Dr. Merve Ozen, interventional radiologist, and Dr. Mark Hoffman, minimally invasive gynecologic surgeon (MIGS), discuss how collaboration between IR and gynecologic surgery provides comprehensive medical, surgical, and interventional treatment options for women suffering from uterine fibroids, pelvic congestion syndrome and other causes of chronic pelvic pain.

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SHOW NOTES

In this episode, host Dr. Aparna Baheti interviews Dr. Merve Ozen, interventional radiologist, and Dr. Mark Hoffman, minimally invasive gynecologic surgeon (MIGS) about how collaboration between IR and gynecologic surgery provides comprehensive medical, surgical, and interventional treatment options for women suffering from uterine fibroids, pelvic congestion syndrome and other causes of chronic pelvic pain.

Drs. Hoffmann and Ozen began a combined clinic after a discussion between their two departments. Though IRs were enthusiastic about performing uterine fibroid embolization (UFE), they were not able to due to a lack of referring gynecologists. Dr. Hoffman was interested in this collaboration, and he knew a very supportive and motivated nurse who wanted to lead this initiative. He says that despite pushback from other MIGs in his department, he had a supportive department chair who allowed the project to go forward.

Next, Dr. Ozen describes a day in their collaborative clinic. She begins by reviewing imaging and patients for the day, ordering new imaging if needed, and discussing patients with Dr. Hoffman. They each see their patients which takes about 45 minutes per visit due to the complexity of chronic pelvic pain and the many potential causes and contributing factors. Some patients require meeting with both physicians to discuss all options. They see four to five patients each day. Every day runs differently depending on the patients and their individual needs, but it runs smoothly due to the supportive nursing staff.

Dr. Hoffman discusses medical management including birth control pills, which are often a first-line option or an option for someone who wants the least invasive treatment. He also offers hysterectomy (laparoscopic, robotic, vaginal, abdominal) for women who wish to never have more uterine bleeding, and myomectomy, with hysteroscopic myomectomy being the most minimally invasive and allowing patients to go home the same day after recovering from anesthesia. Dr. Ozen discusses UFE and treatments for other causes of pelvic pain. She does hypogastric nerve blocks for pain, ovarian vein embolization for pelvic congestion syndrome, and cryoablation for chronic pelvic pain. She has also been able to treat some unique ectopic pregnancies that Dr. Hoffman has seen, including a cervical and an abdominal ectopic pregnancy which provided lifesaving treatment without invasive surgical evacuation.

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RESOURCES

BackTable Ep. 199: Advanced Minimially Invasive Pain Interventions with Dr. Prologo:
https://www.backtable.com/shows/vi/podcasts/199/advanced-minimally-invasive-pain-interventions

Non-surgical management of abdominal ectopic pregnancy with uterine artery embolization:
https://pubmed.ncbi.nlm.nih.gov/35321265/