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March 2010 Reading Time: 15 Minutes • Essure – A n Office-based le5950 Univading
ersity Avenue West Des Moines 50266 515.875.9 dge
Permanent Birth Control 2 Option for Your Patients 3 Hearing Technology • Research News in Brief 100 iowaclinic.com innovation communication education Laparoscopy for Gynecologic Cancers The Access Center at The Iowa Clinic By Steven Elg, M.D., Ph.D. – Gynecologic Oncologist By John Matsuura, MD – Vascular Surgeon The Iowa Clinic Gynecologic Oncology Department The Iowa Clinic Cardiovascular Services Department The Iowa Clinic's Gynecologic Oncology Department A patient who faces the prospect of hemodialysis for is pleased to offer the only Single Port Laparoscopic renal failure has tremendous challenges that will alter Program in Iowa for suspected pelvic masses, his or her lifestyle forever. They must commit a half prophylactic salpingo-oophorectomies for patients with day to treatment an average of three times a week. BRCA1/2 mutations as well as early endometrial cancers. Unfortunately, the hemodialysis access fistulas and catheters are prone to complications of thrombosis and infection. It takes a dedicated staff The idea behind this innovative approach is to utilize a single small to monitor and maintain dialysis access in these patients. As vascular incision in a natural orifice of the body such as the umbilicus. Unlike surgeons, we have often played a role in creating robotic surgery which leaves the patient with four to five incisions up to hemodialysis access fistulas and grafts. ¾ of an inch in size or traditional laparoscopy which results in three to However, the role of maintenance was four ½ inch incisions, single port laparoscopic surgery employs a single ¾ not clearly defined and patients often inch incision that is virtually "scar less". presented when their access had already failed. Nephrologists and Since performing the first single port hysterectomy in Central Iowa last dialysis centers had few options year we have found that patient satisfaction has been extraordinarily beyond sending patients to favorable. Technological advances that make the surgery possible include radiology, where they sat in a a 5 mm laparoscope with an articulating head and exceptionally good crowded waiting room until their optics as well as articulating 5mm instruments. Sometimes multiple name was called to undergo complex procedures can be performed through the same small single treatment of their failed access. incision by a team of trained surgeons. Recently Dr. Fialkov, a Urologist with The Iowa Clinic, performed a partial nephrectomy and I followed As a group, we recognized the to remove bilateral ovarian masses through the same tiny incision. This growing problem. How would we surgery was reported to be the first of its kind in Iowa and resulted in a feel, if we were in their situation? Is very short hospitalization as well as a minimal scar for the patient. there a more efficient and cost effective solution? Two months ago, we opened Single port laparoscopy may not be suitable for all women requiring the doors to the Access Center at The Iowa surgery for a gynecologic malignancy, which is why we also perform Clinic. It is the first access center in Iowa and is designed with a clinic robotic and traditional laparoscopy. A decision on the surgical approach to the problem of hemodialysis access. Jessica is our dedicated, approach should be made full time receptionist and scheduling secretary. She talks directly with after careful consultation the dialysis centers and schedules the patients for appointments rather with a physician familiar than the traditional, come early and "pick a number and wait in line". with all available techniques.
Barb Thompson is our access nurse who has many years of experience in both critical care and radiology nursing. Stephanie Steuben is our To contact Dr. Elg please certified radiology technician who comes with several years of experience call 515-241-4161.
in endovascular therapy. Our vascular group covers the Access Center full time to meet the needs of our patients. It is hoped, the patients will recognize our center as their doctor's office. No more hospital registration and sitting in crowded waiting areas. The came walk in and have immediate service. We are also providing ongoing monitoring of their access. We place a high priority on education. Through word of mouth from our patients, we now see referrals from over 15 dialysis centers in the State of Iowa from places as far away as Ottumwa and continued on next page > ®2010 The Iowa Clinic, P.C.

Essure – An Office-based Permanent Birth Control Option for Your Patients By Steven Keller, M.D. – Obstetrician & Gynecologist The Iowa Clinic Obstetrics & Gynecology Department The patient typically is instructed to take an over the counter NSAID, such as Ibuprofen, prior to arriving. Consent is obtained and a negative pregnancy test verified. Toradol IM and a paracervical block are Permanent contraception for women via a simple office administered for patient comfort and to reduce the chance of tubal procedure has been available through our office for spasm. A small 5.5 mm hysteroscope with saline is introduced into the nearly 3 years and has become the method of choice uterus, typically with no dilation required. Once both internal ostia are for most women seeking permanent, non-hormonal birth control. identified, the micro-inserts are placed under direct visualization. The The Essure micro-insert tubal occlusive devise allows the patient to patient is also able to watch the procedure herself as the micro-inserts obtain permanent sterilization in the office setting without the need for are placed. She is observed shortly following the procedure, and then general anesthesia and with no incisions. Compared to the traditional discharged to home. She may resume normal activities immediately if laparoscopic tubal ligation, this procedure offers a much quicker recovery, desired. The entire procedure takes 35 minutes on average.
less risk of operative or anesthetic complications and is considerably less expensive. Some patients will pay only the cost of a simple office co-pay. Like many procedures, the devise was initially placed in an outpatient Patients may experience some mild cramping or spotting for 24 – 48 surgical setting when first introduced in 2002, but has quickly become hours, but symptoms typically respond well to Ibuprofen and rest if a popular office procedure. Since FDA approval, tens of thousands of needed. She should continue to use an alternative birth control method women worldwide have had the procedure and studies confirm 99.8% until the HSG is performed 3 months later. effectiveness at 4 years follow-up.
Patient Selection The Essure procedure is a minimally invasive, non-incisional office First and foremost, this procedure is considered to be 100% permanent procedure which can provide permanent birth control with less risk, and not to be considered reversible. Since there are no hormones less discomfort, quicker recovery, greater efficacy and less cost than involved, the procedure will have no effect on cycle length, flow, laparoscopic tubal ligation, and may even be an option for some patients premenstrual symptoms or menopause. Patients should therefore be that would not be laparoscopic tubal ligation candidates. counseled that their menses will likely return to "normal" but should be reminded that this may be heavier than expected if recently on If and when you have a patient who is a candidate for Essure, we hope you'll oral contraceptives. consider The Iowa Clinic Obstetrics & Gynecology Department. Call 875-9290.
The ideal office candidate should demonstrate normal pelvic anatomy The Essure® Procedure for Permanent Birth Control e Esssssuu uree® Procedure for Permanent Birth Contro and be able to tolerate up to 30 minutes in dorsal lithotomy position. This can be assessed at the pre-operative consultation visit.
The Essure® Procedure for Permanent Birth Control The Essure micro-inserts are inserted through the vagina There are very few contraindications but the procedure should not be The Essure micro-inserts are inserted through the vagina nd i ssnnssttuurr e Fcicaa rrllEssur t inn tshccrhriiss iiar and into the Fal opian tubes without incisions.
performed in individuals with a known nickel hypersensitivity, known and into the Fal opian tubes without incisions.
the vagina and into the Fallopian tubes allergy to contrast media, active pelvic infection or any pregnancy event without incisions.
within the last 6 weeks. This procedure can also be performed in situations in which laparoscopic e EEssssuurree m miiccrroo--iinnse placement,icr roo tubal ligation would not typically be advised such as severe pelvic Fww lalhhooiipipain t e m cicrroo--inise e bararrrieier fo to fit each Fallopian tube. This helps to hold the adhesive disease or multiple prior abdominal/pelvic surgeries. Those micro-inserts in place while a tissue barrier forms.
with cardiovascular or respiratory conditions that may make general anesthesia undesirable may also be candidates for the Essure in an office setting.
g thh During the 3 months af e EEssssuurree p prrter the Essur oocceedduurree, t into the Essure micro-inserts to form a natural, permanent barrier.
he hEe 3 m e Essssuurree mi m cicrroo--inise nt bararrrieier.r.
tissue grows into the Essure micro-inserts to form a Mechanism of Action natural, permanent barrier.
The small, flexible micro-inserts consist of polyethylene fibers tightly wrapped around a stainless steel inner core. An expandable nickel alloy coil surrounds the device and when deployed anchors the device TThhee EEssssuurree C Confir eerrffoorrmmee or med after 3 months. Dye within the junction of the uterus and fallopian tube. Once placed, ssuurr o c is inserted into the uterus and an x-ray is taken to confirm that the polyethylene fibers cause reactive in-growth of tissue, which both n Essssuurree the tubes are blocked and that reliance on Essure for permanent permanently blocks the tubes and permanently holds the device in birth control can begin.
place. This process is generally completed in 3 months and a follow-up low-pressure office radiographic hysterosalpingogram (HSG) is performed to confirm tubal occlusion. Occasionally, an additional 3 months may be Copyright 2007 Conceptus Incorporated. All Right
s Reserved. CC-0304 09Nov07F
Copyright 2007 Conceptus Incorporated. All Rights Reserved. CC-0304 09Nov07F
Copyright 2007 Conceptus Incorporated. All Rights Reserved. CC-0304 09Nov07F
Copyright 2007 Conceptus Incorporated. All Rights Reserved. CC-0304 09Nov07F
required for complete occlusion.
The Access Center. . continued from previous page Renal failure will continue to become a major health care problem with amounts to six times the value of all the gold in Fort Knox. It is our hope, an average growth rate of 7% per year. In the U.S. alone, this is a 75 that the Access Center at the Iowa Clinic will become recognized as a billion dollar problem. World wide, there are over 2 million patients quality leader in this area. on chronic hemodialysis and it is estimated that the cost of dialysis will reach one trillion dollars in the next decade. To put it in perspective, that The Iowa Clinic Vascular Access Center can be reached at 515-875-9750.
Advances in Hearing Technology research news in Brief The Iowa Clinic Department of Urology has a long history of providing By Jennifer Brown, MA, CCC-A – Audiologist the finest care for patients in Central Iowa. The department has The Iowa Clinic Audiology & Hearing Aid Department participated in clinical research for over 13 years, including phase II through phase IV studies, as well as device studies. They have worked Hearing aids have come a long way since our with most major pharmaceutical companies and sponsors. Conducting grandparents' times. Gone are the days of the clunky, clinical research allows the specialty physicians access to leading edge cumbersome, whistling monstrosity jutting out of the ears medicine and treatment, and provides patients with the most current of those with hearing impairment. Today's hearing aids aspects of medical science. are more sleek and streamlined than ever. Not only have the cosmetic aspects of hearing instruments been greatly enhanced, the internal Studies have been completed in nearly every urologic condition, features and fidelity of these new instruments has skyrocketed over including BPH, prostate cancer, erectile dysfunction, bladder cancer, the past 5 years. overactive bladder, stress urinary incontinence, prostatitis, and hypogonadism. The research department has been a research center According to the for pivotal new drug applications to the FDA for the following Sergi Kochin, Ph.D., medications, Cialis, Avodart, Uroxatral, Enablex, Vesciare, Toviaz and Zometa to name a few. Hearing Institute, Right now a multi-center study is underway using High Intensity people in America Focused Ultrasound (HIFU) for prostate cancer. It gives the patient have hearing loss, an opportunity to undergo therapy that offers minimally invasive while there are 22 treatment for recurrent localized prostate cancer that has not spread million people in or metastasized outside the prostate. It is considered investigational in the United States and The Iowa Clinic is one of 20 centers undergoing never tried hearing clinical trials for FDA approval. (HIFU is already approved and used aids. We hope to outside the US. Precision focused ultrasound waves are used to ablate diseased prostate tissue via the Sonablate 500 system. The treatment can be repeated if necessary, and having HIFU does not preclude patients With these advancements in technology we are now able to help patients from having further treatment). that we might not have been able to help in the recent past. Not only has the criteria for hearing aid candidacy been expanded, but the new Urologists at TIC have also begun an international multi-center clinical range of features within the instruments themselves allow exceptional trial to explore treatment for patients with overactive bladder symptoms customization to fit the even the most outgoing lifestyles our that could offer improvement over traditional drug therapy. Patients that are refractive to medical therapy are invited to participate in a double blind, randomized, placebo-controlled study using Botox Active learning processes within the hearing instruments analyze the (Botulinum Toxin Type A) for patients with Idiopathic OAB with wearers preferences in actual listening environments and customize urinary incontinence. the settings accordingly. The need for manual adjustments is ultimately reduced, as is the need for numerous return appointments for the For more information about the clinical research conducted at TIC or about the audiologist to adjust the hearing aid. After all, who is more capable above studies, please contact the research nurses at 515-875-9815, you can also of making decisions regarding their own listening preferences than reach Mary Lepic at [email protected]. the patients themselves? You can contact the Urology Department directly to speak to one of the The most exciting advancement in recent years has been connectivity. participating urologists at 515-875-9800. Hearing aids can now be synched wirelessly to cell phones, televisions, MP3 players and computers. This allows the patient to listen to these devices directly through the prescription tuned hearing instruments, providing exceptional signal-to-noise ratios and clarity. The hearing aid wearer simply carries a small, discreet interface that links the hearing instrument to a number of selected devices and transmits the sound wirelessly to the ear. Amerlon Enriquez, M.D., is now board certified in sleep medicine. Dr. Enriquez is the second board certified sleep In a nutshell…out with the old and in with the new. Hearing aids have specialist at The Iowa Clinic and the West Lakes Sleep Center.
indeed come a long way. We are excited to offer this new technology to customize prescription tuned hearing instruments to the high-tech, active lifestyles with which our patients have challenged us.
Amy McEntaffer, M.D., is now board certified in The Iowa Clinic Audiology/Hearing Technology Department is supported by Obstetrics & Gynecology.
five board certified otolaryngologists. Please call 515-875-9450 to schedule John Houghton, D.O., is now board certified in Obstetrics & Gynecology.
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