Advanced Gynecological Surgical Procedures
Getting Women Back Into Life, Relieving Pain
This article was first published in Health View, September 2000.
Mindy Graham of Florence was not doing well. For two years, she had struggled with an assortment of symptoms and chronic, unrelenting pain. She went from one doctor to the next without finding a cause for her ill health. "The pain was awful all the time. My life was miserable; I couldn't eat, couldn't sleep, just pain, pain, pain," she said.
Then, during an appointment with her gynecologist, as Graham described a series of ongoing menstrual irregularities, she also mentioned the other problems she'd been experiencing.
Dr. Thomas Phillips, an obstetrician/gynecologist on staff at Carolinas Hospital System, suspected endometriosis and decided to schedule her for a laparoscopy. The minor surgical procedure would allow him to view her internal organs, and help him to determine exactly what was going on.
Tending her beautiful garden is just one of many activities Mindy is now able to enjoy again following her surgery.
What Dr. Phillips found in the thirty-eight-year-old dental hygienist was significant. "He discovered that I had a bad case of endometriosis," Graham said. Endometriosis occurs when the tissue that lines the inside of the uterus grows in abnormal locations. The tissue can form painful masses, or adhesions, which increase in size over time. As the disease progresses, the most common symptom is usually pain, especially excessive menstrual cramps. Yet a diversity of other symptoms can also plague women.
Because Graham's endometriosis was so severe, it called for a hysterectomy or surgical removal of the uterus. While the majority of hysterectomies are performed as open surgeries with an abdominal incision, other approaches to the procedure are options for some patients. Dr. Phillips scheduled Graham for a laparoscopic-assisted vaginal hysterectomy, a surgical procedure that allows the uterus to be removed through the vagina.
In the operating room at Carolinas Hospital System, a few small incisions were made in Graham's abdomen to allow Dr. Phillips to insert a Laparoscope and operating instruments. The laparoscope is equipped with a tiny video camera and a light source, allowing the physician to see the internal abdominal tissue and organs on a video monitor in the operating room. What Graham knew was that Dr. Phillips would take out her uterus, to free her from the disease that had impacted every faction of her life. What she didn't know was that he was using an advanced surgical tool employing ultrasonic energy, an instrument that would not only change the way her surgery was done, but the way she would recover.
It's called the harmonic scalpel and provides physicians with the ability to make incisions in an entirely different manner. "In traditional surgery, you have to tie off vessels or coagulate them with electricity. As the harmonic scalpel cuts, it stops the bleeding," said Dr. Phillips.
In contrast to electrosurgery, which uses electric energy and lasers, which rely on light energy, the harmonic scalpel utilizes ultrasonic energy created by sound waves. Its blade vibrates at an amazing 55,000 times per second, and does not require the very high temperatures that are used by electrosurgery and lasers. "The main point is safety. It's very interesting that the harmonic scalpel can be used as it is,"said Dr. Phillips. "Since it does not produce the heat that electrocautery does, you can use it in close internal areas that you normally could not use cautery around and there is less tissue damage. It provides a tremendous benefit."
"Whatever is kind to the tissue helps the patient heal faster," he added. "Since you don't have to go through all the muscles of the abdomen, there's less discomfort and you don't have big scars. Most patients go home in 24 hours." He recalled another patient who had the same surgery as Graham. The woman's surgery was on a Monday. By Friday night, she was attending her son's football game. Phillips concluded, "It's a great tool that's advanced surgical intervention by leaps and bounds."
Because a large incision is not necessary, patients like Graham have significantly less pain and scarring and a much shorter recovery time. The harmonic scalpel also contributes to considerable cost savings in the patient's health care expenses. In addition to its role in laparoscopic-assisted vaginal hysterectomies, the harmonic scalpel is used by gynecologists in laparoscopic exams, to remove fibroid tumors in relation to the treatment of endometriosis. "With endometriosis you can cut it out, or ablate it, meaning you can lay the scalpel up against the cells and it will destroy them," said Dr. Phillips.
The harmonic scalpel is also frequently utilized by surgeons in a number of other videoscopic surgeries such as: gallbladder, bladder control problems, gastroesophageal reflux and many common gynecological conditions. Using this device means less tissue trauma, minimal risk of electrical energy to the patient and a clear visual field on the television monitors. Because of these benefits, experts in the surgical community believe that ultrasonic energy will play a lead role in the advancement of videoscopic surgery.
While patients may not be aware the harmonic scalpel was utilized in their surgical procedures, they are well aware that their recovery is not a long and difficult process. If Graham had undergone a traditional abdominal hysterectomy, she could have expected to be out of commission for four to six weeks. In Graham's case, she was out weeding in her garden three days after surgery.
She was ecstatic about her new health status. "The day after surgery I was like a different person. After being so sick for two years, I felt wonderful. I don't think I even took two pain pills in the hospital," she said. Graham was also very pleased with the staff that treated her at Carolinas Hospital System. "Everyone at the hospital was great to me throughout the entire process, and I can't thank them enough."
By Diane J. Epperly, Contributing Writer.
Back to Reference Library.