Do you need a laparoscopic hysterectomy procedure?
Perhaps you have uterine fibroids or there is some other problem with your uterus and you've been told you need to have a laparoscopic hysterectomy procedure done; please, first read the following story!
How Many People Have To Die To Show A New Surgery Technique Isn't Worth It?
A mother of 6 kids under 12 years old, also an anesthesiologist, followed the conventional medical advice to have a laparoscopic hysterectomy procedure to remove uterine fibroids, after trying unsuccessfully to get her surgeon to do the traditional open abdominal procedure…
Here are a few excerpts from the Prevention article:
This year, more than half a million women in the United States will undergo hysterectomies. The majority will be between 40 and 55 years old, and, like Reed, most will have the surgery for uterine fibroids, benign growths in the uterus that can cause pain, bleeding, and other symptoms. Five years ago, only about 12% of these surgeries were performed laparoscopically, done through incisions just big enough to fit a scope and tiny camera. Last year, nearly 30% were done that way, and the numbers were considered likely to rise.
Last fall, a routine hysterectomy seeded cancer throughout Reed's abdomen. The hysterectomy didn't cause the cancer, but it very likely transformed it from stage 1 disease, with a 60% 5-year survival rate, to stage 4 disease, with a grim prognosis. About 85% of women like Reed are dead 5 years after diagnosis.Compared with traditional open abdominal procedures, laparoscopic surgeries were said to result in shorter hospital stays (and, therefore, lower costs for insurers), faster healing, less pain, fewer infections, and smaller scars. Still, when Reed first discussed hysterectomy with her surgeon, she asked for an open operation, despite the larger incision and longer recovery time. “I said, ‘I'm an anesthesiologist. I know how they operate. I'd rather have them see what they're dealing with and not mess around with little holes,' ” she recalls. “Laparoscopic surgery's not all it's touted to be sometimes.”
Muto said no surgeon would do what she wanted. You're young and healthy, Reed remembers being told; there's no reason in the world to have this done as an open surgery. “Dr. Muto wears a nice white coat with the Harvard emblem on it,” says Noorchashm, sitting across from Reed. “He's my colleague, and we trust our own establishment.” He pauses, and then corrects himself. “I trusted the establishment.”
So Reed had MRIs and biopsies to check for cancer, as is standard before a fibroid operation, and went ahead with the laparoscopic hysterectomy. She went home that afternoon, and everything was fine until the surgeon called 8 days later to say that the pathology report showed leiomyosarcoma, a cancer in her uterus. And nothing has been fine since then.
Imagine a hive filled with angry bees flying this way and that, buzzing, darting, stingers at the ready. Now picture that hive inside a woman's belly, where at any moment the bees could explode through the body, wreaking the deadliest kind of havoc. The hive, says Noorchashm, is a good metaphor for a sarcoma, a kind of cancer that can grow anywhere in the body. He's operated on sarcomas and knows that the way to handle them is to carefully remove them in one piece. Now imagine inserting a long spinning saw—something like a handheld blender—into the hive while it's still inside the woman's body and cutting it up into tiny pieces. “What's going to happen,” says Noorchashm, “is a million bees are going to come out and you're dead.”
That saw is called a morcellator, and over the past 10 years or so, it's become standard procedure in laparoscopic surgeries to remove fibroids, the uterus, or both. “Morcellation prevents you from having to make a larger incision,” says Larry Kaiser, dean of the Temple University School of Medicine. “You couldn't take the uterus with fibroids out through these small ports used for the camera and instruments.”
The trouble is, some cancers—like leiomyosarcoma—don't show up on biopsies or MRIs done before surgery. If a woman's uterus is morcellated inside her body, cancer cells are spewed around the abdomen, where they cling to internal organs and, inevitably, grow. Even benign tissue that's morcellated can implant in the abdomen and trigger pain, bowel obstructions, and other problems.
Morcellation is what Reed and Noorchashm want to stop, arguing that it's unacceptable if there's any chance of hidden cancer—and there's pretty much always a chance. “It's flawed surgical procedure,” says Noorchashm. Some ob-gyn surgeons say morcellation is safe if it's done in a containment bag, something like the bag inside a vacuum cleaner. Noorchashm disagrees. Bags can break, he says, especially when you're using a rotating power saw. Instead, he and Reed want surgeons to remove the whole, unmorcellated uterus vaginally when they can, and do the old-fashioned open surgery when they can't.
Noorchashm and Reed were asking for a huge shift in medical practice, and physicians, especially surgeons, can be slow to change, says Brian Van Tine, a physician who heads the Sarcoma Program at Barnes-Jewish Hospital in St. Louis. Part of the resistance was likely financial. If, say, half of the women who have hysterectomies have abdominal surgery rather than laparoscopy and must spend an extra day or two in the hospital, that's a lot of extra costs for insurance companies to cover. “Morcellation saves money,” Van Tine says, “and these surgeries are a huge moneymaker.”
Noorchashm is a realist; he knows that odds are he will lose his wife sooner rather than later. He may also lose his career, but he's not worried about that just now. He's focused on the moment, the here and now. This fight he and his wife are immersed in, a fight not of their choosing.
Of course there are two sides to every story, so read the entire heartbreaking article here where the whole picture is presented, including the risks both ways.
However, even the FDA now agree on this:
In a safety communication notice issued today, the U.S. Food and Drug Administration discouraged the use of laparoscopic power morcellation for the removal of the uterus (hysterectomy) or uterine fibroids (myomectomy) in women because, based on an analysis of currently available data, it poses a risk of spreading unsuspected cancerous tissue, notably uterine sarcomas, beyond the uterus.
Laparoscopic power morcellation is one of several available treatments for uterine fibroids. It is a procedure that uses a medical device to divide the uterine tissue into smaller pieces or fragments so it can be removed through a small incision in the abdomen, such as during laparoscopy.
Based on an analysis of currently available data, the FDA has determined that approximately 1 in 350 women who are undergoing hysterectomy or myomectomy for uterine fibroids have an unsuspected type of uterine cancer called uterine sarcoma. If laparoscopic power morcellation is performed in these women, there is a risk that the procedure will spread the cancerous tissue within the abdomen and pelvis, significantly worsening the patient’s likelihood of long-term survival. (Source)
One thing that isn't touched on in that article is this: what about other laparoscopic procedures?
There are SO many surgeries done laparoscopically these days. What if there is some unknown cancer in another area of our body that also shouldn't be ground up and spread all over when parts are removed? Personally, I see this as just one more reason not to blindly follow any medical advice, but to instead (broken record here) thoroughly do your research first!
Now tell me, what would YOU do, since both procedures have risks? Would you opt for the laparoscopic hysterectomy procedure, or the traditional open procedure?
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