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The ideal doctor would be one who is : competent; compassionate with a caring attitude ; experienced; with a well-organized practice - and has all the time in the world for you! While you may never find someone who meets all these criteria, how can you find a good doctor to take care of you?

Chronic pelvic pain and/or associated intestinal disturbance are a major cause of misery for thousands of patients. Often in constant pain, the patient experiences loneliness, hopelessness, frustration and desperation with thoughts of suicide. Family and work relationships are strained to the limit. Although ADHESIONS are often (but not always) the cause of this pain, treatment for adhesions is not performed either because the surgeon does not believe that adhesions can cause the problem, or because lysis of adhesions is considered too difficult or futile.

The goal of laparoscopic repair of female organ prolapse is to restore normal functioning by correcting female organ supporting defects in the pelvis. The supporting system in the female pelvis is quite complex; however, it is dynamic rather than static. There are basically two systems in the pelvis that provides the active and passive support of pelvic organs to their proper places.

FAQs on Infertility from Malpani Infertility Clinic

I had an interesting email come in the a few weeks ago from a woman looking for advice on finding a doctor:

Fibroids are the most common benign tumors of the uterus. These noncancerous growths are present in 20-40% of women over the age of 35. In some women, the fibroids can become enlarged and cause symptoms of excessive bleeding and pain. While the classic treatment of symptomatic fibroids has been surgical removal of the fibroids (myomectomy) or the uterus (hysterectomy) recent advances now afford a nonsurgical treatment.

Ovarian cysts are enlargements of the ovary that appear to be filled with fluid. They can be a simple fluid filled bleb or contain complex internal structures. The term cyst is used to differentiate them from solid enlargements. Simple cysts have no internal structures and are less worrisome than those with complex structures or solid components. A sonogram or ultrasound test can determine if a cyst is simple or complex.

A significant number of women experience infertility due to surgically correctable causes. Most cases are a result of endometriosis and/or adhesions (scar tissue) from previous surgery or pelvic infection. Endometriosis and adhesions cause distortion and blockage of the fallopian tubes, thus causing infertility. Infertility surgery tries to unblock, release and restore normal anatomy of the fallopian tube.

What could be easier? You arrive in the morning, have your procedure then leave later the same day. This is called out patient surgery. One of the most common and preferred choices of both physicians and patients. This is made possible by less invasive techniques that still facilitate the same, if not better surgery. Everything from anesthesia to recovery is taken care of in a matter of hours. Preparing for such a surgery goes beyond reading the pamphlets your physician hands you. Do your homework and ask questions! The success of both your procedure and recovery depends on YOU.

Laparoscopic hysterectomy (LH) is an optimum approach to the second most common surgical procedure in the United States. There are close to 600,000 hysterectomies performed annually in the US, with the majority performed via the abdominal route.

Video of Laparoscopic Hysterectomy

Around 153 million women around the world have chosen to be sterilized for contraceptive purposes, of these 138 million are in the developing countries. 1 Approximately fifty percent of all female sterilization is performed during the puerperal period or a cesarean section, and the other fifty percent is called “interval sterilization” when there has been no pregnancy for the previous six weeks.

Uterine fibroid is a slowly growing benign smooth muscle tumor. Approximately 25% of women after the age of 35 years harbor uterine fibroid. Most of these women are asymptomatic and in general, they do not need any treatment

Because endometriosis is a common disease entity among infertile patients with a prevalence of up to 50%, one could argue that without laparoscopy clinical work-ups can not completely rule out all of the causes of infertility. The decision to perform laparoscopy on patients with infertility is very complex owing to a number of factors, such as maternal age, semen parameters, tubal patency, pelvic symptoms, insurance coverage, surgical risks, and availability of surgical expertise.

Endometriosis is one of the most common gynecologic disorders and is significantly more prevalent in the setting of infertility. The prevalence of endometriosis in infertile women ranges from 25% to 50% compared to 5% in fertile women. Successful laparoscopic management of all stages of endometriosis was reported as early as 1986. This has revolutionized the management of endometriosis. The benefits of surgical therapy for infertility associated with endometriosis have been well documented.

For the past three decades, gynecologists have been utilizing the hysteroscope in the office to diagnose a variety of conditions that can be responsible for symptoms such as abnormal uterine bleeding, recurrent miscarriage, infertility, and post menopausal bleeding. The most common lesions found during diagnostic office hysteroscopy include cervical and uterine polyps, submucous myomata, uterine septae, intrauterine adhesions, endometrial hyperplasia and endometrial cancer.

Video of Hysteroscopic Polypectomy

It is advantageous to perform surgery in the least invasive way possible while still getting optimal results. Although I usually prefer to do surgery through a laparoscope rather than through a larger incision, I have felt limited by the lack of wrist-like movements of the instruments. I felt that deeper myomas (that couldn’t be removed by a hysteroscope) were better removed through a regular incision.

The most important requirement for successful hysteroscopy is satisfactory distension of the uterus. While many different media have been used, recent advances in equipment have greatly simplified the use of saline for diagnostic and simple operative hysteroscopy that does not require the use of electrosurgical instruments.

It is usually quite simple to find the cause of abnormal menstrual bleeding, although occasionally the cause may not be found. Since abnormal uterine bleeding can be caused by disorders of the uterus, hormone imbalance (usually not ovulating), and pregnancy, it is helpful to look at each area separately. When I see someone for abnormal bleeding, I ask the following questions.

There are many ways to treat cervical dysplasia (CIN). Factors influencing the choice of treatment for cervical dysplasia include the extent and severity of the dysplasia, the age of the woman, and whether or not she has any other gynecological problems. Often the experience of the physician or other clinician, and the availability of equipment are also major factors. The following are the most common methods of treating cervical dysplasia:

Dr. Paul Indman: “Jordan, this is a momentous occasion. It’s hard to believe there’s talk of your retirement and, of course, I don’t believe that you’re really retiring.”Dr. Jordan Phillips: “Well, it’s a change of activity. I will retire as of December 31, 2000 from the Board of Trustees. I anticipate continuing some of my other activities; I’m the Managing Editor of the Journal of the AAGL, and I plan to continue that and other things.”Dr. Paul Indman: “I’m sure you’ll be just as involved as ever.”Dr. Jordan Phillips: “Not on a day-by-day basis.”Dr. Paul Indman: “You’ve been characterized as a visionary by everyone who has spoke and certainly I think you are. Today we saw a presentation on space medicine doing laparoscopy in zero gravity. What do you see as the future of endoscopic surgery?”Dr. Jordan Phillips: “Number one, I think endoscopic surgery has proven that it’s a very important part of the armamentarium for surgery. I see that through the last several years the use of endoscopy has gone from just being a diagnostic tool and a sterilizing tool to being a full operating tool. So now we can do full surgeries using the endoscope but it requires one other major ingredient and that’s the skill of the surgeon so you must have a very competent surgeon doing complicated endoscopic procedures.”Dr. Paul Indman: “What is the AAGL doing to improve the skill of surgeons?”Dr. Jordan Phillips: “We continue to do many things. Not only do we have the annual meeting but we also have regional meetings, we have workshops, and we put on live cadaveric surgical anatomy programs. We’re doing a whole series of things besides publishing the Journal with all the recent articles, putting out News Scope, which is a news article, and having bulletins put out. AAGL has been very busy.”Dr. Paul Indman: “I think the AAGL has been responsible for improving the skill of surgeons around the world and certainly it’s probably the number one influence that I’ve seen. What are some of your wildest dreams that we’ll be doing in twenty-five years?”Dr. Jordan Phillips: “It’s come even faster than that and that is the majority of surgeries performed will be actually done through an endoscope. They’ll be very few operations performed in a routine gynecological practice that’s being done by open surgery. Open surgery doing a full open incision is almost obsolete and there are some departments in the world today where 90% of all gynecologic operations are done through an endoscope.”Dr. Paul Indman: “What do you see as the biggest resistance to that in our country?”Dr. Jordan Phillips: “The biggest resistance that we have is the case that we have to continue to train people and to make them better surgeons and smoother; safe surgeons I guess is the best term to use.”Dr. Paul Indman: “One of the problems I hear constantly with surgeons is that insurance companies are reimbursing less and less, they may essentially reimburse for a half an hours worth of work and the surgeons say - I can do this in a half an hour if I make a giant incision but it will take me three or four hours through a laparoscope, I can’t afford to do that. How can we get around that?”Dr. Jordan Phillips: “They’ve been able to prove that by using a laparoscope it’s less cost because they use less equipment, the patient doesn’t stay in the hospital as long, and most endoscopic operations are done in a short stay. That is they go in in the morning and they have the operation then go home in the afternoon so they don’t even stay overnight so the expenses will change because of the decreased hospital costs.”Dr. Paul Indman: “The total cost though but still the surgeon has such a major disincentive for doing that and I’m wondering how we can change that?”Dr. Jordan Phillips: “We tried to educate the insurance companies that we’re actually saving the insurance company money on their hospital bills and frankly we are. We have tried and we’ve convinced some of the insurance companies to actually have part compensation. If you do a hysterectomy through a laparoscope or do a hysterectomy through an open incision or vaginal they should have equal compensation, whichever method or approach you use.”Dr. Paul Indman: “Let’s get back to you, Jordan, because this is obviously a very important meeting. This is your last meeting where I guess your Chairing the Board.”Dr. Jordan Phillips: “That’s correct.”Dr. Paul Indman: “What do you think you will be doing next, personally?”Dr. Jordan Phillips: “Oh, we’re quite busy. My wife and I have a project in China called Medical Books for China International where we collect unwanted medical books that we send to China. We’ve now completed 60 shipments of 20 tons in each shipment so we’ve sent over 1,000 tons of medical books, journals, audio tapes, and video tapes to China that have been distributed to over 1,000 medical libraries. This takes a lot of organization, and it’s all handled through our own office. We’ve become the focal point for many institutions, many book dealers, and many book distributors to actually have them send their surplus books to us. Now it adds up to actually over 3 million books in all specialties not only in eye, ear, nose, throat, cardiology, chest, GI, GU, orthopedics, all specialties including nursing, veterinary medicine, basic science, medical law, and all of the various paramedical activities in books. So we’ve actually filled the shelves of many libraries in China, which were empty when we started.”Dr. Paul Indman: “So you’ll be working on that a lot?”Dr. Jordan Phillips: “Not a lot, we have it well organized. We have a staff that does it but it does require attention that we go to China. The Chinese distribute the books, we don’t distribute the books, and we’re planning for next June to have a World Congress in China on medical libraryship on the technical aspects of doing a medical library. There’s a lot to it where it’s changed with the use of computers and all the various new modalities that are available, and we’re going to introduce this to China. All of the Chinese major medical schools, and there are 127 medical schools in China, will come to this meeting. My wife, Mary Zoe Phillips, is actually Secretary General of this entire meeting. We did one ten years ago but now it’s ten years later.”Dr. Paul Indman: “What other visions for the future do you have, Jordan?”Dr. Jordan Phillips: “What other visions for myself?”Dr. Paul Indman: “For yourself and AAGL.”Dr. Jordan Phillips: “The AAGL will continue; it will continue its impact, continue its growth, and continue to be innovative. When you have these very dynamic young people who are push, push, push, I think that this is what’s going to happen. I have complete faith in the future.”Dr. Paul Indman: “You certainly need to be congratulated on such a wonderful organization and it’s a true family.” Dr. Jordan Phillips: “Yes, it really is a family and that’s what we started. In fact, we started right from the beginning and I didn’t call them board dinners, I called them family dinners and that’s just what it is. We got involved with the people, their children, their wives, and families and many other things. I can tell you one of the greatest joys I’ve had has been writing letters of recommendation for some of our people to become advanced in their academic activity. To write letters to become professors or associate professors, it’s a joy for me to do that.”Dr. Paul Indman: “The AAGL has been a family to me, thank you so much, Jordan.”Dr. Jordan Phillips: “You’re welcome, Paul Indman, it’s been a pleasure to see you. Thank you.”

Excess absorption of liquid distending media is one of the most frequent complications of operative hysteroscopy. Although most women recover uneventfully, we are seeing cases of permanent morbidity or death resulting from this complications.

Currently there are two ways to treat endometriosis – hormonal therapy and surgery. Depending on the patient’s expectations and the extent of the disease, we may prescribe hormonal therapy, surgery, a combination of surgery and hormonal therapy, or occasionally a just “wait and see” approach.

Fibroids are non-cancerous (benign) growths of the muscle wall of the uterus. They are probably responsible for more unnecessary gynecologic surgery than any other condition. Every year a staggering 600,000 American women have a hysterectomy. And about 30 percent of those hysterectomies, 180,000 in all, are performed because of fibroids. For many years gynecologists have surgically removed these growths, often because of fear of the problems they might cause in the future. And those problems are often overstated.

OBGYN.net Conference CoverageFrom the 34th Annual Meeting - Chicago, Illinois - November 2005

Approximately 750,000 hysterectomies are performed annually in the United States, with a mortality rate of about 12 per 10,000 operations.1 Costs to consumers and insurers have been estimated at approximately $1.7 billion per year.2 Thus, alternative procedures that are safer and less invasive, preserve the uterus, and cost less are increasingly in demand. In recent years, several such techniques have been introduced.

Laparoscopic myomectomy (LM) is a minimally invasive surgical procedure for the removal of uterine myomas. It was first described in the late 1970s by Semm. Subsequently, equipment has been developed to enhance the procedure. LM requires advanced laparoscopic skill and expertise in suturing and tissue removal. Laparoscopic assisted myomectomy (LAM), a procedure that combines operative laparoscopy and minilaparotomy, was described by Nezhat et al in 1994.