Doing More with LESS
Date: January 2, 2014
If gynecologic oncology surgeon Amanda Nickles Fader had her way, most gynecologic procedures would be performed through one tiny incision. She’s working hard to make that happen.
Studies from the past 15 years have shown that minimally invasive surgical (MIS) approaches to treating gynecologic conditions are superior to surgery performed through large incisions, says Fader, who joined Johns Hopkins in April as director of the Kelly Gynecologic Oncology Service and the Minimally Invasive Surgery Center in the Department of Gynecology and Obstetrics. “The recovery is faster,” she says, “there are fewer perioperative complications and less pain, hospitalizations are shorter, and women get back to their lives more quickly.”
Fader is now heading an evolving center of excellence in minimally invasive gynecologic surgery and surgical innovation at Johns Hopkins, one of few hospitals nationwide offering the gamut of minimally invasive procedures for benign or cancerous gynecologic problems. The techniques include laparoendoscopic single-site surgery (LESS), microlaparoscopy and robotic surgery. With conventional laparoscopic or robotic surgeries, the procedures are performed through three to five abdominal incisions. But studies suggest that complications like risk of infection, hernia, visceral injury, nerve entrapment and persistent incisional pain can still occur. During LESS procedures, surgeons operate through one dime-size incision in the navel, where there are few nerves, muscle or blood vessels. Patients can’t see the incision once it’s healed and they require very little pain medication after surgery.
With microlaparoscopy, tiny 2-3 mm incisions are made and miniature laparoscopic instruments are used. “Going from 5-12 mm incisions to 2-3 mm incisions may seem like a small difference,” Fader says, “but it’s the difference between having to repair an incision with a potentially painful stitch to avoid a hernia compared with using a little skin glue or a Band-Aid.”
Early outcomes show that in the hands of experienced surgeons, these techniques can be used safely even for very difficult operations, says Fader, including the removal of ovarian cysts and masses; uterine fibroids; hysterectomies; and select uterine, cervical and ovarian cancer-staging procedures.
Fader and colleagues Stacey Scheib, Edward Tanner and Kara Long Roche are also conducting clinical trials using robotic surgical techniques to detect sentinel lymph nodes in gynecologic cancer patients. Blue or green dyes are injected into the cervix to identify the first group of draining lymph nodes most likely to be involved in uterine or cervical cancer if it has spread, allowing the surgeons to remove fewer lymph nodes. This decreases the risk of complications for patients. Fader and colleagues are also studying the merger of robotics and single-site technology—an option approved by the FDA in February—that may allow for surgery performed through the navel to be performed more easily.
At Johns Hopkins, 85 percent of endometrial and cervical cancer-staging procedures, nearly 100 percent of risk-reducing uterine and ovarian procedures, and 75 percent of overall hysterectomies are performed minimally invasively. Fader alone performs approximately 300 of these procedures annually.
For more information or to refer a patient, call 443-997-0400.