LESS is an advanced minimally invasive approach in which the surgeon operates almost exclusively through a single entry point, typically, the patient’s navel. Potential advantages of LESS include better cosmetic results from a hidden scar at the base of the belly button (this surgical approach is called “scarless surgery” because patients can’t see the incision at the base of the belly button once it has healed), less pain after surgery resulting in the need to use less pain medication, and quicker recovery from fewer incisions.

Dr. Amanda Nickles Fader, M.D. a gynecologic oncologist and minimally invasive surgeon at GBMC, is one of only a handful of gynecologic surgeons in the country trained in LESS procedures. This minimally invasive innovation has recently garnered significant interest across many medical fields, including urology, general surgery, colorectal surgery and gynecology. It remains one of the hottest topics in contemporary minimally invasive surgical research.

Over the last year, Dr. Fader and her colleagues at the Cleveland Clinic have published some of the first studies on the use of single port surgery for gynecologic procedures and have demonstrated that this surgical approach is safe and effective when used to treat a variety of gynecologic conditions including fibroids, endometriosis, pelvic pain, ovarian cysts and pelvic masses. As a gynecologic oncologist, a surgeon who specializes in treatment of precancerous and cancerous female diseases, Dr. Fader has focused her studies on utilizing LESS for women with precancerous conditions like cervical dysplasia, those with pelvic masses or large ovarian cysts, those women at high risk for ovarian cancer who may want their ovaries removed prophylactically to prevent cancer, and for surgeries to treat some early-stage endometrial and ovarian cancers.

Dr. Fader said, “In our first group of published studies, our preliminary data demonstrates that women who undergo single incision laparoscopies use little to no pain medicine after surgery, recover very quickly and are quite satisfied with the cosmetic outcomes because most women can’t see their hidden surgical at the base of the belly button.”

Hope that’s of use to some one. x

Had ultrasound in the UK just prior to going back to Melbourne for a 2 week visit which showed multiple fibroids throughout. Saw an OBG/GYN in Malvern who said only options were hysterectomy or ‘do nothing’. Any other approaches such as myomectomy or embolization she said were not recommended which left me extremely distraught.

Looking for more information I went to the women’s health information centre at RWH in Flemington, they were mortified at the lack of help provided by this first (female) doctor and assisted in provideing names of more knowledgeable gynae specialists for a 2nd opinion. The 2nd doctor was an infertility & laparoscopic specialist. She arranged a referral for a staging MRI to see if I was suitable for MRgFUS which I was able to get done privately the next week.

The MRI showed at least 8 focal typical T2 fibroids scattered throughout the myometrium. The largest being intermural in the fundal region measuring 8.2 x 9.4 x 4.3. Others are: 5.4 x 3.8 x 4.3 left lateral intermural, 4.3 x 5.2 x 3.6 anterofundal intermural, 2 x 1.4 cm in mid to lower body of uterus, and 4.6 cm in the lower body. Uterus is markedly enlarged with a volume of 821cc

The IR advised that I was not currently suitable for MRgFUS as the dominant fibroid abuts the sacral promontory (risk of nerve damage), however recommended a course of GNRH agonist for 3 months when it is probable that I will be likely to be suitable for MRgFUS.

I then returned to London and decided to look into seeing having the MRgFUS at St Mary’s in Paddington. It’s more expensive for the procedure £4,400 vs. ~AU$5,500 but easier to coordinate rather than needing to time GNRH agonist injections around when I could book the re-assessment MRI in Melbourne, time off work etc.

I saw the gynae at St Mary’s then had to wait to get my films reviewed by the radiologists. The Dr told me though that 6 is the maximum number they like to treat due to the amount of time on the table to do more (I have at least 8). Also the beam is only affective apparently to a depth of 12cm and she was concerned that the one at the back might be too far away. They can apparently try things like filling your bowel with air to see if it can move forward enough so that was what I was waiting to find out from the MRI review.

Well the feedback was that I was suitable to have the MRgFUS to the St Mary’s criteria and no need for the GNRH agonist to shrink them first which was even better news. However due to the limitation in the number that they would treat plus the fact MRgFUS may only reduce the volume by 35% and symptoms by 70% I decided I’d investigate surgical options.

I’ve now had a hysteroscopy with polyp removal (see post on how are you feeling after hysteroscopic myomectomy) and am due to have a laproscopic myomentomy on January 25.

I just wanted to share with everyone that I had an experience very similar to Michelle’s – fibroid shrunk considerably at first after MRGFUS and then later increased. I also have a couple other fibroids in there and am just ready to be a hystersister and never have a period again. My one 2 mos. ago sent me to the hospital with bleeding out – that was a first over these last 3 years, but it convinced me to get it taken care of! I also am investigating DaVinci and something else called LESS, which is relatively new and they go in through the navel, but I’m guessing they’ll tell me that’s only for fibroid removal and not hyster (appt. next week).
Hope this info helps! I’m off to read the hyster blog!

What an encouragement and a blessing from God. Have a blessed Christmas and prosperous New Year:+)

EB

However, after about a year, bladder issues started coming back and my periods got longer (presumably just part of perimenopause). Had another ultrasound and my fibroid was almost the same size as it was pre-Exablate (~ 6cm). Best guess is that it shrunk after treatment, but the remaining “safe zone” lining eventually started to regrow.

I really wanted to wait it out (being close to menopause, theoretically) because I don’t like the idea of surgery. But I was afraid that the fibroid might not shrink much even at menopause and honestly, I was finally just sick and tired of it all. Due to the fibroid size and the fact I hadn’t had children, I wasn’t a good candidate for a vaginal hysterectomy and my OB/GYN thought she might have to do an abdominal. Ugh. Not for me.

I found out about da Vinci hysterectomy and connected with a great robotic surgeon. I asked about myomectomy out of curiosity, but he felt that wasn’t the answer and I agreed. I had additional small fibroids and given I’m past childbearing age. Losing my uterus caused no emotional issue for me at all.

I had my da Vinci total hyst (uterus & cervix) on a Tuesday morning and probably did a half mile of laps around the hospital the next morning, went home that afternoon. Got out and walked a block or so the next morning. Went back to work in 4 weeks but definitely could have gone back sooner if it weren’t for the commute. A partial (uterus only) da Vinci hyst would probably be a lot easier all other things being equal; I know a lady who was back to work within 2 weeks (though she owns her own business and had a short commute). Anyway, I needed only ibuprofen after coming home and really had no issues to speak of.

I’m not a big fan of surgery or hospital stays. I’m glad I did the Exablate … it gave me enough time to build up my iron levels and my sick leave time, and most of all the timing of finding a very experienced da Vinci surgeon (with a lot of previous robotic surgery experience). I considered UFE but the likely pain, fever, longer hospital stay turned me off. And I was afraid it might not do the trick.

I know this doesn’t answer your question directly, but wanted to share my story because it seems quite similar to what you are going through. Best of luck finding the right decision for you!

michelle

I am scheduled for an abdominal partial hysterectomy (they take the top part of the uterus but leave the cervix) in 2.5 weeks. I would have an incision across my low belly and be off work ~4 -6 weeks. I have recently checked into a “Da Vinci” robotic assisted surgery (Swedish Hopsital in Seattle) and met with a doctor there. She likes the Da Vinci method over the traditional hysterectomy due to “less blood loss and quicker healing”. She says she can actually see better with the robot arms and eyes where it’s right up against the tissue vs. being a distance away with her own eyes. I don’t like the idea of either actually so was interested in the MR assisted Focused US exablate procedure. I don’t get it~after ablation the fibroid just hangs out there in your uterus? I figured it would kind of come out in peices over a couple months. I did not realize you may not have any positive affect after ablation for months or maybe never. Not only do I not want surgery but am claustrophobic!!! Do you really get to have you head, shoulders and arms OUT of the MR machine during this procedure? Can anyone who has had the ablation with MR focused US or knows anyone who has and it has NOT worked for please respond. I have read thru this blog only quickly so far and I will go back and read more carefully. I would appreciate input and hope you are all doing okay.