As school children, we were always taught to check and double-check our work. So it should come as no surprise that some of the best and brightest surgeons often perform a second-look surgery after a procedure or course of treatment to determine if their patient is free from adhesions (scar tissue). If adhesions are still found during a second-look laparoscopy (SLL), additional procedures may or may not be performed at that time. There are, however, risks to second-look surgery, as well as the cost associated with any surgery.
Gary N. Frishman, M.D., associate director of the Division of Reproductive Endocrinology and Infertility and Residency Program Director at Women and Infants Hospital of Rhode Island and the Warren Alpert Medical School of Brown University, where he is also a professor of obstetrics and gynecology, recently published an editorial entitled 'Is it time to take a second look at second-look laparoscopy?' in the Journal of Minimally Invasive Gynecology, a professional journal for which he is the deputy editor.
'Given both the costs and risks associated with second-look laparoscopy, AAGL (formerly the American Association of Gynecologic Laparoscopists) and our membership should strive to have SLL serve as a model for responsible health care,' said Dr. Frishman. 'This should include a prospective determination of who is the best and, ideally, most cost effective and low-risk candidate alongside capturing outcome data which can be periodically reviewed to confirm any emerging standard of care.'
Laparoscopy is a minimally invasive surgical procedure that involves several small cuts, each measuring less than ½ inch, which are made on the stomach. A tiny camera is put through one cut so the surgeon can see the internal organs on a video screen. The surgeon puts surgical instruments through the other cuts to operate. Laparoscopy gives the surgeon a view that is similar to an open stomach cut but decreases the pain and recovery time.
In discussing SLL, Dr. Frishman concludes that '... it is, indeed, time to take a second look at second-look laparoscopy' to ensure that the procedure is done in a way that balances the benefits to the patient with the costs and frequency of the procedure.
Dr. Frishman said, 'Women and Infants Hospital is fortunate to have many experts in minimally invasive gynecologic surgery such as laparoscopy, and our surgeons are recognized thought leaders on these procedures, the technology, and the best options for our patients.'
About the Journal of Minimally Invasive Gynecology
The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.
About Women and Infants Hospital
Women and Infants Hospital of Rhode Island, a Care New England hospital, is one of the nation's leading specialty hospitals for women and newborns. A major teaching affiliate of the Warren Alpert Medical School of Brown University for obstetrics, gynecology and newborn pediatrics, as well as a number of specialized programs in women's medicine, Women and Infants is the 11th largest stand-alone obstetrical service in the country with approximately 8,400 deliveries per year. It is a U.S. News & World Report 2014-15 Best Children's Hospital in Neonatology and a 2014 Leapfrog Top Hospital. In 2009 Women and Infants opened what was at the time the country's largest, single-family room neonatal intensive care unit.
Women and Infants and Brown offer fellowship programs in gynecologic oncology, maternal-fetal medicine, urogynecology and reconstructive pelvic surgery, neonatal-perinatal medicine, pediatric and perinatal pathology, gynecologic pathology and cytopathology, and reproductive endocrinology and infertility. It is home to the nation's only mother-baby perinatal psychiatric partial hospital, as well as the nation's only fellowship program in obstetric medicine.
Women and Infants has been designated as a Breast Center of Excellence by the American College of Radiography; a Center of Excellence in Minimally Invasive Gynecology; a center for In Vitro Maturation Excellence by SAGE In Vitro Fertilization; a Center of Biomedical Research Excellence by the National Institutes of Health (NIH); and a Neonatal Resource Services Center of Excellence. It is one of the largest and most prestigious research facilities in high risk and normal obstetrics, gynecology and newborn pediatrics in the nation, and is a member of the National Cancer Institute's Gynecologic Oncology Group and the Pelvic Floor Disorders Network.