Access to Less Invasive Surgery

A few posts ago I discussed the excitement about having a robotic surgical system come to the Ogden area. The most exciting part of this is the increasing availability of minimally invasive options to patients in our area. The robotic system does not offer much to a surgeon already trained in advanced laparoscopic techniques but it does increase the number of doctors who can perform advanced laparoscopic procedures.

For some reason, Utah seems to be lagging behind much of the US in its knowledge and acceptance of laparoscopic surgical options for women. Many patients are unaware that there is an option for surgery that does not require them to stay multiple nights in the hospital and take 4-6 weeks off work. Although 90% of patients surveyed said they expected their doctors to discuss less invasive options. Patients should be aware of all surgical and non-surgical options and discuss them in detail, even if their doctor does not offer that option.

Currently in Utah, 60-65% of hysterectomies are performed with a large abdominal incision. Over the last 4.5 years I have been able to decrease my open surgery rate for hysterectomy to less than 4%. Half of that 4% was due to patient choice. How I wish that more physicians would embrace these options and have a significant impact on their patient's lives.

With the advent of robotic surgery availability in Ogden, the number of surgeons performing laparoscopic hysterectomy has more than doubled. Unfortunately, after proven safety and efficacy in multiple studies, there is still resistance to implementation of robotic surgery programs at one local hospital. As these challenges continue, there are numerous women who are forced to accept open surgery as the only option provided by their doctors.

Many people believe that laparoscopic and robotic surgery is more expensive than "open" surgery. This is certainly true for costs of the actual surgery. What they fail to realize is that a less invasive surgery decreases cost outside the operating room. There are fewer costs attributed to lab work, room and board, complications, infections and nursing. There is also a significant financial advantage to patients as they return home sooner and are back to work in 3 days to 2 weeks as opposed to 4-6 weeks.

Taking into account the cost of the entire hospital stay, laparoscopic surgery is less expensive than open surgery and robotic surgery is less than, but almost equivalent to, open surgery.

Certainly I am biased in my discussion of surgical options, but the bias is proven by experience. I have had many grateful patients who have benefited from laparoscopic options. When I sit down and discuss options for a surgical need, all options are discussed including vaginal surgery, abdominal or open surgery, and laparoscopic surgery. In over four years I have had only 2 patients that have chosen to have an open procedure. Patients are grateful to have an option that will not "lay them up" for 6 weeks when vaginal surgery is not an option.

Change is difficult at times, but I am hopeful that those who are passionate about minimally invasive surgery will continue to share their knowledge and experience with others. As this happens, patients will truly be able to make an educated choice that is the best for their life and needs.

Laparoscopic Sacrocolpopexy (Vaginal Prolapse Surgery)

After becoming more proficient over that last few years and with the availability of the Davinci Robotic System, I have now added laparoscopic sacrocolpopexy to the procedures I can offer to patients. Sacrocolpopexy is considered the "gold standard" surgery for severe vaginal prolapse. It is a surgery that uses a synthetic mesh to help the body develop a strong support of the upper vagina to repair prolapse. From inside the abdomen, the mesh is sewn to the front and back of the vaginal wall. A tail of mesh is then sewn to a ligament along the front part of the sacrum.

Again this is a surgery that has been done for years by the "open" technique. For many years now it has been performed laparoscopically and with robotic assistance. The same benefits from laparoscopy apply in this situation also. These include similar operative times, much shorter hospital stay, quicker recovery and faster return to work when desired.

Some complications may occur with this procedure whether it is performed laparoscopically or open. These include bleeding, bowel or bladder injury and occasionally mesh rejection or infection. Thankfully these complications are rare.

The advances in laparoscopic surgery are very exciting to me. Every week I see the benefit it has in women's lives as they are faced with a difficult decision for surgery. They are thrilled and grateful to know that there is an option that does not require weeks off of work and days away from home.