Gynecologic Treatment Options
Dr. Dean Dagermangy explains why women needing gynecologic surgery can expect a quicker recovery and better outcomes with robotic surgery at Loma Linda University Surgical Hospital.
Robotic surgery can be used to treat a variety of gynecologic concerns. At Loma Linda University Medical Center, we specialize in treating women with uterine fibroids, abnormal bleeding, ovarian and uterine cancer and other gynecologic concerns. Our da Vinici® robotic-assisted surgery is just one of the tools we utilize to offer the quickest surgical recovery, and the best outcomes. The procedures listed below are often performed with da Vinci® robotic assistance.
The robotic hysterectomy procedure utilizes four small (1/2 inch) incisions to accomplish what used to require a 6- to 8-inch incision. Removal of the uterus is often necessary when a patient has uterine cancer, uterine enlargement from fibroid tumors, or uterine prolapse. In most cases, the uterus and cervix are removed, and the ovaries are left in place. In cases of cancer, or patient preference, the ovaries can be removed along with the uterus.
With incisions and recovery time similar to the hysterectomy, da Vinci® myomectomy allows removal of fibroid tumors, leaving the normal uterus in place. The robotic arms and wristed instrument tips are uniquely suited for the precise dissection and suturing required to provide a safe and strong closure of the uterus. The myomectomy is most appropriate for patients interested in preserving fertility, but can be utilized in most cases of fibroids depending on patient preference. Although extremely large fibroids may still require an open incision, many patients can be given pre-operative medications to shrink these tumors, allowing the surgery to be done robotically.
Ovarian Cysts or Tumor
Many ovarian cysts will regress on their own over time, and don’t require surgery. When a cyst grows larger over several months, especially when it is causing pain, surgery is often indicated. Most ovarian cysts are benign growths known by names such as “dermoid cysts” or “cystadenomas”. Often the cyst can be removed leaving the ovary intact, but occasionally the entire ovary must come out. Most of these types of surgeries can be performed with laparoscopy using several small incisions. When scarring from previous surgery (such as a previous hysterectomy), or other complicating factors are anticipated, the da Vinici® robotic system is often employed. Most patients can go home the same day as the surgery.
Endometriosis and Pelvic Pain
Patients with short term or chronic pelvic pain require a very careful and comprehensive workup, starting with an office visit. Using a detailed history, a gentle physical exam, and imaging studies such as ultrasound, our physicians can generally develop a good idea what might be causing these symptoms. Sometimes the workup leads away from the operating room and towards other causes such as intestinal or bladder conditions. Sometimes, however, laparoscopic surgery can be helpful to look for gynecologic causes of pain such as endometriosis.
Endometriosis occurs when some of the uterine lining (called endometrium) is pushed out through the fallopian tubes into the pelvic cavity. Because of this abnormal location, the body sees this lining as foreign and attacks it, causing scarring, pain, severe cramping with periods, and painful sex. When endometriosis is found during surgery, it can often be removed or cauterized away. Cases of severe endometriosis can lead to some of the most difficult surgeries in all of gynecology due to the excessive internal scarring. When this is encountered, da Vinci® robotic surgery can be extremely useful in restoring normal anatomy and treating pain.
Vaginal Prolapse Repair
Vaginal prolapse occurs when the ligaments holding up the pelvic organs become weakened and these organs (such as the bladder or uterus) sag down into the upper vagina causing pressure and urinary problems. Vaginal prolapse repair returns the organs to their proper positions inside the pelvis. Often these surgeries are performed in combination with a hysterectomy, depending on the patient’s preference and future fertility plans. Many times the surgery can be performed completely through the vagina, but newer techniques have started to use the da Vinci® robotic system. One of the best treatments for vaginal prolapse, called a sacrocolpopexy or sacrohysteropexy (depending on whether the uterus is retained or removed) has generally been done through a large abdominal incision. With the addition of the da Vinci® system to our toolbox, this surgery can now be accomplished through four or five small (1/2 inch) incisions. A one night hospital stay and return to normal activities in 2- to 4-weeks is the norm.
Cancer Surgery and Lymph Node Removal
For patients with a diagnosis of gynecologic cancer (uterine, cervical, and ovarian are the most common), the fear of what this diagnosis may mean is foremost in their thoughts. The good news is that most cases of uterine cancer, and many early cervical cancers can be completely cured through timely and careful surgery. These surgeries are complicated, involving removal of the uterus, ovaries, and fallopian tubes, as well as some or all of the lymph nodes surrounding these organs. Because these lymph nodes extend further up into the abdomen, a very large incision from the pubic bone to above the navel has traditionally be required – resulting in prolonged hospital stays and slow recoveries. Many gynecologic cancer surgeons have now begun using the da Vinci® robotic system for these surgeries, with superb results. One night hospital stays have now become commonplace, and many patients are back to full activities in several weeks. The stories are truly amazing when compared with previous methods.