Published on January 14th, 2014
St. Luke’s University Health Network, Surgeons Earn Coveted Designation for Minimally Invasive Gynecological Program
St. Luke’s University Health Network, Allentown Campus is one of only three hospitals in Pennsylvania to receive designation as a Center of Excellence in Minimally Invasive Gynecology (COEMIG), recognizing the high level of care provided by its minimally invasive gynecological surgery program. Instituted by American Association of Gynecologic Laparoscopists (AAGL) and administered by the independent health care quality organization Surgical Review Corporation, the COEMIG distinction has beenaccorded to surgeons at St. Luke’s Allentown Campus who have met the program’s requirements.
Along with the designation earned by the facility, four physicians received individual COEMIG certification: Michael S. Patriarco, D.O., Director of Minimally Invasive Gynecology; Tirun Gopal, M.D.; Sheldon Linn, M.D.; and David Hanes, M.D. Additionally, Vincent Lucente, M.D., Chief of Gynecology and Chief of the Section of Urogynecology at St. Luke’s University Health Network, will achieve certification within the year.
An Arsenal of Advanced Procedures
Using laparoscopic, hysteroscopic, endoscopic and robotic-assisted techniques and instrumentation, surgeons at St. Luke’s Allentown Campus offer women an array of minimally invasive gynecological procedures, including cystocele and rectocele repair, endometrial ablation, myomectomy, urinary and fecal incontinence repair, uterine cancer surgery, uterine prolapse repair, and vaginal vault prolapse repair.
Dr. Patriarco cites a litany of beneficial outcomes from minimally invasive surgery.
“In comparison to open surgical procedures, these techniques result in less pain, better surgical outcomes, improved cosmetic outcomes, quicker resumption of normal activities and shorter hospital stays,” he notes. “Consequently, they alleviate some of the burden of health care costs for patients and hospitals. And most minimally invasive procedures are performed on an outpatient basis; very rarely do we keep a minimally invasive surgical patient overnight.”
Joseph Merola, M.D., M.P.H., Chairman of the Department of Obstetrics and Gynecology and Medical Director of Women’s and Children’s Services for St. Luke’s University Health Network, says that while offering a range of minimally invasive options is important, the surgeons place equal emphasis on choosing the correct route by which to perform a given procedure. For example, while vaginal access may be ideal in certain circumstances, if a large tumor blocks vaginal access to the uterus, surgeons will elect to go through the patient’s abdomen.
“If you do it correctly — and by that I mean choosing the right route, for the right person and the right organ — minimally invasive surgery is very cost-effective,” Dr. Merola says. “It increases the patient’s satisfaction by allowing her to get back on her feet and be fully functional.”
Better Solution for a Common Problem
Surgeons perform an estimated 600,000 hysterectomies each year in the United Sates, according to the Centers for Disease Control and Prevention. Authors of a 2009 study published in Obstetrics and Gynecology found that of 518,828 hysterectomies, only 14% were performed laparoscopically and 22% vaginally, while 64% were performed through an open abdominal approach. The prevalence of open abdominal hysterectomy is noteworthy because the American College of Obstetricians and Gynecologists (ACOG) recommends vaginal hysterectomy as the first route surgeons should consider.
“The ACOG clearly states that from a risk/benefit standpoint, the best route through which to remove a uterus is the vagina, and if you can’t, then endoscopy or laparoscopy would be the next preferred routes,” Dr. Lucente says. “If these options are not feasible, then we move to an open abdominal procedure.”
Dr. Patriarco notes: “If a hysterectomy is necessary, you want it performed at a center that will approach the procedure minimally invasively. At St. Luke’s University Health Network, Allentown Campus, there’s less than a 20% chance a woman will need a hysterectomy done via a major, open route.”
He adds that in some cases, such as those involving patients with excessive bleeding, a surgical procedure may not even be necessary.
“If a woman requires a procedure for whatever reason, St. Luke’s physicians will approach it with minimally invasive modalities, some of which may not even involve laparoscopy,” Dr. Patriarco says. “For example, endometrial ablation is about 90% effective for bleeding issues and should be considered first.”
When endometrial ablation, which doesn’t require incisions, fails to stop the bleeding, surgeons are likely to use the appropriate minimally invasive modality to correct the problem, according to Dr. Patriarco.
Balancing What’s New With What’s Best
As in popular culture, fads can appear in medicine. Patients may request the most recently developed treatments — which in many cases may be entirely appropriate. However, the experienced surgeons at St. Luke’s (Allentown Campus) assess every case individually and direct each patient to the optimal treatment modality for the condition.
“The most important thing with minimally invasive gynecology, as with all minimally invasive surgery, is appropriateness. We all like what’s new, and we want to get on the bandwagon — and so do our patients — but we first ensure that what we adopt at a certain time is appropriate according to the clinical evidence, and is cost effective and sanctioned by our governing bodies. Above all, we ascertain that we’re doing the right thing for our patients.”
For more information about St. Luke’s Center for Advanced Gynecologic Care, please call (484) 223-3279 or visit sluhn.org.