Journal of minimally invasive gynecology
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J Minim Invasive Gynecol · Mar 2010
The effect of a gynecologist-interventional radiologist relationship on selection of treatment modality for the patient with uterine myoma.
On the basis of consistent published scientific evidence, the American College of Obstetricians and Gynecologists has given uterine artery embolization (UAE) a level A recommendation as a viable alternative treatment for uterine myomas, describing it as a safe and effective option for appropriately selected women who wish to retain their uteri. Despite the growth of favorable clinical outcome information, many gynecologists do not routinely offer UAE as an alternative to abdominal hysterectomy or abdominal myomectomy. The percentage of laparoscopic hysterectomies in the United States remains less than 20%, reflecting the reluctance or inability of gynecologic surgeons to perform other minimally invasive procedures such as hysteroscopic myomectomy, laparoscopic myomectomy, laparoscopic hysterectomy, or even vaginal hysterectomy. Of great significance, many patients do not wish to have any kind of surgery, no matter how "minimally invasive." As a result, patients seeking less invasive treatments may bypass the gynecologist and be referred directly to an interventional radiologist by their primary care physician, or they may self-refer. Little has been published on the referral relationship between gynecologists and the interventional radiologist who performs uterine artery embolization. The absence of a structured routine referral relationship causes some women to undergo treatments that potentially are not aligned with all of her treatment desires. This study was undertaken to gain insight into the interventional radiologist-gynecologist dynamic and the benefit to patients who are informed of all of their options for the treatment of myomas. ⋯ Establishing a referral relationship with an interventional radiologist for comprehensive uterine myoma treatment supports a trusting, collaborative, long-term, noncompetitive "win-win" relationship between the gynecologist and radiologist, meets the patient's desire for full disclosure of all myoma treatment options, improves the patient's overall medical care and physician/patient experience, and has been demonstrated to improve patient flow to a gynecologist practice. With the guidelines established in this study, no patients were inappropriately left to the gynecologist for post-UAE care. The authors acknowledge that this dynamic is dependent on the individual interventional radiologist and their relationships and open communication with the gynecologist. Finally, the study revealed that failure to fully disclose alternative treatment options, or offer minimally invasive surgical techniques may result in a loss of patients due to patient dissatisfaction.
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J Minim Invasive Gynecol · Jan 2010
Randomized Controlled Trial Comparative StudyA comparative, single-blind, randomized trial of pain associated with suction or non-suction drains after gynecologic laparoscopy.
To estimate the difference in pain associated with the wearing or removal of suction or non-suction drains after gynecologic laparoscopic surgery. ⋯ There is no significant difference in patient discomfort while wearing or after removal of suction or non-suction drains. However, suction drains are more painful to have removed.
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J Minim Invasive Gynecol · Jan 2010
Surgical treatment of endometriosis in private practice: cohort study with mean follow-up of 3 years.
To describe our experience with surgical treatment of endometriosis. ⋯ Laparoscopic excision of endometriosis significantly reduces pain and improves quality of life as measured by both the EQ-5D index and the EQ-5D VAS, with a low complication rate.
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J Minim Invasive Gynecol · Nov 2009
Comparative StudyOffice endometrial ablation with local anesthesia using the HydroThermAblator system: Comparison of outcomes in patients with submucous myomas with those with normal cavities in 246 cases performed over 5(1/2) years.
To estimate the safety and efficacy of the HydroThermAblator (HTA) system for performance of endometrial ablation in the medical office setting using local anesthesia and minimal oral sedation and to compare results obtained in patients with submucous myomas with those in patients with normal endometrial cavities. ⋯ Hydrothermablation performed in the medical office using local anesthesia seems to be a safe, effective, and cost-saving procedure for treatment of abnormal uterine bleeding in women with both normal and myomatous uteri. Although the success rate in patients with normal cavities was higher than that achieved in patients with submucous myomas, hysterectomy because of abnormal bleeding related to myomas was avoided in 88.4% of the group with myomas.
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J Minim Invasive Gynecol · Sep 2009
Comparative StudyOpen abdominal versus laparoscopic and vaginal hysterectomy: analysis of a large United States payer measuring quality and cost of care.
To compare minimally invasive procedures (MIP)-laparoscopic and vaginal hysterectomy with the traditional open abdominal hysterectomy method by evaluating clinical and economic outcomes and use. ⋯ These clinical and economic outcomes should encourage clinicians to consider greater use of minimally invasive hysterectomy procedures in patients who have no contraindications for laparoscopic or vaginal approach to hysterectomy. Significant savings are realized when appropriate candidates receive minimally invasive procedures and are thus able to migrate from the inpatient to outpatient setting.