Facing Gynecologic Surgery While Experiencing Infertility

Posted by Brigham and Women's Hospital April 21, 2015

Antonio Gargiulo, MD, Medical Director, Center for Robotic Surgery

Today’s post is written by Antonio Gargiulo, MD, Medical Director, Center for Robotic Surgery and a fertility expert in the Center for Infertility and Reproductive Surgery (CIRS) at Brigham and Women’s Hospital in Massachusetts and the Center for Reproductive Care at Exeter Hospital in New Hampshire.

Often my patients experiencing infertility need gynecologic surgery because certain conditions can either cause infertility or impair infertility treatments. Most of these conditions can be treated through minimally invasive surgical techniques, resulting in fewer complications and quicker recovery.

The following post provides information about conditions requiring gynecologic surgery and your treatment options. I recommend that all women of reproductive age that need gynecologic surgery should consult a reproductive surgeon (infertility specialists who practice gynecologic surgery). These physicians have received highly specialized surgical training, which is critical in successfully treating gynecologic conditions that may affect your fertility. I also remind patients that obtaining a second opinion before agreeing to any surgical plan is an essential step in their care.

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Transoral Robotic Surgery: Minimally Invasive Treatment for Head and Neck Cancer

Posted by Brigham and Women's Hospital May 21, 2014

With robotic surgery (left), there is no incision and no scars, while open surgery (right) involves an incicsion from the lip to the ear.

With robotic surgery (left), there is no incision and no scars, while open surgery (right) involves an incicsion from the lip to the ear.

Head and neck (oropharyngeal) cancer is the sixth most common cancer in the U.S., with nearly 40,000 new cases diagnosed each year. Though tobacco and alcohol use can raise the risk of developing the disease, exposure to the human papillomavirus (HPV) poses an even greater risk. People who have had an oral HPV infection have a 50 times greater risk of developing head and neck cancer versus the general population. Currently, nearly three quarters of head and neck tumors test positive for HPV. A growing number of these newly diagnosed cases are among men in their forties and fifties.

Since the early 1990s, patients with head and neck cancers have been treated primarily with chemotherapy and radiation. Surgery has been avoided as a first line treatment because head and neck tumors can be difficult to reach, requiring invasive surgery that can affect organ function, lead to swallowing difficulties, and require a feeding tube.

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Getting Surgical Experience – without a Patient

Posted by Brigham and Women's Hospital October 24, 2013

The new robotic surgery simulator is an important tool for physicians new to robotic surgery and experienced robotic surgeons.

The console is identical to the units used in BWH operating rooms, but instead of operating on human patients, surgeons operate in a virtual environment. It’s available to surgeons 24 hours a day, every day, in BWH’s STRATUS Center for Medical Simulation, a facility dedicated to helping health care professionals build their skill sets in simulated environments.

Working with 3-D images that mimic human tissue, surgeons sitting at the simulation console are able to get an accurate visual representation of their proficiency with using the robotic arms and tools. The simulator also records and analyzes a surgeon’s performance throughout a virtual procedure, providing both real-time feedback and a performance report to examine after the procedure.

“Safe robotic surgeons must become one with their operative console, so that the patient-side robot truly functions as an extension of their own body,” says Antonio Gargiulo, MD, Medical Director of the Center for Robotic Surgery at BWH. “This state-of-the-art simulator should give our patients confidence that their surgeon is always a technically competent robotic surgeon.”

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Minimally Invasive Gynecologic Surgery: What You Need to Know

Posted by Brigham and Women's Hospital July 18, 2013

Dr. Sarah Cohen, Division of Minimally Invasive Gynecologic Surgery

Today’s post is written by gynecologic surgery specialist Dr. Sarah Cohen, leader of our new Minimally Invasive Gynecologic Surgery  service in Foxborough.

For many patients, the thought of having gynecologic surgery can be worrisome. Thanks to minimally invasive surgery techniques, however, most women can now undergo surgery with minimal interruption to their lives. Benefits include a shorter hospital stay, minimal pain after surgery, less chance for surgical and post-operative complications, and less blood loss. My patient “Sue” is a good example. I recently performed minimally invasive gynecologic surgery to remove her fibroid tumors. After a short overnight stay in the hospital, she returned home and was back to work within a week.

What is minimally invasive gynecologic surgery?

Minimally invasive gynecologic surgery (MIGS) is a technique by which traditional pelvic surgery can be accomplished using small incisions or openings, as opposed to traditional “open” surgery (which includes a large abdominal incision). MIGS includes several surgical techniques. Laparoscopy is a procedure where a surgeon uses small incisions (5-10mm) to insert tiny instruments into a patient’s abdomen and perform the operation. Robot-assisted laparoscopy is similar to conventional laparoscopy, except the surgeon controls instruments and camera movement from a separate console in the operating room instead of by hand. Vaginal surgery and hysteroscopy (using a camera and instruments to perform intra-uterine surgery) are also used by physicians specializing in MIGS.

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Lasers, Robots, and a Cast of Thousands

Posted by Brigham and Women's Hospital January 4, 2013

Dr. Gargiulo demonstrates his robotic technique to an audience of more than 1,000 surgeons.

Dr. Antonio Gargiulo, Medical Director of Robotic Surgery at the Brigham and Women’s Hospital (BWH), has performed hundreds of computer-assisted laparoscopic surgeries, but the one he performed on October 22, 2012, was very special.

The surgery, a robotic myomectomy to remove a uterine fibroid tumor in a 29-year-old patient, was beamed live from Brigham and Women’s Faulkner Hospital (BWFH) to an audience of more than 1000 fertility surgeons attending the 68th Annual Meeting of the American Society for Reproductive Medicine (ASRM) meeting in San Diego, California. Over the course of two hours, Dr. Gargiulo narrated the ongoing surgery while answering a steady stream of questions from the audience via three moderators.

Dr. Gargiulo and members of the robotic team at the Center for Infertility and Reproductive Surgery (CIRS)  were chosen by ASRM to broadcast the procedure based on their innovative work in robotic reproductive surgery, such as performing the first single incision robotic myomectomy in 2012.

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Is Robotic Surgery Here to Stay?

Posted by Blog Administrator March 2, 2012

Dr. Antonio Gargiulo; Sophia, Anna, and David Watson

Dr. Antonio Gargiulo; Sophia, Anna, and David Watson

Technological innovation can be intoxicating. We’re fascinated by the ability to do something that we’ve never done before – to start a faucet without touching a handle, to take a picture without using film, or to accumulate hundreds of friends without the hassle of talking to them.

But it’s a whole new ballgame when new technology becomes a part of the health care decision-making process. We’re no longer talking about matters of enhanced convenience or new forms of amusement. We’re talking about our bodies, our minds, and perhaps our mortality, and, thus, our fascination becomes tempered by uncertainty. We’re enticed by the potential advantages that a new technology can bring, but we’re also comforted by the reliability of medical practices that are tried and true.

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