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Published: Synapse, 2010 - Vol. 2
Now an Even Less Invasive Option for Gynecologic Surgery is available.
Gynecologic surgery can require an incision of several inches in the abdomen -- called an "open incision" -- to access organs such as the uterus and ovaries and surrounding tissues. But surgeons often opt for less invasive approaches when it's right for the patient and the procedure she needs. Smaller incisions can mean less blood loss, less trauma to healthy tissues, lower risk of complications, minimal scarring, and shorter recovery times -- all potentially great benefits for women.
During laparoscopic gynecologic surgery, for example, the surgeon inserts a thin, lighted telescopic camera (or laparoscope) through a small, ˝-inch incision in the navel to visualize the organs. The physician then makes two or three additional ˝-inch incisions in the abdomen and operates through them using specialized surgical instruments. Some hospitals are now offering robot-assisted gynecologic surgery, in which the surgeon uses robotically-controlled precision instruments to operate through several tiny, one-centimeter abdominal incisions.
An even newer, less invasive option called single-incision laparoscopic surgery, or SILS™,* is just what its name suggests: surgery requiring only one incision and made directly into the belly button. The surgeon works through a specially designed port with multiple openings for inserting the laparoscope and surgical instruments. Because the incision is in the belly button, there is no visible scarring, and having one small incision instead of several can reduce post-surgical pain, complications, and recovery time.
"For selected patients, single-incision laparoscopic surgery is yet another option to offer as we try to further minimize the trauma of surgery and give the most aesthetically pleasing result," says Waleed Shalaby, MD, PhD, Director of Gynecologic Oncology and The Cancer Risk Evaluation Program at The Chester County Hospital.
Dr. Shalaby is one of just a handful of surgeons in the area performing SILS™ for some gynecologic procedures. "Younger women, especially, are looking to get back to their active lifestyles quickly and avoid obvious scarring."
Single-incision laparoscopic surgery is not right for every procedure nor for every woman. Since the Hospital began offering it earlier this year, Dr. Shalaby has used SILS™ primarily for women who need to have one or both ovaries removed. There may be a suspicious mass on the ovary and cancer needs to be ruled out, or persistent benign cysts that are causing a woman enough discomfort to justify removal of the ovary. Other women elect to have their ovaries removed because they test positive for the BRCA genetic mutation, which significantly increases lifetime risk of ovarian cancer. Dr. Shalaby notes that women in these groups tend to be younger, otherwise healthy, and eager for a surgical option that is virtually scarless and causes the least amount of disruption in their lives.
In a few other cases, Dr. Shalaby has used SILS™ as part of the surgery for early-stage endometrial cancer (cancer of the uterine lining), in which the uterus is removed through the vagina. Traditionally, the first part of the surgery -- which typically removes the ovaries and checks for any evidence that the cancer has traveled beyond the uterus -- has been done through several laparoscopic incisions, rather than just one.
January Pasquantonio, Cancer Care Coordinator for The Chester County Hospital, has followed these patients with endometrial cancer from diagnosis to recovery.
"The women who had single-incision laparoscopic surgery as part of their procedure did find it to be less invasive with less scarring and a quicker recovery time," Pasquantonio says. "They liked being out of the Hospital in about 24 hours, as opposed to a few days."
"Generally, women with confirmed or suspected gynecologic cancer are anxious about the potential diagnosis and getting the cancer out -- what kind of surgery they have is secondary," she adds. "But once they get over the initial anxiety, they are interested to know they have different surgical options. It is such an overwhelming and potentially life-changing time, and being able to give a less-invasive option under the right circumstances can alleviate some angst and get them out of the Hospital faster."
Pasquantonio also has worked with some patients who had SILS™ to remove a suspicious ovary that turned out not to be cancerous -- the best possible situation, she says.
"They are so happy it was benign and also that they were able to have the least invasive surgery available to figure that out," she says.
Women with more extensive or complicated gynecologic conditions, such as advanced cancers, are not good candidates for single-incision laparoscopic surgery. Nor are women who are morbidly obese or have scarring from previous abdominal surgeries.
In the right situations for the right patients, though, Dr. Shalaby believes that single-incision laparoscopic surgery will come into even wider use for gynecologic procedures.
"SILS™ is an option for many women instead of laparoscopic or robotic surgery. What it will come down to is what is right for the individual patient and her situation. I just see it as another tool that lets us offer as many minimally invasive surgical options as possible," Dr. Shalaby says.
By Kristine M. Conner
To learn more about your surgical options for gynecological cancers, contact The Women's Specialty Center at 610.732.6730.
*SILS™ is a trademark of Covidien, maker of the port. All surgery presents risk. Any procedure using the SILS™ Port is major surgery and as with any surgery, complications may occur.
A breast cancer (BRCA) gene test is a blood test to check for specific changes (mutations) in genes that help control normal cell growth. Finding changes in these genes, called BRCA1 and BRCA2, can help determine your chance of developing breast cancer and ovarian cancer. A BRCA gene test does not test for cancer itself. This test is only done for people with a strong family history of breast cancer or ovarian cancer, and sometimes for those who already have one of these diseases. A woman's risk of breast and ovarian cancer is higher if she has BRCA1 or BRCA2 gene changes.
Last Updated: 9/13/2010