Last month another clinical study related to pelvic organ prolapse was described in the American Journal of Obstetrics & Gynecology. This study involved 108 women and compared two pelvic organ prolapse treatment approaches: laparoscopic sacrocolpopexy and total vaginal mesh.

Laparoscopic sacrocolpopexy is a procedure that uses soft synthetic mesh to support pelvic organs that have slipped out of their normal positions. The mesh is initially held in place by friction from strap-like arms of mesh material woven through the pelvis. Body tissues then grow through the mesh, creating the final support. This minimally invasive surgery takes only one to two hours. With the da Vinci Sacrocolpopexy procedure that I offer, the surgery is performed using general anesthesia.

While laparoscopic sacrocolpopexy is performed by laparoscopic access, total vaginal mesh is performed by vaginal access. Another difference is that laparoscopic sacrocolpopexy suspends the mesh from the sacrum — a large, triangular bone at the base of the spine — whereas in a total vaginal mesh procedure the mesh is suspended from pelvic ligaments.

Both procedures have been approved for several years; however, until this study was conducted in Australia, there had never been a controlled trial of this scope.

According to the article in the American Journal of Obstetrics & Gynecology, the study found that despite longer average operating time for laparoscopic sacrocolpopexy (97 minutes vs. 50 minutes for total vaginal mesh), the laparoscopic sacrocolpopexy held several significant advantages over total vaginal mesh: The laparoscopic sacrocolpopexy patients generally experienced fewer days as an inpatient, less blood loss, a shorter catheterization period and a quicker return to regular activities. More importantly, two years after surgery the laparoscopic sacrocolpopexy procedures had a success rate of 77% compared to 43% for the total vaginal mesh procedures. Finally, the reoperation rate (to treat symptoms such as further prolapse, incontinence, and mesh contraction or erosion) was 5% for laparoscopic sacrocolpopexy compared to 22% for total vaginal mesh.

I found these results particularly interesting as well as reassuring, since laparoscopic sacrocolpopexy is the primary pelvic organ prolapse treatment I offer in my practice.

More information on laparoscopic sacrocolpopexy and the da Vinci Sacrocolpopexy procedure can be found here. If you have any questions about these procedures or the symptoms they can be used to treat, please give my office a call.

Dr. John Garofalo, M.D., is gynecologist located in Fairfield County, Connecticut. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobgyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

FOR IMMEDIATE RELEASE
April 11, 2011

Norwalk, CT – Today John Garofalo, M.D. was admitted to the Registry of the Council of Gynecologic Endoscopy (CGE) with certification at the highest level of competence in Operative Laparoscopy and Operative Hysteroscopy. He is now one of a select group of Connecticut and Fairfield County physicians to be listed on the Registry. With this certification, CGE recognizes Dr. Garofalo’s experience conducting endoscopic surgeries that led to successful medical outcomes.

Endoscopic surgical procedures performed by Dr. Garofalo include hysterectomy (removal of the uterus), myomectomy (removal of uterine fibroids), sacrocolpopexy (abdominal vault suspension) and endometrial ablation (a procedure performed to treat abnormal bleeding of the uterus).

About CGE

CGE’s mission is to identify endoscopic surgeons and to encourage high standards for gynecologic endoscopy and minimally invasive surgery. As an example, laparoscopic hysterectomy, a minimally invasive procedure which can reduce surgery length, hospital stay, recovery time, pain and the likelihood of complications relative to traditional “open” hysterectomy, is used for only 15% of the 600,000 hysterectomies performed annually in the United States. By offering accreditation, CGE seeks to get more ob/gyns to use endoscopic procedures and, by raising the visibility of endoscopic techniques, to encourage more patients to demand them.

Formerly known as the Accreditation Council for Gynecologic Endoscopy, CGE is devoted to advancing knowledge and effective use of minimally invasive gynecologic surgery. CGE retrospectively reviews physicians’ case lists and randomly selected operative and pathology reports. Physicians whose case lists support the types of surgery they are performing are included as members and are listed in the registry. Surgeons who consider themselves gynecological endoscopic surgeons and can demonstrate sufficient case documentation may apply to be included in the registry, which includes only 1,100 gynecologic surgeons worldwide.

About AAGL

CGE is a professional interest partner of the American Association of Gynecologic Laparoscopists (AAGL), a not-for-profit professional medical association of doctors dedicated to the research and advancement of minimally invasive gynecologic procedures. Founded in 1971, AAGL has approximately 4,000 members located in more than 60 countries around the world. It is the first and largest organization in the world dedicated to advancing the safest, most efficacious and least invasive diagnostic and therapeutic techniques to treat women’s pelvic health disorders. The AAGL’s commitment to women’s health care, which historically has been embodied in the integration of clinical practice, research, innovation, dialogue and continuing education of physicians, now encompasses outreach to and education of patients. More information on AAGL and CGE can be found at www.aagl.org and www.aagl.org/CGE.

About John Garofalo, M.D.

Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. He is also the Associate Director of Gynecology at Norwalk Hospital. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobyn.com or call 203.803.1098.

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In the next few weeks, I’ll be posting a series of blogs about da Vinci surgery and how I use it in my own medical practice. If you have any experiences you’d like to share, please feel free to comment.

First, here’s a bit of history about the da Vinci Surgical System:

Back in the late 1980s, a company working with the U.S. Army developed a system that would allow surgeons to perform battlefield surgery by using remote-controlled medical instruments and cameras. This allowed the surgeons to stay away from the fighting, but it had a few other advantages. The surgery was highly precise and “minimally invasive” (it used very small incisions, usually allowing for quicker recovery and less bleeding than “open” surgery). It’s not exaggerating to say that this company developed a breakthrough in surgical technology.

Some of the people associated with the project realized that the technology could be used with a wide variety of surgeries, and not just on the battlefield. In 1995, a company called Intuitive Surgical was founded to develop the technology for commercial use. Intuitive Surgical launched the da Vinci Surgical System in 1999, and in 2000, da Vinci became the first surgical system of its kind approved by the FDA for general laparoscopic surgery. Since then the da Vinci Surgical System has been used successfully in tens of thousands of procedures.

Next week I’ll write about how da Vinci surgery works. If you need information more quickly, you can click on any of the links below, or you can contact my office directly.

Links to da Vinci surgery resources

daVinciSurgery.com
da Vinci Surgery Patient Stories
Dr. Garofalo’s da Vinci information page

Dr. John Garofalo, M.D., is a certified da Vinci surgeon in Fairfield County, Connecticut. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

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Hysterectomy, or surgical removal of the uterus, can be performed in different ways, including open surgery, laparoscopically, and vaginally. Open surgery provides the most effective way to ensure complete removal of the reproductive system but requires a wide incision through the abdominal wall. Laparoscopic hysterectomy is a minimally invasive procedure that uses thin, fiber-optic telescopes passed through into the abdomen through small cuts in the abdominal wall. In a vaginal hysterectomy, the surgeon operates entirely through the vagina.

While many tests have compared the safety and effectiveness of open and laparoscopic hysterectomies in recent years, relatively few have compared vaginal and laparoscopic hysterectomies. Many tests comparing vaginal and laparoscopic hysterectomies have concluded that vaginal hysterectomies are superior to laparoscopic hysterectomies.

Between April 2004 and April 2006, a team of physicians in Milan, Italy conducted a study to compare the two types of procedures. Sixty women participated in the study, with 30 having a laparoscopic hysterectomy and the other 30 undergoing a vaginal hysterectomy. Women with various medical complications or conditions that might have interfered with the study’s results were excluded. The results were published in the April 2009 American Journal of Obstetrics & Gynecology.

The study found that while the laparoscopic procedure took more time on average, the women who had a laparoscopic hysterectomy generally experienced less blood loss and a shorter hospital stay compared with the women who had a vaginal hysterectomy.

Average Comparisons

Laparoscopic                                         Vaginal

Average blood loss                                83.9 ml                                                178.2 ml

Average hospital stay                           2.7 days                                                3.2 days

Average length of operation               99 minutes                                          82 minutes

Candiani. Laparoscopic vs vaginal hysterectomy for benign pathology. Am J Obstet Gynecol 2009.

Following the procedure, the women who had a laparoscopic hysterectomy generally reported a lower average level of pain on the day of the surgery and experienced faster recovery from pain in the days that followed. The average number of days before returning to work was not significantly different between the two groups.

The women came in for check-ups one, six and 12 months after their procedures. They were evaluated in terms of pelvic pain, urinary dysfunctions, sexual activity, vaginal infections and other factors. Based on clinical and ultrasound evaluations, the two procedures were equally effective.

http://www.garofaloobgyn.com/hysterectomy

http://es.garofaloobgyn.com/hysterectomy.html

Candiani M, Izzo S, Bulfoni A, et al. Laparoscopic vs vaginal hysterectomy for benign pathology. Am J Obstet Gynecol 2009;200:368.e1-368.e7