HEALTH EDUCATION: Keyhole surgery better for cancer hysterectomies

HEALTH EDUCATION: Keyhole surgery better for cancer hysterectomies

Keyhole surgery for women’s health

Star 2.com

Keyhole surgery for women’s healthIn addition to better cameras and instruments, technology has resulted in the development of 3D laparoscopy, and more recently, single incision laparoscopy, where the surgery is performed with just a single incision in the umbilicus. Photos: Handout

Not many women know of the availability of laparoscopic (keyhole) surgery.

This was emphasised in a simple survey of all the female drug representatives who visited me, where I found that very few of these generally well-informed women had heard of laparoscopic surgery.

Most of them asked how conditions such as a fibroid or endometriosis could be treated with this type of surgery.

The most common questions I get from female patients are: “How can you remove a large fibroid through a small incision?” and “I was told by my doctor that laparoscopic surgery is not as thorough as traditional laparotomy”.

If surgery has been recommended to you, it is always advisable to go for a second opinion as there is always room for alternatives.

As a patient, you will have additional insight into your condition and the medical options available to treat that condition.

Most significant during the consultation is the conversation you have with your gynaecologist on your concerns.

Laparoscopy is minimally-invasive surgery, usually performed using three to four small incisions and involving the use of a small camera that is inserted through one of the incisions to allow a surgeon to see clearly inside the body.

The area being operated on is enlarged on a video screen, allowing the surgeon to clearly view the surgical area.

The procedure requires much smaller incisions than are used in traditional open gynaecological surgeries.

Due to the small incisions, the surgical wounds heal fast and patients experience very little postoperative pain.

There are also only small scars left on the abdomen. The chances of wound infection are low and bleeding during laparoscopic surgery is also minimal.

keyhole surgery

For many gynaecological procedures, such as removal of an ectopic pregnancy or treatment of endometriosis or ovarian cystectomy, laparoscopy has become the treatment of choice.

Compared with laparotomy, multiple studies have shown that laparoscopy is the less expensive option due to a shorter hospital stay and a shorter recovery time.

The advantages of the laparoscopic approach over other procedures, including hysterectomy, sacrocolpopexy, and the staging and treatment of gynaecologic cancers, continue to broaden.

Upon my recommendation of the procedure, the next question I usually get is on the safety of laparoscopic surgery in comparison to traditional laparotomy.

This will depend on the expertise and experience of the doctor.

While complications may occur in both open laparotomy and laparoscopic surgeries, the most important aspect is that the performing surgeon can diagnose and correct the complications immediately.

Over the years, laparoscopic techniques have also continued to evolve, primarily as a result of technological advances.

In addition to better cameras and instruments, technology has resulted in the development of 3D laparoscopy, and more recently, single incision laparoscopy, where the surgery is performed with just a single incision in the umbilicus.

This advancement is cosmetically advantageous because the incision is made in the “hidden” umbilicus.

These methods are available and currently being used here in Malaysia.

However, only 5% of gynaecological conditions are being treated in Malaysia via the laparoscopic route.

Due to the lack of awareness, we are far behind other Asian countries such as Singapore, Taiwan, Japan and Korea, where more than 50% of benign gynaecological diseases are performed laparoscopically.

keyhole surgery

With all the benefits tied to the procedure, women should take charge of their medical care by educating themselves about laparoscopic surgery.

At some point in life, some of us may be required to go through surgery.

It is always something that requires a great deal of thought and consideration as it involves some discomfort, risk and disruption to one’s life.

Begin your own healing and recovery from surgery by taking charge of the decisions that need to be made.


Dr S. Selva is a consultant obstetrician and gynaecologist, and the author of Laparoscopic Surgery in Gynaecology and Common Diseases in Women.

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Survival rates after hysterectomies performed by keyhole surgery have proved to be just as good – and safer – for women with a common form of uterine cancer as a more invasive abdominal surgery.

Related image

Image: varicocele

A 10-year global study involving QUT monitored 760 women in Australia, New Zealand and Hong Kong who had undergone either a total abdominal hysterectomy.

The surgeries involved either an incision in the abdomen, or a total laparoscopic hysterectomy performed through three or four small keyhole incisions.

Endometrial cancer is the most common gynaecological cancer in developed countries, and 80 per cent of cases are diagnosed at early stages.

The main treatment of early-stage endometrial cancer is surgery.

QUT researcher Professor Monika Janda said women had traditionally been told the total abdominal surgery was a safer operation with better long-term outcomes, even though the keyhole surgery had quicker recovery time.

“This is the end of a 10-year study and it really does give reassurance to women who have to have a hysterectomy,” she said.

“When we started our research back in 2005, there were strong opinions against total laparoscopic hysterectomies, with some clinicians warning that women would suffer harm from this new surgical technique.”

“This study has now proven that a woman with endometrial cancer can have a total laparoscopic hysterectomy through keyhole surgery, have much better short-term results and her long-term outcome is just as good as a woman who has a total abdominal hysterectomy.”

QUT health economist Professor Nick Graves said the university had previously shown there were tangible economic benefits via a linked study that he led researching the cost for hysterectomies.

“The results of that study were released in 2013 found that, although the initial surgery costs for laparoscopic hysterectomies were higher, we found the overall cost to the health system was less because patients needed fewer hospital bed days and had higher quality-adjusted life years after surgery,” Professor Graves said.

Professor Janda said that given its better short-term results, combined with the equivalent survival rates, keyhole hysterectomies should be considered the standard of care for patients with early endometrial cancer.

Story credit: QUT newsroom.

SOURCE:

Keep It Clever.com.au

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Related imageIn addition to better cameras and instruments, technology has resulted in the development of 3D laparoscopy, and more recently, single incision laparoscopy, where the surgery is performed with just a single incision in the umbilicus. Photos: Handout Source: star2.com

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Keyhole surgery better for cancer hysterectomies: global survival study

29 March 2017A 10-year global study involving QUT has found that survival outcomes after hysterectomies performed by keyhole surgery are just as good – and safer – for women with endometrial cancer as the more invasive total abdominal hysterectomy.The study monitored 760 women in Australia, New Zealand and Hong Kong who had undergone either a total abdominal hysterectomy (TAH), involving an incision in the abdomen, or a total laparoscopic hysterectomy (TLH) performed through three or four small incisions.

QUT researcher Professor Monika Janda (pictured below) is lead author of an article on the findings of the LACE trial (Laparoscopic Approach to Cancer of the Endometrium) released in JAMA (Journal of the American Medical Association) today (March 29, Australian time).

She said women had traditionally been told a TAH was a safer operation with better long-term outcomes, even though a TLH had quicker recovery time due to its less invasive nature.

“This is the end of a 10-year study and it really does give reassurance to women who have to have a hysterectomy,” she said.

“When we started our research back in 2005 there were strong opinions against total laparoscopic hysterectomies, with some clinicians warning that women would suffer harm from this new surgical technique.

“This study has now proven that a woman with endometrial cancer can have a total laparoscopic hysterectomy through keyhole surgery, have much better short-term results and her long-term outcome is just as good as a woman who has a total abdominal hysterectomy.

“The five-year post-operation survival rates are virtually identical. Of the women who completed the study, 81.6 per cent who had a laparoscopic hysterectomy were disease-free four-and-a-half years later, compared to 81.3 per cent of women who had an abdominal hysterectomy.

“Our previous ‘quality of life’ study released in 2010 has already found that the short-term, quality of life benefits of TLH surgery are much better when compared to TAH because women returned to physical and function wellbeing quicker.

“Taken together, these two key papers show women that if they have a laparoscopic hysterectomy they can have an excellent outcome.

“Given its better short-term outcomes, combined with the equivalent survival rates, total laparoscopic hysterectomies should be considered the standard of care for patients with early endometrial cancer.”

Endometrial cancer is the most common gynaecological malignancy in developed countries, and 80 per cent of cases are diagnosed at early stages.  The main treatment of early-stage endometrial cancer is surgery.

The clinical leader of the study, Professor Andreas Obermair from the Queensland Centre for Gynaecological Cancer at The University of Queensland, said the study had already made an impact in the operating theatre.  He said it had helped increase the number of laparoscopic hysterectomies being performed because results had filtered down through the 27 surgeons who took part, and their colleagues, as the trial progressed.

“In part because of this trial, now almost every gynaecological cancer unit in Australia is offering laparoscopic hysterectomies,” he said.

QUT health economist Professor Nick Graves, who was also an author on the new LACE paper, said the university had previously shown there were tangible economic benefits via a linked study that he led researching the cost for hysterectomies.

“The results of that study were released in 2013 found that although the initial surgery costs for laparoscopic hysterectomies were higher, we found the overall cost to the health system was less because patients needed fewer hospital bed days and had higher quality-adjusted life years after surgery,” Professor Graves said.

“There was a $3000 saving for every surgery performed as a total laparoscopic hysterectomy compared to a total abdominal hysterectomy.”

Professor Janda and Professor Graves are both members of QUT’s Institute of Health and Biomedical Innovation and QUT’s School of Public Health and Social Work.

Professor Obermair said the study was a success for Australian women and thanked his colleagues from around Australia, New Zealand and Hong Kong, the study funders, as well as all those patients who volunteered to be part of the research.

“Only through the generosity of these women can we can reassure patients that they receive optimal treatment for their cancer through a laparoscopic procedure,” he said.

Release date: Wednesday, March 29, 2017
Media contacts:
– Mechelle McMahon, QUT media officer,
 media@qut.edu.au
– Rose Trapnell, QUT media team leader, 07 3138 2361 or 0407585901, 
or media@qut.edu.au

 

SOURCE:

Queensland University of Technology, AU

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