Dr Kirsten Connan

Laparoscopic surgery, also known as ‘keyhole surgery’, is today one of the commonest forms of gynaecological surgery. Originally pioneered by gynaecologists 40 years ago, minimally invasive laparoscopic surgery has significant benefits over traditional 'open' surgery.

Demonstrated benefits of laparoscopic surgery can include:

• Faster and less painful recovery.
• Reduced time in hospital.
• Faster return to work and daily activities.
• Reduced adhesions and other long-term consequences.

Dr Connan has a special interest in advanced laparoscopic surgery, particularly in its use for treating complex endometriosis (stage 4 endometriosis) and performing minimally-invasive total laparoscopic hysterectomies. Kirsten's skills and expertise in advanced laparoscopic surgery were developed through her training at The Royal Women's Hospital in the Endometriosis/Pelvic Pain Unit (G2), both as a senior trainee and later as a qualified specialist.

Kirsten is an accredited Level 6 (6-B) laparoscopic surgeon as per RANZCOG / AGES classification and credentialing. Level 6 describes the highest level of complexity for laparoscopic surgery.

In addition to advanced laparoscopic surgery, Dr Connan also offers both emergency and elective laparoscopic surgery across other gynaecological areas:

• Laparoscopic tubal ligation for permanent contraception.
• Diagnostic laparoscopy, including assessment of tubal patency (dye studies).
• Laparoscopic ovarian cystectomies, salpingectomies and oophorectomies.
• Laparoscopic treatment of ectopic pregnancies.
• Laparoscopic adhesiolysis (removal of adhesions).

Importantly, it must always be considered that the best and least-invasive option for every woman is to avoid unnecessary surgery. Dr Connan believes this should always be kept foremost in mind when considering treatment options. While a good surgeon knows how to operate, a better surgeon knows when not to.

RANZCOG is the Royal Australian and New Zealand College of Obstetricians & Gynaecologists, and AGES is the Australasian Gynaecological Endoscopy & Surgery Society. Dr Connan is a FRANZCOG Fellow and examiner and an active member of AGES.

Dr Connan has a special interest in managing pelvic pain, and in particular, endometriosis. Endometriosis is a common and sadly often debilitating gynaecological condition for many Australian women. In the past many women suffered in silence, unaware that their pain was not normal and that there were treatment options available.

Managing endometriosis most importantly requires a holistic, multi-disciplinary team approach to care, involving your gynaecologist, physiotherapists, psychologists, and often other medical specialists. Surgery can be an important and beneficial component of endometriosis treatment, but is best provided as part of a holistic treatment plan.

Not all laparoscopic surgery for endometriosis is beneficial, and it is important to be cared for by a gynaecological surgeon with experience in correlating your symptoms with pelvic ultrasound results, and with expertise in correctly identifying endometriosis during laparoscopic surgery. Because endometriosis can occur in many parts of the pelvic anatomy, it can sometimes be challenging to safely excise without damaging other structures. Dr Connan has particular expertise in the excision of complex endometriosis and endometriomas.

Certain endometriosis symptoms, such as bowel motion pain and discomfort (dyschezia), can be important indicators of the need for further investigation before undergoing endometriosis surgery. In this example, referral to a colorectal surgeon and pre-operative colonoscopy can ensure having the correct expertise available at the time of your endometriosis surgery and so maintain your safety.

Dr Connan is one of only a small number of Hobart gynaecologists recommended for laparoscopic treatment of ASRM Stage 4 endometriosis. Stage 4 (severe) endometriosis often involves disease requiring bowel or urological resection, ureterolysis (exposure of the ureters), removal of residual cervix, removal of residual ovaries with significant anatomical distortion, or extensive resection of adhesions. This degree of complex endometriosis surgery should only be performed by a level 6 laparoscopic surgeon.

Less extensive laparoscopic endometriosis surgery can often be performed as day-surgery, allowing you to return home after your operation. More extensive surgery, as may be required to treat severe endometriosis, can often need one or two nights in hospital after surgery. In this situation you will be reviewed each day by Dr Connan. At discharge follow-up appointments will also be made for review of your recovery by Dr Connan back in her TasOGS rooms.

Kirsten is also a passionate supporter of the important work done by Endometriosis Australia in advocating for Australian women living with endometriosis.

ASRM is the American Society for Reproductive Medicine.

Women may require or choose to have a hysterectomy for any number of reasons, including having heavy (menorrhagia) or painful periods (dysmenorrhoea) that cannot be controlled with other treatments, large fibroids causing pain or discomfort, or when high risk for endometrial cancer. In all situations the surgical removal of a woman's uterus (hysterectomy) should not be approached lightly or unnecessarily, and must be considered within the context of each woman's own unique experience and needs.

As with any form of surgery, a hysterectomy should only ever be considered as part of a larger, holistic approach to a woman's healthcare. Many gynaecological conditions that were once thought to require a hysterectomy can now be successfully managed with much less invasive means.

Total laparoscopic hysterectomy (TLH) describes an operation performed through laparoscopic 'key-holes' to carefully remove the uterus. It is distinctly different from a traditional 'open' total abdominal hysterectomy, which requires a horizontal incision through the abdomen, or a vaginal hysterectomy, where the entire operation is performed through the vagina. Nonetheless these traditional surgical techniques are still appropriately utilised, such as when a large uterus cannot be safely removed laparoscopically.

The advantages of a laparoscopic hysterectomy include faster recovery times, less pain, shorter hospital stays (typically from 1 to 3 days), less time away from family and work, and smaller scars.

Although laparoscopic hysterectomies are increasingly commonly performed by many gynaecologists, the quality of surgery and your recovery after an operation can vary. There is very good medical evidence showing that surgical success and complication rates are affected by both the training experience of the surgeon and the number of laparoscopic hysterectomies that a surgeon regularly performs. You can ask your gynaecologist some quick questions to help you assess this. Good gynaecologists will be happy to discuss these issues with you and be able to provide you with their own practice data.

1. How many years have you been performing laparoscopic hysterectomies?
2. How many laparoscopic hysterectomies have you performed in total and how many do you do each year?
3. What proportion of your laparoscopic hysterectomies:
   • Have you needed to convert to an open operation?
   • Have experienced post-operative wound infection?
   • Have needed to unexpectedly return to theatre for a second operation?
   • Have resulted in injury to the ureters, bladder or bowel?

All surgery involves the risk of complications, and it is important that you have the opportunity to discuss these issues in an open and transparent way so that you can have complete confidence in your surgeon.

In addition to Dr Connan's special interests in advanced laparoscopic surgery for endometriosis and hysterectomies, she frequently performs simpler laparoscopic operations for many common gynaecological conditions, both electively and if required in an emergency. These include, but are not limited to:

• Laparoscopic tubal ligation or salpingectomy (removal) for permanent contraception.
• Diagnostic laparoscopy, including assessment of tubal patency (dye studies) for fertility investigation.
• Laparoscopic ovarian cystectomy (removal of ovarian cysts), salpingectomy (removal of fallopian tubes) and oophorectomy (removal of ovaries – as may be required for cancer prevention in those with BRCA gene mutations) .
• Laparoscopic treatment of ectopic pregnancies.
• Laparoscopic adhesiolysis (removal of adhesions).

Kirsten is mindful that the best and least-invasive option for every woman is always to avoid unnecessary surgery. Dr Connan strongly believes that this should always be kept in mind when planning your treatment.

Dr Connan does not perform surgery for known gynaecological cancer (ovarian, uterine or vulval cancer) as this should only be performed by sub-specialist gynae-oncology surgeons to ensure the best outcomes from your treatment. Hobart is fortunate to have two experienced gynae-oncologists, Associate Professor Penny Blomfield and Dr Michael Bunting, who Kirsten refers such cases to.