Gynecology

Plano OB Gyn Associates J. Kyle Mathews, MD

Welcome to the Virtual Office for Plano OB Gyn Associates. Founded by J. Kyle Mathews, MD, Plano OB Gyn Associates is dedicated to providing state of the art care for women. Our staff offers timely, compassionate and personalized care. We strive to provide you with answers and options, as quickly as possible, and to assist you in understanding the personal solutions best suited to meeting your individual needs. Through this site you access to the latest medical information on Women’s Health and the ability to establish a personal medical home in order to receive guidance regarding you healthcare concerns.

Gynecology

Dr. Mathews has vast experience in both general and complex gynecology. A complete range of Gynecological services are offered from adolescent to geriatric care. Services include Annual Well Women Exams, Contraception, STD education and prevention, treatment of Endometriosis, Fibroids, management of menstrual problems, treatment of PMS, and menopausal management. The office has the most up-to-date diagnostic and therapeutic equipment available. Dr. Mathews emphasis on minimally invasive surgery offers patients options such as Laparoscopic Hysterectomy, Laparoscopic Supracervical Hysterectomy, Robotic Surgery, Advanced Vaginal Hysterectomy Techniques, Office based Endometrial Ablation, and Office based Tubal Sterilization.

Gynecology Glossary of Terms – Click Here

Partial List of Procedures

Office Based Procedures

Essure, Permanent Tubal Sterilization,

A is a permanent birth control procedure that works with your body to create a natural barrier against pregnancy. This gentle procedure can be performed in a doctor’s office in less than an hour.

Trusted by women and doctors for over five years, Essure is covered by most insurance providers. If the Essure procedure is performed in a doctor’s office, depending on your specific insurance plan, payment may be as low as a simple co-pay.

Essure offers women what no birth control ever has

No cutting
No going under general anesthesia
No slowing down to recover
No hormones
No guessing – your doctor can confirm when you can rely on Essure for birth control
Short procedure time – Essure only takes about 13 minutes to perform
Trusted by women and doctors for over five years

And you’ll never have to worry about unplanned pregnancy again.

The Essure procedure is permanent and is NOT reversible. Therefore, you should be sure you do not want children in the future.

About the Procedure

The Essure procedure does not require any cutting into the body. Instead, an Essure trained doctor inserts small flexible micro-inserts™ through the body’s natural pathways (vagina, cervix, and uterus) and into your fallopian tubes.

The procedure can be performed in the comfort of a doctor’s office without general anesthesia, and most women resume their normal activities within one day.

During the 3 months following the procedure, your body and the micro-inserts work together to form a natural barrier that prevents sperm from reaching the egg. During this period, you must continue using another form of birth control (other than an IUD or IUS).

Three months after the Essure procedure, a doctor will perform an Essure Confirmation Test, to confirm that the tubes are fully blocked and that the women can rely on Essure for permanent birth control.

Unlike birth control pills, patches, rings, and some forms of IUDs, Essure does not contain hormones to interfere with your natural menstrual cycle. Your periods should more or less continue in their natural state.

Endometrial Ablation, Thermachoice and Novasure are methods of treating Excessive Menstrual Bleeding.

Excessive menstrual bleeding (menorrhagia), is a debilitating condition that affects approximately 22% of all menstruating women and accounts for more than 30% of the 670,000 hysterectomies performed in the United States. Hysterectomy, the second most frequently performed surgical procedure in the United States, is the most common surgical treatment for menorrhagia. Hysterectomies performed to treat excessive menstrual bleeding cost the U.S. healthcare system an estimated $1.5 billion annually.

Both procedures destroy the lining of the uterus resulting in a reduction in menstrual flow. Some patient may experience no bleeding. The success rate is 80% and these procedures can be done in an office setting under local anesthesia or light sedation. The patient may return to work the next day. No incisions are required and your natural hormonal function is not affected. These therapies should not be used if you ever want to have children and a reliable contraceptive method or sterilization should be used after treatment.

Thermachoice

Novasure

Day Surgery or Hospital Based

J. Kyle Mathews, MD, Plano OB Gyn Associates

Dilatation & Curettage (D & C):

A surgical procedure used to remove the lining (endometrium) and contents of the uterus. The D & C is most often used to diagnose and treat abnormal uterine bleeding. It is also used to treat incomplete spontaneous miscarriage. The procedure is normally performed in a hospital or day surgery setting.

Fibroid Tumor Removal (Myomectomy):

Is the removal of fibroid tumors (leiomyoma, myoma) from the uterus. This may be done through incisions in the lower abdomen, or by the use of a Laparoscopy or Robatic. This procedure is indicated in patients who are experiencing pelvic pain, anemia caused by excessive bleeding, pressure on the bladder, abnormal uterine bleeding, difficulty becoming pregnant, and discomfort with sexual intercourse. The procedure is performed in a hospital setting and recovery time is about 2 to 4 weeks. The uterus is left intact, and you will still have menstrual periods. This procedure is most often performed in patient who want the option to have children in the future.

Fibroid Vaporization Therapy:

A technique using a wire loop electrode through a hysteroscope to remove fibroid tumors within the uterine cavity. The procedure is done in the hospital or day surgery setting. The procedure is only indicated for the treatment of fibroid tumors that are within the uterine cavity (submucosal). Patients can generally return to work in 2 to 3 days.

Hysteroscopy:

The Hysteroscopy is a small lighted telescope used for visual examination of the cervix and uterine cavity to help diagnose and treat abnormalities. This procedure is used to evaluate and treat abnormal uterine bleeding, infertility, uterine polyps, fibroids or adhesions, and congenital malformations of the uterine cavity. The procedure may be performed in the hospital or day surgery setting.

Hysterectomy, Abdominal, Vaginal, Laparoscopic, Robotic:

The removal of the uterus, cervix, and possibly the fallopian tubes and ovaries through an incision or incisions in the abdomen or vagina. Hysterectomy is the second-most common surgery among women in the United States, topped only by Caesarean-section (C-section) surgery to deliver babies. Sometimes other reproductive organs are removed at the same time as the hysterectomy. When the cervix is removed along with the uterus, the procedure is called a “complete” or “total” hysterectomy. If the ovaries and fallopian tubes are removed it is stated separately. “Complete or Total Hysterectomy with removal of Fallopian Tubes and Ovaries,” or “BilateralSalpingo-oophorectomy.”If only the upper part of the uterus is removed, leaving the cervix in place, the procedure is called a “partial,” “subtotal” or “supracervical” (pronounced “soop-ruh-SER-vuh-kul”) hysterectomy.

A Word About Hysterectomies. Abdominal, Vaginal, Laparoscopic, or Robotic. Which Approach is right.

Hysterectomy is the most common nonobstetric major surgical procedure performed in the U.S. with over 670,000 performed annually. Today, in the U.S. over 75% of these surgeries are performed by an open abdominal approach. It has been well documented and is the American College of Obstetrics and Gynecology opinion that the majority of hysterectomies performed in the U.S. should be done by the vaginal approach.

Studies have show that the decision to perform a hysterectomy abdominally or vaginally has more to do with the training and experience of the surgeon than the condition for which the procedure is being performed. Many doctors state that having had a prior Cesarean Section, or an enlarged uterus with Fibroids make vaginal hysterectomy not possible. The most recent studies suggest that physicians can perform vaginal hysterectomy in approximately 77 to 89% of patients and Cesarean Section and Fibroids are not contraindications for vaginal hysterectomy.

So why are most hysterectomies done abdominally? The answer has to do with the training programs in the U.S. The overwhelming majority of these programs are heavily weighted with Obstetrical care and provide minimal gynecological surgical training. Many of today’s graduates have less than 10 vaginal hysterectomies on their case list. The deficiency in training and experience in vaginal surgery is a considerable concern for our College and organizations such as The Society of Pelvic Reconstructive Surgeons. The recent development of a sub specialty in Female Pelvic Medicine and Reconstructive Surgery or Urogynecology is one way this problem is being addressed.

Over the past several years, laparoscopic hysterectomies have become popular. The Laparoscopic Supracervical Hysterectomy or LASH procedure has gotten considerable attention in the lay press and on the Internet. The proponents of this approach state there is better sexual function, less vaginal prolapse, and faster recovery. Numerous well designed studies have shown that there is no benefit regarding sexual function and no deference in the incidence of vaginal prolapse. Furthermore, the benefits of a decreased recovery time are only present when Laparoscopic Hysterectomy is compared to an Open Abdominal approach and not a vaginal hysterectomy.

“There has been renewed interest in supracervical hysterectomy as a way to reduce operative complications and reduce the effects of hysterectomy on urinary and sexual function. Unfortunately, these possible benefits are not supported by recent evidence,” says Denise J. Jamieson, MD, chair of ACOG’s Committee on Gynecologic Practice. Studies go on to say that Laparoscopic Supracervical Hysterectomy is associated with increased operative time, increased operating room expense, increased complication with injury to the bladder being the most common, and up to a 20% rate of cyclic bleeding from the cervical stump when the cervix is left behind. While there are indications for these approaches, they should be based on medical indications and not marketing. I do perform these approached in those patients where this approach is indicated.

Robotic Surgery has now become the next marketing campaign to be presented to patients. The da Vinci is stated to be “one of the most effective, least invasive treatment options for a range of uterine conditions. da Vinci Hysterectomy is performed using the da Vinci^™ Surgical System, which enables surgeons to perform with unmatched precision and control – using only a few small incisions.” This technology, while impressive, essentially takes the Laparoscopic Hysterectomy to a new level of complexity and cost. The proposed benefit of improved precision, less complications, less blood loss, shorter hospital stays, less scaring, less pain, and faster return to normal daily activity have shown to be true when compared to open abdominal hysterectomy. When compared to Laparoscopic Hysterectomy these benefits are less obvious and when compared to Vaginal Hysterectomy, they are non existent. Studies have shown that the average operative time is nearly doubled and the complication rate is significantly increased during the initial learning phase. The Robot does not make a surgeon a better surgeon.

The Robots true benefit is in cases where the patient would have to undergo an Open Incision such at treating Endometrial (Uterine) Cancer or where hysterectomy would have to be done open, abdominal approach, because of some condition present. In the case of Endometrial Cancer, patients traditionally have an Open Abdominal Hysterectomy and Biopsy of Lymph Nodes. With Robotic Surgery, the patient can undergo a Laparoscopic or Vaginal Hysterectomy and then the Robot is used to do the Lymph Node Biopsies. The Robot also is of benifit in cases where a large amount of suturing is required such as Myomectomy. Suturing with the Robot is easier than with a laparoscopy. This technology is remarkable and should be used. It should however not be marketed as having benefits over vaginal hysterectomy. NO STUDY to date has shown that to be the case. When vaginal hysterectomy is not possible, Robotic Surgery may be a viable option.

Dr. Mathews offers the da Vinci Surgical System for patients with complex gynecological problems as part of his ongoing effort to bring the most advanced minimally invasive tools and technology to his patients.

So which approach is right? There may be instances in which any of the above mentioned approaches for hysterectomy would be appropriate. That said, the literature is clear in its findings that vaginal hysterectomy should be the preferred approach whenever feasible. See the references below.

Reference: (web links)

American College Of Obstetrics & Gynecology http://www.acog.org/from_home/publications/press_releases/nr10-21-09.cfm

Society of Pelvic Reconstructive Surgeons

http://www.sprs.org/determining-the-route-of-hysterectomy-sprs.html

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