Garofalo Obgyn

In my last blog, I mentioned that da Vinci surgery provides precision that’s crucial when working in close proximity to delicate organs like the bladder. In addition, the camera technology provides a great deal of detail. If you’re facing the prospect of surgery and you think of the kind of surgery you’d prefer to have, hopefully words like detail and precision are ones that come to mind.

This combination of detail and precision makes da Vinci very well suited for a variety of surgery types and procedures, including several that I do regularly as part of my medical practice. For this blog I thought I’d talk about da Vinci surgery and hysterectomy.

Not your mother’s hysterectomy

If your mother or grandmother had a hysterectomy, it was probably done vaginally or through a horizontal incision in the abdomen. She probably stayed in the hospital for about six days, with a recovery period that lasted four weeks or longer. In comparison, women who have a da Vinci hysterectomy can expect to stay in the hospital for about one day, followed by about a week of recovery.

As a minimally invasive procedure, the da Vinci hysterectomy is a much simpler and less traumatic experience. Instead of a long incision, da Vinci hysterectomy uses five small incisions, spaced across the abdomen. Compared to open abdominal surgery, there’s less bleeding, less pain, minimal scarring, quicker recovery, a shorter hospital stay, and a lower likelihood of complications.

Here are a few quotes from women who have had da Vinci hysterectomies, including one of my own patients. These quotes and many others can be found on www.davincistories.com.

“I am truly amazed how quickly I was able to recover after having major surgery. My incisions were minimal, my recovery was quick.” – Maureen, Madison CT

“The da Vinci procedure has transformed the surgical procedure from a long, difficult recovery to a relatively painless, quick procedure with very little downtime. It is perfect for active working people who don’t have six weeks to be down.” – Anne, Enfield CT

“I had my surgery a week before Christmas, and I was up to entertaining for the holidays.” – Tina, West Suffield CT

 More information

If you’d like more information or to see a da Vinci hysterectomy testimonial, go to this page on my website. The testimonial video is at the bottom:

http://www.garofaloobgyn.com/hysterectomy.html

If you need additional information, you can click on any of the links below, or you can contact my office directly. In my next blog, I’ll write about another condition called myomectomy that can also be treated using da Vinci.

 Links to da Vinci surgery resources

daVinciSurgery.com

da Vinci Hysterectomy

da Vinci Surgery Patient Stories

Dr. Garofalo’s da Vinci information page

Dr. John Garofalo, M.D., is a certified da Vinci surgeon in Fairfield County, Connecticut. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

As I mentioned in my last blog, the da Vinci Surgical System uses a computerized interface between the surgeon and the instruments to conduct surgical procedures. The name “da Vinci” was chosen for the system because legendary artist and inventor Leonardo da Vinci is credited with designing the first robot. It’s also a fitting name because Leonardo da Vinci used anatomical accuracy and three-dimensional details to lend realism to his art.

For many people, the use of robots or robotic tools in surgery raises some concerns. One commonly accepted definition of a robot is “an automatically guided machine, able to do tasks on its own.” This definition is a bit vague, but experts generally agree that robots tend to do some or all of the following: move around, operate a mechanical limb, sense and manipulate their environment, and exhibit intelligent behavior, especially behavior which mimics humans or other animals.

Given only those definitions to describe da Vinci technology, I’d be concerned too. To be honest, I’ve avoided using the word “robot” or “robotic” to describe the da Vinci Surgical System in my website. It’s not really an accurate term, since the da Vinci system is directed and controlled by a human being – in this case, a specially trained surgeon whose finger movements are transmitted electronically from a console in the surgery room to the da Vinci cameras and surgical instruments. Along with the surgeon and the equipment, an assistant surgeon, an anesthesiologist, and a nurse are generally by the patient’s bed.

While it’s definitely not the kind of robot you might picture from the movies, da Vinci surgery draws upon years of robotic technology. The cameras and surgical tools are truly state-of-the-art, and provide a level of precision which is crucial when working in close proximity to delicate organs like the bladder. Benefits of da Vinci surgery usually include:

• Less pain after surgery
• Less scarring
• Lower risk of infection
• Less blood loss
• Faster recovery

When my patients ask me about da Vinci technology, I generally tell them this: The da Vinci Surgical System is not the only option for surgery, but it has many advantages and few disadvantages relative to more traditional methods of surgery.

In my next blog, I’ll write about the types of conditions that can be treated using da Vinci. If you need information more quickly, you can click on any of the links below, or you can contact my office directly.

Links to da Vinci surgery resources

daVinciSurgery.com

da Vinci Surgery Patient Stories

Dr. Garofalo’s da Vinci information page

Dr. John Garofalo, M.D., is a certified da Vinci surgeon in Fairfield County, Connecticut. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

As one of the first doctors in Fairfield County, Connecticut to be certified in da Vinci surgery, I’m asked a lot of questions about the technology and how it can be used to treat endometriosis, uterine fibroids, pelvic organ prolapse and other conditions. Since I’ve seen so much interest and heard so many questions about da Vinci surgery, I thought it would be helpful to use this blog to provide information to women who may be considering or facing surgery.

In the next few weeks, I’ll be posting a series of blogs about da Vinci surgery and how I use it in my own medical practice. If you have any experiences you’d like to share, please feel free to comment.

First, here’s a bit of history about the da Vinci Surgical System:
Back in the late 1980s, a company working with the U.S. Army developed a system that would allow surgeons to perform battlefield surgery by using remote-controlled medical instruments and cameras. This allowed the surgeons to stay away from the fighting, but it had a few other advantages. The surgery was highly precise and “minimally invasive” (it used very small incisions, usually allowing for quicker recovery and less bleeding than “open” surgery). It’s not exaggerating to say that this company developed a breakthrough in surgical technology.

Some of the people associated with the project realized that the technology could be used with a wide variety of surgeries, and not just on the battlefield. In 1995, a company called Intuitive Surgical was founded to develop the technology for commercial use. Intuitive Surgical launched the da Vinci Surgical System in 1999, and in 2000, da Vinci became the first surgical system of its kind approved by the FDA for general laparoscopic surgery. Since then the da Vinci Surgical System has been used successfully in tens of thousands of procedures.

Next week I’ll write about how da Vinci surgery works. If you need information more quickly, you can click on any of the links below, or you can contact my office directly.

Links to da Vinci surgery resources

daVinciSurgery.com
da Vinci Surgery Patient Stories
Dr. Garofalo’s da Vinci information page

Dr. John Garofalo, M.D., is a certified da Vinci surgeon in Fairfield County, Connecticut. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

If you occasionally forget to take your birth control pills, you should consider using the Nuvaring. The Nuvaring is a soft flexible plastic ring that is inserted into your vagina and removed after 3 weeks. A new ring is then inserted one week later. Just like birth control pills, the Nuvaring contains a combination of estrogen and progesterone. Instead of having to take a birth control pill every day, the Nuvaring prevents pregnancy for a full four weeks by slowly and continuously releasing estrogen and progesterone into your body every day for 21 days. Since it contains the same types of hormones that birth control pills contain, using the Nuvaring has the same risks and benefits for your health. As compared to birth control pills, the major advantage of the Nuvaring is the convenience factor.

Although many of my patients were initially resistant to the concept of wearing a vaginal ring, well over 90% of my patients who have tried the ring have been very satisfied with their contraceptive choice. The Nuvaring is easy to place and remove and it does not interfere with spontaneity or intercourse. You will not even know it is there and your partner will probably not know either- and if he does notice something, it won’t bother him. The Nuvaring cannot get lost inside of you and it rarely slips out. When properly used, the Nuvaring is 99% effective.

For more information, go to the Nuvaring website at http://www.nuvaring.com/Consumer/index.asp or schedule an appointment with me for personalized contraceptive counseling.

H1N1 FLU ANNOUNCEMENT

Please listen to this important announcement about the risks and prevention of the Swine Flu H1N1 Virus for pregnant women.

Where: Stamford Town Center 
What: daVinci Robotic Surgical System Demonstrationon
When: Saturday, September 26 from 1-7pm

For anyone interested in learning more about DaVinci surgery for the treatment  of women’s

health conditions, I urge you to stop by The Stamford Town Center this Saturday between 1 and 7pm.  I will be demonstrating the DaVinci surgical system along with Urologist, Jonathan E. Bernie, M.D., Chief of Robotic Surgery at Norwalk Hospital.

DaVinci Surgery Demo at Stamford Town Center

The community health education event, “Learn about Advanced Robotic Surgery,” is being offered as a public service by Norwalk Hospital to provide information about the new and expanding field of robotic surgery in the treatment of both prostate cancer and women’s health conditions such as fibroids, endometriosis and pelvic organ prolapse.  I’ll be joined by other Norwalk Hospital doctors and patients who will answer questions.

Before this breakthrough, traditional laparoscopy has never become widely applied outside a limited set of routine procedures.. The robot allows us to view anatomical structures clearly and perform a precise surgical procedure through small incisions.  With the daVinci Surgical System we can perform complex procedures using a minimally invasive approach with confidence.

Many surgical procedures performed today using standard laparoscopic technique may be performed more quickly and easily using the daVinci Surgical System. This is because robotic surgery delivers increased clinical capability while maintaining the same “look and feel” of open surgery.

Robotic surgery enhances surgical capabilities and can improve clinical outcomes.  Research has shown that patients experience less blood loss and need for transfusions, less post-operative pain and discomfort, less risk of infection, shorter hospital stay, and faster recovery and return to normal daily activities.

For more information about robotic surgery, please attend the September 26th event at the Stamford Town Center off of Exit 8 on I-95, or call the Norwalk Hospital Community Relations Department at (203) 852-2250.

The truth is that there is no scientific evidence supporting the safety or effectiveness of compounded bioidentical hormones. There is also no scientific support for the use of hormone assays from salivary, urine or blood for the adjustment of hormone replacement dosage.

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Patients occasionally ask me about the safety and effectiveness of  Bioidentical Hormone Replacement Therapy (“BHRT”). They point out that they can get natural hormones in personalized doses based upon levels of hormones in their saliva. They are told by compounding pharmacies and their marketers that BHRT

• is a safer, natural alternative to dangerous prescription drugs
• is superior to FDA-approved hormone therapies
• can slim you down by reducing hormone imbalances
• can prevent senility, Alzheimer’s disease, stroke, and various cancers

It sounds great, doesn’t it?

The truth is that there is no scientific evidence supporting the safety or effectiveness of compounded bioidentical hormones. There is also no scientific support for the use of hormone assays from salivary, urine or blood for the adjustment of hormone replacement dosage.

With the approach of menopause, decreasing estrogen levels may be associated with hot flashes, vaginal dryness, poor memory, insomnia and osteoporosis. Treatment with estrogen and progesterone (HRT) can relieve these symptoms and help prevent osteoporosis. The benefits of HRT are accompanied by an increase in the risk of cardiovascular disease and breast cancer. Because of these risks, the FDA requires that pharmaceutical companies manufacturing HRT include appropriate warning labels within the packaging of all these medications. The American College of Obstetricians and Gynecologists (ACOG) recommends that HRT should only be used for relief of severe menopausal symptoms that do not respond to natural methods or non-hormonal medications. HRT should be used at the lowest effective dosage for the shortest possible period of time.

In order to get initial FDA approval for sale and marketing of HRT preparations, pharmaceutical companies were required to produce scientific evidence supporting the safety and efficacy of their product. The FDA also mandates ongoing monitoring of the manufacturing processes and reporting of adverse drug events. BHRT, on the other hand, is not made by pharmaceutical companies; it is made by compounding pharmacies that are not subject to the rigors of FDA regulation. The bottom line is that because BHRT preparations have not undergone rigorous clinical testing for safety or efficacy, we really do not know if these preparations are either safe or efficacious. Important decisions about one’s health should not be based on what seems like a good idea. Safety and efficacy claims must be based on the best available scientifically derived evidence and must be reevaluated in the light of emerging data.

Your decision of whether or not to take hormone therapy for menopausal symptoms is highly individualized, based on your health, risk factors, and personal wishes. You should be sure to have all the information you need in order to make an informed decision.

For more information on bioidentical hormones:

Click here for an article from the FDA   http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm049311.htm

Click here for an article from the American College of Obstetricians and Gynecologists http://www.acog.org/from_home/publications/press_releases/nr02-03-09.cfm)

For more information about salivary testing for hormone levels:

Fugh-Berman A et al. Bioidentical Hormones for Menopausal Hormone Therapy: Variation on a Theme. J. Gen. Internal Med. 22: 2007.  http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2219716

Chatterton RT Jr, Mateo ET, Hou N, et al. Characteristics of salivary profiles of oestradiol and progesterone in premenopausal women. J Endocrinol 2005;186:77-84.  http://www.ncbi.nlm.nih.gov/pubmed/16002538

John M. Garofalo, MD

Because pregnant women with influenza are at higher than average risk of complications from influenza, the Center for Disease Control  (CDC) has recommended prompt treatment for pregnant women with influenza-like symptoms. The CDC recommends that doctors and patients should not wait for definitive lab reports before starting antiviral medications because the best response to antiviral medications is seen when treatment is initiated early in the course of the illness.  Pregnant women who have been exposed to the  H1N1 influenza strain by a family member or other close contact should also be treated promptly even if they do not have any symptoms- this is called chemoprophylaxis.  

Pregnant women should see their obstetrician promptly or go to the emergency room if respiratory illness is experienced. The symptoms of influenza include cough, sore throat, rhinorrhea, fever, body aches, headache, fatigue, vomiting and diarrhea. To prevent influenza remember to get your yearly influenza vaccine,  avoid people with known respiratory illnesses, wash your hands regularly and cover your cough. 

For more detailed information, see the CDC webpage on pregnant women with H1N1 influenza.

A recent medical study found that women who had a laparoscopic hysterectomy generally experienced less blood loss, less pain and a shorter hospital stay compared with women who had a vaginal hysterectomy.

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Hysterectomy, or surgical removal of the uterus, can be performed in different ways, including open surgery, laparoscopically, and vaginally. Open surgery provides the most effective way to ensure complete removal of the reproductive system but requires a wide incision through the abdominal wall. Laparoscopic hysterectomy is a minimally invasive procedure that uses thin, fiber-optic telescopes passed through into the abdomen through small cuts in the abdominal wall. In a vaginal hysterectomy, the surgeon operates entirely through the vagina.

While many tests have compared the safety and effectiveness of open and laparoscopic hysterectomies in recent years, relatively few have compared vaginal and laparoscopic hysterectomies. Many tests comparing vaginal and laparoscopic hysterectomies have concluded that vaginal hysterectomies are superior to laparoscopic hysterectomies.

Between April 2004 and April 2006, a team of physicians in Milan, Italy conducted a study to compare the two types of procedures. Sixty women participated in the study, with 30 having a laparoscopic hysterectomy and the other 30 undergoing a vaginal hysterectomy. Women with various medical complications or conditions that might have interfered with the study’s results were excluded. The results were published in the April 2009 American Journal of Obstetrics & Gynecology.

The study found that while the laparoscopic procedure took more time on average, the women who had a laparoscopic hysterectomy generally experienced less blood loss and a shorter hospital stay compared with the women who had a vaginal hysterectomy.

Average Comparisons

                                                              Laparoscopic                                         Vaginal

Average blood loss                                83.9 ml                                                178.2 ml

Average hospital stay                           2.7 days                                                3.2 days

Average length of operation               99 minutes                                          82 minutes

Candiani. Laparoscopic vs vaginal hysterectomy for benign pathology. Am J Obstet Gynecol 2009.

Following the procedure, the women who had a laparoscopic hysterectomy generally reported a lower average level of pain on the day of the surgery and experienced faster recovery from pain in the days that followed. The average number of days before returning to work was not significantly different between the two groups.

The women came in for check-ups one, six and 12 months after their procedures. They were evaluated in terms of pelvic pain, urinary dysfunctions, sexual activity, vaginal infections and other factors. Based on clinical and ultrasound evaluations, the two procedures were equally effective.

http://www.garofaloobgyn.com/hysterectomy

http://es.garofaloobgyn.com/hysterectomy.html

Candiani M, Izzo S, Bulfoni A, et al. Laparoscopic vs vaginal hysterectomy for benign pathology. Am J Obstet Gynecol 2009;200:368.e1-368.e7