Advances in Minimally Invasive Gynecologic Procedures: Robotic-Assisted Hysterectomy & Myomectomy

Intro: We're talking wellness at MemorialCare Health System. It's time for Weekly Dose of Wellness. Here's Deborah Howell.

Deborah Howell (Host): And welcome to the show. We're so pleased to have you here. I am Deborah Howell and this is your Weekly Dose of Wellness. Today's guest is the wonderful Dr. Gerardo Bustillo, Medical Director of Minimally Invasive Surgery at Orange Coast Memorial Medical Center. With more than 25 years of experience in minimally invasive gynecologic procedures, Dr. Bustillo is one of only a few gynecologists in California trained in single-site robotic surgery. Welcome, Dr. Bustillo.

Gerardo Bustillo, MD: Good morning Deborah. How are you?

Deborah Howell (Host): Oh, I'm great because you know today there are more options than ever before if you need to have a hysterectomy or a myomectomy. Let's talk about some of the options. First of all, what is minimally invasive surgery?

Gerardo Bustillo, MD: Well, minimally invasive surgery is surgery that is performed through much smaller incisions than in the past. Now, actually we've had minimally invasive surgery for quite a long time, but the exciting thing is that now with the advent of robotic surgery we're able to do so much more in this way.

Deborah Howell (Host): Mm-hmm. Excellent. It's always a good piece of news if you're a patient to have a much smaller incision. What are some of the gynecologic procedures that can be performed in a minimally invasive way?

Gerardo Bustillo, MD: Well there's a variety of procedures. Certainly the more common, the most common would be a hysterectomy or removal of the uterus and a myomectomy which is removal of only fibroids and leaving the uterus intact. There are other procedures that we do in our field, for example, surgery to correct pelvic prolapse, but these kinds of procedures are less common. So the two main ones would be hysterectomy and myomectomy.

Deborah Howell (Host): Okay. And then in terms of the robotics, how does the robotic surgery work?

Gerardo Bustillo, MD: Well, as I said before, minimally invasive surgery has been around for quite a long time and what we do is we make small incisions and we put small instruments through these incisions and as a consequence, you know, there's less scarring, the patient has much less pain postoperatively and can return to normal life. The exciting thing with robotic surgery is that we use these same small incisions but we use very, very accurate, precise instruments to basically make it possible to do much more complex surgeries and for example to sew much more effectively and to do surgeries that in the past would have required a much, much larger incision. So patients really benefit from this new technology.

Deborah Howell (Host): It really is awesome. What are the differences in the traditional hysterectomy and myomectomy surgeries compared to robotic assisted?

Gerardo Bustillo, MD: Well, in the traditional hysterectomy and myomectomy, the patient typically would have a bikini-cut type of incision like we do for a cesarean section. But with the robotic procedure again, as I mentioned, we used a few small incisions and now with the single site surgery we can actually use one incision which is just incredible. But the majority of these procedures are performed through several small incisions and you know small instruments, very precise instruments are placed through these incisions and with the three dimensional optics that we have and the ability to zoom in, we can certainly do much, much finer work and really extend the benefit of minimally invasive surgery to women who in the past would have always had a larger incision and consequently you know would have healed much more slowly.

Deborah Howell (Host): Slowly and you know, chance of infection if you have four incisions instead of one, you know, is much larger.

Gerardo Bustillo, MD: Exactly. So there you know, in terms of the surgery itself the incisions are smaller, there's less scarring as a result, there's less bleeding. And then in the immediate post operative time there's less pain. The hospital stay is shorter than in the past and then in terms of recovery there's a much, much shorter recovery time with a much quicker return to normal life for these patients. So it's really a win for everyone.

Deborah Howell (Host): It really is. And sometimes you can even do it without any hospital time.

Gerardo Bustillo, MD: Exactly. There are some physicians who will send the patient home, you know, the day of surgery or certainly usually by the next morning.

Deborah Howell (Host): Wonderful. It's a great day to be a patient. It really is.

Gerardo Bustillo, MD: Well it's never good to be a patient, but if you have to be a patient, it's certainly wonderful to have these options.

Deborah Howell (Host): Absolutely. But we can't really get better than single site because you have to have at least one incision. So I'm sure improvements now are gonna have to be with the instruments themselves and the things that they do and the robotics.

Gerardo Bustillo, MD: Exactly. The single site is a challenge and you know again there's not that many surgeons trained to do this, but it's really incredible cosmetically for the patient to have just one scar, which you know sometimes is almost not even visible. But again that's not something that a lot of gynecologists can do. But we do offer that here at MemorialCare.

Deborah Howell (Host): Lovely. How common are hysterectomies?

Gerardo Bustillo, MD: Well, hysterectomies are very common and really in the past too many hysterectomies were performed, but I you know we - I definitely feel that surgery for removal of the uterus needs to be something that's indicated, but there's probably about half a million performed in the United States every year. It's certainly the most commonly performed gynecologic surgery.

Deborah Howell (Host): I hadn't realized it was that many. Well then let's talk a little bit about uterine fibroids as well because it seems to be they're definitely on the rise. Do they always need to be removed?

Gerardo Bustillo, MD: No, no, of course they do not. And in fact, fibroids are also extremely common. So fibroids are benign growths of the muscle of the uterus. They're usually very firm, little tumors, they're not cancer, but they're benign tumors of the wall and they're very common. Up to eighty percent of women will have them sometime in their lifetime, but the majority of those fibroids do not have to be removed. They become a problem when they cause abnormal bleeding or pelvic pain or symptoms, what we call bulk symptoms where just by being there the patient has a sensation of fullness and discomfort, sometimes having trouble with her urinary functions and also they can affect fertility and pregnancy as well.

Deborah Howell (Host): Never a good thing.

Gerardo Bustillo, MD: We can now remove fibroids through these small incisions where in the past it was extremely difficult to do that simply because you have to do a lot of sewing. When you remove the fibroid, you know, you want to conserve the uterus and you have to do a lot of sewing in multiple layers and very, very few gynecologists could ever master that. So the vast majority of patients in the past would have a bikini cut incision for their myomectomy. Well now you know, with this wonderful technology we can offer them the benefits of the minimally invasive techniques and again their recovery and everything is just wonderful.

Deborah Howell (Host): Okay, so I want to do over.

Gerardo Bustillo, MD: You wanna do over. Well, you know, myomectomy is in the majority of cases performed in women who of course want to keep their uterus for childbearing. And the beauty, one of the added benefits is that because the surgery is minimally invasive, their recovery is shorter and they can get on to the business of attempting to get pregnant sooner than in the past.

Deborah Howell (Host): Well I know you're very gung ho on it, but is robotic surgery always the best option with these procedures?

Gerardo Bustillo, MD: No, no. I you know, I think it's extremely important to take every case individually. And you know certainly ideally it's nice to avoid any surgery whatsoever, but it's very important, you know, when you sit down with the patient is to understand exactly what her situation is and to go through the options of treatment for you know, some people basically just need to be observed and monitored and nothing needs to be done. Other patients will benefit from medicine, but then other patients will best benefit from surgery. And when the physician and the patient as a team together come to the conclusion that surgery would be the best option, well it's wonderful to have these minimally invasive techniques as an option because patients do so much better.

Deborah Howell (Host): For sure. So how does someone pick the right surgeon?

Gerardo Bustillo, MD: Well, I think it's important to do your homework. Certainly robotic surgery is not easy to do. I mean, it really takes some special training and experience. So I would say look for a surgeon who's done quite a few cases and who has a good reputation in the community. You know, ask around. Do some investigation online, even though sometimes that's a little bit dangerous. You know, there are reputable websites where doctors are reviewed by other patients and by the medical community in general. So you know, there are organizations that doctors belong to that kind of guarantee that they've had the proper training and experience as well.

Deborah Howell (Host): Fabulous. Well, you've been such a wonderful guest. I wish we had another thirty minutes to talk to you about all things gynecological, but we want to just thank you in the meantime for being on the show.

Gerardo Bustillo, MD: Well, thank you so much, Deborah. I really enjoyed it.

Deborah Howell (Host): Great different options for today's patients in this great age of medicine. That's Dr. Bustillo. To learn more about Dr. Bustillo or to listen to a podcast of this show, you can visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell, join us again next time as we explore another Weekly Dose of Wellness. Have yourself a fantastic day.