The most significant development in recent years has been minimally invasive surgery. In the early 1970s, the laparoscope became popular as a means of evaluating the pelvic organs for investigation of symptoms such as pelvic pain and infertility. At that time research showed that the pre-operative presumed diagnosis proved to be incorrect in more than 50% of cases! Since that time, however, there have been other developments. Ultrasound (Q4.7), for example, increases our ability to evaluate the structure of the pelvic organs without surgery reducing to some degree the need for laparoscopy
Minimally invasive surgery has been a significant development although its exact place is still under evaluation. Some gynaecologists now specialise in this form of surgery. At one time a diagnosis of an ectopic pregnancy necessitated a laparotomy to remove the tube. The patient would remain in hospital for a week and would be off work for another five weeks. We have learned from minimally invasive surgery that hospitalisation can be reduced.
A thirty year old lady presented with a second ectopic pregnancy in her right Fallopian tube. Two years earlier she had an ectopic in the same tube. The ectopic had been removed and the tube conserved. She now wished to have the tube taken away. Through a mini-laparotomy incision (conventional surgery rather than minimally invasive) the tube was taken away. The patient went home on the second post-operative day. Two weeks later she was back at work and had recommenced swimming. It is unlikely that she would have done better with minimally invasive surgery.
Pilots specialise in the type of plane they fly: a Concorde pilot would not be expected to fly a jumbo nor a jumbo pilot a Concorde. Similarly, the accelerating developments in gynaecology should lead to the conclusion that individual gynaecologists should confine their interests and work with others in a team to ensure that patients receive the best possible options and treatments.
Robotic surgery is being developed. The instruments are moved by a robot with the surgeon sitting away from the patient at a console. The advantages are that there is less pain for the patient, the patient can return to normal activity more quickly and the scar is cosmetically better.
A comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy and robotic techniques has been undertaken in Sanford, USA.
One hundred and ten patients underwent hysterectomy with bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy for endometrial cancer staging. All cases were performed by a single surgeon, at a single institution (40 robotic, 40 laparotomy, and 30 laparoscopic) and were retrospectively reviewed to compare demographics and peri-operative variables including, operative time, estimated blood loss, lymph node count, hospital stay, complications, and return to normal activity. Additionally, a cost comparison between all three modalities was performed. Patients undergoing robotic assisted hysterectomy and staging experienced longer operative time than the laparotomy cohort with no difference in comparison to the laparoscopic cohort. Estimated blood loss was significantly reduced for the robotic cohort in comparison to the laparotomy cohort and comparable to laparoscopic cohort. The complication rate was lowest in the robotic cohort (7.5%) relative to the laparotomy (27.5%) and laparoscopic cohorts (20%) (p=0.015, p=0.03).
Please click on the required question.
- 1 Which doctor should I see?
- 2 What are symptoms and signs?
- 3 How can we be certain whether an abnormality that my doctor has found is the cause of my problem or an incidental finding?
- 4 How do doctors arrive at a diagnosis?
- 5 What does a gynaecologist do during a consultation?
- 6 What is the purpose of the pelvic examination?
- 7 Will a blood test to assess a hormone level provide a guide to treatment.
- 8 I have a phobia about blood tests. What should I do?
- 9 What is pelvic ultrasound?
- 10 What are CAT and MRI scans?
- 11 Will my general practitioner receive information from my specialist gynaecologist?
- 12 Will I see the same specialist every time I attend the out-patients clinic?
- 13 What is known about emotion. Information?
- 14 Could my emotional problems be of hormonal origin?
- 15 Does my doctor understand my anxieties and concerns about my gynaecological problem?
- 16 How much information do patients want about their condition?
- 17 Will the doctor listen to my views on how my problems should be managed?
- 18 How do doctors decide on the best treatment?
- 19 How do doctors decide on the best hormone treatment?
- 20 How long will my hormone treatment be effective?
- 21 What are the risks of surgery?
- 22 How long do gynaecological operations take?
- 23 Have there been advances in gynaecological surgical treatment?
- 24 I have been offered a choice of treatments. How can I decide which will be best for me?
- 25 What is the place of support groups?
- 26 Where can I obtain more information?
- 27 Are there any dangers in acquiring health information on the internet?
- 28 Support Groups.
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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
