Breakthroughs in Minimally Invasive Surgeries for Women’s Health

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello, and welcome to the show. You're listening to Weekly Dose of Wellness, brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Marc Winter, Medical Director of Robotic Surgery at Saddleback Memorial Medical Center in Laguna Hills. With more than 20 years of experience performing gynecological surgeries, Dr. Winter has focused on developing and offering minimally invasive procedures. Dr. Winter completed his residency training at the University of California, Irvine, College of Medicine, where he is currently an Assistant Clinical Professor. Welcome, Dr. Winter.

Marc Winter, MD: Thank you for having me.

Deborah Howell (Host): Good morning to you. Today on the show we're going to be talking about breakthroughs in minimally invasive surgeries for women's health and hopefully hear an announcement about a major technological breakthrough as well. First of all, doctor, in which areas of women's health do you specialize?

Marc Winter, MD: Well, I specialize, I'm a gynecologist. I specialize in women's care in general, but specifically minimally invasive surgery which I've been doing for a long time. And over the last two years, more specifically robotic surgery. At Saddleback Hospital we've developed a very robust program and have a lot going on within that realm.

Deborah Howell (Host): Speaking of robustness, now I'm understanding that Saddleback Memorial Medical Center might have had a couple of breakthroughs in surgical techniques. Maybe you could speak to that.

Marc Winter, MD: Sure. Well, as I mentioned, we've been performing robotic surgery for about two and a half years. And one of the things we've tried to do is decrease the amount of incisions. Not just for cosmetic purposes, obviously that's a big deal, but also less incisions, less pain, less issues that could happen. So people have been trying to do surgery with one incision for a while, but from a technical point of view it's much more difficult and your arms have to cross to get the right angles to be able to operate properly. So the robot itself has come up, the company that makes the robot came up with a way to do single site surgery, so just one incision, where your right hand as it crosses over is crossed on the robot, so right is right, left is left, it makes sense as you're operating. So we're the first in California, actually the first on the West Coast, to perform a robotic single site hysterectomy.

Deborah Howell (Host): For women this is very, very good news. Especially women in our area.

Marc Winter, MD: It's very, really exciting for me because I see this as, you know, just tip of the iceberg where things are going, technology is going to get better and better, make it more applicable for more types of procedures, and as technology gets better, again, it's not just better cosmesis, we're getting less complications, better results for our patients. We're very excited about that.

Deborah Howell (Host): Now let's take a step back just for a minute. When considering a hysterectomy, what surgery options do women really have at this point?

Marc Winter, MD: That's a great question because depending on your circumstances or who you're going to see as a physician, sometimes we're guilty in general of not going over every single option in detail. There are the traditional hysterectomy, your quote-unquote "mother's hysterectomy," with a large incision, like a C-section type of incision. There are regular laparoscopy, which the idea is small incisions, quicker recovery, faster return to normal activity, less pain. And then robotic surgery. And of course, now the single site. Some procedures can be performed vaginally, which is also a good alternative and quick recovery as well. But the problem with vaginal surgery is it's limited as to what most doctors are comfortable being able to perform that way, where with robotic surgery we can take care of almost everything.

Deborah Howell (Host): And Dr. Winter, do you perform all three types of surgeries yourself?

Marc Winter, MD: In my career I've performed everything. So occasionally, I'll perform abdominal procedures or the traditional procedure when necessary. Regular laparoscopy, although for my hysterectomies I prefer most of the time the robotic approach.

Deborah Howell (Host): Sure. Now let's talk a little bit more about that single site robot-assisted hysterectomy compared to traditional hysterectomy or even other conventionally minimally invasive procedures. What makes it so brilliant?

Marc Winter, MD: Well, single site is literally one small incision. So the incision is about an inch in size. And through that incision we're able to do a complete hysterectomy. Which to me, it still seems like technology is advancing so quickly, I'm a little awed by it as well.

Deborah Howell (Host): That's why I had to ask you again. I'm like, really?

Marc Winter, MD: Yeah, yeah. So like I said, cosmetically, we can hide it, and you almost can't tell you had surgery. And like I said, the early results are these patients are doing very well from it. I had the laparoscopy myself for a partial, and I call it my drive-by hysterectomy. I mean, it was amazing compared to my mother, what she had had to go through in her day.

Marc Winter, MD: Exactly. And again, things continue to evolve in a good way.

Deborah Howell (Host): Well, okay. So now I want to ask you what factors to consider when recommending the best approach for your patients. You said you have done, in recent history, traditional hysterectomies, so what do you take a look at?

Marc Winter, MD: Well, I think the reasons to do a traditional hysterectomy these days are rare. So if somebody is advising you to have a traditional hysterectomy, I think do your homework. Don't be shy about getting a second opinion, go see somebody who's experienced in all methods of minimally invasive surgery, so that you really can get a different perspective and make an educated decision.

Deborah Howell (Host): What are some of the symptoms a woman might have prior to having a hysterectomy?

Marc Winter, MD: Sure, the biggest things, most common things are fibroids, which are smooth muscle tumors that grow within the uterus that can cause pain and pressure, sometimes abnormal bleeding is a very frequent reason, and then the other reason sometimes I take care of women that have prolapse problems, where things are falling down and need to be reconstructed or pulled back up to their normal position.

Deborah Howell (Host): Okay, and along with these come bloating and pain and just...

Marc Winter, MD: Yeah, I mean any kind, I think if a woman is having any kind of abnormal issue, pain, bloating, again, is something that shouldn't be ignored, sometimes that could be an early sign that there's something going on inside and should be checked out by a physician.

Deborah Howell (Host): I mean, that's just general, common sense. If anything seems weird with your body, go see your doctor.

Marc Winter, MD: Absolutely. Listen to your body and just make sure everything's okay, that'll keep you in good stead.

Deborah Howell (Host): Okay. Tell us a little bit about the Robotic Surgery Epicenter, if you would.

Marc Winter, MD: Sure. A little over a year ago, Saddleback Memorial became the only robotic surgery epicenter for gynecology in Orange and LA County. We are one of only 22 centers of teaching in benign gynecology in the country. So what it is, based on our hospital, our surgical team, the efficiency of the team, in addition to my experience, that all went together and us being tapped, so to speak, by Intuitive, the company that makes the robot, to, they're very selective as far as picking centers that have quote-unquote "everything together" where they can be a teaching center. So basically, on a weekly basis, I have people coming from all over the country to look over my shoulder and see what we're doing and observe the latest techniques so to speak in robotic surgery, which it's been a great thing for us, and a great thing for me, I enjoy teaching and showing people better ways to do things and obviously it keeps you on your toes as well.

Deborah Howell (Host): And the more techniques and the more surgeries you do, the more you learn as well.

Marc Winter, MD: Absolutely, absolutely. There's always, always something to learn.

Deborah Howell (Host): Robotic surgery epicenter. I'm wondering what the difference between a center and an epicenter is.

Marc Winter, MD: Yeah, again, that's just a term for within the robotic surgery world, those are the centers where teaching goes on.

Deborah Howell (Host): What else should we know as women as we age and go through life and go through the changes?

Marc Winter, MD: Well, I think seeing your doctor on a regular basis, communicating whatever issues you have with your physician, and you know, the world is changing quickly, so it's exciting. Your doctor can educate you, as well as on the internet there's a lot out there to see, and there's talks locally where people can learn about things and different issues. Within our office, occasionally I'll talk about minimally invasive surgery. One of my other partners does a regular talk on menopause and the changes women go through. One of my other partners gives a talk on before you get pregnant. So there are a lot of educational opportunities around for people if they're interested in improving their health.

Deborah Howell (Host): Dr. Mark Winter, I want to thank you so much for finding the time to talk to us today about these breakthroughs in women's health. It is an exciting time to be a woman. Thank you so much for being on the show.

Marc Winter, MD: You're welcome, it's really my pleasure and thank you for having me.

Deborah Howell (Host): And now we'll let you go back to helping your many women patients who are patiently awaiting you.

Marc Winter, MD: That they are.

Deborah Howell (Host): I'm Deborah Howell, join us again next time as we explore another Weekly Dose of Wellness, brought to you by MemorialCare Health System. Have a great day.