percent to over 90 percent. The number of laparoscopic appendectomies nearly tripled from 27 percent to 70 percent. Yet, in this same time period, the laparoscopic approach to hysterectomy remained dismally small; that is, a minimal rise from 10 percent to 20 percent (figure 1).

What is just as alarming is the lack of knowledge that women have regarding minimally invasive gynecologic surgery. In 2008, an internet survey was conducted by Russell Research, in the United States. Over 50 percent of the 526 participants, 18 years or older, had experienced at least one of the following symptoms:
• Stress urinary incontinence
• Menorrhagia
• Fibroids
• Organ prolapse
This survey revealed a number of startling findings. Less than 40% of women surveyed knew that hysterectomies could be greatly reduced by newer, less invasive techniques, and only 45 percent of women had ever heard of myomectomy. Less than 50 percent of women suffering from menorrhagia were aware of endometrial ablation, and only one in five women surveyed understood that endometrial ablation could be performed as an “in-office” procedure. Furthermore, one in three women with symptoms of stress urinary incontinence were unaware of sling procedures, and just 19 percent of women knew that sterilization could be performed in an office setting.
These findings supported the contention of the surveyors that while the public is well aware that cholecystectomy and bariatric surgery are laparoscopic procedures, when it came to pelvic health disorders, patients were unaware of their options. The study also revealed the tremendous bond of trust that the patient has with her gynecologist. Nearly every woman who participated in the survey expected their ob-gyn would inform them about minimally invasive treatment options, even if the doctor doesn’t offer them. Furthermore, the treatment regimen prescribed would involve the least amount of pain. Finally, 94 percent of women expected their gynecologist to offer options of care that least effect lifestyle.
There is an obvious disconnect between the fact that women are unaware of their minimally invasive gynecologic options, yet they also believe their gynecologist is providing them with the most innovative and least invasive options. Adding to this, the fact that the number of hysterectomies performed via a minimally invasive approach is depressingly low, it is obvious that patients are neither being informed of their treatment options completely, and…

ISGE ACTIVITIES

“Say it ain’t so Smalls”

Charles Miller, MD

Please Login to read the rest of the article....

Start a Discussion:

Lost Password:
Please enter your email address: