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Endometriosis Zone editorial advisor
Marc R. Laufer, MDChief of Gynecology; Children's Hospital Boston
I have set out to improve healthcare of girls and young women through advances in medical gynecologic care. Endometriosis is a chronic disease that can cause debilitating pain and infertility. Through my studies of adolescents with chronic pelvic pain, I have determined that endometriosis occurs in approximately 70% of girls and young women who do not respond to conventional medical therapy for dysmenorrhea. Understanding the existence, and rate of occurrence of adolescent endometriosis will help to improve the diagnosis and treatment of young women suffering with pelvic pain. Our most recent work has shown that early diagnosis of this disease and its surgical and medical treatment retards progression of the disease. This will hopefully reduce the incidence of future infertility. Thus far I have developed and reported seven new procedures to advance surgical gynecology. I developed and reported the first laparoscopic oophoropexy, which attempts to preserve ovarian function and fertility by surgically moving an ovary out of a radiation field. This operation is now offered as a standard part of the protocol for girls treated for medulloblastoma. We have now completed long term follow up studies of these patients and shown improved ovarian function as compared to patients without having had an oophoropexy. I have defined a surgical technique to improve gynecologic surgeons’ ability to identify clear lesions of endometriosis, thus facilitating the diagnosis and treatment of this disease. I have also developed a new technique to address clitoral hood adhesions resulting from lichen sclerosis, our technique presents a novel surgical approach to avoid post-operative re-agglutination of the clitoris which results in a “clitoral entrapment syndrome”. Additionally I have developed a new method for labioplasty, which is a labial reduction procedure for women with labial hypertrophy. This new technique aims to decrease labial scarring and subsequent dyspareunia for women needing a labial surgical reduction. Recently I have also developed a new procedure for creation of a vagina with artificial skin for the treatment of Mayer-Rokitansky-Kuster-Hauser Syndrome. This technique eliminates pain and scar from an autologous skin graft donor site. We have also described a new “staged” surgical procedure to address a very rare congenital anomaly of the reproductive tract involving bilaterally obstructed upper vaginas with bilateral agenesis of the lower vagina. Most recently we reported a new technique to preserve normal ovarian tissue in girls and adolescents with ovarian cysts that are greater than 10 cm. With this technique we demonstrated that the residual ovarian tissue was of the same volume as the non-affected ovarian tissue. Hopefully, these surgical advances will help to improve the lives of affected women. During my 22 years in the Harvard Medical community, I have had the continued opportunity to teach medical students in their core rotation through didactics, grand rounds, inpatient and outpatient clinics, and in the operating room. I teach and mentor OB/GYN residents in their 6-week rotation in pediatric and adolescent gynecology. I have also had the opportunity to teach, mentor, and conduct research with reproductive endocrine fellows, adolescent medicine fellow and residents, pediatric residents, and pediatric emergency residents and fellows. As the field of pediatric and adolescent gynecology is fairly new, I have shared my knowledge to educate clinicians and traveled nationally and internationally for lecture presentations, and visiting professorships. I have had the opportunity to teach live pediatric laparoscopic surgery in an international pediatric surgery course in Bologna, Italy. Dr. S. Jean Emans and I continue to offer our yearly Harvard Medical School’s Continuing Medical Education Course “Pediatric and Adolescent Gynecology”. I have been the Course co-director for over 15 years and am very pleased that the Medical School has recognized this course for its excellent evaluations. Based on the identification of a lack of educational materials for OB/GYN residents in the field of pediatric and adolescent gynecology I have developed, and raised funding for a collaborative educational CD-ROM which will be released in the spring of 2008. In an American College of Obstetricians and Gynecologists and North American Society of Pediatric and Adolescent Gynecology joint effort I have edited a case based CD-ROM in the field that will be distributed [free of charge] to all OB/GYN residency programs in the USA and Canada. This CD-ROM will hopefully help to improve understanding and recognition of clinical cases of pediatric and adolescent gynecologic issues. Another mission that I have made a priority is the education of young women and their families about normal health and development as well as specific abnormalities and diseases. In May of 1998, the Center for Young Women’s Health (CYWH) was launched with a leadership grant from the Children’s Hospital League. Under my co-direction with Dr. S. Jean Emans, the CYWH provides local, regional, national, and international resources to young women, their families, and health care providers. Our website [www.youngwomenshealth.org] is nationally and internationally recognized as the first place for girls’ health resource materials. Now in its 10th year, the website receives over 140,000 visitors per week and was recently identified by the Wall Street Journal as one of the best sites for health care information. Our materials are provided in English and in Spanish. Peers have acknowledged my expertise in pediatric and adolescent gynecology, endometriosis, and congenital anomalies of the reproductive tract. I have co-authored and co-edited a widely utilized text, Pediatric and Adolescent Gynecology, 4th Edition (1998) and the 5th Edition (2005). I have served as the Chair of the American Society of Reproductive Medicine’s Pediatric and Adolescent Gynecology Special Interest Group, and have served as Chair of the American College of Obstetrics and Gynecology’s Committee on Adolescent Health. In addition, I have served on many committees and have been President of the North American Society of Pediatric and Adolescent Gynecology. I have been privileged to be able to work in an emerging area of medicine. I am
able to care for girls and women with specific medical issues and perform
specialized surgeries. Through my clinical activities I have been able to share
my clinical experience and enthusiasm as I teach patients, medical students,
residents, fellows, pediatricians, surgeons, and gynecologists.
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