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Re: NovasureFrom: aditi desai (draditidesai@yahoo.co.uk)Wed Jan 16 02:11:42 2008
I have quite a lot of experience with Novasure.We did 130 cases this year. about 30% true amenorrhoea rate.most of the others just had very light periods. Easy to perform,just takes 2 mins.Does not work(array does not open and cavity integrity teat fails)in very small<4 cm cavities or very large and irregular ones i.e.>10cm.post op pain much lesser than thermachoice.We also did some cases under local anesthetic - half of them tolerated it really well ,half of them did not like the pain during the 2 mins. Its grea >t Aditi
----- Original Message ---- From: "Joanne Bulley, MD" <islesannie@gmail.com> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> Sent: Wednesday, 16 January, 2008 5:53:14 AM Subject: Re: Novasure We started using it in the hospital in 2003 -- really god results. One of my main issues is trying to decide who I think is likely to have adenomyosis. The "failures" I have had where I have done a hyst eventually had either adenomyosis OR total stenosis of the cervix with pain from retained blood in the uterus. I have had 2 of the latter - and one of those was a patient who had had a rollerball ablation years earlier and really wanted to avoid hyst. She had had a Mirena prior to the roller ball (without good resolution of her DUB). With the 20/20 retrospectoscope I think it was incorrect to work with her on her interest in avoiding hyst. The prior HS Ablation resulted in teh cavity being too short - so the Novasure treated the endocervix ad sealed it shut. The Novasure folks really encourage seeking patients who are sick of their menses - almost to the point of doing it for anyone who just doesn't like having menses. I did purchase the unit for the office - falling to that "deal too good to say no to" -- but since I am solo with a mature practice not getting referrals from other docs (since everyone else in town is part of one major group) I have not "used" all the Novasure Devices I purchased. But it will still come out "ahead by having purchased it. I have done a few in the office - and have had a hell of a time getting one insurer to cover the cost of the device. It is a great device. I love it - it is very simple to use - but you should still be "smart" about it and not go willy - nilly using it on anyone who just doesn't like her menses. Even though some other devices have some documentation on a level of effectivness for DUB with fibroids - I really think an ablation procedure should only be done on relatively small uteri that are truly anatomically normal. If the patient has fibroids or polyps - then do some other procedure appropriate to that rather than overuse ablation! So - I stared doing them in the Main OR - then did office - and the other folks in town got the "special services unit" (think - unit where they do colos) - so I have done them there. You "pick" which patient might be best for which spot. The ones for the office have to know up front that it will be like one humongous labor pain. YEs you give some drugs but that is fairly minimal in the office (unless you want to do all that is required to do in office conscious sedation). The ones for our "special services unit" are those that need a bit more in the way of drugs (like some IV fentanyl & Toradol with oral aprazolam. The ones for the main OR are those who "want everything you can give" - ie those who are nulliparous - or those who even after years of gentle gyn exams still lift their bottom off the gyn exam table just for the speculum exam. You know who those folks are! Feel free to e-mail me off list. The printed articles about 5+ years history of follow up show 95% with either amenorrhea (50% or so) or scant menses (45% or so) (panty liners instead of diapers for their flow). The other 5% are either eumenorrhea, hypermenorrhea/mennorrhagia, or hyst. Joanne
At Tue, 15 Jan 2008, Glen Elrod wrote:
>
-- Joanne Bulley,
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