At the Forefront of Gynecologic Innovations in Surgery
With less pain, scarring, recovery time, and risk of complications, robot-assisted surgery has become the preferred treatment in surgical solutions for many patients referred to the Department of Obstetrics and Gynecology at Wake Forest Baptist Health.
In the area of gynecologic oncology, Wake Forest Baptist Health offers robot-assisted surgery to patients with endometrial cancer, early stage cervical cancer, and in the completion of staging for early ovarian cancer. These procedures often involve a hysterectomy, bilateral salpingo-oophorectomy, lymph node dissection, staging biopsies (to determine the extent of disease) and omentectomy.
The urogynecologists at Wake Forest Baptist Health also see many patients who are referred with pelvic organ prolapse. Many of these cases are either severe, or have previously been repaired but have failed. The urogynecolgic surgeons are able to offer different approaches for repair including robot-assisted sacrocolpopexy. Compared to the open approach used at many institutions, “robot-assist sacrocolpopexy allows the surgeon to complete an extensive repair with a reduction in hospitalization and recovery time,” said Samuel S. Lentz, MD.
At Wake Forest Baptist’s Center for Reproductive Medicine, Tamer M. Yalcinkaya, MD, reported the world’s first published case of a robot-assisted ovarian transplant in the November 2010 issue of Fertility and Sterility.
The case involved a patient who, in 2003, chose to cryopreserve her ovary before undergoing extensive chemotherapy. After two years of intermittent cancer treatments and two years cancer-free, the patient was cleared by her oncologist to move forward with an ovarian transplant and was referred to Wake Forest Baptist Health.
Using the da Vinci® Surgical System, Yalcinkaya grafted thawed cortical pieces from the patient’s previously frozen ovary into pockets that he created in the patient’s remaining ovary. Although the ovary was non-functioning due to the chemotherapy, it still had a blood supply and served as a host for the transplanted cortical tissue. Within six months, the patient began to experience a normal menstrual cycle and no menopausal symptoms, even though her hormones occasionally reflected those of a perimenopausal woman.
“Robot assistance has facilitated a major advancement in the field of ovarian transplantation,” said Yalcinkaya. “There have been a handful of documented cases in which women became pregnant after a transplantation of an ovary that had been cryopreserved before chemotherapy, but these cases involved a laparotomy and most of them required some means of reproductive assistance.”
This procedure is not limited to cancer patients. Yalcinkaya can also cryopreserve and later transplant ovarian tissue from very young patients who face fertility-damaging treatments for kidney disease and connective tissue disorders, among others.
Wake Forest Baptist Health surgeons also use robot assistance for hysterectomies, myomectomies, tubal surgery, endometriosis procedures, surgery for pelvic pain, sterilization reversals, removal of lesions or polyps, and reconstructive surgery of the reproductive tract, including C-section repairs.
“These options illustrate why Wake Forest Baptist Health is so unique—it’s the comprehensive nature of our surgical subspecialty,” said Lentz. “Patients are often referred to us with many complicating factors. By offering many different therapies, we’re able to provide the appropriate treatment for each individual patient.”