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Evolving Surgical Concepts
At St. John’s Riverside Hospital, innovative techniques open the door to safer, more efficient treatment for many patients previously contraindicated for gynecologic surgery.
Suzanne Greenidge, MD, FACOG, Senior Clinical Attending at St. John’s Riverside Hospital, says surgeons at the Yonkers hospital embrace the trend away from traditional open procedures to less invasive surgeries associated with minimal complications and faster recoveries.
Traditionally during open hysterectomies, surgeons make an abdominal incision approximately 3.5 to 4 inches long, manipulate tissue and organs, and then remove the uterus. Because of the internal manipulation, patients require a lengthy period to return to normal function.
“After the bowels are manipulated in open hysterectomies, patients are usually not able to eat solid foods for one to two days,” Dr. Greenidge notes. “It takes longer for the bowels to respond because surgeons move them around more, causing a delayed response and slowing recovery.”
Laparoscopic hysterectomy, on the other hand, doesn’t require as much maneuvering of the bowel, so patients often begin eating within 24 hours of the procedure. Improved visualization and the use of small instruments specially designed to operate through small incisions minimize tissue disruption. Other postoperative benefits, such as reduced bleeding and fewer associated complications, stem from surgeons only making three or four tiny incisions.
“Less blood loss is a key benefit for this modality,” Dr. Greenidge says. “It also improves patient confidence because they leave surgery with a similar blood count as they enter with.”
Back to Work
After an open hysterectomy procedure, patients’ mobility is often compromised by pain. Additionally, following a typically two- to four-day postoperative hospitalization, women who have undergone the procedure often require a six- to eight-week recovery time.
Laparoscopy returns patients home in 24 hours and reduces the recovery period to a matter of weeks or days, compared to months following open procedures.
“Improved recovery time is a major reason many patients want these procedures,” says Dr. Greenidge. “One of the best advantages is being able to return to work as quickly as possible. Because we’re able to perform the surgery through tiny incisions, patients aren’t in as much pain following the procedure and can return to work sooner than they could following an open operation.”
Expanding the Demographic
One of the major benefits of minimally invasive, laparoscopic surgery is that it opens eligibility to a wider range of patients — any patient cleared for surgery, according to Dr. Greenidge. Open surgery can be difficult to perform on obese patients, but Dr. Greenidge relates that patients in this demographic are perfect candidates for laparoscopy.
“Open surgery is more difficult to perform if we have to go through a lot of tissue,” she explains. “Because we operate through tiny holes in laparoscopy, we don’t have to worry about exposing tissue and can treat the internal organs the same as we would in any other patient.”
Into the Future
Dr. Greenidge is currently undergoing certification to perform robotic surgery in the future at St. John’s Riverside. She says the new modality will create even more opportunities for enhanced patient care in Lower Westchester County.
“Minimally invasive surgery is the way of the future,” Dr. Greenidge says. “It improves patients’ lives by returning them to work faster, reducing postoperative complications and increasing overall satisfaction. Physicians shouldn’t be afraid to break from traditional views of surgery that included long recovery times and intricate postoperative care.”
For more information about minimally invasive procedures available at St. John’s Riverside Hospital, please visit www.riversidehealth.org.
Source: MD News October 2013, Lower Hudson/Bronx Edition