The Advantages of Having Your Hysteroscopy at The Center

Hysteroscopy is a commonly performed procedure today often used for assisting in the diagnosis and management of abnormal menstrual bleeding including unexplained post-menopausal bleeding.

Hysteroscopic Uterine ExamIn nearly all communities hysteroscopy is performed either in an office, an ambulatory surgery center or a hospital.

At the Center for Menstrual Disorders we perform hysteroscopy in an office-based setting while providing excellent pain control, in a familiar environment at low cost to you and your insurer. We offer a highly experienced and skilled staff who’ve worked together for many years with proven equipment that is often unavailable even at the most well-known and respected medical centers.

1. Pain control

Hysteroscopy is a safe procedure but it is not painless. In a study by Bradley and Widrich (1) the authors studied 417 women who were referred for hysteroscopy in an office setting. The patients described the pain they experienced as follows:

 Pain at Hysteroscopy Percentage
Easily acceptable 34.5 %
Acceptable discomfort 22.2%
Tolerable discomfort 27.4%
Barely tolerable 12.4%
Intolerable 3.4%

From my standpoint that means at least 15.8% (the sum of the last two groups) found office hysteroscopy to be either intolerable or barely tolerable while another 27.4% found it to be uncomfortable but “tolerable”.

Some women might find this acceptable but I personally do not. I believe that patients should not have “barely tolerable” or “intolerable” procedures. This is neither good for patients nor their physicians. Women will suffer two-fold. First, they had a bad experience and second, the information that they were supposed to get may be unreliable or not obtainable at all. Importantly, the physician does not benefit from these scenarios as she or he is rushing to get through procedure and not cause you further pain.

For this reason many physicians offer diagnostic hysteroscopy in an operating room or ambulatory surgery center (ASC). While this solves the issue of pain there are numerous other issues one must consider in a hospital or ambulatory surgery center.

  • Procedures there are often more expensive for the patient and the insurer
  • Hospital and ambulatory surgery centers do not offer the convenience of the “home-like” atmosphere found in your physician’s office.
  • You will be there—hospital or ASC–many additional hours dealing with the various “systems” imposed by hospitals and ASCs. Although hospitals and ASCs do a wonderful job they are not designed to tailor their routines to your individual needs. This often adds significant time and cost to their procedures.

Hospitals and ASCs do a very good job but theirs’ is a “one size fits all” approach to diagnostic hysteroscopy. At the Center for Menstrual Disorders we are able to offer a range of pain control services based on the patient’s needs. Our pain management is individualized. The one important benefit we offer is that you can begin a procedure with little or no sedation–if you wish—and then you can ask for additional medication, as you see fit, in order to get you through the procedure.   If you wish you can simply decide to be asleep for the entire procedure and have no memory of it.

2. A Familiar Environment

One of the attractive features of office based procedures is that you’re already familiar with the environment. You already know how to get here and where to park your car. You’ll recognize the staff and you may have already seen our procedure room. The atmosphere is designed to be “home-like” and we feel it is a far more relaxing atmosphere than you’ll generally experience in most ASCs or hospitals today.

3. Cost

In general the out-of-pocket costs for most women is significantly less for an office-based procedure at the Center for Menstrual Disorders than the same procedure performed in a hospital or ASC. Please check with your insurer or ask one of our staff to check for you and compare.

4. Communication

Not only are hospitals and ASCs larger and more complex providers of health care but often you feel that there is no one around to answer questions for you, your family members or loved one. Because this is an accredited office based surgery center I am always here! I am available–to anyone that you’ve designated–to share medical information with anyone you wish.

5. Specialized Equipment

Hospitals spend a great deal of money purchasing and maintaining capital equipment often bring you, the consumer, advanced medical equipment and know-how. And while that’s true the same cannot be said of the limited field of hysteroscopy.

Because we specialize in menstrual disorders we have a vast array of hysteroscopes that are meant to accommodate many different situations that can unexpectedly arise. I am not making a boisterous claim in stating that we have a greater variety of specialized hysteroscopy equipment presently unavailable in any hospital or ASC in Western, New York. We do. The reason is simple. I am a specialist in a very narrow area of gynecology—hysteroscopy and hysteroscopic surgery. We invest in unique equipment that is presently unavailable in local hospitals and ASCs.

6. Knowledgeable Staff

Hysteroscopy requires a dedicated staff. Our nurses and technicians assist on hundreds of cases each year. Some of our staff have been with me for over 25 years! Two of our nurse practitioners have even published articles in scientific journals.

7. Experience, experience, experience!

We make no claim to be the best at what we do. But I have been performing office hysteroscopy for over 30 years and have completed many thousands of diagnostic and operative procedures.

 

REFERENCES

  1. Bradley LD, Widrich T. State-of-the-art flexible hysteroscopy for office gynecologic evaluation. J Am Assoc Gynecol Laparosc. 1995; 2(3):263-7

Why Bother Getting a Second Opinion?

Never in the history of women’s health care have there been as many alternatives to hysterectomies.

Obviously we are not talking about life-saving hysterectomies that are performed for cancers or acute hemorrhage following the birth of a child. But many—and possibly most–hysterectomies can now be replaced with other modalities that include:

  1. Careful observation and non-surgical monitoring of the condition.
  2. Hormonal medication and Intrauterine Devices (IUDs) to control heavy vaginal bleeding
  3. Non-hormonal medication to control heavy vaginal bleeding
  4. Endometrial ablation and Endomyometrial Resection
  5. Myomectomy (removing fibroids that reside inside or outside of the uterine cavity)
  6. Uterine artery embolization or uterine fibroid embolization

In addition, if you and your physician decide that hysterectomy is an appropriate choice for you there are still many choices that include the following:

  1. Does the hysterectomy involve the removal of the entire uterus or can the cervix remain?
  2. Does the hysterectomy also include removal of the ovaries?
  3. Will the hysterectomy be done laparoscopically?
  4. Will the hysterectomy be done robotically?
  5. Will the hysterectomy be done vaginally (with no abdominal incisions)
  6. Will the hysterectomy be done with a large abdominal incision (laparotomy)
  7. If I keep my ovaries should the fallopian tubes be removed?

WHO IS BEST SUITED TO PROVIDE A SECOND OPINION?

Years ago a colleague of mine entertained the idea that he would open a “second opinion” practice in Rochester. He envisioned a practice in which he was paid for his opinion only—in other words he would not use his position of knowledge or authority to siphon patients from other physicians only to enrich himself.

This would be the “ideal second opinion.” Under the best of circumstances you can visit a physician with your medical records in hand, allow for an examination (if necessary) and a thorough history so that the physician can get to know your particular needs and expectations and together reach a decision about hysterectomy—whether it is necessary. Perhaps you might decide that no therapy is required or that a less invasive method is appropriate. If a hysterectomy should prove appropriate for your condition you would be referred to a physician (who had no financial relationship with your “second opinion doctor”) with an excellent reputation and superior skills.

A QUESTION YOU SHOULD ALWAYS ASK YOUR DOCTOR—WHETHER IT’S YOUR “FIRST OPINION” OR YOUR “SECOND OPINION”

A question you should always ask your physician who is proposing an invasive treatment is simply this—“if I was your family member, daughter, wife, sister or other loved one would you recommend this surgery?” This is a legitimate question. Most physicians are honest, well-meaning and want the best for you. But this question may have them think a little harder. It’s a worthwhile question and you should strongly consider asking it no matter who is proposing surgery.

WHY DON’T WOMEN GET A SECOND OPINION?

There are many reasons women choose to not get a second option. Here are a few to consider. There are others as well.

  1. I don’t want to offend my doctor
  2. I trust my doctor and another doctor is just going to tell me the same thing anyway.
  3. It may cost some extra money to get a second opinion.
  4. A second opinion may mean that I have to delay my surgery and I can’t live with the problem any longer
  5. My friend had the same problem and she had a hysterectomy and she’s happy.
  6. My mother had a hysterectomy and so I knew I would eventually have one anyway.
  7. “I just want it out!”
  8. I did my on-line research and a hysterectomy seems the best way to go!

This will begin a multi-part series in which we begin to explain what might be gained by a second opinion. This article may not answer all of your questions but you will likely learn that there are a vast array of options available today that were not available only 10 years ago. You may learn that some of the “latest technologies” such as “robotic hysterectomy” do not offer results that are superior to other forms of hysterectomy—and they are not “less invasive” that other treatment options.

REASONS HYSTERECTOMIES ARE PERFORMED

Hysterectomies are the second most commonly performed surgical procedure performed on women today—over 600,000 annually in the United States. In general, the reasons for which hysterectomy is recommended fall into one of 3 categories:

  1. To save livesThis is not why the vast majority of hysterectomies are performed. This group includes women with various cancers and women who have rare life-threatening hemorrhage that may follow the birth of a child.
  2. To correct serious problems that interfere with normal function. This group includes women with very large pelvic masses (including some uterine fibroids), serious and incapacitating endometriosis as well as some other uncommon issues related to urinary and bowel function.
  3. To improve the quality of life. This is the largest group of women who eventually undergo hysterectomy and includes women with heavy, irregular or painful periods. Many of these women have fibroids (though not as large as in the previous group). Other women in this group may have uterine or pelvic organ prolapse while some have moderate amounts of endometriosis or adenomyosis.

With the exception of group 1 – there is generally both time and reason for a second opinion.

PERSONAL DISCLAIMER

I have been a practicing gynecologist in Rochester since 1980. Like most gynecologists I trained to perform hysterectomies and was among the first to perform laparoscopic hysterectomies as far back as 1989. Frankly, our practice took off in a different direction and approximately 10 years ago I stopped performing them. They are still necessary and I still refer patients for hysterectomy. However, after years of looking for alternatives to hysterectomy I no longer performed enough of them to feel that I was the best person to offer them. I feel that women who should undergo hysterectomies should be referred to the best physicians I know.

Under no circumstances, should you require a hysterectomy, will I personally perform one—but I will refer to the very best talented surgeons available.

Why It Makes Sense To Have Your Office GYN Procedure Done Here

The Center provides a nationally and internationally standard of excellence in the care of menstrual disorders.  Dr. Wortman has been an important innovator in gynecology since the 1980s.  He has invented procedures such as hysteroscopic endomyometrial resection and reoperative hysteroscopic surgery for endometrial ablation failures.  Dr. Wortman server on the Editorial Board of the Journal of Minimally Invasive Gynecology and is the Medical Director of the Center for Menstrual Disorders and Reproductive Choice. 

At the Center’s offices we also offer the option of virtually any office-based gynecologic procedure to be performed with Intravenous Sedation or with Monitored Anesthesia Care.  Dr. Wortman works with Dr. Stefan Lucas, a Board Certified Anesthesiologist who provides anesthesia care for our patients.

Why is this important?

Many so-called “office procedures” –simply put—are painful.  You may have heard of some of these procedures but here’s a sampling.

  • Insertion of an Intrauterine Device (IUD)
  • LEEP (loop electrosurgical excision procedure)
  • Diagnostic hysteroscopy
  • Cervical biopsy
  • Endometrial biopsy
  • D and C
  • Removal an endometrial polyp (polypectomy)
  • Endometrial ablation
  • Hysteroscopic myomectomy
  • Vaginoplasty

Although many women do fine with having these procedures performed with the use of “local anesthesia” or oral medications, the truth is that most women find these procedures uncomfortable and even painful.

Why doesn’t my own doctor use anesthesia or intravenous sedation in an office-setting?

The simple fact is that gynecology offices in New York State can offer these services only if they are accredited for office-based surgery.  Our office has been accredited since 2008 by the Accreditation Association for Ambulatory Health Care (AAAHC).  Accreditations are performed every 3 years and provides the public with the reassurance that an important standard of care has been achieved and maintained.

If you would like to learn more about having your office-based procedure performed at the Center, please contact our office.

Why Are We The Only Ones?

Why are we the only ones performing Ultrasound Guided Reoperative Hysteroscopy Surgery (UGRHS) for endometrial ablation failure?

So why are you the only one? It’s a question I often get asked from women across the country and abroad.

Let me try and explain this complex issue and why you don’t find this procedure readily available around the country—at least not yet. Continue reading “Why Are We The Only Ones?”

HYSTEROSCOPY – What is it?

Women know of many gynecologic procedures. Many women have heard of terms such as colposcopy, endometrial biopsy, hysterectomy, tubal ligation and others. But most are not familiar with the term “hysteroscopy.” In this brief section we’ll attempt to explain hysteroscopy and how it can benefit women who might be dealing with such issues as abnormal menstrual bleeding, uterine (endometrial) polyps or certain types of fibroids. Hysteroscopy is also often used in the diagnosis of infertility.

Hysteroscopy—sometimes referred to as “Diagnostic Hysteroscopy” and is a test in which a thin “lit” telescope is placed inside the uterus to look within the uterine cavity. The information that is provided by hysteroscopy is enormous.

Here are some of benefits of hysteroscopy Continue reading “HYSTEROSCOPY – What is it?”