A hysterectomy is the surgical removal of the uterus, and this operation is an exceptionally common procedure with over half a million hysterectomies performed in the United States every year. Gynecologists employ the procedure to treat a range of both cancerous and benign conditions including tumors, uterine fibroids, and heavy or prolonged menstrual periods, also known as menorrhagia. Depending on the condition being treated, the patient’s age, and other factors, a hysterectomy may be performed along with a salpingo-oophorectomy – removal of the ovaries and fallopian tubes. There are several options performing a hysterectomy procedure, one of which is a Da Vinci hysterectomy, which offers patients several distinct benefits. Read More
This is the fifth in a series of five blogs about conditions that can be related to abnormal uterine bleeding.
Mild vs. serious menstrual cramp pain
Most women experience mild to moderate menstrual cramping on occasion. When it occurs, the medical term for it is usually “primary dysmenorrhea,” which means painful menstrual cramps caused only by normal menstruation and not by an underlying condition or disease. Symptoms of normal primary dysmenorrhea can include pain that:
- feels like mild to moderate cramps in your lower pelvis or back
- occurs a day or two before your period or during the first few days of your period
- is accompanied by mild nausea or diarrhea
- doesn’t interfere with your daily activities
- improves with one or two doses of ibuprofen
Primary dysmenorrhea is caused by the release of chemical compounds called prostaglandins in your uterus, and it often improves as you get older. Primary dysmenorrhea often responds well to prostaglandin-lowering treatments such as ibuprofen, magnesium and certain dietary changes. Read More
The FDA speaks out
Earlier this month, the U.S. Food and Drug Administration issued a memorandum that discouraged surgeons from using a common procedure called power morcellation to remove uterine fibroids. Power morcellation uses a medical device to divide uterine fibroids into smaller pieces that can be removed through a small incision in the abdomen, such as during laparoscopic surgery.
Why was the FDA announcement necessary?
New data from the Center for Devices and Radiological Health show that power morcellation can spread undetected cancers more often than previously realized. According to the data, one in 350 women who undergo a hysterectomy to treat fibroids or who have fibroids removed have undiagnosed uterine sarcoma — a type of cancer that can be aggressive. If power morcellation is performed in women with this kind of uterine cancer, the procedure can spread the cancer around the abdomen and pelvis.
A few days ago, I saw a local newspaper article that described a botched robotic surgery from 2009. The article went on to claim that new surgical technologies such as the da Vinci® Surgical System are not always properly evaluated by physicians and hospitals in terms of their potential harm to patients. Perhaps most alarming, the article noted that there are questions about the experience and expertise of many of the surgeons who use the equipment.
I always encourage my patients to be fully informed about the advantages and potential risks of any procedure they’re considering. From my perspective, the recent media coverage provides an excellent opportunity to explain robotic surgery and review what you can do to help prevent the kind of complications mentioned in the article. Finally, at the end of this blog you’ll find a description of my practice and what my patients can expect if they choose robotic surgery.
Yesterday, I appeared on “Health Talk” to discuss SILS – Single Incision Laparoscopy Surgery.
In a nutshell, instead of a six-inch incision required by traditional surgery (or even the three to four smaller half-inch incisions utilized in standard laparoscopic surgery), SILS surgery is accomplished through a single small incision in the belly button.
The following operations can be performed by SILS:
- Removal of uterus (hysterectomy)
- Removal of ovary (oophorectomy)
- Removal of gallbladder (cholecystectomy)
- Removal of appendix (appendicectomy)
- Repair of paraumbilical or incisional hernia
- Diagnostic laparoscopy with biopsy
Beginning Sunday, May 19, each evening at 8 and 10 pm, you can view this very infomative segment. Health Talk is Norwalk Hospital’s TV show which broadcasts on Cablevision Local Programming Channel 84.
If you have questions about SILS or need more information, call my office at 203.855.3535.
Insights from Chicago on a potentially safer type of surgery
Last month I went to a conference in Chicago that focused on an exciting new type of surgery — one that has the potential to reduce scarring and recovery times, along with other potential benefits. The conference was the 7th International NOTES® Summit, sponsored by the American Society for Gastrointestinal Endoscopy and the Society of American Gastrointestinal and Endoscopic Surgeons.
What is NOTES?
NOTES stands for natural orifice transluminal endoscopic surgery. The word “translumenal” refers to going beyond the margins of a hollow organ (or “lumen”, such as the stomach or vagina). “Endoscopic” is a type of surgery that uses special surgical instruments to go through small incisions or natural body openings in order to diagnose and treat diseases and other medical conditions. Instead of “traditional” surgery involving large incisions, or even laparoscopy, which uses specialized surgical instruments used through small incisions, NOTES involves interior incisions made within the body’s natural openings. Read More
For many of my patients, the word “surgery” has a host of associated meanings: long hospital stays, time away from home/family/work, significant pain, lengthy recovery period … and visible scarring. I’m excited to say that scarring will become less of an issue for some of my patients in the next few months, when I will start providing a new service called SILS™.
What is SILS?
An acronym for single incision laparoscopic surgery, SILS made its way onto the medical scene in the late 1990s. You may have heard of by a different name: “belly button surgery”. SILS has risen to the forefront of abdominal surgery in recent years along with the development of related technology. While few physicians have received training so far, SILS is gradually catching on.
What are the advantages of SILS?
With SILS, only one umbilical incision is needed to perform the procedure. Using SILS technology, multiple instruments including the telescope can be placed through the incision. (In standard laparoscopy, the umbilical port is used only for observation through the “telescope”. In order to manipulate tissue and place sutures, standard laparoscopic techniques require the placement of two or three additional abdominal ports/incisions.) Compared to traditional port placement, SILS offers a lower risk of complications and additional postoperative pain.
How does SILS work?
Those of you who have followed my blogs for a while know that I’ve written about pelvic prolapse a few times — once about daVinci surgery and another time regarding a clinical study that was set up to see if synthetic mesh inserted through a vaginal incision is beneficial in the repair of pelvic organ prolapse. Pelvic organ prolapse is a relatively common condition caused by the weakening of pelvic muscles and ligaments that support organs such as the bladder and uterus. When this weakening occurs, these organs can slip out of place, often pushing into or through the vagina. Pelvic organ prolapse can be uncomfortable and it can interfere with bowel movements, urination and sexual activity.
FOR IMMEDIATE RELEASE
April 11, 2011
Norwalk, CT – Today John Garofalo, M.D. was admitted to the Registry of the Council of Gynecologic Endoscopy (CGE) with certification at the highest level of competence in Operative Laparoscopy and Operative Hysteroscopy. He is now one of a select group of Connecticut and Fairfield County physicians to be listed on the Registry. With this certification, CGE recognizes Dr. Garofalo’s experience conducting endoscopic surgeries that led to successful medical outcomes.
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. Read More