Selected Podcast
Benefits of Minimally Invasive Gynecologic Surgery
Gaby Moawad, MD, FACOG, explains the most common minimally invasive gynecologic surgeries, including hysterectomy, removal of fibroids and ovarian cysts, endometriosis, and prolapse correction, as well as the benefits (fewer complications, faster recovery). Dr. Moawad also discusses why it's important for women considering these types of procedures to feel empowered to ask questions about the surgeon's experience and success rates, to help ensure the best possible outcomes.
Featured Speaker:
Learn more about Gaby Moawad, MD
Gaby Moawad, MD
Gaby Moawad, MD is board-certified in Obstetrics & Gynecology. He is an assistant professor of Obstetrics & Gynecology at The George Washington University School of Medicine & Health Sciences, and a member of the medical staff at The George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates.Learn more about Gaby Moawad, MD
Transcription:
Dr. Michael Smith (Host): Today’s topic is “Benefits of Minimally Invasive Gynecologic Surgery.” My guest today, is Dr. Gaby Moawad. He is board-certified in obstetrics and gynecology and a member of the medical staff at the George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates.. Dr. Moawad, welcome to the show.
Dr. Gaby Moawad (Guest): Thank you for having me, Dr. Mike.
Dr. Smith: What kind of conditions are best treated with minimally invasive gynecologic surgery?
Dr. Moawad: When we speak about benign conditions – which is non-cancerous conditions – I can tell you most of the pathology that a woman would have is treatable with minimally invasive surgery. I’ll give you some examples. For example, hysterectomies, or removal of the uterus, removal of fibroids, ovarian cysts, endometriosis, which causes severe pelvic pain, all of these conditions are treatable by minimally invasive surgery. Now, when we go to cancer – some of the cancers at an early stage, women could benefit from minimally invasive surgery, but other advanced cancer, there might be a question. It depends on the skills, and the stage of cancer and the patient can talk to their doctor to see which is the most optimal approach for their pathology.
Dr. Smith: Dr. Moawad, when we say, “minimally invasive,” maybe you can help us to understand what that really means and what are the benefits to this type of surgery?
Dr. Moawad: Let me go back in a historical overview. Traditionally, most of these surgeries were done through a larger cut in the belly, whether through a cesarean cut – bikini cut we call it sometimes – or through a vertical cut or up-and-down cut. These surgeries have the potential of high risk of complications like infections, bleeding during the procedure, and other complications including herniation of the scar, opening of the scar prematurely, pain – lots of pain for the patient. Recently, in the 90s, we started talking about minimally invasive surgery, which is doing the same surgery that we do in a traditionally open fashion, doing it through little, keyhole incisions. Small incisions -- most of the time a quarter of an inch to an inch incision where we use instruments like sticks, sometimes, or we use the robot. These types of surgeries can achieve the goal of the surgeries that were done traditionally with less complications – less bleeding, less potential risk for herniation, definitely less pain and the path to recovery. Patients do go back to their normal activity within two weeks after surgery in comparison to what was six to eight weeks after open or traditional surgery. Patients do go home the same day after the procedure or even the next day after the procedure and can get back to normal daily activity way faster than traditional open surgery.
Dr. Smith: Right, and more, and more primary care doctors when it comes – or even ob-gyn doctors when it comes to these types of procedures are recommending minimally invasive surgery for their patients. More and more are coming to – are using this type of technique. When you look at how often minimally invasive surgery is being used versus traditional, is this really the go-to now, or are we still seeing a lot of the traditional surgeries happening?
Dr. Moawad: Unfortunately, there is lots of traditional surgery, but I would say the primary option is minimally invasive surgery because we want to get these patients back to their daily, normal activity, back to their family -- taking care of their kids, or their partners, or doing the stuff that they want to do. Traditional surgery will hinder and will delay all of that. Especially lots of women are professional women – they have work, they have families to take care of, so as much as we can get them back to their daily activity, that is beneficial.
Now, the problem is there is some surgery criteria – and I would encourage every patient to ask their surgeon about how many cases they do, the training they underwent to do minimally invasive surgery because minimally invasive surgery is a fellowship that you can do to provide the patient a higher chance of completing their surgery in a minimally invasive fashion, and giving them the advantages of that, versus low-volume surgeons who do not do these surgeries very frequently, and who do not perform – do not have special training for these types of surgery.
This is the thing -- that’s why, unfortunately, most of the surgeries are still done in an open, traditional fashion. That’s why we have our duty to encourage all women to choose the option of minimally invasive surgery when feasible and at least discuss it with their surgeon – with their physician.
Dr. Smith: And don’t assume that your surgeon is well-trained in minimally invasive surgery. We have to ask those questions, right?
Dr. Moawad: Definitely. And especially in the obstetrics and gynecology field because it’s a delicate bond between the physician and the patient – they had their kids with them, when they have problems, they come for their check-up with them. There is a bond that is created and sometimes they cannot provide the optimal approach for them, so that’s why it’s our duty to encourage patients to read and seek for the best options for themselves and to ask their physicians how well they’re trained, how many of these procedures do they do, and what has been their success rate so they can be well-informed before they undergo any surgery.
Dr. Smith: And you would suggest asking the specific question to the surgeon, “Have you done a fellowship in minimally invasive surgery?” Is that something you would ask?
Dr. Moawad: Yes, definitely, because fellowship-trained people have a vaster [sic] experience. Doing minimally invasive surgery is like any skill that you want to maintain. If you ran a marathon – I give this example all the time to my patients – if you ran a marathon last year, that does not make you eligible to run a marathon this year without training. You could run it, but you need to train. Doing low-volume surgery – and it’s proven in time that low-volume surgeons do not provide the same quality of surgical care as much as high-volume. Not because their high-volume surgeons are better than them, because they have the volume to maintain their skills, and continue to provide an efficient and higher quality of care.
Dr. Smith: Right, right, and I think you make a good point. It’s about training. It’s about experience – and these are questions that patients have to be more comfortable asking of, not just the surgeons, but general practitioners, what have you – any healthcare providers. We need to encourage patients to ask these kinds of questions.
Dr. Moawad: I completely agree.
Dr. Smith: You had mentioned, Dr. Moawad, in the beginning, some of the common conditions that you can treat with minimally invasive surgery, can you review those one more time? What makes a good candidate for this approach?
Dr. Moawad: Well, I can speak about gynecologic minimally invasive surgery. In gynecology, almost all of the benign conditions are eligible for minimally invasive surgery, and I would say the common procedures are hysterectomy – which is the removal of the uterus, removal of ovarian cysts, removal of fibroids. There are lots more complex procedures that could be done minimally invasive like prolapse correction, pelvic pain surgeries, all of these surgeries are eligible for minimally invasive surgery. Everybody is a candidate for minimally invasive surgery with the appropriate, well-trained physician. Now, there’s always a risk of conversion to open surgery, and that would happen only to complete the surgery safely. The risk of conversion to a traditional surgery is lower in the right hands – a well-trained surgeon. I would say the primary approach that we offer all of our patients is a minimally invasive approach, but also, we have to individualize the treatment for each and every patient. Some of the patients have a high-risk for cancer potentially, so open surgery is safer for them. Some other patients have way more complex pathology that needs a multidisciplinary approach – different surgeons from different specialties. You have to make the best approach, and the safest approach, to help your patient reach her goals.
Dr. Smith: Right, so in summary then, Dr. Moawad, what would you like people to know about minimally invasive gynecologic surgery?
Dr. Moawad: In summary, minimally invasive surgery is a well-proven, well-studied approach. They are safe and efficient in the right, well-trained surgeons’ hand. That should be the primary approach for every single patient. Now, on the other hand, the patient should seek a specialist in minimally invasive surgery – should not be shy to ask her surgeon how many cases do they perform, what have been their success rates in minimally invasive surgery, and have a well-open discussion with her surgeon to be able to be informed and empowered to undergo whatever procedure she thinks is best for her.
Dr. Smith: Dr. Moawad, I want to thank you for the work that you’re doing, and I want to thank you for coming on the show today. You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Moawad or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment. This is Dr. Mike Smith. Thanks for listening.
Dr. Michael Smith (Host): Today’s topic is “Benefits of Minimally Invasive Gynecologic Surgery.” My guest today, is Dr. Gaby Moawad. He is board-certified in obstetrics and gynecology and a member of the medical staff at the George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates.. Dr. Moawad, welcome to the show.
Dr. Gaby Moawad (Guest): Thank you for having me, Dr. Mike.
Dr. Smith: What kind of conditions are best treated with minimally invasive gynecologic surgery?
Dr. Moawad: When we speak about benign conditions – which is non-cancerous conditions – I can tell you most of the pathology that a woman would have is treatable with minimally invasive surgery. I’ll give you some examples. For example, hysterectomies, or removal of the uterus, removal of fibroids, ovarian cysts, endometriosis, which causes severe pelvic pain, all of these conditions are treatable by minimally invasive surgery. Now, when we go to cancer – some of the cancers at an early stage, women could benefit from minimally invasive surgery, but other advanced cancer, there might be a question. It depends on the skills, and the stage of cancer and the patient can talk to their doctor to see which is the most optimal approach for their pathology.
Dr. Smith: Dr. Moawad, when we say, “minimally invasive,” maybe you can help us to understand what that really means and what are the benefits to this type of surgery?
Dr. Moawad: Let me go back in a historical overview. Traditionally, most of these surgeries were done through a larger cut in the belly, whether through a cesarean cut – bikini cut we call it sometimes – or through a vertical cut or up-and-down cut. These surgeries have the potential of high risk of complications like infections, bleeding during the procedure, and other complications including herniation of the scar, opening of the scar prematurely, pain – lots of pain for the patient. Recently, in the 90s, we started talking about minimally invasive surgery, which is doing the same surgery that we do in a traditionally open fashion, doing it through little, keyhole incisions. Small incisions -- most of the time a quarter of an inch to an inch incision where we use instruments like sticks, sometimes, or we use the robot. These types of surgeries can achieve the goal of the surgeries that were done traditionally with less complications – less bleeding, less potential risk for herniation, definitely less pain and the path to recovery. Patients do go back to their normal activity within two weeks after surgery in comparison to what was six to eight weeks after open or traditional surgery. Patients do go home the same day after the procedure or even the next day after the procedure and can get back to normal daily activity way faster than traditional open surgery.
Dr. Smith: Right, and more, and more primary care doctors when it comes – or even ob-gyn doctors when it comes to these types of procedures are recommending minimally invasive surgery for their patients. More and more are coming to – are using this type of technique. When you look at how often minimally invasive surgery is being used versus traditional, is this really the go-to now, or are we still seeing a lot of the traditional surgeries happening?
Dr. Moawad: Unfortunately, there is lots of traditional surgery, but I would say the primary option is minimally invasive surgery because we want to get these patients back to their daily, normal activity, back to their family -- taking care of their kids, or their partners, or doing the stuff that they want to do. Traditional surgery will hinder and will delay all of that. Especially lots of women are professional women – they have work, they have families to take care of, so as much as we can get them back to their daily activity, that is beneficial.
Now, the problem is there is some surgery criteria – and I would encourage every patient to ask their surgeon about how many cases they do, the training they underwent to do minimally invasive surgery because minimally invasive surgery is a fellowship that you can do to provide the patient a higher chance of completing their surgery in a minimally invasive fashion, and giving them the advantages of that, versus low-volume surgeons who do not do these surgeries very frequently, and who do not perform – do not have special training for these types of surgery.
This is the thing -- that’s why, unfortunately, most of the surgeries are still done in an open, traditional fashion. That’s why we have our duty to encourage all women to choose the option of minimally invasive surgery when feasible and at least discuss it with their surgeon – with their physician.
Dr. Smith: And don’t assume that your surgeon is well-trained in minimally invasive surgery. We have to ask those questions, right?
Dr. Moawad: Definitely. And especially in the obstetrics and gynecology field because it’s a delicate bond between the physician and the patient – they had their kids with them, when they have problems, they come for their check-up with them. There is a bond that is created and sometimes they cannot provide the optimal approach for them, so that’s why it’s our duty to encourage patients to read and seek for the best options for themselves and to ask their physicians how well they’re trained, how many of these procedures do they do, and what has been their success rate so they can be well-informed before they undergo any surgery.
Dr. Smith: And you would suggest asking the specific question to the surgeon, “Have you done a fellowship in minimally invasive surgery?” Is that something you would ask?
Dr. Moawad: Yes, definitely, because fellowship-trained people have a vaster [sic] experience. Doing minimally invasive surgery is like any skill that you want to maintain. If you ran a marathon – I give this example all the time to my patients – if you ran a marathon last year, that does not make you eligible to run a marathon this year without training. You could run it, but you need to train. Doing low-volume surgery – and it’s proven in time that low-volume surgeons do not provide the same quality of surgical care as much as high-volume. Not because their high-volume surgeons are better than them, because they have the volume to maintain their skills, and continue to provide an efficient and higher quality of care.
Dr. Smith: Right, right, and I think you make a good point. It’s about training. It’s about experience – and these are questions that patients have to be more comfortable asking of, not just the surgeons, but general practitioners, what have you – any healthcare providers. We need to encourage patients to ask these kinds of questions.
Dr. Moawad: I completely agree.
Dr. Smith: You had mentioned, Dr. Moawad, in the beginning, some of the common conditions that you can treat with minimally invasive surgery, can you review those one more time? What makes a good candidate for this approach?
Dr. Moawad: Well, I can speak about gynecologic minimally invasive surgery. In gynecology, almost all of the benign conditions are eligible for minimally invasive surgery, and I would say the common procedures are hysterectomy – which is the removal of the uterus, removal of ovarian cysts, removal of fibroids. There are lots more complex procedures that could be done minimally invasive like prolapse correction, pelvic pain surgeries, all of these surgeries are eligible for minimally invasive surgery. Everybody is a candidate for minimally invasive surgery with the appropriate, well-trained physician. Now, there’s always a risk of conversion to open surgery, and that would happen only to complete the surgery safely. The risk of conversion to a traditional surgery is lower in the right hands – a well-trained surgeon. I would say the primary approach that we offer all of our patients is a minimally invasive approach, but also, we have to individualize the treatment for each and every patient. Some of the patients have a high-risk for cancer potentially, so open surgery is safer for them. Some other patients have way more complex pathology that needs a multidisciplinary approach – different surgeons from different specialties. You have to make the best approach, and the safest approach, to help your patient reach her goals.
Dr. Smith: Right, so in summary then, Dr. Moawad, what would you like people to know about minimally invasive gynecologic surgery?
Dr. Moawad: In summary, minimally invasive surgery is a well-proven, well-studied approach. They are safe and efficient in the right, well-trained surgeons’ hand. That should be the primary approach for every single patient. Now, on the other hand, the patient should seek a specialist in minimally invasive surgery – should not be shy to ask her surgeon how many cases do they perform, what have been their success rates in minimally invasive surgery, and have a well-open discussion with her surgeon to be able to be informed and empowered to undergo whatever procedure she thinks is best for her.
Dr. Smith: Dr. Moawad, I want to thank you for the work that you’re doing, and I want to thank you for coming on the show today. You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Moawad or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment. This is Dr. Mike Smith. Thanks for listening.