Laparoscopic
Laparoscopic Surgery Means Less Pain, Little Scarring
Hysterectomies, among the most common reproductive surgeries for women,
are undergoing a quiet revolution in the Tampa Bay area. Over the past 15 years
at Dade City’s Pasco Regional Medical Center, Dr. John Ferlita and another local
physician have used advanced, minimally invasive, surgical techniques to perform
more than 5,000 laparoscopic hysterectomies. More laparoscopic surgeries are
performed at Pasco Regional Medical Center than at all other Tampa Bay area
hospitals combined.
“These doctors are a treasure,” says hospital CEO Michael Arno.
“Here in Dade City, they have taken the extraordinary and made it ordinary.”
Instead of cutting across the patient’s belly – or, worse yet,
from her breastbone down to her navel – these surgeons insert their long, narrow
surgical tools through buttonhole-sized incisions. A miniature camera, inserted
through another tiny incision, allows them to view the operating area on a video
screen. The average uncomplicated procedure takes them 45 minutes or less.
The Best for the Patients
The benefits to the patients are many. The average
laparoscopic hysterectomy patient –
- Experiences relatively little pain;
- Loses about 3 ounces of blood, less than
she loses in one day’s heavy period;
- Has relatively little risk of infection;
- Has fewer chances for complication;
- Has less need for a transfusion;
- Is up and walking within a few hours of
surgery;
- Returns home to her family the following
day;
- Returns to work within a week; and
- Has minimal, if any, permanent scarring.
The old-fashioned surgical technique, called
abdominal, or open, hysterectomy requires a horizontal or vertical cut at least
half-a-foot long, three-to-five day hospital stays, and four-to-six weeks out of
work.
From Extraordinary to Ordinary
More than 600,000 women will have a hysterectomy this year in the United States.
Fewer than one in ten will have a minimally invasive procedure.
"This country is 15 years behind the times,” says Dr. Ferlita. “It is deplorable
for women to have their bellies opened for a minor problem, a benign problem.”
In 1989, Dr. Harry Reich performed this country’s first laparoscopic
hysterectomy in Chicago The microchip was key to expanding this kind of surgery.
Microchips permitted the development of smaller and smaller electronic devices,
including cameras. “I thought this was the best thing that ever happened to me,”
says Dr. Ferlita. “As gynecologists, we have always done laparoscopy – tubal
ligations, diagnostic studies. But because of the lack of technology, we were
limited to looking into a scope – peering in and seeing a small, little area –
so it was very uncomfortable to do anything major. But microchips in cameras
changed everything.”
In May 2005, the doctors began team-teaching the laparoscopic procedure to
surgeons who come to Dade City for training. Success came with their very first
session as one surgeon who attended returned to Miami and performed two
laparoscopic hysterectomies within the next month. He had tried only two in the
preceding four years. The Dade City surgeons, eager to mentor colleagues seeking
to learn laparoscopy, are delighted.
The Way of the Future
“As technology advances, you will be able to do more and more through a scope or
through a camera system,” says Dr. Ferlita. “My interest is that surgeons think
laparoscopic hysterectomy first, open case second, just like they do for gall
bladders. Opening the abdomen for gall bladders is very rare today. Laparoscopic
first. That’s how it should be with hysterectomies.”
Clinically compelling reasons for an abdominal hysterectomy include malignancy
and a uterus too large to be removed by laparoscopic surgery. For surgeons less
experienced in advanced laparoscopy, internal fibrous bands that result from
infection, surgery or trauma – called adhesions – can also be a reason to open
the abdomen.
The doctors urge patients to ask questions and seek information on the Internet.
What questions should a potential hysterectomy patient ask?
“She should ask if she is a candidate for laparoscopic hysterectomy,” says Dr.
Ferlita. “If the answer is ‘No,’ ask, ‘Why not?’”
Susan Frimmel, Publicity Director for Pasco Regional, adds another set of
questions. “How many incisions do you do? How big? Where are you going to make
the incision? Can you show me?” If the surgeon plans to make incisions of
several inches or more, the procedure is not laparoscopic and Frimmel suggests
asking tough questions to find out if a minimally invasive procedure is
available.
Dr. Ferlita agrees. “Minimally invasive surgery is the way surgery is heading.
It is the way of the future.”
Excerpted from article by Kit Ingalls.
