John T. Repke, M.D., F.A.C.O.G.
Greetings from Penn State Hershey! I am pleased to share with you the first issue of the OB/GYN Medical Report from the Department of Obstetrics and Gynecology of the Penn State College of Medicine and Penn State Milton S. Hershey Medical Center.
We recognize the importance of collaboration among our peer physicians, and regularly work with other academic medical schools to propel our field forward through new research discoveries, better patient care, and educating new physicians. Our hope is that this publication helps inform physicians like yourself of some of this important work, and that you find it to be a valuable resource.
In the coming year, this publication will feature Penn State Hershey clinicians and researchers who are helping to raise current standards of patient care and shape the future of OB/GYN practice. Our department features five divisions – General OB/GYN, Maternal-Fetal Medicine (MFM), Reproductive Endocrinology and Infertility (REI), Gynecologic Oncology, and Urogynecology/ Minimally Invasive Gynecologic Surgery. Continue reading
A residency training program that stresses minimally invasive hysterectomies is proving to be not only feasible, but a highly effective strategy for providing valuable surgeon training and improving patient outcomes. As leaders of Penn State Milton S. Hershey Medical Center’s Division of Urogynecology and Minimally Invasive Gynecologic Surgery, Gerald Harkins, M.D., and his colleague Matthew Davies, M.D., have closely tracked resident performance and patient outcomes. At the September 2013 Minimally Invasive Surgery Week and Endo Expo in Reston, VA, Harkins and his colleagues presented the first full twelve months of outcomes data from the training program. Among 537 patients who underwent hysterectomies for benign indications including abnormal bleeding, pelvic pain, fibroids, endometriosis, and prolapse/incontinence in a single year, 96 percent underwent minimally invasive surgery, either with vaginal or laparoscopic approach with a resident as the lead surgeon or the first assist, explained Harkins in an interview. Training new physicians and surgeons to provide up-to-date standards of care, including the use of minimally invasive techniques and robotic surgery, is a major challenge facing the health care field today. “Most physicians with established practices don’t have the necessary training in minimally invasive techniques, and so despite evidence that such techniques are safer and more cost-effective,1 60 percent of hysterectomies are still open procedures,” says Harkins. Recent nationwide OB/GYN residency training data suggest most U.S. trainees continue to lack needed minimally invasive surgical experience, with the average surgical resident completing sixty-four abdominal, eighteen vaginal, and twenty-three laparoscopic hysterectomies during training.2
Kristin Riley, M.D., fellow, assists Gerald Harkins, M.D. during minimally invasive gynecologic surgery. As part of its residency training program, residents act as lead surgeon or as first assist in 96 percent of the minimally invasive hysterectomy procedures at Penn State Milton S. Hershey Medical Center.
For infertile women with polycystic ovary syndrome (PCOS) or couples with unexplained infertility who wish to become pregnant, fertility treatment is often expensive and invasive, and holds greater risks. Increasingly, couples are being advised to consider in vitro fertilization (IVF) as a front line treatment. “Even though we have effective strategies for inducing ovulation and achieving pregnancy in women with PCOS or unexplained infertility, going straight to IVF for infertility treatment results in high cost and in risky multiple gestation pregnancies,“ explains Richard Legro, M.D., Penn State Hershey Obstetrics and Gynecology. Multiple gestation pregnancies are associated with risks to the mother, as well as the infant, including preterm labor and delivery, infant morbidity, and ensuing financial and personal burden to the parents. Worldwide, rates of twin pregnancies have increased nearly 60 percent, and rates of higher-order multiple pregnancies have increased a staggering 400 percent since 1980, largely ascribed to infertility therapy, including injectable gonadotropins and IVF. Gonadotropin regimens are also associated with increased risk of ovarian hyperstimulation syndrome which can be life-threatening. Continue reading
Ovarian cancer, occurring in approximately 25,000 women each year in the United States, frequently presents as advanced disease, with most cases at stages 3/4 at initial detection. Improvements in chemotherapy regimens and cytoreductive surgery have boosted five-year survival rate to about 40 percent. “On average, most of these patients will require two or three additional cytoreductive surgeries over five years, and right now most are managed with conventional open laparotomies,” explained James Fanning, D.O. of Penn State Hershey Gynecologic Oncology.
Minimally invasive laparoscopic surgery is one strategy Fanning and his colleagues are actively employing to reduce the complications and morbidity associated with repeated cytoreduction in their patients with advanced ovarian cancer. “Because a minimally invasive laparoscopic approach is well-proven to lead to less blood loss, postoperative pain, gastrointestinal complications, and adhesions, this type of procedure was evaluated for cytoreduction in patients with ovarian cancer.” In one report of outcomes among twenty-five patients with advanced stage 3/4 ovarian cancer, all of whom had evidence of omental metastasis and ascites, and in whom Fanning performed laparoscopic cytoreduction, disease outcomes were similar to those typically seen with open laparotomy.1 Continue reading