Advanced Care for women's pelvic health
When Barbara Marcus of Old Bridge was diagnosed last fall with fibroids and a prolapsed—or dropped—uterus, bladder and rectum, her gynecologist wanted to perform major abdominal surgery to correct the condition. But she wasn’t ready.
Today's minimally invasive procedures such as sils offer easier treatment- and quicker recovery- for uterine prolapse, fibroids, and incontinence.
When Barbara Marcus of Old Bridge was diagnosed last fall with fibroids and a prolapsed—or dropped—uterus, bladder and rectum, her gynecologist wanted to perform major abdominal surgery to correct the condition. But she wasn’t ready.
“I walked out,” she recalls. “The problem wasn’t bothering me that much, and I'd never had any surgery before, not even for my tonsils.”
The conditions she had aren’t much fun to talk about, but they’re really quite common. By age 60, one in three women in the u.s. will have a hysterectomy due to fibroids, pelvic pain, bleeding or prolapse.
A woman’s pelvic floor comprises a sheet of muscles and ligaments that supports the uterus, small intestine, rectum and bladder. Pregnancy, childbirth, hormonal changes or excessive weight can stretch and weaken those muscles and ligaments. if pelvic floor muscles are weak, the organs may drop and bulge into the vagina, a condition called prolapse. When that happens, a woman may feel as if something is falling out of her vagina. The problem also can cause sexual dysfunction or sensations of fullness or pain, and make it difficult to hold urine or have a bowel movement.
Marcus’ symptoms got worse in March, while she and her husband, Joel, were wintering in coconut creek, florida. fibroids on her uterus grew bigger and she started experiencing bladder-control problems. Together, these conditions caused pain and a feeling of fullness that was negatively impacting her quality of life.
“It was very annoying,” she says.
So she went to see Martin Michalewski, M.D., who had performed a laparoscopic hysterectomy on a friend of hers five years before. A specialist in urogynecology and advanced laparoscopic surgery, he has helped to pioneer many of the new minimally invasive procedures used to perform hysterectomies and treat pelvic floor disorders. “I met him back when my friend had her surgery and was impressed with him,” says Marcus. Dr. Michalewski examined Marcus and recommended an outpatient laparoscopic procedure—but said he couldn’t do it himself, because he was in the process of relocating to New Jersey. Initially she planned to have one of the doctor’s partners do her surgery, but when she asked, “Where in New Jersey?” and he said, “Long Branch,” she replied, “That’s just down the road from me!”
When Joel suddenly needed a hernia procedure, she postponed her operation to help care for him, then arranged to meet Dr. Michalewski when they came back north later in the spring.
“She kind of followed me to New Jersey!” Dr. Michalewski says with a laugh. On June 9, he performed a laparoscopic hysterectomy and a pelvic floor repair called a sacral colpopexy on Marcus at Monmouth Medical Center—all through a single, tiny incision in her navel.
This so-called single-port laparoscopic surgery (SILS), approved for this use by the Food and Drug Administration in April 2009, is the latest step in the progression of minimally invasive procedures, explains Dr. Michalewski, who for a year and a half has been teaching this method to other surgeons. “We’ve gone from long incisions to bikini cuts to a few small punctures to robot-controlled laparoscopy and now to single-port entry through the belly button,” he says. The benefits from using this method are fewer complications and quicker recovery. “Instead of a week in the hospital and six weeks’ recovery, women now come to the hospital in the morning and leave in the afternoon,” he says. “They can be back to their routines in a week or two.”
And going through the navel has added benefits. “There is no muscle under the belly button to cut through, which means less pain, no visible scar and easier healing,” the doctor says. In fact, it represents the next step in minimally invasive surgery and is a precursor to NOTES— Natural Orifice Translumenal Endoscopic Surgery, which is peformed through the mouth, rectum or vagina, and is currently being studied for use in a variety of surgical specialties. “The belly button is a natural orifice, so this is very close to incisionless surgery,” he says.
After removing the fibroid-laden portion of Marcus’ uterus, Dr. Michalewski then laparoscopically stitched a mesh grid onto the pelvic floor to act as a kind of suspension system to hold the organs up. According to Covidien, the company that provides the needed equipment, this was the first such combination surgery done in this way in New Jersey.
The patient was pleased. “I moved a bit slowly up the stairs my first day home, but after that it got easier day by day,” she says.
The only postsurgical care required was cleaning a less-than-1-inch wound in her belly button with peroxide. “That was it,” she says. “After a day or two I just needed Tylenol for the pain. I could go to the market, the mall and restaurants with no problems. And the constant pressure I’d felt was gone right away.”
Soon after, she even played golf again, something she had discontinued in Florida when her condition worsened. (“But don’t ask me what I shot,” she says with a laugh.) Marcus understands some women’s reluctance to talk about, or seek treatment for, these sometimes-embarrassing conditions. “But if you can have a procedure done laparoscopically, go quickly,” she says. “It fixes the problem.”
“Almost everything in gynecology and urogynecology can be done nowadays with laparoscopic, robotic or SILS procedures,” Dr. Michalewski adds. “They’re fully covered by all insurance plans, and they’re elective outpatient procedures that improve your life and leave no scar. You go home the same day and you don’t even need to tell people you had it done.”
