JOURNAL ARTICLES

 WOMEN'S HEALTH 

As a cancer surgeon performing surgery on women in the second half of their lives, menopause is a frequent issue of concern. Whether or not to use hormones in the natural or surgical menopause, and which safe combination of estrogens and progestogens is helpful and safe has been a frequent topic of Dr. O’Hanlan’s early research. Dr. O’Hanlan has participated in two national hormone trials: WHI, PEPI, and ACS

 

The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial, in which she contributed to two reports on the effects of hormones on the uterine lining with regard to precancer and cancer formation.

 

And another, in which she co-authored a report on diagnosing precancer and cancer formation in the uterine lining using ultrasound measuring of the thickness of the lining.

 

She also contributed to the manuscript on risk for heart disease in the menopause. 

 

WOMEN’S HEALTH RESEARCH GRANTS:

  • 1990-1995 - National Cancer Institute, Postmenopausal Estrogen/Progestin Interventions Trial (PEPI) (#HL25562).

  • 1994 - National Institutes of Health, Multicenter Trial of Group Therapy for Breast Cancer, Spiegel D, O'Hanlan K, Carlson R, SPO Grant (#13330).

  • 1994 - American Cancer Society, Stanford University Institutional Research Grant, Prevention of Endometrial Carcinoma in Obese Women with cyclic Provera. (#2-HJZ-620).

  • 1994  - American Medical Association, Women Physicians Health Study, Erica Frank, M.D. and K. O'Hanlan, M.D., survey of 2,500 female members of the American Medical Association and the American Association of Physicians for Human Rights.

  • 1995 - National Institutes of Health, Woman Health Initiative (WHI), Clinical Trial and Observational Study, Marcia Stefanick, (WH-93-90-W).

  • 1995-1997 - National Institutes of Health, Postmenopausal Estrogen/Progestin Interventions. Follow-up (PEPI), Marcia Stefanick, (NIH #N01-HV-48134). 

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Dr. O’Hanlan removed the largest tumor in the word.
(See video here)

WOMEN’S HEALTH CURRICULA:

  • 1995 - Third Year Curriculum in Reproductive Health, Women’s Health Clerkship, Stanford University School of Medicine.

  • 2000 - Fourth Year Curriculum in Reproductive Health. Healthy Women, Healthy Lives, MCP  Hahnemann School of Medicine, Philadelphia, Pa.

  • 2004 - Reproductive Health Initiative, Model Curriculum, 2nd edition, American Women’s Medical Association.

She then wrote a book, three medical school curricula and four book chapters to synthesize this information so that physicians can help all women to achieve their maximal health.

Natural Menopause: Guide To A Woman’s Most Misunderstood Passage

Perry, Susan, and Kate O’Hanlan, Addison Wesley Publishing Company, New York, NY, 1996.

Natural Meno Book cover.png

The San Francisco Chronicle called the first edition of Natural Menopause

”the most authoritative and wide-ranging explanation of the basics of menopause yet published.” Now in this newly revised edition, authors Susan Perry and Kate O'Hanlan include all the latest information on hormone replacement therapy and breast cancer, as well as new studies on menopause and osteoporosis, heart disease, Alzheimer's, depression, exercise, diet and malnutrition, natural remedies, skin patches, and much more. Without minimizing the discomfort many women experience, Perry and O'Hanlan show that good nutrition, a good exercise program, and good sex are often the best prescriptions—and that hormone replacement therapy carries risks and should be taken only after careful and informed deliberation. Natural Menopause is the comprehensive reference every woman should turn to before and during menopause for a safe and healthy passage.

WOMEN’S HEALTH BOOK CHAPTERS:

O'Hanlan, K.A. and Fourcroy, J., "Reproductive System," Chapter 10. The American Medical Women's Association Women's Healthbook, The Philip Leif Group, Inc., New York, NY 1995.

 

Rosenbaum, M. and O'Hanlan, K.A., "Sexuality," Chapter 12. The American Medical Women's Association Women's Healthbook, The Philip Leif Group, Inc., New York, NY 1995.

 

O'Hanlan, K.A., "Menopause," in Behavioral Medicine for Women:  A Comprehensive Handbook, ed.: E. Blechman, Guilford Publications, New York, 1995.

 

O'Hanlan, K.A. and Fourcroy, J., Part 1, "The Reproductive System" The American Medical Women's Association Guide to Pregnancy and Childbirth, The Philip Leif Group, Inc., New York, NY 1995.

 

 PATHOBIOLOGY OF GYNECOLOGIC CANCERS 

Pathologists at Stanford classified two different types of endometrial cancer. One was very usually curable with just a hysterectomy, and the other required hysterectomy and additional surgical procedures to diagnose spread, and usually required chemotherapy as well. While at Einstein, Dr. O’Hanlan had multiple patients in whom an intermediate cancer was observed by our pathologists. It had some features of each of the two types, and these patients had an intermediate survival pattern. The message about the virulence of papillary endometrial cancer is that even in apparently early stages, one must look for metastases and consider chemotherapy if spread is seen.

 

During her first few years at Stanford, while operating on women with ovarian cancer, Dr. O’Hanlan sometimes noticed small nodules a few inches away from the obvious cancer nodules that were on the surface of the intestines. She also sometimes noticed that some of the lymph nodes directly underneath the involved bowel were sometimes enlarged, which is where the intestines drain into the lymphatic system. Rarely, it was observed that the ovarian cancer had invaded directly through the wall, to varying extents into the bowel wall layers, sometimes right through the wall into the lumen (inside).

Mere papillary features of endometrioid carcinoma increase virulence.png

Mere papillary features of endometrioid carcinoma increase virulence

Upon removing these involved bowel segments, and studying them under the microscope, it was found that these nodules had indeed invaded the multiple layers under the surface, and in the mesentery were metastases of cancer that had spread underneath the surface of the bowel within the longitudinal lymphatic channels, and around the bowel wall into the channels in the mesentery, enlarging those lymph nodes just as had been seen with colon cancer that starts inside the bowel wall.

It was known that primary colon cancer spread by invasion through the wall to the outside of the bowel, and longitudinally under the surface lymphatic channels, and into the lymph nodes that are in the mesentery. That is why colon cancer surgeons remove an extra 2 inches of bowel away from where the cancer was growing inside the bowel and also remove a pie shaped wedge of the mesentery in order to remove the possibly involved lymph nodes.

Ovary cancer on surface of bowel can invade and access lymphatics.png

Ovary cancer on surface of bowel can invade and access lymphatics

Historically, the instruction in bowel surgery performed for ovarian cancer involvement has been to remove only the “sleeve” of the bowel and to not resect any of the mesentery as it was thought that ovary cancer just sits on the bowel surface, without invading the wall or entering the lymphatics.

However, this research confirmed that ovarian cancer did not just sit on the bell, but rather invaded through it, and longitudinally underneath the surface, and around it into the mesenteric lymph nodes. The longer the patient had the cancer after initial diagnosis or after secondary, later, surgery, there was an increasing likelihood of finding cancer invading deeper into the layers, and even through the wall, and in the lymph nodes of the mesentery.

This changed the instructions for how Gynecologic Oncologists remove the bowel when it is involved with ovarian cancer.

It is now known that ovarian carcinoma metastases to gastrointestinal tract appear to spread like colon carcinoma. Gynecologic Oncologists do not simply remove a sleeve anymore, but rather remove the segment that is involved with cancer, plus a 5 cm longitudinal distance of uninvolved bowel, and the mesentery beneath it in a wedge-like fashion, as is performed for colon cancer. This now gives ovarian cancer patients their greatest chance of achieving “zero visible residual” which greatly increases their survival probability.

 

Dr. O’Hanlan also contributed to the manuscripts of others writing about intestinal cancers that spread to the ovaries, salivary gland cancers that spread to the ovaries, and blood tests for cervical cancer.

 

 LAPAROSCOPIC SURGERY 

Laparoscopic hysterectomy is safe for very obese women and very large uteruses and ovaries. Many surgeons have thought that obese women should not have laparoscopic surgery attempted, but it has been shown that this is by far a safer TLH approach for very high-BMI women with a much quicker recovery. Especially when a pelvic mass is present, TLH can reduce complications and get a women back to her life more quickly and safely. Dr. O’Hanlan has proved that TLH can be performed in women whose BMI is even very high, over 40, with no higher complications than those with lower BMI’s.

 

Even massive uteruses can be removed laparoscopically. Dr. O’Hanlan proved that the impact of this approach may result in a tiny amount of higher blood loss, but is safe and effective and preferred. The size and configuration must be studied by ultrasound so that the size can be estimated. They can be placed in surgical bags, which are brought out through the vagina, and then the massive uterus is removed piecemeal through the vagina from within the bag.

 

Sterilization of the outside of the body should be done effectively. Preparing the patient’s abdomen for surgery requires sterilizing the entire abdomen, the upper thighs, the entire vulva and the inner vagina. Dr. O’Hanlan pioneered the most economical and efficient approach to doing this is with a single field prep, which is proven to be safe. Instructions for nurses in single field prep have been provided by my co-author, and the Director of Gynecologic Surgery at my former hospital, Beth Charvonia, RNBS.

Single field prep (We use chlorhexidine now).png

Single field prep (We use chlorhexidine now)

Everting the unbo for a central incision, invisible.png

Everting the unbo for a central incision, invisible

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Colpotomy closed with good USL support

The first entry into the abdomen can be challenging. Dr. O’Hanlan exclusively uses direct trocar entry, through the apex of the bellybutton, in order to leave a beautiful scar that cannot be seen because it is deep inside the belly button. This technique is also safest and fastest.

 

Identifying the bladder margins, checking the inside, and preventing bladder pain are important.

Difficult dissection’s around the bladder during laparoscopic surgery can be very difficult due to adhesions, endometriosis, or prior surgery. Dr. O’Hanlan pioneered the technique of identifying the bladder margins by puffing out the bladder with air (Cystosufflation), which she has shown to be safe, and preventive of injuries to the bladder.

 

Sometimes it’s necessary to look inside the bladder during or after advanced laparoscopic surgery in order to make certain that there are no holes in the bladder and that the ureters are pumping the urine from the kidneys in the normal fashion. Dr. O’Hanlan pioneered the procedure, Laparoscopic cystoscopy, in which the tiny camera-scopes are used to look in the bladder, assuming all the tissue surfaces have been adequately cleansed and sterilized.

 

Preventing pain after TLH is important. It is now standard to give pain preventative medication prior to surgery so that patient’s wake up comfortably. Some patients have exquisite bladder pain after TLH whether they have a look inside their bladder (cystoscopy), or just the usual total laparoscopic hysterectomy procedure. It has been shown that preoperative Pyridium, a bladder-specific pain medication, reduces pain after a laparoscopic hysterectomy, especially when cystoscopy is performed.

Assessing and restoring support to the vagina is essential at every hysterectomy. After performing a laparoscopic hysterectomy, closing the upper end of the vagina can be challenging and complicated. Support for the vagina during the closure of the top of it must always be provided so that prolapse does not happen years later. A Uterosacral Ligament suspension of the top of the vagina can be performed by all Gynecologic surgeons.

 

One medium sized incision around the belly-button or four teeny weenie incisions?

In 2007, Dr. O’Hanlan performed the first single incision total laparoscopic hysterectomy, bilateral removal of the tubes and ovaries and appendectomy. This surgery left a 4 cm incision around the patient’s belly button, which, upon later inspection, Dr. O’Hanlan deemed was less satisfactory then having four tiny hidden half inch incisions placed discreetly around the abdomen.

Should appendectomy be performed with gynecologic surgery?

In 2008, Dr. O’Hanlan published the results of having performed 257 appendectomies on what is called an “incidental basis” (not essential to the reason for the surgery, unnecessary but preferred) for her gynecologic surgery patients. Since women are at risk of getting appendicitis even late in life, and because this is this problem can be hard to diagnose and result in a delay, and greater sickness, prevention seem to be prudent. After 762 incidental appendectomies, it was still seen to be safe during laparoscopic surgery. Whether a woman’s surgery is by open-incision or laparoscopically, an “unnecessary appendectomy” is safe and well tolerated.

 

Dr. O’Hanlan pioneered performing an appendectomy at every (open-incision or laparoscopic) gynecologic surgery in which the patient consents. This procedure is credited with reducing risk of prolonged hospitalization for appendicitis later in life.

 

Complications are indeed associated with performing total laparoscopic hysterectomy, but they should not be any higher than those associated with the old-fashioned open hysterectomy.

After Dr. O’Hanlan had performed her first 830 total laparoscopic hysterectomies, she published her complications that her patients had suffered on their intestinal tracts, their urinary tract, the vascular system, and healing problems. Fortunately these were appropriately rare, and have become even more rare over the last 20 years, as she has performed over 2300 laparoscopic hysterectomies.

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Dr. O'Hanlan with co-author, director of gynecologic surgery  Beth Charvonia, RNBS.

 LAPAROSCOPIC CANCER  HYSTERECTOMY   AND LYMPHADENECTOMY SURGERY  

 

Dr. O’Hanlan founded the Laparoscopic Institute for Gynecology and Oncology (LIGO) because Gynecologic surgeons were slow to learn the procedure, with only 20% of hysterectomies being performed laparoscopically in 2006.

Gynecologic Oncologists were lagging even further behind General Gynecologists in adopting laparoscopic surgery over laparotomy (open incision), possibly because the idea that hysterectomy for cancer, which can often require additional procedures such as lymph node dissections and omentectomy, could not be performed through tiny incisions. They can.

Eventually the pursuit of overcoming the dogma that open-incision surgery was exclusively appropriate for cancer cases was best served by establishing a series of proofs thorough the literature:

 

Total laparoscopic hysterectomy (TLH) was better for endometrial cancer than open (TAH).

Total laparoscopic hysterectomy (TLH)  is proven to be especially safe and preferable for elderly with cancer, and proven to be especially safe and preferable for obese with cancer.

 

TLH is effective when pelvic lymph node dissection (lymphadenectomy) needed even when the patient is obese.

 

Dr. O’Hanlan established that adequate number of nodes can be removed laparoscopically from high aortic area, and produced teaching videos showing technique for Laparoscopic infrarenal lymphadenectomy. She made a poster at 2015 SGO meeting comparing two routes for high aortic lymphadenectomy and a poster showing results of results of high aortic lymphadenectomy (at right). She described her video showing high aortic lymphadenectomy rational technique is safe and feasible.

Comprehensive lymphadenectomy 2 approaches poster.jpeg
Comprehensive Lymphadenectomy poster.jpeg

A comprehensive therapeutic lymphadenectomy for cervical cancer staging can be lifesaving and help with radiation treatment planning. After performing many lymphadenectomies, Dr. O’Hanlan compared two approaches and proved that the extraperitoneal route for high aortic lymphadenectomy is easier to learn. Finally, Dr. O’Hanlan confirmed that the extraperitoneal high aortic/pelvic lymphadenectomy does not negatively impact quality of life.

 

The extraperitoneal infrarenal lymphadenectomy technique is safe, and can influence treatment decisions about radiation or chemo, in An Atlas of Gynecologic Oncology Investigation and Surgery.

 

Radical inguinal lymphadenectomy using laparoscopic N.I.R. light can identify important nodes that drain the cancer area in vulvar cancer.

 

 SURGICAL EDUCATION 

In 1992, Dr. O’Hanlan began developing her technique for Total Laparoscopic Hysterectomy (TLH) and related cancer procedures that met all the surgical and oncologic standards she was trained to observe. She then published many journal articles on laparoscopic techniques which she pioneered, confirming that patients benefited from the much smaller incisions of laparoscopic surgery, compared to patients operated with the traditional open-incision technique. Nearly all patients go home the next day, and return to work within two weeks.  A typical open, abdominal procedure involves a five-to-seven inch incision and a six week recovery period.  

 

​Whenever safely possible, hysterectomy and other gynecologic surgeries should be performed in a minimally invasive fashion, because this route of surgery confers more health and safety benefits and precludes the possibility of many severe complications related to large incisions. The morbidity and mortality burden for any individual patient, as well as the burden in terms of increased costs to the healthcare system writ large, is massive. She has published a number of articles describing newer and safer techniques, including articles on how to perform said techniques in the context of a known malignancy. More recently the focus of these efforts has been channeled through the annual LIGO meeting, but she gave frequent lectures, video presentations, plenary discussions, etc. at international major meetings (AAGL, ACOG, SGO, et al.). 

 

Dr. O’Hanlan is one of the most experienced laparoscopic surgeons in the United States. She has performed over 2,300 total and radical laparoscopic hysterectomies, and has taught these techniques at workshop sessions internationally.

 

Dr. O’Hanlan was considered a “high volume surgeon,” performing upwards of twenty major laparoscopic procedures every month.  “Published evidence confirms that high volume surgeons offer patients the best outcomes,” she says.  “After surgery, my patients would come back to see me and say, ‘I can’t believe how good I feel.  If I had known it was going to be this easy, I would have done it years ago.’”

 

To establish her credentials in education, she qualified in three ways:

She took the exam for General Surgeons in the Fundamentals of Laparoscopic Surgery (FLS) in May 2008.

In June 2012, she submitted fifty of her most complex surgeries with the pathology reports and was accredited with AAGL’s highest surgical certification: Council of Gynecologic Endoscopy, Oncology Subspecialty, level 4 (CGE-4).

She also volunteered to take the AAGL Essentials in Minimally Invasive Gynecology (EMIG) exam in July 2012 to complete her advanced certifications.

By 2006, Dr. O'Hanlan saw that laparoscopic technology could be used to perform 98% of benign and most (but not all) gynecologic cancer conditions; but even with such well-documented benefits, there was a slow uptake in the mainstream use of these procedures in the early 21st century. She thus founded the Laparoscopic Institute for Gynecologic Oncology (LIGO) and wrote the course in 2006, certified by the American College of Obstetrics and Gynecology and the American Board of Obstetrics and Gynecology, teaching over 2,600 surgeons from 43 countries around the world minimally invasive surgeries, using both cadavers and pelvic simulators.

 

Dr. O’Hanlan proved that the LIGO evidence-based educational strategy worked to promote skills that translated to participant surgeon’s operating room skills in the research report on the course’s effects.

 

She was also a frequently invited speaker at the annual clinical meeting of the international Society for Gynecological Oncologists (SGO) and the American Association of Gynecologic Laparoscopists (AAGL), presenting her LIGO evidence-based surgery learning strategy, with 41 poster and video presentations, 7 University grand Rounds and ations, and 60 journal publications to date.

  1. O'Hanlan, KA, Garnier, A-C, Huang, G, Comparison of Total Laparoscopic and Laparotomic Hysterectomies, #251, Journal of the Society of LaparoEndoscopic Surgeons, Annual Meeting, Orlando, FL, 4:368, 2000.

  2. O'Hanlan, KA, Garnier, A-C, Huang, G, Lopez, L, Total laparoscopic or laparotomic hysterectomies: Comparison of a non-randomized series of 55 surgeries for endometrial carcinoma, sarcoma or hyperplasia in a teaching hospital, #98, Annual clinical meeting of the Society of Gynecologic Oncology, Nashville, TN, March, 2001.

  3. O'Hanlan, KA, Huang, GS, Garnier, A-C, Lopez, L, Role of total laparoscopic hysterectomy in the management of adnexal pathology and BMI, Poster presentation at the annual clinical meeting of the Society for Gynecologic Oncologists, January, 2003.

  4. O'Hanlan, KA, Dibble, SL, Huang, GS, Garnier, A-C, Total Laparoscopic Hysterectomy for oncological indications with outcomes stratified by age, Abstract #259, page 157, proceedings from the Annual Meeting on Women’s Cancer, Society of Gynecologic Oncologists, San Diego, CA, February 7-11, 2004.

  5. O'Hanlan, KA, “Total Laparoscopic Hysterectomy for Oncological Indications” video, Annual Meeting on Women’s Cancer, Society of Gynecologic Oncologists, San Diego, CA, February 7-11, 2004.

  6. O'Hanlan, KA, “Total Laparoscopic Staging for Gynecologic Cancers” video, Annual Meeting on Women’s Cancer, Society of Gynecologic Oncologists, San Diego, CA, February 7-11, 2004.

  7. O'Hanlan, KA, O’Holleran, Michael “Radical Pelvic Lymphadenectomy” video, Annual Meeting on Women’s Cancer, Society of Gynecologic Oncologists, Miami Beach, FL, March 3-5, 2005.

  8. O'Hanlan, KA, O’Holleran, M, “Radical Para-Aortic Lymphadenectomy” video, Annual Meeting on Women’s Cancer, Society of Gynecologic Oncologists, Miami Beach, FL, March 3-5, 2005.

  9. O'Hanlan, KA, O’Holleran, MS, Morbidity of total laparoscopic hysterectomy with oophorectomy (TLHBSO) versus bilateral salpingo-oophorectomy (BSO) for patients with familial ovarian cancer risk or adnexal pathology. Proceedings from the Society of Gynecologic Oncologists Annual Clinical Meeting, Palm Springs, March 22-26, CA 2006.

  10. O'Hanlan, KA, O’Holleran, MS. Total Laparoscopic Hysterectomy for Uterine Pathology: Impact of Body Mass Index on Outcomes. Proceedings from the Society of Gynecologic Oncologists Annual Clinical Meeting, Palm Springs, CA, March 22-26, 2006.

  11. O'Hanlan KA, O’Holleran M. Morbidity of total laparoscopic hysterectomy  +/- staging lymphadenectomy for uterine neoplasia. Proceedings from the Society of Gynecologic Oncologists Annual Clinical Meeting. March 22-26 2006.

  12. O'Hanlan, KA, O’Holleran, MS. Morbidity of total laparoscopic hysterectomy +/- staging lymphadenectomy for uterine neoplasia. Proceedings from the Society of Gynecologic Oncologists Annual Clinical Meeting, Palm Springs, CA, March 22-26, 2006.

  13. O'Hanlan, KA, O’Holleran, MS, “Total laparoscopic hysterectomy in a 350 lb. nulligravid women” video, Annual Meeting on Women’s Cancer, Society of Gynecologic Oncologists, Palm Springs, CA, March 22-26, 2006.

  14. O'Hanlan, KA, O’Holleran, MS, “Total Laparoscopic Radical Hysterectomy (Wertheim III)” video, Annual Meeting on Women’s Cancer, Society of Gynecologic Oncologists, Palm Springs, CA, March 22-26, 2006.

  15. O'Hanlan, KA, Dibble, SL, Garnier, A-C, Reuland, ML, Total laparoscopic hysterectomy: technique and Districts complications from 750 cases, Abstract #7533, proceedings from the Annual District Meeting, 3,6,8,9 American College of Obstetricians and Gynecologists, Kohala Coast HA, November 10, 2006.

  16. O'Hanlan, KA, Dibble, SL, Garnier, A-C, Reuland, ML, 199 Incidental appendectomies during total laparoscopic hysterectomy, Abstract #7661, proceedings from the Annual District Meeting, Districts 3,6,8,9 American College of Obstetricians and Gynecologists, Kohala Coast HA, November 10, 2006.

  17. O'Hanlan, KA, S. P. McCutcheon, et al. (2011). "Laparoscopic hysterectomy: impact of uterine size." Presented at the Annual meeting of the AAGL in Las Vegas, NV, 2010

  18. O'Hanlan, KA, "Total Laparoscopic Hysterectomy:  Evaluation of an evidence-based educational strategy using a novel simulated suture and knot-tying challenge, the “Holiotomy” Presented at the Annual meeting of the AAGL in Las Vegas, NV, 2010, Journal of Minimally Invasive Gynecology 17 (2010) S1–S24.

  19. O'Hanlan, KA, “Retroperitoneal Lymphadenectomies" video, Presented at the Annual meeting of the AAGL in Las Vegas, NV, 2010.

  20. O'Hanlan, KA, “Retroperitoneal Lymphadenectomies" video, Presented at the Annual meeting of the AAGL in Las Vegas, NV, 2010.

  21. O'Hanlan, KA, “Retroperitoneal Lymphadenectomies" lecture and slide presentation, Annual Meeting on Women’s Cancer, Society of Gynecologic Oncologists, Orlando, FL, March 22-26, 2011.

  22. O'Hanlan, KA, “Total Laparoscopic Hysterectomy (Wertheim I)” lecture, Annual Meeting on Women’s Cancer, Society of Gynecologic Oncologists, Orlando, FL, March 22-26, 2011.

  23. O’Hanlan, KA, “Prevention and management of hemorrhage during laparoscopic surgery” Grand Rounds, M. D. Anderson Cancer Center, Houston, TX, August 24, 2011.

  24. O'Hanlan, KA, “Avoiding complications with TLH" “Managing complications with TLH” lecture and slide presentation, “Combined single-field Prep for TLH” video presentation, Annual Meeting of American Association of Gynecologic Laparoscopists, Hollywood, FL, November 7, 2011.

  25. O'Hanlan, KA, “TLH for Endometrial Carcinoma: Highest Standards of Care " “TLH—Detailed Dissections- Tips and Tricks” “TLH for women with massive uteri” “Laparoscopic Management of Pelvic Masses” “Laparoscopic Radical Hysterectomy and Pelvic Lymphadenectomy” “Laparoscopic Retroperitoneal Lymphadenectomies“ lecture and slide presentations, The First Romanian National Congress of Minimally Invasive Surgery in Gynecology and the 08th International Congress of AAGL, June 27 - 30, 2012, Palace of the Parliament, Bucharest, Romania.

  26. O'Hanlan, KA, J. Ferry, M. Chivukula, M. Harrington, M. O'Holleran, Comparison of aortic nodes yields and metastasis rates above and below the inferior mesenteric artery in clinically low stage carcinomas, poster at Society for Gynecologic Oncologists Annual Meeting, March 9-12, 2013, Los Angeles, CA.

  27. O'Hanlan, KA, J. Ferry, M. Chivukula, M. Harrington, M. O'Holleran, Transperitoneal versus retroperitoneal approach for staging aortic lymphadenectomy, poster at Society for Gynecologic Oncologists Annual Meeting, Los Angeles, CA, March 9-12, 2013

  28. O'Hanlan, KA, J. Ferry, M. Chivukula, M. Harrington, M. O'Holleran, Impact of obesity on surgical outcomes of laparoscopic radical pelvic lymphadenectomy for women with cervical, endometrial or ovarian cancer, poster at Society for Gynecologic Oncologists Annual Meeting, Los Angeles, CA, March 9-12, 2013.

  29. O'Hanlan, KA, Direct Trocar Entry Via Umbilical Apex, video for plenary presentation at the American Association of Gynecologic Laparoscopists annual clinical meeting, Washington DC, November 10-14, 2013.

  30. Plenary speaker, Society for Gynecologic Oncology debating conventional laparoscopy v. robotic dependent surgery in gynecologic oncology. Annual clinical Meeting for the Society for Gynecologic Oncology, Tampa, FL, March 23, 2014

  31. O'Hanlan, KA, M.S. Sten, N.N. Ford, M. Chivukula, S.P. McCutcheon, Laparoscopic retroperitoneal therapeutic pelvic to infrarenal lymphadenectomy, poster #317 at Society for Gynecologic Oncologists Annual Meeting, Chicago, IL, March 27-29, 2015.

  32. O'Hanlan, KA, M.S. Sten, N.N. Ford, M. Chivukula, S.P. McCutcheon, Laparoscopic comprehensive therapeutic pelvic to infrarenal lymphadenectomy, poster #319 at Society for Gynecologic Oncologists Annual Meeting, Chicago, IL, March 27-29, 2015.

  33. O’Hanlan, KA, Comprehensive therapeutic pelvic to infrarenal aortic lymphadenectomy, video presentation for Society for Gynecologic Oncologists Annual Clinical Meeting, San Diego CA, March 19-22, 2016.

  34. O’Hanlan, KA, Radical vulvectomy with sentinel node detection using indocyanine green (ICG) and near infrared (NIR) merged visualization, SGO 48th Annual Meeting on Women's Cancer, Washington DC, March 13, 2017.

  35. O’Hanlan, KA, Noblett, KN, Uterosacral ligament colposuspension: a procedure every gynecologist should be able to perform, video presented to the American Association for Gynecologic Laparoscopy, Annual Clinical Meeting, Washington DC, November 14, 2017.

  36. O’Hanlan, KA, Laparoscopic Institute for Gynecology and Oncology course presented to the Romanian Obstetrical and Gynecological Society Annual Clinical Meeting, Bucharest, Romania. November 23, 2017

  37. O’Hanlan, KA, Chair, Hysterectomy Course 702, didactic and cadaver dissection training at the American Association for Gynecologic Laparoscopy, Annual Clinical Meeting, Las Vegas NV, November 14, 2018.

  38. O’Hanlan, KA, Chair, Hysterectomy from A to Z, didactic and cadaver dissection training at the University of British Columbia Advanced Workshop on Retroperitoneal Surgical Anatomy, Vancouver, BC, November 24-25, 2019.

  39. TM Siebert, KM Lewis, A Shander, KA O'Hanlan, Validated Intraoperative Bleeding Scale (Vibe Scale): Relevance and Utility in Gynecological Surgery, Journal of Minimally Invasive Gynecology, 2019.

  40. O’Hanlan, KA, Co-chair, Hysterectomy 605, didactic and cadaver dissection training at the American Association for Gynecologic Laparoscopy, Annual Clinical Meeting, Vancouver, BC, November 9, 2019.

  41. O’Hanlan, KA, Keynote, DA Boyes Annual Clinical Symposium, Dissecting the challenging parametrium, didactic training at the University of British Columbia, Vancouver, BC, November 7, 2019.7, 2017.

GRAND ROUNDS AT UNIVERSITIES

  1. Grand Rounds, “Reduction of complications from laparoscopic oncology" lecture and slide presentation, University of California, Irvine, December 2, 2011.

  2. Grand Rounds,  “Prevention and management of complications from Total Laparoscopic Hysterectomy" lecture and slide presentation, Kaiser Santa Rosa, May 17, 2012.

  3. Grand Rounds, “Prevention and management of hemorrhage during laparoscopic surgery” M. D. Anderson Cancer Center, Houston, TX, August 24, 2011.

  4. Grand Rounds: “Avoiding and managing complications from advanced laparoscopic procedures”, Thomas Jefferson University, Department of Obstetrics and Gynecology, Philadelphia, PA, July 24, 2014.

  5. Oncology Grand Rounds: “Comprehensive therapeutic pelvic to infrarenal lymphadenectomy for gynecologic malignancies”, Duke University, Department of Obstetrics and Gynecology, Durham, NC, July 28, 2014.

  6. Grand Rounds: “Reducing complications from advanced laparoscopic procedures”, University of Kentucky at Louisville, Department of Obstetrics and Gynecology, Louisville KY, February 1, 2017.

  7. Grand Rounds: “Avoiding and managing complications from advanced laparoscopic procedures”, Morehouse School of Medicine, Department of Obstetrics and Gynecology, Atlanta GA, March 17, 2017.

Kate and Dr. Pam Emeney.jpeg

Kate and Dr. Pam Emeney

 

 OPEN INCISION SURGERY 

2 fibroids so large.JPG

Well 99% of benign gynecologic surgeries can and should be performed laparoscopically, some benign surgeries should be performed using an open incision. In 1991 I removed the largest ovarian tumor in the world, and published it with my medical group, the society for gynecologic oncologist but also registered it with Guinness book of world records.

 

Some patients have fibroids that are so large (see photo) that their surgeries should be performed open as well. Better and better techniques are being advanced to enable even very vascular, and very large fibroid uterus can be operated on and reduced to normal size laparoscopically. This procedure requires some pretty advanced skills.

 

Most cases of pelvic mass, and even early ovarian cancer can be operated on laparoscopically. When there is evidence on CT or MRI studies showing that any gynecologic cancer has spread to the upper abdomen, the surgery should be done using a vertical open incision. The goal of ovarian cancer surgery is to remove every visible tiny speck of ovarian cancer in order to provide your patient with the highest chance of getting the cancer literally cured, or providing the greatest longevity if it can't be cured. All lymph nodes that are enlarged should also be removed.

 

 NON-SURGICAL GYNECOLOGIC CANCER CARE 

When ovarian carcinoma metastasize to the lungs, sometimes chemotherapy needs to be given in the intensive care unit so that the patient with respiratory failure can be extubated.

 

Choriocarcinoma of the ovary, or with unusual genotypes, and after chemotherapy can deaf be difficult to diagnose and treat.

 

When young women develop uterine cancer and their surgery must take place before they have completed their fertility plans, the eggs can be removed from the ovary, fertilized, and stored so that a sister or friend can carry their baby.

 

Small cell carcinoma of the cervix has been shown to be extremely virulent. Adding chemotherapy to the radiation protocol has made it curable.

 

 COMPLICATIONS IN SURGERY 

In 1986, Dr. O’Hanlan published a pioneering paper about using a vascular approach to plug a bleeding blood vessel that opens up after surgery. This procedure is used in rare situations today, but can be life-saving. Postoperative bleeding should be quantified and can be addressed with hemostats, extra stitches, surgical clips, and even a cautery. However sometimes these are not necessary and a solution called a “surgical hemostat” can sometimes be necessary. The surgical hemostats are used only for the mildest form of bleeding, as determined by current standards of bleeding quantification.

 

A young patient with a very puzzling array of symptoms and many prior operations to address her pain was seen by Dr. O'Hanlan in 1991. During surgery, a small bottle cap was found in the hidden space behind the patients pelvis (the retroperitoneum). Once removed, all her symptoms disappeared. Upon later questioning, the patient recalled putting the bottle cap into her vagina 9 years earlier. The cap had migrated through the back wall of her vagina into the retroperitoneum and could not be found through normal exams.

Bottle cap retrieved from the left retroperitoneum after nine years.png

Bottle cap retrieved from the left retroperitoneum after nine years

TLH-takeback rate of 2.7, overall complications at 6.8%.png

TLH-takeback rate of 2.7, overall complications at 6.8%

Clostridium difficile, “C. Diff,” is an intestinal infection that became widespread starting in the late 1980’s, occurring nearly exclusively in surgical patients. Nowadays, anyone can develop this diarrheal infection.

 

Surgical complications always need to be addressed and studied so that they can be prevented in the future, recognized more quickly, and managed more effectively. After Dr. O’Hanlan’s first 830 laparoscopic hysterectomy cases, she published her complication types and rates and described the methods of better prevention, earlier recognition, and more effective management. Closing the vaginal cuff at the end of the hysterectomy requires the ability to suture laparoscopically. Dr. O’Hanlan describes the challenges of Cuff closure and the need to do it carefully, with good support.