Over the last few years I have travelled to Hong Kong and China to operate and run surgical workshops where I have had the honour of teaching and working with other specialist gynaecological surgeons. I am registered as a specialist gynaecologist in Hong Kong and have been accredited to operate as an advanced level laparoscopic surgeon. I have been asked to speak at a meeting in Shanghai later in the year and I am planning to return to Hong Kong in the next few months to consult and operate. After talking with a number of Hong Kong surgeons including conversations at our most recent AGES conference, it struck me that there are now some significant differences evolving in the management of endometriosis currently in Australia as compared to Hong Kong.
Recent advances in imaging technology that I have alluded to previously now allow the diagnosis of deep invasive endometriosis via ultrasound rather than laparoscopy. It is early days with this technique but in the hands of experienced practitioners there is a high probability of predicting this form of disease which is of immeasurable value to both the patient and the surgeon and potentially avoids the use of an unnecessary diagnostic laparoscopy. I am not aware of any units in Hong Kong at this stage utilising this technique but I believe it would be certainly a useful addition to their diagnostic armamentarium and I hope to discuss this with some of my colleagues on my next visit.
My general understanding of the practice of obstetrics and gynaecology in Hong Kong is that virtually everybody is a generalist obstetrician and gynaecologist with perhaps specific certain interests. Some surgeons that I have encountered are excellent with excision of deep invasive endometriosis although they would rarely resort to any form of bowel resection and this is certainly thought to be an uncommon surgical manoeuver. Given the amount of material recently published about the extent of deep invasive endometriosis, I am sure there is a significant cohort of women within Hong Kong who have both under-diagnosed and under-treated endometriosis. In Australia there are an increasing number of specialists, albeit small at this stage, who have focused virtually their whole practice on the treatment of endometriosis. Like many other surgical disciplines where specialization occurs it seems to me as self-evident that the outcomes for complex problems are superior in the hands of those who do little else other than work in that particular field. I believe there is an opportunity for this type of practice to be established in Hong Kong and I have been discussing these issues with junior colleagues.