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High-tech Tool for Hysterectomy

Every year in the United States, 600-thousand women undergo hysterectomies. It's the second most frequently performed surgery in women of reproductive age. But now, a new high-tech tool is helping women recover faster than ever before.

Every month 41-year-old Erin Kennedy suffered with severe pain, cramps, and heavy bleeding.

Kennedy told Ivanhoe, "My whole abdomen was so tender to the touch I couldn't get hugs from the kids."

Erin and her doctors tried for a decade to relieve the menstrual pain with drugs, birth control, and chemical menopause. Nothing worked.

"It would just feel like someone was just ripping my whole pelvic region apart" Kennedy explained.

Erin opted for hysterectomy. Dwight Im, M.D., Director of the Gynecologic Oncology Center at Mercy Medical Center in Baltimore, Maryland is one of a handful of surgeons in the United States performing robotic minimally-invasive hysterectomies using a smaller incision than ever before.

Dr. Im told Ivanhoe, "Instead of the traditional three to five whole hysterectomy, you have one single incision, perhaps an inch long, right through the belly button."

Dr. Im says the challenge has been closing the internal surgical site once the uterus is removed.

"Now for the first time, we have an instrument, a needle driver that can actually rotate 45 to 50 degrees as your wrist moves" Dr. Im explained.

The wristed needle driver allows the surgeon to suture through that one tiny opening. As a result, patients recover quickly, going home the same day or early the next.

"I'm not on even half the pain medicine I was on before I came in" Kennedy said.

For Erin, it means back to being "mom" in no time at all.

The U.S. food and drug administration approved the single-site wristed needle driver for use in November. In addition to hysterectomy, doctors can use the instrument for minimally-invasive removal of the ovaries and fallopian tubes for non-cancerous conditions.

Contributors to this news report include: Cyndy McGrath, Supervising Producer/Field Producer; Cortni Spearman, Assistant Producer; Travis Bell, Videographer and Jamison Koczan, Editor.

BACKGROUND: A hysterectomy is a surgery where the uterus is removed. Hysterectomy is the second most common surgery among women in the U.S. and there are several reasons why a woman may choose to undergo a hysterectomy. These include uterine fibroids, heavy or unusual vaginal bleeding, uterine prolapse, endometriosis, adenomysosis, or cancer/pre-cancer of the uterus, ovary, cervix or the lining of the uterus. During the procedure doctors may or may not remove the ovaries and fallopian tubes. The ovaries may be removed in order to lower the risk of ovarian cancer.

(Source: http://www.womenshealth.gov/publications/our-publications/fact-sheet/hysterectomy.html#)

TYPES OF HYSTERECTOMIES: There are several different ways a hysterectomy can be performed. The type of surgery you receive depends on your health and the specific reasons for the surgery.

 

·         Abdominal Hysterectomy: The doctor enters through the abdomen with an incision.

·         Vaginal Hysterectomy: Performed through a small cut in the vagina.

·         Laparoscopic Hysterectomy: The doctor makes tiny cuts and uses the laparoscope to guide himself through your pelvic organs. He is then able to remove the uterus through small cuts made either in the abdomen or the vagina.

·         Robotic Surgery: The doctor uses a robotic arm to perform the surgery through small cuts in the lower abdomen.

(Source: http://www.womenshealth.gov/publications/our-publications/fact-sheet/hysterectomy.html#)

NEW TECHNOLOGY/MORE FROM DR. IM: A new high-tech tool has made it easier for doctors to perform hysterectomies. Dwight Im, MD, Director of Gynecological Oncology at Mercy Medical Center in Baltimore, Maryland says "The biggest problem with the single site laparoscopy is when you put the instruments through a tiny hole, the instruments have to criss-cross," making it a difficult procedure to perform. With the robotic surgery and new needle driver tool, doctors are able to rotate 50 degrees as their wrists move. Dr, Im says "This is as close as we get to having a scar-less surgery." With this new tool, hysterectomy patients are able to go home the same day or the next day after surgery.

(Source: Dwight Im, MD)

FOR MORE INFORMATION ON THIS REPORT, PLEASE CONTACT:

Dwight Im, MD

410-332-9205

dim@mdmercy.com

If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at mthomas@ivanhoe.com

Dwight Im, M.D., Director of the Gynecologic Oncology Center at Mercy Medical Center in Baltimore, Maryland, talks about a high-0tech surgical tool that could mean faster recovery for women.

Interview conducted by Ivanhoe Broadcast News in December 2014.

I want to talk about robotic surgery in your area can you give our viewers some context?

Dr. Im: The biggest misconception that our viewers may have is that the robot is doing the surgery. There is no R2-D2, I am the robot. Perhaps it's a misnomer in a sense that there's not an actual robot performing the surgery. What it really is, is an enhanced laparoscopic surgery. During a typical minimally invasive surgery you would make a big incision, instead, you make a few small tiny holes and then you put an instrument that you can actually manipulate. The biggest difference between robotic surgery and conventional laparoscopic surgery is that the surgeon instead of looking on the monitor, he actually can look inside of the patient's abdomen with a three dimensional view and when he moves his fingers the tip of the instruments move as if they're his own fingers.

This has been around for several years right, the robotic surgery?

Dr. Im: For a gynecologic condition it's been around since 2006, so about eight years.

Tell me about what is new; what is the new tool, the technique with robotic surgery that you're testing.

Dr. Im:  When you use the term minimally invasive to me ultimately you just want to have one tiny incision that people can barely see. The traditional robotic surgery requires a minimum of three holes, sometimes four, five or six holes. The latest advancement in robotic surgery is you are using one, one inch incision through the umbilicus or the belly button. Which intuitively sounds pretty exciting but it has its own limitations.

What is the latest change to robotic surgery that you're using right now?

Dr. Im: The latest change is the single site robotic hysterectomy. It means instead of the traditional three to five hole hysterectomy you have one single incision perhaps an inch long right through the belly button. And that was approved by the FDA in March last year.

How is this tool different, how does it enable you to do the surgery with just that one hole?

Dr. Im: The biggest problem with the traditional single incision laparoscopic surgery was that when you put an instrument through a tiny hole the instruments have to crisscross. So when you move your left hand it's the instrument that's in the right hand that has to move so it's counter intuitive. What the robotic surgery has done is it has fooled the instruments so that when you move your right hand even though the instrument is on the left side it moves as if it's on the right side. That's the biggest advancement in technology. There's only one incision, a small incision where you have five instruments going in through a tiny hole. So it has its own limitations. What has happened lately is that unlike the traditional robotic surgery where the instruments move as if they're part of your wrist it does not always do that with single site hysterectomy. The instruments as wonderful as they are still do not have the wristed motion except now we have one instrument that can do that.

How is that one instrument able to do the work of several instruments?

Dr. Im: The biggest problem or the limiting step for a hysterectomy laparoscopically or robotically was the closure of the vaginal cut. Once the uterus and cervix are removed from the vagina how do you close the cut? Because in order to place a suture in the vagina you have to have a wristed motion if possible and that wasn't always the case. But now for the first time we have an instrument, a needle driver that can actually rotate 45 to 50 degrees as your wrist moves.

It's essentially the suturing; it's the closing up again after the surgery is complete?

Dr. Im: It's the closure of the vaginal cut and until now most surgeons have been reluctant to learn this technique because of the limitations of the non-wristed motion but now they can all do this.

What is the benefit to the patient having this kind of technology?

Dr. Im: If you're a woman and you're interested cosmoses for example; first of all you don't want to be cut open unless you really have to. And in terms of minimally invasive surgery you want it to be truly minimally invasive. By that I mean you want to have a scar that is virtually scar-less and this is as close as we get to have a scar-less surgery because a lot of the times the scar is through the belly button and you can't even tell you actually had surgery.

Are there any drawbacks from your perspective for using this, any difficulties to having something so small?

Dr. Im: The single site hysterectomy is certainly more challenging to learn for a surgeon doing a routine more traditional robotic laparoscopic surgery. But once you get over the learning curve it is a much better surgery in my opinion, not only for the surgeon but also for the patient because she recovers quickly and she's happy that she only had one incision. Plus antidotally the pain is much less than somebody who's had several holes.

Tell me about the conditions that you can use this tool for.

Dr. Im: The FDA indications for a single site hysterectomy is any hysterectomy that is being performed for the so called benign conditions, which means heavy uterine bleeding, fibroids, endometriosis where a hysterectomy is indicated. If it's cancer, the FDA has not given us approval thus far.

Why would it not be approved yet for cancer? What would be the concern?

Dr. Im: Because in most cases cancer surgery for a gynecologic situation is typically a hysterectomy as well as taking the lymph nodes out. It's much more challenging from the technical standpoint to remove the lymph nodes using the single site platform.

Is there a time when the FDA would be able to look at using this tool to take the lymph nodes too at some point?

Dr. Im: Absolutely. Right now what we have available is the wristed needle driver but eventually when you have wristed instruments for example, scissors, cautery and so on then yes, absolutely then it will become available in my opinion.

Again, this is just for removing the uterus?

Dr. Im: The uterus as well as the ovaries and fallopian tubes.

How long is this surgery, is it faster than other robotic surgery?

Dr. Im: It really depends on the surgeon. Some surgeons may take two hours and the exact same surgery can be performed by another surgeon in thirty minutes or so. In large my surgeries are about an hour or so for the single site hysterectomy.

What is the recovery time as opposed to surgery?

Dr. Im: Most people go home the same day, sometimes they stay over-night. By the next day I expect them to be up and about, walking around, hardly taking any pain medicines and then they are back to working full time within about two weeks.

I know you were the first to use this after the FDA approved it, do you know how widespread its use is now? You mentioned learning curves for surgeons, are you part of training the next generation of surgeons that will use this?

Dr. Im: I get typically ten to 20 doctors every month that come in to visit me to learn so my guess is there may be 50 to 100 doctors right now who are trained to perform single site hysterectomy including the wristed needle driver.

Is there anything I didn't ask you that you think is important for our viewers to know?

Dr. Im: I think that the patient has to realize that yes you would like to have a minimally invasive surgery if at all possible but what you also have to realize is, is my surgeon capable of performing such surgery. Just because it's minimally invasive doesn't mean it can be performed by anybody. You need to do some research, make sure your surgeon has the credentials and has the experience of robotic surgery including the single site surgery.

Is this covered by most insurance?

Dr. Im: It's covered by all the insurances because it is really laparoscopic surgery.

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.