gynecologic surgery

Dr. Gamburg talks about endometriosis surgery

Robotic surgery for Endometriosis: Delaware Valley OBGYN blog

Princeton NJ gynecologist discusses endometriosis surgery with the daVinci robotic device.

In the video above, one of Dr. Eugene Gamburg's patients describes her experience undergoing a combined robotic surgical procedure with a surgeon at the University Medical Center of Princeton at Plainsboro, and how it saved her wedding day.

 

Dr. Seth Derman, our practice's fertility specialist also answers some frequently asked questions  about this disease.

What is endometriosis?

Endometriosis is a disease in which tissue similar to the endometrium is located in places in the body where it normally does not belong. Endometrium is the layer of tissue that lines the uterus. It is where a pregnancy will implant, and part of it sheds monthly during the menstrual period. Endometriosis is typically found on the surfaces of organs near the uterus, the ovaries, the fallopian tubes, bladder and intestines, although it may also be been seen in distant parts of the body.

What are the symptoms of endometriosis?

The most common symptoms of endometriosis are pelvic pain, painful menstrual periods and painful intercourse. Because the implants of endometriosis respond to hormones similarly to normal endometrium, which fluctuate throughout the month, the symptoms of this disease are are often cyclic.

How is endometriosis diagnosed?

Endometriosis can only properly be diagnosed using surgery to directly inspect for it, and possibly confirm the diagnosis by biopsy. Routinely subjecting women to laparoscopy or other surgery is not practical, so oftentimes, the diagnosis of endometriosis is presumed without confirming the diagnosis.

How is endometriosis treated?

Your doctor may treat endometriosis in a number of ways. Sometimes this involves surgery, but it usually involve medications that suppress ovulation cause the implants to shrink down. This may include progesterone like drugs (progestins) and birth control pills that create a pregnancy-like hormone environment or drugs like Lupron, the create a temporary menopause-like situation. These medications often work because Endometriosis symptoms typically improve with pregnancy and menopause.

What is daVinci robotic surgery about?

Laparoscopy which involves a inserting a telescope into the abdomen is commonly used to diagnose and treat endometriosis. The daVinci surgical robot is a device often used to complete surgeries laparoscopically that are difficult to do without open surgery. Because it enables the surgeon to see far greater detail and operate with greater precisions, many gynecologists will use robotic surgery to treat the disease. Our team of gynecologic surgeons is among the most experience in DaVinci and minimally invasive surgery in the area.

Does endometriosis affect fertility?

This answer to the this question is a bit more complicated. Advanced staged endometriosis (stages 3 and 4) can clearly cause infertility. With early stage endometriosis (stages 1 and 2), it is a little less straightforward. While there is reasearch to suggest that treating early stage disease helps to improve pregnancy rates, there are other data which shows women with early stage endometriosis have similar outcomes to those with unexplained infertility. Either way, it is important to understand that even in couples with endometriosis-related infertility, there may be other reasons for not conceiving, so it is still important to see a fertility specialist for a testing.

 

Dr. Pierce brings minimally invasive procedure to Princeton

YOUR HEALTH: Princeton Doctor performs single-site robotic hysterectomy

By Stephanie Vaccaro

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This article previously appeared in the Princeton Packet  

Single site robotic hysterectomy in Princeton NJ

Dr. Bruce Pierce, the medical director of the robotic surgery program at Princeton HealthCare System, was the first doctor in the northeast to do a single-site robotic hysterectomy with the da Vinci Xi system robot. The surgery involved removing the uterus and both tubes and ovaries.   This surgery is frequently done with a larger incision that is similar to that of a C-section.   ”And that requires a two- to three-day hospital stay followed by a six-week recovery period,” Dr. Pierce said. “Since I do it minimally invasively with the robot, I’m able to make one tiny incision in the belly button and because of that, my patient goes home the same day. And basically in two weeks they’re back to work. They’re back to their normal routine.”

The benefits of robotic surgery 

The value of robotic surgery is clear.   ”Basically, it’s using technology to make a major surgery into a minimally invasive procedure, with the focus on quicker recovery,” Dr. Pierce said, adding that it involves less scarring. “Ninety percent of these surgeries can be done as outpatient.”   Earlier this year, a large study was published in the “Journal of International Gynecology & Obstetrics,” with thousands of patients with a variety of hysterectomies. “They found in surgeons who were experienced with robotics, meaning they had more than 60 cases under their belt, they found the robotic hysterectomy has less complications, less need for re-operation, less need for readmission, and less bleeding and infection,” Dr. Pierce said. “The main thing was the surgeons needed to be experienced.”   What makes a patient a good candidate for robotic surgery? “It depends on the surgeon’s level of experience,” Dr. Pierce said.   He also said that it’s important to note that there is a learning curve with robotics.

The importance of using an experienced robotic surgeon

   "It’s not perfect right out of the gate," he said. “With a beginning surgeon, you basically have to pick the easiest candidate, meaning somebody who is not overweight, somebody who has not had a lot of previous surgery, somebody whose uterus is small, a non-complex surgery. But the more experienced you get with the new technology, you’re able to expand the patient base to a more complex patient. So, all of a sudden these patients who used to be not candidates for robotics are now candidates with experienced robotics surgeons.”   How will this technology develop? “The future though lies with more women becoming candidates and more complex cases being done in a minimally invasive manner,” Dr. Pierce said.   What about the naysayers? “The detractors of robotics say it’s too expensive,” Dr. Pierce said, but he pointed out considerations as fewer hospital stays, and returning to a work a month earlier.   Dr. Pierce has done hundreds of robotic surgeries for the past eight years. He has also taught other physicians how to do it for many years now. When considering robotic surgery, experience matters, he said, “I want to emphasize that an experienced surgeon is crucial to improved outcomes."