21 Oct 2010
A new simulator program has been developed to teach gynaecologists the technique of embolisation currently carried out by radiologists.
Gynaecologists who want to practise their skills at choking blood vessels that feed fibroids will be able to do so on a new simulation program by next year.
Dr Bruce McLucas, an American gynaecologist, hopes to train gynaecologists in this minimally invasive technique, which is now generally conducted by radiologists.
The non-surgical method, called uterine artery embolisation (UAE), shrinks fibroids by clamping the blood vessels that feed them, starving them of nutrients that fuel their growth.
A tiny catheter is inserted to block blood flow in the artery that supplies blood to the fibroid.
“Fibroids are the most common benign tumours in women, affecting 40 per cent of those aged above 40. However, the problem is that most gynaecologists do not learn embolisation during their medical training,” said Dr McLucas, 65.
He was in Singapore to give a talk on the simulation technology at the Asia-Pacific Association for Gynecologic (correct spelling?) Endoscopy and Minimally Invasive Therapy, an annual congress from Sept 29 to Oct 3, which brings together specialists from the region.
He performed the first embolisation procedure in the United States in 1994, having learnt the technique in France.
He added that with the help of the medical simulator, gynaecologists should be able to perform the procedure independently within a year.
Trouble with fibroids
Fibroids develop in the muscle of the womb. While most are harmless and can be left alone, some can cause heavy bleeding and pain.
The condition can also dent one’s chances of getting pregnant – for example, if the fibroid happens to block the fallopian tubes.
In nine out of 10 women, embolisation manages to shrink the fibroid by 60 per cent within six months, which is usually enough to stop the pain and other complications.
Although they may not be completely eliminated, this procedure is far less damaging than a myomectomy or hysterectomy, said Dr McLucas.
A hysterectomy involves removing the entire womb, sometimes along with the ovaries and fallopian tubes. A myomectomy is the surgical removal of fibroids while retaining the womb and hence the woman's reproductive capability.
Done under sedation, embolisation leaves no scars and there is no blood loss as well.
Since it is an outpatient procedure, it also means less cost and recovery time for the patient, said Dr McLucas, who was headed to Hong Kong next to present the training module carried out on a machine called the Vascular Intervention Simulation Trainer, or Vist simulator for short.
Developed by Swedish company Mentice, such a machine costs about 70,000 to 230,000 euros (S$127,762 to S$419,738).
Currently, embolisation is done primarily by radiologists and Dr McLucas believes that having gynaecologists perform it instead can benefit women.
“A radiologist is someone who comes in and does the procedure; he doesn’t evaluate the patient beforehand and he doesn’t follow up with the patient afterwards,” he said. “The benefit of having a gynaecologist perform embolisation is that you will have continuity of care.”
An example of how continuity of care can benefit a patient would be in the case where embolisation fails to suppress the fibroids, said Dr Chris Ng, a gynaecologist who runs a private practice at Camden Medical.
“If the procedure fails to reduce or get rid of the fibroids, gynaecologists will need to perform open surgery or laparoscopic surgery,” he said.
Dr Ng added that some patients may also feel more at ease with their regular gynaecologist whom they trust and are more familiar with.
Teamwork rules
However, Associate Professor Tan Bien Soo, senior consultant radiologist at Singapore General Hospital (SGH), said that radiologists should not be shut out as teamwork between different specialists contribute to optimal results.
At SGH, whereby roughly 300 fibroid removal procedures are performed a year using various methods, embolisation involves radiologists, gynaecologists and anaesthetists, with the radiologists performing the procedure itself.
“We believe that each of these specialists has an important but distinct role to play,” he said.
Radiologists are trained in catheter skills and radiation safety – knowledge that ensures the procedure is done safely.
“By working as a team, we ensure the best outcome and best experience for patients,” said Prof Tan, who added that radiologists at the hospital also provide patient care before and after embolisation, alongside gynaecologists.
In nine out of 10 women, embolisation manages to shrink the fibroid by 60% in six months
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Dept of Obstetrics and Gynaecology
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