Minimally Invasive Robotic Surgery for Women

While no woman wants to face surgery, today the vast majority of gynecologic conditions can now be treated effectively without a big incision and shorter recovery time.   Robotic assisted surgery requires only a few small incisions, so you can get back to life faster – within days rather than the usual weeks required with traditional open abdominal surgery.

Robotic assisted surgery offers a minimally invasive option with all the impact of an open procedure for certain surgeries including urology, gynecology and cardiothoracic surgery.

At the cutting edge of robotic technology, the da Vinci Robotic Surgical Systems gives surgeons better images with three dimensional, true to life pictures in crisp detail. With this degree of accuracy, surgeons can operate in relatively confined spaces with significantly increased visualization and precision. These surgical instruments are designed to precisely mimic motions of the human hand and wrist.

Minimally invasive robotic gynecologic procedures include hysterectomy, sacrocolpopexy, ovarian cystectomy, and salpingo-oopherectomy (bilateral and unilateral). The most common is hysterectomy. If you are considering or your doctor has recommended a hysterectomy, you are not alone – one in three women in the U.S. will have a hysterectomy before turning 60. However, new technology like the da Vinci Surgical System has made the traditional hysterectomies a thing of the past.  The traditional abdominal hysterectomies are performed with open surgery, which requires a wide incision below the navel. This procedure can be painful, involving heavy medications, risk of infection and significant blood loss. After surgery, a recovery of at least 6 weeks is necessary. In addition, many patients are not happy with the scar left by the incision of a traditional abdominal hysterectomy.

Since minimally invasive surgeries require only tiny openings for instruments, patients leave the hospital without large, traumatic incisions. There are many other benefits as well: Minimally invasive entry points, smaller incisions, shorter hospital stay, tiny scars, decreased risk of infection, less scarring and blood clots, faster recovery time, speedier return to daily activities and in many cases, better clinical outcomes.

As you can see a minimally invasive robotic surgery will have you getting back to life much faster. As a woman, I understand those benefits and educate my patients to the best of my knowledge. If I am personally faced with having a hysterectomy, I will definitely choose the minimally invasive option.

Grace Gibbs, D.O., F.A.C.O.O.G.

Lexington Women’s Health

Dr Grace Gibbs

Breast Cancer Through the Eyes of a Survivor… Who is also a Nurse

When ask to write a blog article, I did not know how to start. I tried googling it, asking others and then I just started to write what I know and hopefully you will get the jest of my story.

I was blind- sided with the diagnosis of breast cancer June 26, 2013. I faithfully had my mammograms every year, did self-breast exams, saw my gynecologist yearly, and decreased my caffeine intake until it was almost non-existent. I practiced what I preached. I am an OB/GYN nurse and have been for thirty plus years. I have four sisters with no issues and no relatives that I know about ever diagnosed with breast cancer. My mammograms always came back with several benign cyst, so my thought was my radiologist was mistaken, it was just a cyst.

After my mammogram, an ultrasound was performed and Dr. Kenney said,” I am so sorry it is breast cancer”.  A biopsy was performed and an MRI was scheduled for the following Tuesday. It all happened so fast that it is now just a blur.

I quickly had reversed the role of a nurse to a patient. The first thing we tell patients is not to do is go on the internet but where did I go straight to the uncaring, unedited, unbiased internet. Every horror story with pictures you can only imagine. I was starving for answers but was too proud to say I had no idea what I was facing.

The fear, confusion, and anger was all crashing in. My appointment with the general surgeon was expedited due to Dr. Reva Tackett and many prayers. The general surgeon was very informative I am sure, my husband at least got the information I was still in shock I suppose.

Was it going to be a lumpectomy and radiation, unilateral mastectomy or bilateral mastectomy and possibly chemo and radiation? I didn’t know. I just wanted the cancer gone.    I decided my breast were attached to me and I was not that attached to them! This was true until I woke up and they were gone. I will not lie this was pretty much devastating until I convinced myself that they were gone and I was not. Cancer used to be a death sentence.

Now the treatment regimen: Breast reconstruction had already begun with tissue expanders, chemo therapy starts in four weeks so another surgery to have a port put in to administer the chemo.   I thought I handled double mastectomy, tissue expanders, and drains, this couldn’t be worse.   WRONG!! The port surgery was a piece of cake. The first chemo not so bad until the third day, it was bad, hugging the toilet, even hard to hold my head up. After two rounds of chemo I lost my hair. I went to my hairdresser, Sherre, I have known since my high school prom and we both laughed and cried while she shaved the little scraggly parts of my hair that was left. I tried wearing wigs but I am more of the hat kind of woman.

It was time I quit focusing on the negative and start focusing on survival. Surviving takes strength and determination and mostly a great support team. My sons and family were a blessing. It was hard letting them see me like this and I am sure it was a very difficult time for them to see me like I was as well. The visits they would make with me were my highlights.  My friends and my co-workers kept me going as well. All the food, the prayers and hugs go a long way. Knowing they were there for me no matter what was and is a comfort.

I am now over a year out and just had my port removed. My hair, well any hair is good hair and it is coming back. My nails are now actually growing. The last reconstruction with tattoos and the sculpting of nipples was completed October 1st of this year. I had to ask if I could have UK blue tattooed areolas and if  the piercings automatically done,  but I guess it was not time to joke.

It seems like it has been a long process but it does make me appreciate things more! I really don’t sweat the small stuff nearly as much as I did.   I now have a beautiful fourteen month old granddaughter and a grandson on the way and God continues to bless me. My goal is to be a blessing to someone else. Even if it just to share my story and to let others know that breast cancer isn’t always a death sentence and to live life to its fullest and they are not alone.

Tammy Crupper, RN

Lexington Women’s Health

Cervical Cancer trends

The incidence of cervical cancer continues to drop despite increasing STD rates. This is due to more sensitive screening tests including computer imaged liquid cytology and HPV DNA tests.  The HPV vaccine is expected to reduce cervical cancer rates even more in the years to come.  The HPV vaccine has reduced infection rates by 56% (in the teenagers 14-19 years of age) and is recommended for girls aged 11-12 or girls 13-26, if they were never vaccinated. The screening guidelines keep changing, but don’t be confused.  This disease is deadly but can be prevented if you get regular screening. The incidence of cervical cancer continues to drop despite increasing STD rates. This is due to more sensitive screening tests including computer imaged liquid cytology and HPV DNA tests. The HPV vaccine is expected to reduce cervical cancer rates even more in the years to come. The HPV vaccine has reduced infection rates by 56% (in the teenagers 14-19 years of age) and is recommended for girls aged 11-12 or girls 13-26, if they were never vaccinated. The screening guidelines keep changing, but don’t be confused. This disease is deadly but can be prevented if you get regular screening. The Pap test is recommended for all women between the ages of 21 and 65 years old. If you are 30 years old or older, you may choose to have an HPV test along with the Pap test (co-testing). If you are older than 65 and have had normal Pap test results for several years, your doctor may tell you that you do not need to have a Pap test anymore. (Source: CDC fact sheet)

 

STDs are on the Increase

Here are some frightening facts.

-One in two sexually active persons will contact an STD/STI by age 25.

-Over 14 million people acquire HPV each year.

-By age 50, at least 80 percent of women will have acquired genital HPV infection.

-Each year, one in four teens contracts an STD.

The 4 most common STDs are: HPV, Chlamydia, Trichamoniasis, and Gonorrhea (source: American Sexual Health Association)

 

Don’t be tricked by a Lack of Symptoms

Trichomonas vaginalis (or “trich”) is a parasite that affects both men and women and is considered the most common curable STD. In the United States, an estimated 3.7 million people have the infection, but only about 30% ever develop any symptoms.  The parasite inhabits the vagina, penis or mouth and is transmitted during sex.  Infected people without symptoms can still pass the infection on to others. Symptoms can come and go and may include itching, burning after urination, or a thin discharge with an unusual smell. Having Trichamoniasis can make it feel unpleasant to have sex. Without treatment, the infection can last for months or even years. Trichamoniasis can increase the risk of getting or spreading other STDs like HIV or HPV, which causes cervical cancer. It is not possible to diagnose Trichamoniasis based on symptoms alone. For both men and women, the most sensitive laboratory test is the RNA (not DNA) test offered by Hologic. The best news is that Trich can be cured with a single dose of oral antibiotic medication. (Source: CDC fact sheet)        .

Did You Know?

The only cancer for which the Pap test screens is cervical cancer. It does not screen for ovarian, uterine, vaginal, or vulvar cancers. So even if you have a Pap test regularly, if you notice any signs or symptoms that are unusual for you, see a doctor to find out why you’re having them. (Source: FDA & College of American Pathologists)

 

Richard Lozano, MD

Cytopathologist at Pathology & Cytology

The Robotic Surgery Revolution

So what’s all the hype about robotic surgery? If you would have told me ten years ago that I would be spending my days in the operating room with a robot assisting me, I would have thought you were crazy! But it’s true. When the difficult decision is made to undergo hysterectomy, we are often concerned about the amount of time required for recovery. We’re all too busy to be down for surgery! We want the least invasive option that will meet our needs safely.

 Robotic surgery has distinct advantages over traditional surgery requiring a large incision on the abdomen. Robotic surgery is done through small incisions less than one centimeter. It follows that there is less pain with robotic surgery. Robotic surgery is much more precise than other operations and as a result, there is less blood loss. Operations for women with multiple prior surgeries or a very large uterus can be done with robotic technique. If you are facing hysterectomy and are told you are not a candidate for minimally invasive surgery, certainly seek a second opinion! Chances are, you could be home the same day as your operation and back to most normal activities in 2 weeks!

 

Jennifer A. Fuson, MD

Jennifer Fuson 2014 Black and White

 

 

Excessive Menstrual Bleeding

Excessive menstrual bleeding affects millions of women every year. Women who are affected suffer decreased quality of life, reduced productivity in the workplace and the constant threat of inconvenience or embarrassment.  Chronic health conditions such as fatigue and anemia can result from heavy bleeding. Until recently, women were expected to suffer with the bleeding, take hormonal medications or have a traditional hysterectomy with a large abdominal incision. Today’s women are offered many newer options. Women suffering from heavy menstrual flow should talk with their healthcare provider about the options that may be appropriate for them. These generally include:

 

NSAID therapy. Medications such as Motrin®, Advil® or Aleve®, taken three to five days prior to menstruation, may reduce bleeding up to 30%. This treatment requires very regular cycles in order to work well.

 

Hormonal therapy. Hormones either in the form of oral contraceptive pills or cyclic progesterone can induce a regular and lighter flow. This treatment is very effective to induce regular menstrual cycles and may have the added benefit of improving acne and PMS.

 

Hormonal intrauterine system. Mirena® is a device that slowly releases progesterone in the uterine cavity. This dramatically reduces or even eliminates bleeding by keeping the lining very thin and healthy. It is an excellent alternative for people who want to avoid oral hormonal therapy. This requires only a simple office procedure, minimal discomfort and no down time.

 

Global endometrial ablation. Done in the office or operating room, this technique uses thermal energy to destroy the lining of the uterus, resulting in significantly decreased uterine bleeding. 85% of people will see reduced or even absent menstrual flow following ablation.

 

  1. This surgery is now often done on an outpatient basis with tiny incisions using traditional laparoscopic techniques or with the newer da Vinci robotic surgical system. These minimally invasive surgical procedures offer definitive treatment, and patients are able to get back to their lives quicker than ever before and with less pain. No longer are large abdominal incisions,extended hospital stays and long recoveries usually necessary.

Women experiencing excessive menstrual bleeding that affects their ability to enjoy a happy and productive life should speak with their provider about the treatment options that might be right for them. It is no longer necessary to plan family, recreational and work activities around episodes of heavy menstrual bleeding. Newer options available today make it easier than ever to be free from the uncertainty of heavy or irregular menstrual flow. Despite the newer nonsurgical options, hysterectomy is sometimes necessary.  When performed in a minimally invasive way, women can get back to doing the things they enjoy faster than ever before.

Jennifer Fuson, MD Lexington Women’s Health