I’m writing about pelvic organ prolapse again because of a recent clinical study that was set up to see if synthetic mesh inserted through a vaginal incision is beneficial in the repair of pelvic organ prolapse. This surgical procedure, called vaginal colpopexy, has been performed using sutures for many years with success rates in the neighborhood of 65-75%. These failure rates are much higher than the failure rate with da Vinci sacrocolpopexy, which I wrote about in my April blog.

Because the failure rate of vaginal colpopexy without mesh was so high, many surgeons have been adding mesh augmentation of vaginal colpopexy in an effort to improve outcomes. Unfortunately, the use of mesh for this indication had never been tested with the most rigorous of scientific studies — the randomized clinical trial — until the study referenced in this blog.

The bottom line from this study is that there were so many complications with the vaginally implanted mesh that the trial was cut short. More than 15% of the patients who received the mesh experienced a potentially serious complication called “erosion”, in which the vaginal tissue split and the mesh protruded, often causing pain and infections. These results were much more negative than the FDA’s warning in 2008 that vaginally implanted mesh complications were “rare”.

Not only were more complications found among the patients in the mesh group, there was also no improvement in success rates for the remainder of patients who had mesh placed. The success rate of surgery was the same whether or not the patient had a mesh implant. In the words of the report’s lead author, “The bottom line is not only were there more complications, but the mesh didn’t prove any better than traditional surgery.”

The alternative to surgical procedure that I recommend for pelvic organ prolapse is da Vinci sacrocolpopexy. In a sacrocolpopexy, the vaginal vault is supported by affixing it to a bone called the sacrum, located at the base of the spine. Sacrocolpopexy is also done with mesh, but it does not result in a high risk of mesh complications because the mesh is not placed through the vagina.

A recent medical report entitled Surgical Management of Pelvic Organ Prolapse in Women supported sacrocolpopexy as the gold standard for pelvic organ prolapse treatment. According to the report, sacrocolpopexy advantages include a high success rate, durability of the repair, and the essential absence of mesh complications. Since sacrocolpopexy using the da Vinci surgical technique can be done without the large abdominal incision previously used for abdominal sacrocolpopexy (discussed on this page of my website), it can be done without the need for a prolonged or painful recuperation.

I have been performing sacrocolpopexy surgery with the da Vinci surgical system with outstanding results, and I am happy that I have avoided the use of vaginally placed mesh for repair of pelvic organ prolapse. We have not seen any cases of mesh erosion in the patients who have had da Vinci sacrocolpopexy. In my  opinion da Vinci sacrocolpopexy is the best procedure for pelvic organ prolapse.

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.garofaloobyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

Lately I’ve been getting a lot of questions from my patients about the Essure birth control procedure. Maybe it’s because of the recent publicity from Olympic gold medalist Picabo Street, who announced earlier this year that she’d undergone the procedure. In any case, I thought I’d answer some of the most common questions I’ve heard. I’ve also included some useful links at the bottom of this blog.

What is Essure?

The Essure procedure is a permanent birth control method developed by an American company called Conceptus. Essure is their main product.

During the procedure, tiny flexible coils made out of polyester fibers, nickel-titanium and stainless steel are passed by a small tube called a catheter from the vagina through the cervix and uterus and into the Fallopian tubes. (Fallopian tubes are two very thin tubes that lead from the ovaries into the uterus.) Once in place, the Essure coils cause tissue growth (scarring), which seals a portion of the Fallopian tubes. This tissue barrier prevents sperm from reaching the ovaries.

How long has the Essure procedure been used?

Hundreds of thousands of women have had the Essure procedure, which was approved for use in the United States in 2002. I’ve been conducting Essure procedures for several years.

While the Essure procedure is relatively new, Essure coils are made from materials that have been used successfully for many years in cardiac stents and other medical devices that are placed in the body.

Is the Essure procedure permanent?

According to the manufacturer, the Essure procedure is intended to be permanent and non-reversible. However, as of last month, less than two dozen successful Essure reversals have been performed – all in the past three years – and the first “Essure reversal baby” was born just a few months ago.

Before having the Essure procedure, you should be sure that you do not want to have any more children.

Is the Essure procedure right for me?

Most women are candidates for the Essure method, but sometimes the coils cannot be placed due to issues such as prior tubal blockage, fibroids distorting the uterine cavity, or uterine septum (when a wall of tissue divides part or all of the uterus). In addition, the Essure procedure is not recommended for women who:

• are pregnant or have been pregnant in the past six weeks
• are not certain they are finished having children
• have had a recent infection in the pelvis
• have serious, chronic health problems
• are allergic to contrast dye or nickel
• are taking corticosteroids (a type of anti-inflammatory drug)

If you’ve had any of these conditions, we can discuss whether Essure is appropriate for you.

Tune in next week …

In my next blog I’ll write about the Essure procedure’s risks and benefits, and how it compares to another procedure, called tubal ligation – or “getting your tubes tied”.

More information

If you’d like additional information, you can click on any of the links below, or you can contact my office directly.

Links to Essure resources

Essure’s home page
Essure patient and physician testimonials
Essure patient information booklet pdf
Essure confirmation test booklet pdf
Dr. Garofalo’s webpage on permanent birth control and Essure
Dr. Garofalo’s Essure consent form pdf

Dr. John Garofalo, M.D., is gynecologist located in Fairfield County, Connecticut including Bridgeport, Norwalk, Stamford, Westport and Danbury. 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.

This combination of detail and precision makes da Vinci very well suited for a variety of surgery types and procedures, including several that I do regularly as part of my medical practice. For this blog I thought I’d talk about da Vinci surgery and hysterectomy.

Not your mother’s hysterectomy

If your mother or grandmother had a hysterectomy, it was probably done vaginally or through a horizontal incision in the abdomen. She probably stayed in the hospital for about six days, with a recovery period that lasted four weeks or longer. In comparison, women who have a da Vinci hysterectomy can expect to stay in the hospital for about one day, followed by about a week of recovery.

As a minimally invasive procedure, the da Vinci hysterectomy is a much simpler and less traumatic experience. Instead of a long incision, da Vinci hysterectomy uses five small incisions, spaced across the abdomen. Compared to open abdominal surgery, there’s less bleeding, less pain, minimal scarring, quicker recovery, a shorter hospital stay, and a lower likelihood of complications.

Here are a few quotes from women who have had da Vinci hysterectomies, including one of my own patients. These quotes and many others can be found on www.davincistories.com.

“I am truly amazed how quickly I was able to recover after having major surgery. My incisions were minimal, my recovery was quick.” – Maureen, Madison CT

“The da Vinci procedure has transformed the surgical procedure from a long, difficult recovery to a relatively painless, quick procedure with very little downtime. It is perfect for active working people who don’t have six weeks to be down.” – Anne, Enfield CT

“I had my surgery a week before Christmas, and I was up to entertaining for the holidays.” – Tina, West Suffield CT

More information

If you’d like more information or to see a da Vinci hysterectomy testimonial, go to this page on my website. The testimonial video is at the bottom:

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

If you need additional information, you can click on any of the links below, or you can contact my office directly. In my next blog, I’ll write about another condition called myomectomy that can also be treated using da Vinci.

Links to da Vinci surgery resources

daVinciSurgery.com

da Vinci Hysterectomy

da Vinci Surgery Patient Stories

Dr. Garofalo’s da Vinci information page

Dr. John Garofalo, M.D., is a certified da Vinci surgeon and gynecologist 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.

As I mentioned in my last blog, the da Vinci Surgical System uses a computerized interface between the surgeon and the instruments to conduct surgical procedures. The name “da Vinci” was chosen for the system because legendary artist and inventor Leonardo da Vinci is credited with designing the first robot. It’s also a fitting name because Leonardo da Vinci used anatomical accuracy and three-dimensional details to lend realism to his art.

For many people, the use of robots or robotic tools in surgery raises some concerns. One commonly accepted definition of a robot is “an automatically guided machine, able to do tasks on its own.” This definition is a bit vague, but experts generally agree that robots tend to do some or all of the following: move around, operate a mechanical limb, sense and manipulate their environment, and exhibit intelligent behavior, especially behavior which mimics humans or other animals.

Given only those definitions to describe da Vinci technology, I’d be concerned too. To be honest, I’ve avoided using the word “robot” or “robotic” to describe the da Vinci Surgical System in my website. It’s not really an accurate term, since the da Vinci system is directed and controlled by a human being – in this case, a specially trained surgeon whose finger movements are transmitted electronically from a console in the surgery room to the da Vinci cameras and surgical instruments. Along with the surgeon and the equipment, an assistant surgeon, an anesthesiologist, and a nurse are generally by the patient’s bed.

While it’s definitely not the kind of robot you might picture from the movies, da Vinci surgery draws upon years of robotic technology. The cameras and surgical tools are truly state-of-the-art, and provide a level of precision which is crucial when working in close proximity to delicate organs like the bladder. Benefits of da Vinci surgery usually include:

• Less pain after surgery
• Less scarring
• Lower risk of infection
• Less blood loss
• Faster recovery

When my patients ask me about da Vinci technology, I generally tell them this: The da Vinci Surgical System is not the only option for surgery, but it has many advantages and few disadvantages relative to more traditional methods of surgery.

In my next blog, I’ll write about the types of conditions that can be treated using da Vinci. 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.