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Health

Gynecologist sees advantages in robot-assisted removal of uterine fibroids


Published:   |   Updated: July 29, 2013 at 11:28 AM

When Yvonne Patterson had a hysterectomy to remove uterine fibroids, she spent 10 days in the hospital and six weeks recovering from the surgery.

The pain after surgery was unbelievable, she remembered, and the recovery was slow and painful.

"It was worse than childbirth," she said.

That was 23 years ago, long before laparoscopic surgery became routine for treating conditions like Patterson's. Complications from her fibroids, benign tissue inside her uterus, triggered Patterson's complete hysterectomy.

Laparoscopic surgery was first introduced in the early 1990s and has changed how surgeons perform what used to be invasive procedures. Today the treatment for fibroids, even if the patient elects to have the hysterectomy, is far less invasive than when Patterson underwent the procedure.

It is now less invasive than ever with the introduction of robotic surgery, which is an improvement on the laparoscopic procedure, and significantly decreases the degree of pain and recovery time for the patient while giving surgeons increased control and optimal viewing.

Oak Hill Hospital uses the da Vinci Surgical System for most surgeries that used to require opening the patient, which led to more pain and longer recovery times.

According to davincisurgery.com, the da Vinci Surgical System combines computer and robotic technologies to create a new category of surgical treatment, robotic assisted laparoscopic or endoscopic surgery.

Surgeons are provided with enhanced capabilities to treat broader ranges of conditions using minimally invasive approaches. This means major surgeries with only a few tiny incisions. In addition, the surgeon experiences better visualization, precision, dexterity and control than occur during traditional surgical approaches.

Dr. Niloufer Kero, a 30-year practicing gynecologist whose practice is located at 11373 Cortez Blvd., said the da Vinci is the way to go for gynecological surgeries. Hysterectomy is a common procedure for the treatment of uterine fibroids that are causing other major health issues.

Fibroids, according to the Mayo Clinic, are noncancerous growths of the uterus that appear in as many as three in four women.

Fibroids are not associated with an increased risk for uterine cancer and almost never become cancerous.

The growths, which can vary in size, develop from smooth muscular tissue, called myometrium, as single cells that divide repeatedly to eventually create a "firm, rubbery mass."

They may grow rapidly or slowly or may remain the same.

They can range in size from seedlings to bulky masses that may distort or enlarge the uterus. Some may even expand the uterus into the rib cage.

But fibroids can also remain undetected, especially those that cause no symptoms.

Others, like Patterson's, can create certain problems, including interfering with a woman's ability to conceive.

Kero often discovers fibroids during routine pelvic exams. She stressed the importance of routine annual exams, as they have been paramount in discovering many health issues patients had no idead they had, some much more serious than fibroids, that may require immediate action to save lives.

While rarely serious, fibroids can impact a healthy lifestyle and can hinder a patient's desire or ability to become pregnant.

Treatment is dependent on the type and location of the fibroid.

There are different types of fibroids, defined by the location in the uterus. They include:

Submucosal fibroids, which grow in the inner cavity of the uterus. They may cause prolonged, heavy menstrual bleeding and may interfere with a woman's ability to conceive.

Subserosal fibroids project to the outside of the uterus. These types f fobroids can sometimes press on the bladder, causing urinary symptoms.

Intramural fibroids grow within the muscular uterine wall. If large enough, these types of fibroids can distort the shape of the uterus and cause prolonged heavy menstrual periods, pain and pressure.

Common symptoms of fibroids include:

Heavy menstrual bleeding

Prolonged menstrual bleeding

Pelvic pressure or pain

Frequent urination

Difficulty emptying the bladder

Constipation

Backache or leg pain

A doctor should be seen if a patient experiences overly heavy or painful periods, spotting or bleeding between periods, pain with intercourse, enlarged uterus and abdomen or difficulty emptying the bladder.

If a hysterectomy is suggested, Dr. Kero would then schedule the robotic assisted laparoscopic surgery, using the da Vinci System.

Kero is one of the first surgeons to use the da Vinci System in Hernando County. She had been performing major gynecological surgeries with the laparoscope, also considered minimally invasive surgery.

She was happy with the decrease in pain and recovery time for her patients with the laparoscope. Many of her patients were going home within 24 hours after surgery.

Seeing those kinds of results with laparoscopic surgery, she was intrigued when the da Vinci was introduced.

"When I first started (with the da Vinci) I wanted to see what was the difference," she said. "I wanted to learn it because I'm very fascinated with any new advances in surgical technology."

She also wanted to be well informed since her patients began asking about it.

"I expected I would still use the laparoscope," she said. "But when I started doing it I realized my patients have very minimal pain, faster recovery, and they go home sometimes in four hours."

The da Vinci System is an enhancement to the typical laparoscopic procedure. The robotic arms, manipulated by the surgeon seated at a console, have greater dexterity than traditional laparoscopic arms.

Another difference is in the clarity of the high definition, 3D camera and the ability for the surgeon to zoom in.

With about 10 percent of her surgeries using the laparoscope alone, Kero said she couldn't see clearly enough if there were complications. But with the da Vinci, the view is so much clearer. Only about 3 percent of her patients will require a more extensive incision.

"It is a good experience for me, the surgeon, but it's an even better experience for the patient," Kero said. "In fact, I would love to put that in bold; "less pain, faster recovery." My problem with the patient now is that they want to go to work the next day because they feel so good," Kero joked.

Kero expressed once again the importance of regularly scheduled check-ups for all her patients. It is the only way to help maintain good health, she said, and to insure that nothing is missed.

Hernando Today correspondent Kim Dame can be reached at damewrites@yahoo.com

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