it's medical expriments for the lot of you

January 26, 2010 10:30 PM

What do I need to consider before undergoing a medical procedure that my doctor has not yet performed on anyone else?

I have scheduled an adiana procedure with my gynecologist. It's a new nonsurgical procedure that is akin to a tubal ligation but without the anesthesia, incisions, and scars. I'm middle-aged (but nowhere near menopause yet) and I already have children who are nearly grown. My pregnancies were high-risk. No question that I want permanent irreversible birth control. (Reacted badly to IUDs, monogamous, too old for hormones.) But my doc has never done the procedure before -- as simple and noninvasive as it is, I'm still concerned about being a guinea pig. She's been trained in the procedure, but I believe the training is from the adiana company's reps, not from other docs. In general what do I need to be aware of/concerned about & what should I ask my doc about before the procedure? All comments are welcome but I'd especially like to hear from anyone who has participated in medical trials and/or who has had this procedure. (anon because my kids read MeFi!)

posted by anonymous to Health & Fitness (9 answers total)

I'm not an MD, but I found this page on the Adiana website for doctors that says "[a] minimum of 3 proctored cases are required to complete the training". I'm pretty sure that means anyone who's completed the training has successfully done three of these procedures under the supervision of another doctor who has more experience with the procedure, but I'd have to hear from someone with a real medical background to be sure.

Does anyone at your clinic have more experience with Adiana than your doctor? You might be able to have them sit in.
posted by tellumo at 10:55 PM on January 26, 2010

Remember that you are well within your right to ask another doctor to do the procedure if you are for whatever reason uncomfortable. I would investigate the idea from tellumo of having another doctor sit in, consider your gynecologist's experience in performing other related procedures, and try to get a good handle on "what can go wrong if my doctor makes a mistake during the procedure?" vs. the more common "what are the side effects?" Ultimately, it's your body and your call, and if you want someone else to do it, any good doctor should be fully understanding of your choice and support you.
posted by zachlipton at 12:44 AM on January 27, 2010

I know my friend's doctor was going to do his first surgery of a particular sort on her and he said he would have another, experienced surgeon with him.
posted by IndigoRain at 1:12 AM on January 27, 2010

The only really good reason to be your doctor's first case of any procedure is because you trust them, and want them specifically to do it. Most surgical procedures are associated with significant learning curves, and by going first you risk less efficacy and/or more complications. However Adiana is felt to be quite simple, with no significant learning curve. Even so I would not go ahead if the only training has been from the reps, with no supervised cases.
posted by roofus at 3:28 AM on January 27, 2010

Don't be afraid to say "Look, I'm not comfortable being your first case here, so I'd like someone more experienced to do this."

It's fine to be concerned with your doctor's feelings (so be polite, of course) but this is your body.
posted by rokusan at 3:28 AM on January 27, 2010

Ask if it's possible to have another doctor supervise "just in case." Admit that while you have faith in her, you are nervous about the procedure and would like a tiny bit of added security. It may or may not be possible to get a second doc in the room due to scheduling issues, but it will give your doctor a chance to address and allay your fears. That would be how I would handle it. Good luck!
posted by grapefruitmoon at 5:46 AM on January 27, 2010

This sounds very similar to the Essure procedure, though clearly with some differences. Has your doctor performed Essure before? It's been in the UK for awhile now and came to the States in 2002. It may even be a bit more reliable according to some sources than Adiana. If your doctor's performed Essure before, then that may be another option to consider. Also, if he's performed Essure before, I imagine he's probably okay to perform Adiana, but I wouldn't have it done without another doctor fully trained in the procedure present.

Just for posterity, here's a really good comparison of the two procedures in how they're performed, the efficacy of each, and the safety of each.
posted by zizzle at 7:15 AM on January 27, 2010

As others have noted, if you're uncomfortable with this, of course, you can look for another physician to perform the procedure. But there are a few practical realities here that are being overlooked. One is that Adiana was just approved for use by the FDA several months ago. Consequently finding someone with what you might consider to be adequate experience in using the Adiana system might be quite difficult, and you may simply have to wait until Adiana has been in regular use amongst gynecologists. Secondly, while your physician may not have performed this procedure specifically, they may have extensive experience with hysteroscopy which is still at the heart of the Adiana system. I'm by no means an expert on the subject, but would suspect that the Adiana would be fairly easy to perform for someone who is already competent at performing hysteroscopy and hysterosalpingograms.
posted by drpynchon at 10:21 AM on January 27, 2010

You could try telling your doctor something like "I read on the internet that you shouldn't go to a doctor for a procedure unless she's done the procedure at least 5 times. I know that this a new procedure, but even so, having read that made me kind of nervous..." and let her respond to that. You're kind of passing blame on to the internet, while still opening the door for her to explain what precautions she's taking given that you're the first one. Maybe if she knows you're worried, she'll even suggest that you go to someone else.

By the way, for peace of mind: keep in mind that she wants to not mess up as much as you want her not to mess up -- her track record will consist entirely of you until she does another procedure; you and only you will determine whether she can tell her next patient that she has a track record of 100% (or 0%) success. If anything, she'll probably be extra careful and cautious and meticulous than she would be if you were a later patient.
posted by sentient at 12:04 PM on January 27, 2010