Advanced Gynecologic Technique Performed by SLUCare Physicians is Virtually Scarless, Speeds Recovery

By use of an innovative technique, surgeons at SLUCare–The Physicians of Saint Louis University can offer almost scarless surgery and rapid recovery to patients seeking ovary or fallopian tube removal and hysterectomy.

Laparoendoscopic single-site (LESS) surgery represents the logical next step in minimally invasive surgery from traditional and robot-assisted laparoscopy. Patrick P. Yeung Jr., M.D., Director of the Center for Endometriosis and Minimally Invasive Gynecologic Surgery at Saint Louis University, adopted the LESS technique in 2009 and has used it for hysterectomies and ovary or fallopian tube removal ever since.

The key innovation of LESS surgery is the way surgeons access the pelvis. In traditional laparoscopic surgery, they introduce the camera and instrumentation through ports docked in multiple abdominal incisions, allowing a triangulated approach to the surgical site. In LESS surgery, surgeons introduce three instruments through one port located in the layer of tissue known as the umbilical fascia, or the basin of the belly button. Thus any scarring is practically invisible.

“We make a 2-centimeter incision into the tough umbilical fascia, which, in my training, we called ‘the layer that keeps in the chitlins’ because it is the strength layer,” Dr. Yeung says. “To get optimal cosmetic results, we match the skin incision to the belly button’s natural creases. We tailor the incision to match each patient’s belly button.”

Dr. Yeung explains that, because triangulation does not naturally occur when instruments are introduced through a single site, specially developed graspers, cameras and other instrumentation that bend at the tip help surgeons recreate triangulation at the surgical site.

The Reality of Scarless Surgery

When Dr. Yeung joined SLUCare and introduced LESS surgery to the St. Louis area, his colleague, M. Brigid Holloran-Schwartz, M.D., associate professor, Saint Louis University Department of OB/GYN; and Director, Section of Minimally Invasive Gynecologic Surgery, was uncertain whether it would produce markedly improved cosmesis.

“I was a bit skeptical when he called it a ‘scarless surgery,’” recalls Dr. Holloran-Schwartz. “Then I performed a case with him — and many subsequent cases. It’s truly remarkable how superior the cosmetic results are.”

In addition to enhanced cosmesis, Dr. Holloran-Schwartz notes that LESS procedures significantly reduce recovery times — typically returning patients to their normal routines in two weeks as opposed to six — and reduce pain and scar tissue formation compared with laparotomy.

Patients are often pleasantly surprised to learn of the LESS option and the benefits it entails.

“Patients who need a hysterectomy come in and inquire about robot-assisted surgery because they’ve heard about it,” Dr. Yeung says. “I tell them we can certainly do that and perform the procedure through five holes. Or, we could do it through a single hole. They usually didn’t know they had this scarless surgical option.”

SLUCare–The Physicians of Saint Louis University practices at multiple locations throughout the St. Louis area. Patrick P. Yeung Jr., M.D., OB/GYN, and M. Brigid Holloran-Schwartz, M.D., OB/GYN, are certified Center of Excellence Surgeons at SSM St. Mary’s Health Center, a nationally designated Center of Excellence in Minimally Invasive Gynecology located in Clayton, MO. They also have privileges at St. Luke’s Hospital in Chesterfield, MO. For information, please visit us at

Source: MD News May/June 2013, St. Louis Edition



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