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OBGYN.net Conference CoverageOBGYN.net visits China-OBGYN.net in a meeting underwritten by InSightecMarch 2006
Dr Zhu Lan: Hello. Let me introduce myself. I am Dr Zhu Lan, I am from Peking Union Medical College Hospital. I am a general gynecologist and a urogynecologist.
Dr Zhengyu Zhang: Hello, I am Dr Zhang from Beijing China Hospital. I majored in general gynecology.
Dr Zhu Lan: Today, we will talk about the fibromyoma in China. In our hospital, the doctors are divided in different parts. In our general gynecologists, some or the most common disease is fibromyoma. It is also the condition in your hospital?
Dr Zhengyu Zhang: Yes, fibromyoma is the main disease, especially for young ladies. Some ladies they never gave birth to a child and they suffer from myomas and for some ladies who are aged from 30 to 50 years, they suffer from myomas. It is very common, very common.
Dr Zhu Lan: Yes. Diagnosis for this disease is not very difficult but the treatment has improved a lot in China, especially for micro-invasive surgery, you can use it very fast and very safely in China.
Dr Zhengyu Zhang: Many ladies want to preserve their uterus when they have a large myoma. It is a challenge to the doctors. We must take the myoma out and also preserve the uterus and also preserve the ability to give birth to a child in the future.
Dr Zhu Lan: Especially Dr Zhang can do this. He is an expert in laparoscopy so it allows him to do this action, laparoscopic myomectomy and also some LAVHs. Most of the patients can be done by laparoscopy. We can also do this by the vaginal route, especially if the myoma is not so big and a bigger myoma can also be done by the vaginal route with a myomectomy. It is very new and very safe.
Dr Zhengyu Zhang: What do you think if the patient wants to have a myomectomy? Do you want to perform abdominally or vaginally or by laparoscope?
Dr Zhu Lan: It depends on the patient location and it also depends on the doctor’s experience.
Dr Zhengyu Zhang: I think that for a myoma, if the patient has not given birth to a child, I think maybe laparoscopic myomectomy is more convenient through the vagina or an abdominal myomectomy.
Dr Zhu Lan: Yes, but generally it is the patient who has a myomectomy through the vaginal route, maybe a 5 cm, less than 8 cm myoma, can be done through the vaginal route.
Dr Zhengyu Zhang: If the patient is complicated by infertility especially, maybe is complicated by endometriosis, I think you can have a laparoscopic myomectomy so you can find the disease and also you can treat at the same time. I think laparoscopic is better.
Dr Zhu Lan: It is better, yes, sure. If the patient has a suspected or is accompanied by other disease, maybe with laparoscopy, it can be diagnosed more exactly.
Dr Zhengyu Zhang: Yes, sure. I find about 10% to 20% of patients who suffer from myoma may be complicated by endometriosis. It is very common now. What do you think of the hysteroscope for hysterectomy? What do you think of performing it abdominally, vaginally or laparoscopically?
Dr Zhu Lan: It depends on the patient. Usually it is the size. Generally, in China, the laparoscopic skill and the vaginal skill are not too bad, so generally it is the senior doctor, I mean the gynecologist doctor, who can do the hysterectomy and laparoscopically the vaginal route is generally less than 12 gestational weeks, maybe if the size is generally big, maybe the operation time is longer and blood loss may be more so it is not set. It really means invasive surgery, so this is an indication that laparoscopic or vaginal route hysterectomy in China suggests a limit with regard to 12 gestational weeks.
Dr Zhengyu Zhang: According to my knowledge and also to my experience, I prefer laparoscopic hysterectomy more, especially for a very large uterus.
Dr Zhu Lan: Yes.
Dr Zhengyu Zhang: That is according to the trends, especially when we get the knowledge from AAGL and sometimes from the journals. For the new trainees, it is maybe for supracervical hysterectomy.
Dr Zhu Lan: Supracervical?
Dr Zhengyu Zhang: Yes, I think it has become the gold standard for the treatment of myoma, yes, supracervical hysterectomy. However, maybe two or five years ago, made me think of supracervical hysterectomy as not superior to total hysterectomy. That made me think that maybe supracervical hysterectomy, especially performed by laparoscope, is superior to total hysterectomy. What do you think of it?
Dr Zhu Lan: Yes, because I am also a urogynecologists, I pay more attention to the pelvic floor support, so if the supracervical hysterectomy can not injure the pelvic floor, there is a big benefit for the pelvic floor support. I think if patients just suffer from fibromyoma, supracervical hysterectomy, maybe is better. But if patients also are complicated by endometriosis, then supracervical is not the best choice and maybe leave the uterine ligament and maybe the patient feels pain and it is easy to have recurrence of the endometriosis.
Dr Zhengyu Zhang: Yes, for the surgery of supracervical hysterectomy, especially performed by a laparoscope, I think is very easy and very safe for the patients who can go to work two to three weeks post operation and I think maybe very good surgery for the patient who suffers from myoma.
Dr Zhu Lan: Yes, also the Chinese gynecologist works very hard, I think, also in laparoscopic surgery and some other things, there are a lot. In our hospital, in hysterectomy for fibromyoma generally the patient wore down and laparoscopy for the patient and the surgery, the patient was open, so it was a down route.
Dr Zhengyu Zhang: Yes.
Dr Zhu Lan: Okay?
Dr Zhengyu Zhang: Okay? Is that too much?
Dr Zhu Lan: Because China can be more open so we can have more chances to go overseas and learn and there are more advantages to learn skills. I hope through this internet, we can have more chances to connect with other senior doctors and profile our doctors.
Dr Zhengyu Zhang: I came to the conclusion for the patient who suffers from myoma. If you have myoma, we have the world’s technology emerging in this area. The patient can suffer very little and we can treat the disease, especially for laparoscope, myomectomy, laparoscopic supracervical hysterectomy and also laparoscopic hysterectomy and we will have to give the patient more.
Dr Zhu Lan: That is the choice in our hospitals. Yes. Thank you.
Dr Zhengyu Zhang: Thank you very much, yes.