Dr. Scott Rushing performs a robot assisted single-site hysterectomy

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Nov 2, 2014

Hysterectomy leaves no scars
Cutting edge, single-site surgeries now being performed at hospitals in Clark County
By Marissa Harshman, Columbian health reporter

Ten years ago, a hysterectomy would have required an incision that spanned the length of the woman's abdomen and left a considerable scar.

Five years ago, the use of robotics in laparoscopic surgery meant a hysterectomy could be performed through five small incisions across the abdomen.

Today, the procedure can be completed through one 2-centimeter incision inside the belly button, leaving no visible trace of the surgery.

"It sounds a little futuristic," said Dr. Scott Rushing, a gynecologic oncologist at Compass Oncology. "It's the newest application of robotics."

Rushing is one of a handful of gynecologic surgeons performing single-site, scarless hysterectomies at PeaceHealth Southwest Medical Center. The technology is new to the hospital and Clark County; Rushing performed the first single-site hysterectomy Sept. 10. The Vancouver hospital is the only Clark County hospital offering the procedure.

A few general surgeons at PeaceHealth Southwest also now are performing single-site cholecystectomies (gallbladder removal surgeries). Legacy Salmon Creek Medical Center began performing single-site gallbladder surgeries about six months ago.

The single-site procedures not only eliminate the visible scars, but also reduce pain and length of hospital stays, Rushing said.

"We think the future of most surgery is going to be one site," he said. "This is the portal into more exciting surgeries."

PeaceHealth Southwest pursued the new technology with improved patient outcomes and satisfaction in mind, but also with the understanding that local access to leading health care technology could help its bottom line by attracting patients.

The PeaceHealth Southwest Foundation and its donors shared that belief and helped fund the hospital's robotic surgery system at the hospital.

"If we continue to work hard to provide the very best local care, we are confident that our patients will continue to choose PeaceHealth Southwest," said hospital spokesman Randy Querin.

Scarless hysterectomy

Rushing is using the single-site surgery to reduce the cancer incidence among women at increased risk of uterine and ovarian cancers. Many of the women on whom he performs the procedure have tested positive for genetic mutations that make them predisposed to cancer. Many times, they're younger women, and the minimally invasive procedure with no visible scars is appealing to them, Rushing said.

During a surgery Wednesday, Rushing removed the uterus, ovaries and fallopian tubes of a 51-year-old woman who tested positive for Lynch syndrome. The hereditary condition increases the risk for colon, uterine and ovarian cancers, Rushing said.

The procedure was performed as a preventive measure; the woman had not been diagnosed with cancer and the surgery did not reveal cancer.

After the woman was under anesthesia, Rushing made a 2-centimeter incision in her belly button and placed an hourglass-shaped rubber port in the opening. The port provided space for four tools: an 8.5 millimeter camera, two 5 millimeter instruments and a device to suction the smoke produced from the cauterizing.

Rushing operated the surgical robot from a terminal in the corner of the operating room. Rushing uses a monitor with a 3-D image from the camera to navigate the surgery site. His thumbs and middle fingers operate the controls of the two instruments: forceps and a cautery hook. Floor pedals allow Rushing to maneuver the camera position and to use the tools for cauterizing.

Using the two instruments, Rushing detached the woman's uterus, ovaries and fallopian tubes. The organs were removed vaginally. Rushing then used forceps and the 3-D camera to stitch closed the opening at the top of the woman's vagina. Finally, the incision in the belly button was stitched, and the woman was able to return home later that same day.

The single-site procedure took about two hours. A traditional laparoscopic hysterectomy — in which a surgeon would use five small incisions, one for each instrument — takes less time, gives the surgeon more space to operate and allows the surgeon to use an additional instrument, Rushing said. But the procedure often means the patient stays longer in the hospital and experiences more pain, he said.

"It's real painful for us to get them all in one hole," Rushing said. "Sometimes, we'll go through a little more pain so the patient can go through a little less pain."

Gallbladder removal

The single-site process is similar for cholecystectomies.

The traditional laparoscopic procedure would require three ¼-inch incisions and one ½-inch incision, said Dr. Mark Eichler, a general surgeon performing the procedure at PeaceHealth Southwest. If the patient has a large gallstone that needs to be removed, Eichler typically has to make an incision larger to do so. The single-site surgery, however, is performed through one 1-inch incision in the belly button, he said.

The scar is unnoticeable and, because there are fewer incisions, the patient experiences less pain, Eichler said.

"I think this is a good step in the evolution of more minimally invasive surgery," he said.

Robotic Surgery

Raw Video: Dr. Scott Rushing performs a robot assisted single-site hysterectomy.

To view the article online, click here.