Karen Rae Abbott, MD

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New Ideas for Pelvic Support Therapies

Karen Abbott, MD and Barbara Nesbitt: "My breast cancer survival story"

Coverage of the 37th Annual Global Congress on Minimally Invasive Gynecology

My breast cancer survival story

 It is November 11th, 2005. We  are at the AAGL meeting in Chicago. I am Hans van der Slikke, gynecologist from  Amsterdam. I have the pleasure of having next to me Karen Rae Abbott who is a  urogynecologist from Reno, welcome. 
 
 

 I would like to talk about fibroids, especially  what you see as new ways of treatments for fibroids presented at this AAGL  meeting.
 
 

 There are a lot of new things out. I think the most  exciting is some of the new technology using robotics for laparoscopic  myomectomies. Unfortunately most people that deal with fibroids, and I do not  know of your experience in your country, the minute you discuss suturing they  freak out. So, people have been looking for alternative therapies so they do not  need to do suturing. Between some of the new suturing devices and also the  robotics there are a lot more that can be done now, minimally invasively.
 
 The first thing is to educate the patients of what their options are. They vary  from learning to tolerate the problem as long as it is not life threatening,  medical therapy or uterine artery embolization in those patients that are not  desiring future pregnancies, because the statistics for pregnancies after that  have been, uncertain shall we say, or surgical intervention. Of course it  depends on the skill of the surgeon, whether they feel comfortable with a  laparoscopic approach or not, or hysteroscopic approach for that matter. There  are a lot of options out there and the patients need to be aware of them.
 
 

 So, talking about minimally invasive treatments  like embolization and clipping the artery, what is your preference?
 
 

 I’ve been doing laparoscopic myomectomies for about  ten years, so I am very comfortable with them, and our patients do really well  and have successful pregnancies afterwards. In fact, I was involved in a  clinical trial when embolization first started. I was part of the  laparoscopic/hysterectomy arm, and our patients did much better than the  embolization arm in terms of post-operative pain and patient satisfaction. I  think it depends on how comfortable you are with minimally invasive technology,  and I am.
 
 Embolization has its moments, especially in patients that are not good surgical  candidates, or they have symptomatic fibroids. But when you deal with patients  that have self-embolized fibroids, knowing how they feel the pain they  experience; if you can go in and resect them minimally invasively, so they do  not have that embolization pain, and they can persist for a time, I’m more  comfortable with that.
 
 

Let’s talk about this trial you did. Were there  any women in the embolization arm who had failure of their ovarian function?
 
 

Yes, there were several women who had premature  ovarian failure as a result of the embolization. There were actually two  patients who ended up having to have surgery because of intractable pain after  the embolization. I think that patients need to be aware that it sounds  wonderful, but it is not necessarily 100%. It also depends on if there are  multiple fibroids, and what the sizes are. If you are dealing with one big  fibroid that makes a lot more sense than if you have a uterus filled with them.  You really have to treat it on a case-by-case basis, as you know. 
 
 

 Yes, it is a very customized treatment,  depending on the number and the size of the fibroids, and the localization of  course. There are also some other therapies shown here that are almost  non-invasive, like the focused ultrasound treatment. Did you see that?
 
 

 That is very interesting. I will be interested to  see how it is five years out. The problem with new technology is that sometimes  it looks really wonderful, then five years later you find out, just like some of  the old meshes, the original categoric fashion meshes that looked wonderful and  two years later they were gone. Like anything, you have to see.
 
 

 That’s true. I think already they have a couple  of hundred patients at hospital. It seems quite revolutionary. 
 
 

 And did you have experiences with other  treatments, like cryomyolysis?
 
 

 Yes, we used to do that. Before, we used to go in  and try cryomyolysis before they had embolizations, especially for small  superficial fibroids. I consider that an old technique, not a new one. 
 
 

 I agree with you on that. Was there anything  else we did not cover?
 
 

 I cannot think of anything we have not covered!
 
 

 I thank you very much. The most important thing  is that women know that it is seldom necessary to remove the uterus.
 
 

 Absolutely! I think uterine preservation is  something that is very important and I think that women are becoming more aware  of that. I think in generations past it was rather like; “ Well, let’s just get  everything out” and now they are finding that there are alternatives to that. 
 
 

From the 34th Annual Meeting - Chicago, Illinois - November 2005

Minimally Invasive & Non-invasive Treatment of Fibroids

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Karen Rae Abbott, MD

Articles

New Ideas for Pelvic Support Therapies

My breast cancer survival story

Minimally Invasive & Non-invasive Treatment of Fibroids

Minimally Invasive & Non-invasive Treatment of Fibroids Video