hysterectomy

RECENT POSTS

WSJ: Women At Risk, Doctors Split On Procedure Linked To Rare Cancer

Here’s another excellent Wall Street Journal report on the controversial procedure known as “morcellation.”  Reporter Jennifer Levitz notes that even after the FDA issued a warning on the practice (which involves a “laparoscopic power morcellator” that allows for less invasive surgery to remove fibroids by slicing them up, but can also potentially spread a rare type of cancer through the body) doctors are split on how to proceed.

According to the report:

The FDA said women undergoing surgery for what look like benign fibroids actually have a 1 in 350 risk of hosting an undetected cancer called a uterine sarcoma. Morcellating these tumors can spread cancerous tissue internally and significantly worsen the odds of long-term survival, the agency said.

So what are women to do when the medical community itself is divided? From the WSJ:

(wikimedia commons)

(wikimedia commons)

A number of doctors believe the FDA overreached, and think the cancer risk is so small that gynecologists can go an entire career without seeing a case. Others call the advisory a necessary precaution.

Hospitals and private practices are taking an array of approaches. The University of Pittsburgh Medical Center system, which has more than 50 obstetrics and gynecology practices, opted to continue using the device.

The medical system changed its informed-consent forms to include wording on cancer risk and told doctors to discuss the risk with patients. But Allen Hogge, chairman of obstetrics, gynecology and reproductive sciences there, questioned the data behind the FDA’s estimate. The FDA began looking at the issue after media reports late last year about a prominent Boston doctor who discovered she had sarcoma after morcellation.

“I think this is mostly public relations and not science,” Dr. Hogge said. In response, the FDA said it conducted a rigorous analysis of published literature.

The common practice of morcellation, which is often used for hysterectomies, came under fire when Dr. Hooman Noorchashm, a cardiothoracic surgeon at Brigham and Women’s Hospital and his wife, Dr. Amy Reed, an anesthesiologist at Beth Israel Deaconess Medical Center launched a publicity campaign aimed at stopping the procedure, Continue reading

OB-GYNs: Beware Marketing Hype On Robotic Hysterectomy

The influential American College of Obstetricians and Gynecologists (ACOG) is warning women that despite an aggressive marketing campaign to promote pricey robotic surgery for hysterectomies, that approach may not be the best choice available for patients.

Citing a recent JAMA study that found robotic hysterectomies cost more but aren’t really better, ACOG president, James T. Breeden, MD, in a statement said it’s “important to separate the hype from reality” when considering this type of robotic surgery.
robotic surgery

Here’s the full ACOG statement:

Many women today are hearing about the claimed advantages of robotic surgery for hysterectomy, thanks to widespread marketing and advertising. Robotic surgery is not the only or the best minimally invasive approach for hysterectomy. Nor is it the most cost-efficient. It is important to separate the marketing hype from the reality when considering the best surgical approach for hysterectomies.

The outcome of any surgery is directly associated with the surgeon’s skill. Highly skilled surgeons attain expertise through years of training and experience. Studies show there is a learning curve with new surgical technologies, during which there is an increased complication rate. Expertise with robotic hysterectomy is limited and varies widely among both hospitals and surgeons. While there may be some advantages to the use of robotics in complex hysterectomies, especially for cancer operations that require extensive surgery and removal of lymph nodes, studies have shown that adding this expensive technology for routine surgical care does not improve patient outcomes. Consequently, there is no good data proving that robotic hysterectomy is even as good as—let alone better—than existing, and far less costly, minimally invasive alternatives. Continue reading

Robotic-Assisted Hysterectomy Costs More, But No Better, Study Finds

Robotic-assisted surgery is all the rage — it’s up about 400 percent in the last few years, according to one estimate.

Robotic hysterectomies are also on the rise: in the U.S. thousands of women undergo hysterectomies for various gynecological disorders and many of these are performed using minimally invasive techniques, including laparoscopy and with the help of a surgical robot.

But a new study from the Journal of the American Medical Association that compared robotic and laparoscopic hysterectomies among more than 264,000 women with non-cancerous gynecologic conditions found that there was no difference in complication rates or outcomes. The big difference was cost: the robotic hysterectomy was, on average, about $2,200 more, the study found.
robotic surgery

The JAMA report notes that robotic hysterectomies took off in recent years, up from 0.5% in 2007 to 9.5% by 2010.

One driver is likely the intense marketing of surgical robots by its manufacturers. A 2011 study out of Johns Hopkins found that hospitals are misleading patients about the benefits of robotic surgery and that hospital websites routinely use industry-provided content and overstate claims of robotic success. Continue reading