United Healthcare’s Announcement on Laparoscopic GYN Procedures Will Increase the Risk of Unnecessary Invasive Open or Blind Vaginal Procedures; Move prompts other insurance companies to follow suit;
DualPortGYN and LAAM Minimally Invasive Laparoscopic GYN Procedures Do Not Require Power Morcellation
By limiting the kinds of procedures women can have for hysterectomy and myomectomy to treat multiple gynecological conditions, insurance companies may put women at risk for more invasive open procedures that are unnecessary. In February 2015, United Healthcare announced it would not approve procedures that use power morcellators. The following month, additional insurers, Aetna, Cigna, Health Care Service Group and America’s Health Insurance Plans followed suit.
While done with good intentions, the blanket actions could have other consequences. Procedures performed by advanced laparoscopic surgeons, who don’t rely on a robot or power morcellator, can be performed safely and are the least invasive, most effective procedures available.
Conversely, the other surgical option that the insurance companies are giving a pass are single port vaginal procedures, which are often performed blind. What that means is that the procedure is done primarily through the vagina, with no additional incision. While this is the most minimally invasive, it is not the safest. There are risks to performing procedures without having a visual guide to the pelvic cavity. A surgeon cannot guarantee that there will not be collateral damage due to risks of complications from previous surgeries, or infections with pelvic adhesions to the uterus that may make a vaginal removal impossible. Ultimately, this will mean that surgeries will have to be converted to open procedures.
“The real discussion should be on how OB/GYN surgeons can be trained on powerful new techniques and procedures to enhance surgical outcomes for their patients,” said Dr. Paul MacKoul, MD, fellowship-trained laparoscopic GYN surgeon. “These techniques avoid power morcellation, eliminating any potential risk for the spread of cancer, and are safer for patients.”
Power morcellators have been used in conjunction with procedures performed using a robot, and can potentially spread cancer cells in the pelvic cavity.
The issue at hand is the use of power morcellation, which has been used to assist in standard laparoscopic or robotic GYN procedures. Power morcellators have been proven to spread cancer cells if used on a patient without detecting the presence of cancer prior to surgery. When standard laparoscopic or robotics procedures are performed, the assumption by an insurance provider may be that a power morcellator will be used.
By unilaterally grouping all minimally invasive laparoscopic procedures under that umbrella, United Healthcare and other providers ignore advanced minimally invasive laparoscopic procedures that do not require power morcellation.
DualPortGYN and LAAM are two procedures that used advanced techniques for minimally invasive procedures that would otherwise have to be performed in an invasive open surgery.
Both DualPortGYN and LAAM use retroperitoneal dissection, a technique used to map the entire pelvic cavity to prevent injury. DualPortGYN uses uterine artery ligation to control blood loss, and in the case of LAAM, bilateral uterine artery ligation, (BUAL) is used as a temporary measure to control blood loss, while ensuring a healthy uterus for fertility.
The advantage of these advanced techniques is that only 2 tiny incisions are needed, versus a large open incision or a blind vaginal approach. Both of these procedures can be performed on women with fibroids. They have been used to perform thousands of procedures safely.
Morcellation is not always necessary for GYN procedures, but manual morcellation is a safer approach. Manual morcellation when necessary, combined with DualPortGYN or LAAM procedures removes the risk of spreading cancer.
The blanket approach, as started by United Healthcare, may require patients to choose procedures that would require longer recovery times and more pain. Patients with massive fibroids, painful endometriosis, or adenomyosis, GYN cancers, or prolapse who are already suffering, should not have to choose a procedure that may make their condition worse, or require extensive recovery periods.
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