County doctors demonstrate innovative hysterectomy

October 27, 1992|By Donna E. Boller | Donna E. Boller,Staff Writer

Sharon Baker says she didn't really mind having her hysterectomy televised for a group of visiting obstetrician-gynecologists, so long as they didn't know who she was.

There was little chance that they'd be able to identify her.

What the doctors saw on the color TV screen in the Carroll County General Hospital cafeteria was a tan uterus, some yellow bowel, some dark red blood and tiny metal instruments.

The TV was set up for two demonstrations of a new hysterectomy technique devised by local obstetricians-gynecologists Samuel Ahn and Paul Vietz in cooperation with German physician Kurt Semm, a pioneer in surgeries using laparoscopes.

A laparoscope is a thin hollow tube containing a camera that allows a surgeon to peer into the abdomen through a small hole. A TV monitor shows the camera picture to the surgeon.

The operation is a little like trying to tie your shoes by looking at them in a mirror, but it offers patients some major advantages. The laparoscopic hysterectomy means shorter hospital stays, shorter recovery time at home than traditional abdominal hysterectomies and a smaller scar.

Mrs. Baker, 28, was able to leave the hospital three days after the operation.

Two weeks later, she says she's "going crazy" around the house and wants to return to her job as head teller in the Eldersburg office of Westminster Bank & Trust Co.

"I don't feel like I've had major surgery," she says.

Mrs. Baker was recommended for a hysterectomy because she had endometriosis, a condition in which tissue that lines the uterus also is found in other parts of the abdomen, causing frequent cramps. When Dr. Ahn advised a laparoscopic hysterectomy, it sounded good to her.

The obstetrician-gynecologists who came to Carroll County General to learn the technique asked a number of technical questions: Is he fixing the cervix to the tenaculum [grasping instrument]? Is the scope a diagnostic scope?

And one non-technical question: How do you bill for this surgery?

The answer: Bill it as a hysterectomy.

In the operation, the surgeon makes three small incisions at the navel and pubic hair line, then inserts the laparoscope, which will transmit a picture to a monitor that guides the doctor in manipulating other instruments through the remaining cuts to detach the uterus.

When the uterus is cut free of surrounding tissue, the surgeon inserts a device that minces it so the tiny pieces can be suctioned out through a tube.

The laparoscopic hysterectomy allows surgeons to preserve part of the cervix, which plays a role in sexual pleasure. They can also leave intact the tissue surrounding the pelvic floor, which helps to reduce the chance of bladder problems later, Dr. Vietz has said.

Dr. Semm's decision to leave one patient's ovaries alone stirred debate among the observers. The American doctors had urged him to remove them.

"We are no longer radical surgeons to say she doesn't need [the ovaries] any more," Dr. Semm said. "She will need them the rest of her life."

Dr. Ahn explained later that American doctors reason that, after menopause, ovaries no longer function, "and then we worry about ovarian cancer."

Dr. Semm believes that the ovaries continue to work after menopause, so he tries to preserve them during a hysterectomy unless he sees some medical reason for removal.

"How true that is, we don't know. I don't know of any study that's been done," Dr. Ahn said.

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