The chief of gynecology at Greater Baltimore Medical Center says he is one of a small number of specialists in the country -- estimated at 25 or more -- who are performing a new, less traumatic type of hysterectomy using laparoscopy technology.
Dr. James H. Dorsey predicts that the technique, which removes the uterus through the vagina, will become the method of choice in the future, and that traditional hysterectomy through a 5- to 12-inch abdominal incision will rarely be necessary.
Dorsey, who in the past has used a lighted tube, or laparoscope, to cut out ovaries, uterine tumors and implants of endometrium that cause infertility in women, has done 20 laparoscopic hysterectomies during the last 18 months.
He believes that he and two other GBMC surgeons he has trained are the only ones using the new approach in Maryland.
The lighted tube, which has a tiny lens at one end and a miniature video camera at the other, is inserted through a small incision in the navel. It gives the surgeon a panoramic or close-up view of the pelvic cavity.
Other surgical instruments are inserted through three small abdominal punctures and are used to separate the uterus from the pelvic wall. The uterus, which normally is flat and pear-shaped, is then removed through the vagina. If necessary, the tubes and ovaries can also be removed during the procedure, which takes about 90 minutes.
Laparoscopic hysterectomy eliminates the discomforts of major surgery and the patient makes a quicker comeback, Dorsey said yesterday. And, it's not only easier on the patient, but easier on her pocketbook.
Georgette Gravelle, 68, a travel agent who underwent the new-style surgery July 31, said she feels so good, she is leaving for a vacation in Jamaica this weekend.
"For the first week, I took it easy," the Perry Hall woman said in a telephone interview. "But I'm not taking it easy any more. The doctor gave me a prescription for a painkiller, but I never used it. He told me not to drive for a while. But the other day I felt like taking a little ride -- very carefully -- and I did."
The new procedure leaves no scarring, Gravelle said, just three tiny incisions, each of which has two stitches.
"Hospital stay is shortened to about two to three days instead of five to seven days for the traditional hysterectomy, and the recovery period at home is one to 10 days vs. six weeks for the abdominal procedure," Dorsey said.
On top of these pluses, the bill is about $2,500 less for those women whose problem permits them to switch from the old to the new method.
The new procedure, Dorsey said, seems headed for popularity much like that achieved by laparoscopic gall bladder surgery, which was introduced two years ago in the Northeast by the University of Maryland Medical Center in Baltimore.
"When we do a laparoscopic hysterectomy, we tie off and cut the blood vessels and the ligaments that hold the uterus in place," he explained. "And, we accomplish that right down to the vagina.
"We haven't opened the abdomen and we haven't handled the bowel. The new procedure cuts down on infection, on bowel problems following the hysterectomy and on post-operative pain."
Hysterectomy is one of the most common and controversial surgeries in the United States. Some 650,000 American women undergo the procedure each year. Many hysterectomies are unnecessary, says Dr. Winnifred B. Cutler, a reproductive biologist and leading authority on women's health.
Some consumers' groups fear that laparoscopic technology will make hysterectomies more appealing to women because the old surgery was harsher. These groups maintain that many hysterectomies are done to correct problems that could be handled more conservatively or would fade away naturally with menopause.
But Dorsey and other surgeons, who use the laparoscope for other gynecological surgery, contend that widespread use of the technology could one day reduce the need for hysterectomies. They believe the technology will enable physicians to diagnose and treat conditions earlier and without removing the uterus.
More than 65 percent of hysterectomies today involve open abdominal surgery; the rest are accomplished vaginally. Dr. Harry Reich, a Kingston, Pa., gynecologist, who says he performed the world's first laparoscopic hysterectomy in January believes that laparoscopy will eventually cut the number of the traditional abdominal procedures to less than 10 percent.
With some exceptions, laparoscopic hysterectomy is done for exactly the same reasons as the conventional surgery, according to Dorsey. "One does it for fibroids, one can do it for ovarian cysts, for pre-cancerous lesions, for people who have excessive bleeding and uterine tumors," he said.
However, he added, patients will still have to undergo the traditional abdominal hysterectomy if they have cancer of the ovary or such enormous fibroids that there is no way they can be taken out by the laparoscope.