Posts Tagged ‘OBGYN’

Once a Cesarean… Twice a Cesarean… Always a Cesarean?

Posted: November 23, 2010 in Health
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I will save you the lecture I give to medical students and residents. I will save you all the complex medical information and bring it down to why this matters to you.

If you never had a C-section, you should not ask for one unless needed or recommended by your health care provider. Think twice before you ask for a C-section (Cesarean delivery) for non-medical reasons as social convenience, avoiding a timely or painful labor, or other personal reasons. I will not delve into the controversial debate on the ethics of “Cesarean delivery on maternal request (CDMR)”, “patient-choice cesarean” or “cesarean on demand”. I am all for choice and autonomy, you are entitled to decide what is best for you, but you should be empowered with the right to full knowledge of all details and entailed risks.

If you had one previous C-section, you should have a discussion with your health care provider early in your pregnancy about the method of delivery. Most women with one previous C-section are good candidates for a trial of labor, an attempt at a vaginal (natural) delivery.

If you had two previous C-sections, or if you are carrying twins and had one previous C-section, you might be a good candidate for attempting to deliver vaginally according to recently released recommendations by the American College of Obstetricians and Gynecologists (ACOG) in August 2010. Talk to your provider about these options.

I will not be able to provide you with all facts in this brief blog, and each pregnant woman is unique in her needs. The take home message is this:

“You do not anymore need to dismiss the option of having a natural delivery just because you had one or even two previous Cesarean deliveries.”

You have the choice and you should be actively involved in making this decision with your health care provider.

Carrying a newborn baby. (Photo published with patient's permission)

Bigger surgeries. Smaller incisions!

Posted: October 26, 2010 in Health
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Assisting in a DaVinci Robotic hysterectomy in 2008 at University Hospitals Case Medical Center demonstrating a minimally invasive approach to surgery.

I just came back from Harvard’s Minimally Invasive Gynecologic Surgery conference held in Boston Oct. 15 to 18 under the supervision of Dr. Jon I. Einarsson. I have met Dr. Einarsson in 2003 In Houston, Texas during a minimally invasive surgery rotation with Dr. Robert Zurawin at Baylor. I was happily surprised to see Dr. Zurawin at the same meeting.

We are witnessing fast-paced advancements in technology that allows us to provide patients with the same benefits of surgery at lower risks, and faster recovery. These advancements are changing the field the way we know it and breaking traditional notions about surgery.

Surgery has traditionally been associated with a large scar, pain and lower mobility after surgery, a long recovery period and a longer time off work. This is changing.

Removal of the uterus (hysterectomy) is the second most common surgery in USA (The most common is Cesarean delivery). Hysterectomy should be done through the vagina whenever possible. In most cases, this is not possible due to the size or position of the uterus or due to lack of adequate training of the surgeon (at least in USA). Traditionally, the alternative was an abdominal hysterectomy (Through a large incision on the abdomen). In Canada they call it “Le grande opération”, French for “the big surgery”.

Peggy Turbett - (The Plain Dealer, 2008) Doctors at University Hospitals Case Medical Center perform a hysterectomy using a robotic device called the da Vinci Surgical System. While Dr. Vivian von Gruenigen works the robot's "arms" from a control booth (shown on the left), Dr. Hasan Abdessamad, right, assists with surgical instruments.

There is nothing big about a hysterectomy anymore when we can do it laparoscopically (through three small incisions). I send my patients home the next day and back to work a week later. They barely use any pain medicine at home.

In the Harvard conference there was much more muscle-flexing. Minimally Invasive Surgeons are now doing almost anything laparoscopically, even pelvic exenteration (or pelvic evisceration = a radical cancer surgery that removes all organs from a woman’s pelvic cavity). Robotic gynecologic surgery has picked up in USA and is starting to pick up in the more socialist Canada. It did not arrive to Lebanon as far as I know and according to DaVinci Surgery website.

I met the Da Vinci Robot in Houston in 2003 and was privileged to be trained on using it in Cleveland at University Hospitals – Case Medical Center.

With robotic surgery, the surgeon does not have to be scrubbed or even in the same room as the patient. Robotic surgery will allow surgeons to perform surgery remotely on people in war fields, in distant or under-served areas, or even in a space shuttle.

The DaVinci is not the only robotic system. The new generation of robots are lighter and smaller, making their use easier. They also have tactile feedback, so they feel just like the new generation video games.

Appreciating the Da Vinci robotic arms

It is only the begining.

Trying out the Da Vinci Console before we bought it - Cleveland 2008