ANN ARBOR, MI -- Imagine being a woman and being told you had several tumors on your uterus and the primary surgery to remove them would cause you to loose your fertility. You might think 'if that's my only option I don't have much choice'. In fact, nearly 180,000 women each year in the United States who have fibroid tumors on their uterus make the decision to have a hysterectomy, a procedure that removes the entire uterus.
Now, a new procedure at the University of Michigan Health System is changing that. It's called a robotic myomectomy and it allows women to maintain their fertility while surgically removing their fibroid tumors. By performing the surgery robotically, the procedure is done minimally invasively with quicker recovery times for the patient.
"At UMHS, we've been fortunate to have the ability to utilize robotic technology in the treatment of some of gynecology's most complex problems, one of which is the treatment of uterine fibroids," says Arnold Advincula, M.D., clinical assistant professor in the Department of Obstetrics and Gynecology at UMHS. "We now can give women a choice, actually a much better choice in how to treat their tumors."
Lisa Rudgers knows first hand the choices women are presented with when they have fibroid tumors. She found out she had the tumors on her uterus after noticing a mass in her abdomen.
"I sat down with Dr. Advincula and he was able to really clearly show me the surgical options I faced," says Rudgers. "I am not yet 40 years old and if I didn't have to face the idea of having a hysterectomy, I really didn't want to do that. So, I choose the minimally invasive robotic myomectomy."
What are uterine fibroids?
Uterine fibroids are the most frequent pelvic tumors seen by gynecologists. They are benign tumors of fibrous tissue and smooth muscle. The fibroids can be found in 1 in 2 African-American women and 1 in 4 Caucasian women. The highest prevalence occurs in the fourth decade of life.
"Fibroid tumors can cause of variety of symptoms," says Advincula. "For some women, they experience pelvic pain and pressure on their bladder because of the size of the tumor. In other women, they may experience bleeding that becomes a significant disruption in their life because their cycles are no longer once a month and for a few days, but can go on for several weeks."
How are uterine fibroid tumors treated?
Uterine fibroids can be treated in a variety of ways including surgically and non-surgically. The first approach is through medications or hormonal therapies. The second is with interventional radiology that injects a chemical into the fibroid which blocks the blood supply to the tumor thereby causing it to shrink. The third is surgically either by a hysterectomy or a myomectomy.
"Myomectomy is the removal of a fibroid tumor from the uterus while leaving the uterus intact," notes Advincula. "Traditionally, it's been done through an open incision on a patient's abdomen, or more recently through laparoscopy which allows a surgeon to operate through small incisions. The latter technique is effective with smaller tumors, but for larger tumors that's where using the robot is highly effective."
What is a robotic myomectomy?
Currently, UMHS is the only institution in the world performing robotic myomectomies on a regular basis. Instead of performing the surgery by the patient's side, Advincula operates from a console a few feet away, viewing a three-dimensional image captured by cameras inside the patient and controlling the surgical instruments. Although a second surgeon, nurses, and medical assistants are next to the patient, Advincula performs the entire surgery by operating the arms of the seven-foot robot remotely. A procedure Advincula thinks benefits both the surgeon and the patient.
"The robot acts as an extension of the surgeon's hands," Advincula says. "The biggest advantage is that I don't have to compromise my approach that I would otherwise do in an open case. I can take out a larger tumor of the uterus and repair it with very little damage to the tissue surrounding the tumor. This is very important to women who are choosing this surgery and want to retain their fertility and potentially have children in the future."
Since the surgery is performed minimally invasively, patients who undergo a robotic myomectomy have a quicker recovery time than they would with traditional open and laparoscopic surgeries.
"I was back up and in the gym and at my desk within a few days, running within a couple of weeks," says Rudgers. "The recovery time was very minimal because there was no incision and because there was no hysterectomy."
Advincula says although some women with uterine fibroid tumors have to have a hysterectomy, a robotic myomectomy is providing other women an opportunity to retain their uterus and subsequently, retain their fertility.
"The success that we have been seeing with the robotic myomectomy here at UMHS has been phenomenal," says Advincula. "It very satisfying to be able to give women a choice in their treatment."
The UMHS Department of Obstetrics and Gynecology is exploring the application of robotic surgery in the use of hysterectomy, as well as complex gynecologic surgery involving cancer staging.
The robot joined UMHS's operating team late in 2001, and has successfully assisted in nearly 100 surgeries -- including various thoracic procedures, removal of kidneys from living organ donors, gynecological and prostate procedures, and several pediatric surgeries.
UMHS is one of the first hospitals in Michigan and the United States to perform robot-assisted surgery since the Food and Drug Administration approved the approach for laparoscopic surgeries in July of 2000. The da Vinci robot is a $1 million device created by Intuitive Surgical Inc.
Facts about uterine fibroid tumors:
-Fibroids can be found in the cavity of the uterus, in the wall of the uterus or on the outside of the uterus. -Fibroids may be as small as a tiny pea or as large as a small watermelon. -Fibroids may grow as a single tumor or in clusters. A cluster of fibroids can vary in size. -Not all fibroids are symptomatic.
For more information on uterine fibroid tumors and robotic myomectomies, visit the following websites:
UMHS -- Minimally Invasive Surgery Program http://www.med.umich.edu/obgyn/mis/davinci.htm
UMHS -- Minimally Invasive Surgery Program Clinic http://www.med.umich.edu/obgyn/mis/fibroid.htm
National Institutes of Health -- Uterine Fibroids http://health.nih.gov/result.asp?disease_id=705
National Institute of Child Health & Human Development Fast Facts about Uterine Fibroids http://www.nichd.nih.gov/publications/pubs/fibroids/sub1.htm
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