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600 SILS hysterectomies...Complication rate less than 0.5%...

It still amazes me that surgeons will not embrace this technique. The rapid return to activity and the patients genuine appreciation for it have continued to impress me. I will continue to promote it as long as I am able.

RCM

Well, we just completed our 500th SILS hysterectomy.  It reinforces the premise that when patients are given an option of multiple incisions vs 1 incision the choice is obvious... 1000 less incisions compared to traditional laprascopic and robotic hysterectomies.  Hopefully, more people will become aware of this option.

RCM

We were recently awarded the Center of Excellence in Minimally Invasive Gynecological Surgery (COEMIG) designation from the Surgical Review Corporation (SRC) and the American Association of Gynecoloical Laparoscopists (AAGL). This designation is awarded to surgeons and hospitals that are commited to the highest level of advanced minimally invasive gynecological surgery.  We ae proud to share this designation with Piedmont Medical Center's Women's Center

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RCM

I am often consulted for a second opinion regarding treatment options for various gynecological issues. This is absolutely appropriate.  Patients should actively seek different opinions on something as important as your health management, especially if it may involve surgery.  Unfortunately, many patients are reluctant to do this.  Why?

I am told that patients do not want to upset their primary ob/gyn.  That since their ob/gyn delivered their children,  they trust them completely.

While I absolutely believe trust is an important aspect of a health care relationship, there are often multiple ways to accomplish the same outcome, and these should be explored.  I often joke that some patients do more research selecting what cable tv package they will order than what surgeon will operate on them.  I hope that is because the public, in general, has a high view of physicians and correctly assumes that we are all competent and well trained in our field.  However, like in most fields, ob/gyn has many areas of sub-specialization (hormonal management, menopause, surgery, high risk obstetrics) to name a few. We all have different areas on which we concentrate our practices.

If you are considering surgery:

Discuss all options with at least two providers.

Ask your friends who have had similar issues for their thoughts and recommendations.

Do your due dilegence and research your surgeons on line, and in the community.

Do not be afraid to ask the question: "If I was your wife or yourself, who would you want to do this surgery and why?"

RCM

The President of the American Congress of Obstetricians Gynecologists James T. Breeden, MD released a statement this month recommending the advantages of vaginal and laparoscopic hysterectomies (including Single Incision Laparoscopic Surgery or SILS hysterectomy) over daVinci robotic hysterectomies.http://acog.org/About_ACOG/News_Room/News_Releases/2013/Statement_on_Robotic_Surgery

In May of last year, a randomized trial between vaginal and (multi-incision) laparoscopic hysterectomies found laparoscopic hysterectomies were associated with less pain, quicker return to work than vaginal hysterectomies. Vaginal hysterectomies were associated with less cost to the system but more pain.

My spin is one should avoid an open incision (abdominal hysterectomy).  They may be necessary but should be rare. Go with laparoscopic hysterectomy for less pain and quicker recovery; go with SILS hysterectomy for even less incisions than traditional laparoscopic hysterectomies. Whatever you do make sure you get a second opinion or at least feel very comfortable with your doctor's experience and plan of care.

RCM

There seems to be a lot of confusion regarding types of hysterectomies: partial, complete, total, subtotal, with or without ovaries. I will try to clarify:

Total Laparoscopic (or vaginal or abdominal) hysterectomy (TLH) is the medical term for "partial hysterectomy": the removal of only the uterus and cervix...Result: no more periods, no more babies, hopefully no more pain associated with you period. You still have your ovaries; therefore, you will not need to take any hormones as a result of the surgery.

TLH with bilateral salpingo-oophorectomy (BSO) is the medical term for "complete hysterectomy": Removal of uterus, cervix, tubes and ovaries.  Result: Same as TLH; however, because your ovaries have been removed, you may need to take some form of hormonal supplementation if you are not already in menopause.  Removing the ovaries is not performed as often as it once was.  There is some good data that removing the ovaries (while making you surgically menopausal with the associated hot flashes, mood swings etc) may also increase you risk of heart disease. My general recommendation is to leave the ovaries unless they are involved with the disease process that you are treating.

Subtotal or Supracervical hysterectomy: Removes only the uterus, leaving behind the cervix. Pros:  quicker surgery, leaves ligaments intact. Cons: an increased potential need to remove the cevix in the future for persistent/recurrent bleeding and pain. Continued risk for cervical cancer and need for annual pap smears. In general, I  do not recommend leaving the cervix unless the pathology prevents us from removing it (ie. very large fibroids, scarred pelvis) but this is rare.

This is just a quick overview and each patient's situation is unique. My hope is to clarify the terminology that even many doctors confuse.

RCM

I believe in giving patients all of their options for treatment from the most conservative to the most invasive (along with the relative risks / benefits) at the beginning of our treatment discussions.  

Because the majority of hysterectomies in this country are done for "benign" (non-cancerous) conditions, it is usually about one's "quality of life" that is being addressed.  Is it necesssary to fail all methods of non surgical treatment (ie.  months of birth control pils, spending money on a treatment option that the patient doesn't want only so they can say they "failed" at that treatment?) before proceeding to more difinitive surgical therapy?  

Clearly, if the symtoms do not represent a significant problem for the patient, then no treatment is the best option; however, these are not the patients that I see.  I can not tell you how many patients I have seen that have been tried on multiple pills, progestins, IUD, NSAIDs and even narcotics before their provider even began discussing possible surgical options, if they ever did.

I am all for attempts at non-surgical management as long as the patient understands ALL of her options and agrees/desires that approach.  If we as doctors do not talk about minimally invasive options like Mirena IUS, endometrial ablation and SILS hysterectomy, who will?

RCM

Well it is up and running. In the future I plan to add patient information regarding hospital stay, post op instructions etc.  I hope this site will serve as a resource for patients in need of gynecoloical surgery.

RCM