The first total laparoscopic hysterectomy was performed in 1989. However, as minimally invasive surgery grew in other fields, it lagged for gynecology. It wasn’t until the past decade or so that doctors and patients alike have begun to take advantage of the spectrum of benefits that these procedures provide, say Kristin Patzkowsky and Karen Wang, both members of the Minimally Invasive Surgery Group in the Department of Gynecology and Obstetrics at Johns Hopkins. Khara Simpson—who, like Patzkowsky and Wang, is fellowship-trained in minimally invasive gynecologic surgery—recently joined the team in September.
Much like minimally invasive surgery in other fields, using these techniques can provide a lower risk of complications during procedures, such as bleeding, and an easier recovery, with less pain and bleeding afterward, a lower risk of infection, and an earlier return to normal function. “For many of our patients, who juggle busy home and work lives,” says Wang, “being able to return to a normal schedule as soon as possible is especially attractive.”
The three surgeons perform all of their procedures laparoscopically, even those that can be a challenge to perform as open procedures, including myomectomies for large or numerous fibroids, resections for stage 3 or 4 endometriosis, or total hysterectomies for large fibroid uteri. Any of these cases can be performed either as traditional laparoscopies or robotically, depending on surgeon preference, Wang says.
The team performs hundreds of minimally invasive gynecologic surgeries each year.
For patients interested in avoiding transfusions for religious or other reasons, Wang adds, their minimally invasive group offers a “bloodless medicine service,” with blood salvaged, filtered and returned to patients if needed.
The team plans to establish a multidisciplinary endometriosis group that can tackle this often complicated disease from multiple angles, including with medicine, surgery, radiotherapy, nutrition, physical therapy, pain therapy and reproductive endocrinology for patients interested in preserving their fertility. They also plan on establishing a minimally invasive gynecologic surgery fellowship to train future generations of surgeons in these techniques.
“Many of our patients tell us that if they’d known how easy the surgery would be, they would have done it years ago,” says Patzkowsky. “That’s why we do what we do: to help people get back to the lives they deserve.”