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Hysterectomies: Surgeries
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It would be naive to think that the popularity of hysterectomies wasn't in some way related to the financial rewards on the part of Gynaecologists. Australian obstetricians and gynaecologists perform a lot of surgery and earn higher incomes than physicians, surgeons or medical practitioners. In 1991-92 the overall average annual income for full-time obstetricians and gynaecologists was $320,00 per annum with at least 25 percent of them earning more than $550,000 annually from private patients alone. Added to this is income derived from sessional work public patients. Such income is often between $100,000 and $200,000 per annum. 25 IN the Us, gunaecologists, hospitals and drug companies make more than 4 billion dollars a year fromthe business of hysterectomy and castration.
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Endometriosis — This can cause both abnormal bleeding and chronic pelvic pain and accounts for about 10% of hysterectomies. Endometriosis is caused by the abnormal migration or growth of endometrial cells (which normally line the uterine cavity) onto surfaces of pelvic organs or onto the lining (peritoneum) of the pelvis and abdomen. These cells bleed; precipitate pain, scar tissue formation and development of blood filled cysts when stimulated by hormones produced by the ovaries during the reproductive years. This condition may then cause severe menstrual pain and diminish fertility. Hormonal, anti-hormonal, as well as laparoscopic surgeries to excise the abnormal implants or bloody cysts will be the first line of therapy. Hysterectomy is the last resort.
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Although not licensed for treating menorrhagia until January 2001, Mirena has been used as a contraceptive method since May 1995, which coincides with the start of the fall in hysterectomies. The hypothesis is that Mirena is already in widespread use and having a considerable impact on the number of hysterectomies being performed. The epidemiology of Mirena for the management of menorrhagia in primary care remains to be elucidated and should be answered by the ECLIPSE study (International Standard Randomised Controlled Trial Number 86566246 (www.controlled-trials.com/isrctn)). Care should be taken with this interpretation as the use of Mirena for the management of menorrhagia is a relatively new development, and as over half of patients who have a Mirena inserted in randomised studies go on to have a hysterectomy4 we may yet see an increase in surgery over the next three or four years.
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From January 1 to December 31, 1996, the information on all hysterectomies performed for benign disease in Finland was registered by the surgeon into a structured database. The data concerning pre-, peri- and post-operative surgical details and morbidity were collected during the patients' stay in the hospital. The post-operative outcome of the patients was evaluated at the end of the convalescence period. The collected data included the indication for surgery, the type of hospital (five university, 17 central, 31 local and five private hospitals), the experience of operator anonymously (30 or >30 operations), the patient characteristics, the duration of surgery, the estimated amount of bleeding and/or episodes of accidental bleeding requiring intervention intra- or post-operatively, the uterine weight, concomitant surgery including procedures due to endometriosis, and post-operative morbidity, the length of the hospital stay and the sick leave.
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Most of Huh’s robot-assisted surgeries have involved women with cervical cancer who required hysterectomies, either with or without removal of the ovaries. Previously, these surgeries would have been performed either with open incisions or with traditional laparoscopy. “The robot assists in a laparoscopic approach, but the field of vision for the surgeon presents in a three-dimensional view, a huge advantage over the two-dimensional view available with traditional laparoscopy,” he said.
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There are three basic fears about hysterectomies that, although firmly rooted, should now be irrelevant. Irrelevant or not they are often given by patients as reasons why hysterectomies are undesirable. Most doctors agree that no woman should have major surgery when lesser procedures are now available for many of the conditions for which hysterectomies were recommended.
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