Top Docs Q&A: Keith Isaacson

This post is part of our Top Docs Q&A series where we ask a physician who was selected as one of our Top Docs questions about their field, life as a doctor, and practicing in the Greater Boston area.

Name: Keith Isaacson

Hospital Affiliations: Newton-Wellesley Hospital, Massachusetts General Hospital, Brigham and Women’s Hospital

Title: Director of Minimally Invasive Gynecologic Surgery and Infertility at Newton-Wellesley Hospital; Associate professor at Harvard Medical School

Field: Gynecology

Specialty: Reproductive Endocrinology

Keith Isaacson specializes in reproductive endocrinology with a focus on minimally invasive techniques. In conjunction with computer scientists at MIT,  Isaacson has developed a smartphone app to help endometriosis patients monitor their condition and stay informed.

Why did you choose this specialty?

Back when I started, reproductive endocrinology and infertility were the leaders in minimally invasive gynecologic surgery. I was interested in reproductive surgery, preserving women’s organs for future fertility, and correcting conditions using laparoscopic techniques.

What do you like most about the field?

We’ve made tremendous strides in being able to treat women who have severe diseases, such as advanced endometriosis and large fibroid tumors, using minimally invasive techniques. Even though they may have a three or four hour surgery, patients will come home the same day and are typically back to their normal activities within one or two weeks. The field has been advancing for the last 30 years, and I don’t see it stopping.

In the time that you’ve been practicing, how has the field changed?

When I got to Newton-Wellesley in 2001, more than 90 percent of women that required a hysterectomy for non-cancerous lesions had the procedure done with an open incision. They’d be in the hospital three to four days, and out of work for six weeks. As of 2013, 94 percent at Newton-Wellesley are treated using minimally invasive techniques and 75 percent of those women go home the same day. In just 10 or 11 years, we’ve completely reversed the trends.

What are the latest advancements in the field?

There was a big push for using the robotic technology. New technologies like that are coming out every year. We certainly aren’t jumping to adopt them, but we’re eager to test them and evaluate them. There are new technologies for treating uterine fibroids and endometriosis. We have new training technology to teach our residents and fellows, who are using computer simulation technologies.

What do you hope for the future of reproductive endocrinology and infertility?

We have a unique collaboration at Newton-Wellesley with MIT called the Center of Gynepathology Research. The clinicians are working with computer scientists and basic scientists to rethink many of the diseases that women have where there really hasn’t been much progress with non-surgical therapeutic modalities in the last 30 years. When I talk about being minimally invasive, it wouldn’t surprise me in 10 years if we’ll look at surgery as being kind of old school.

In collaboration with MIT, you are exploring a new “systems biology approach” to the treatment of endometriosis. What does this mean?

It’s a new approach that has never been done in gynecology particularly for endometriosis, which affects 20 percent of all women of reproductive age. This approach is not just looking at one or two proteins; we’re looking at the whole system from the time the cell gets into the body to the time where it actually causes the disease. Once you understand that, then you can target the therapy in an individualized way.

How is this approach different?

We’re hoping to be able to say you not only have endometriosis, you have this specific type and therefore Therapy A will work better than Therapy B. Instead of using a kitchen sink approach where everybody gets treated the same, we can potentially come up with targeted therapies that are more effective. It’s really exciting, and it’s not being done anywhere else in the world.

You are working with MIT to develop an app for endometriosis patients. What can you tell me about it?

Patients who have the condition can get the most updated information about the disease. They can use the app if they’re going to have surgery; they’ll have their instructions on it, and what they can expect. They can utilize the app to track their symptoms on a daily basis. The alternative to that has always been to send the patient a survey every six months. Getting this information in real time and in a very user-friendly way is going to be much much more effective and relevant.

What will this app contribute to the overall field?

No matter who’s doing research in this disease, whether it’s research for surgery or research for medication, you have to track the outcomes more accurately to determine if your therapy is effective. To my knowledge, this will be the most accurate method of tracking outcomes. The app is in trials now with the patients. Based on the feedback, it should be available within the next six to eight months.

What advice do you have for women regarding reproductive health?

I think the best advice is they need to be in a comfortable relationship with their health care provider so they get answers to their questions that make sense to them. Feel free to get a second opinion;  that doesn’t mean you have to keep shopping until you find the answer you want, but at least an answer that makes sense so you work together.