4 • WINTER 1996 ISSUE
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SINAI HOSPITAL
Surgical Alternatives To Hysterectomy
PECIAL ADVERTISEM EN
H
ysterectomy has been the tioning, and both of these tech-
enormous. "At Sinai's Department
traditional surgical proce-
niques burn off the bleeding tissue
of Obstetrics and Gynecology, we're
dure used for certain pa-
and bring a halt to the problem in
more interested in applying tech-
tients with excessive or the majority of cases. Because these nology to better serve our patients
intractable bleeding. Now,
effects are permanent, most of the than any other reason, and we
there are alternative surgical ap-
women will never have a period
hope that some day hysterectomies
proaches that may be able to be
again or be able to have children.
won't be necessary for heavy bleed-
used in place of the major surgery
Although bleeding problems can
ing except for cancer or very large
required for hysterectomy. The en-
occur at any age, most will be pre-
fibroids," says Dr. Goldrath.
dometrium is the lining of the
sent in women between the ages of
Laser surgery may also be used
uterus, and advances in technolo-
30 to 50 and in many, they would
for a variety of other gynecological
gy now allow for the destruction of have already completed their fam-
problems. One of the most common
this lining as an alternative to re-
ilies. The advantage of endometri-
ones is found in the cervix (the
moving the uterus, in suitably
selected cases. The destruc-
Nationally renowned Milton Goldrath, MD,
tion of the lining is called en-
a pioneer is laser and laparoscopic surgery
dometrial ablation, and the
at Sinai, instructs physicians on the use of
current techniques use either
laparoscopic and lasar techinques.
laser surgery or a procedure
called rollerball ablation that
uses electrical energy. Both of
these techniques are able to
be offered to patients by the
gynecologists practicing in the
Department of Obstetrics and
Gynecology at Sinai Hospital.
The word lasers may bring
to mind your last trip to Dis-
ney World with colorful light
rays playing against the night
sky to the sound of show
tunes. You may also think of
the scanners at your local
store. But lasers are much
more than an amusement
park phenomenon or a means
of reading those UPC codes.
They are important medical
tools that perform a variety
of tasks, often much more ef-
fectively than traditional
methods. Sinai's Department
of Ob/Gyn has been at the
forefront in state-of-the-art
laser application.
Milton Goldrath, MD a
Sinai gynecologist, pioneered
the use of lasers in women's
health. In 1979, he discovered
that by passing a laser light beam
al ablation by either technique is
opening of the uterus) when cells
through a tube and into the uterus,
that it will cure the problem in the
change and become abnormal.
he could stop excessive non-can-
majority of patients with a mini-
These pre-cancerous lesions, which
cerous bleeding by removing the
mum of discomfort and trauma.
could become cancer if left un-
endometrial lining, and this
The procedure can be done as same treated, are known as cervical dys-
surgery provided a more desirable
day surgery with a woman re- plasia. These abnormal cells can
alternative to hysterectomy.
turning home within a few hours.
be destroyed with a laser once and
More recently, an alternative to
Most women go back to work in a for all. Again, the procedure is rel-
laser surgery has been provided by
day or two after the procedure.
atively easy and can be performed
the rollerball technique. With this
It is estimated that of the
as same day surgery.
procedure, electrosurgical energy 600,000 hysterectomies performed
As is the case with excessive
is used to destroy the lining and the
in the United States, about 200,000
bleeding, Sinai's gynecologists see
procedure may be somewhat sim-
could have been avoided by treat- .a lot of patients with cervical dys-
pler and reduce operating time
ing the problem with laser ablation
plasia. However, these women tend
when compared to the laser.
or rollerball. The cost represented
to be younger — in their teens to the
Women who bleed excessively have by time lost from work and family,
early thirties. Doctors are pretty
an endometrium that is malfunc-
discomfort and actual expense is
sure cervical dysplasia is caused by
44*
the same human papilloma virus
that causes genital warts. Human
papilloma virus is a sexually trans-
mitted disease seen primarily in
sexually active individuals. While
symptoms of warts will cause most
women to go the doctors fairly
quickly, cervical dysplasia has no
symptoms. Thus, even if one is
young, it is very important to go for
an annual Pap smear, which is the
only way cervical dysplasia can be
detected. The laser can also be used
to treat genital warts, al-
though it is usually reserved
for the stubborn cases that do
not respond to medication.
The laser is an option in
treating endometriosis, an-
other problem that causes un-
told pain and discomfort to
thousands of women. With
endometriosis, pieces of the
endometrium (the same tis-
sue that causes excessive
uterine bleeding) somehow
escape from the inside of the
uterus and begin growing in
other parts of the pelvis.
Every time a woman has
a period, the endometrium
outside the uterus swells and
ultimately bleeds the same
as the endometrium inside
the uterus. While inside
the uterus, the swelling and
bleeding are normal and
referred to as the period.
Outside the uterus, this cy-
cling can be very painful and
result in infertility. Laser can
destroy this wayward tissue
and relieve the intense
cramping, pain and some-
times the infertility associat-
ed with endometriosis.
Even though laser technol-
ogy is useful for suitable pa-
tients, gynecologists don't
always choose a laser. "Fifty per-
cent or more patients with heavy
periods can be treated with hor-
mone pills," says Dr. Goldrath. "It's
always a matter of what is best for
the patient. It is a very conserva-
tive attitude, but it's the way our
OB/Gyn physicians care for people
at Sinai."
These technologies and medical
management skills are an integral
part of the training program for
Sinai OB/Gyn Department physi-
cians. A list of specially trained gy-
necologists can be accessed through
the physician referral service at
1-800-248-3627.