{"id":479,"date":"2012-03-03T17:48:27","date_gmt":"2012-03-03T17:48:27","guid":{"rendered":"http:\/\/thegroupforwomen.com\/?p=479"},"modified":"2022-03-31T23:32:27","modified_gmt":"2022-03-31T23:32:27","slug":"jon-crockford-md-c-dwight-groves-md-advocates-to-laparoscopic-alternative-to-hysterectomy","status":"publish","type":"post","link":"https:\/\/thegroupforwomen.com\/jon-crockford-md-c-dwight-groves-md-advocates-to-laparoscopic-alternative-to-hysterectomy\/","title":{"rendered":"Jon Crockford, MD & C. Dwight Groves, MD: Advocates to Laparoscopic Alternative to Hysterectomy"},"content":{"rendered":"

by Tina D. Fries<\/em><\/strong><\/p>\n

Abnormal bleeding. Uterine Fibroids. Pelvic pain disorder. Endometriosis. These are some of the most common reasons more than 600,000 total abdominal hysterectomies are performed on women each year in the United States, making hysterectomy one of the most commonly performed surgical procedures.<\/p>\n

By age 60, one in three women will have undergone the procedure, with 65% of them having both uterus and cervix removed, with or without ovaries or fallopian tubes, in the most invasive way: through a 4-8 inch abdominal incision requiring an extended hospital stay and a 4-6 week recovery time.<\/p>\n

But there are alternatives to total abdominal hysterectomy. Vaginal hysterectomy \u2014 with or without the assistance of a laparoscope \u2014 is performed by removing the uterus through an incision in the vagina, requiring a 2-day hospital stay and 4-week recovery period.<\/p>\n

Since 2001, Surgeons\u00a0Jon L. Crockford, M.D., and\u00a0C. Dwight Groves, M.D.\u00a0of\u00a0The Group For Women,<\/strong>\u00a0a Division of Mid-Atlantic Women\u2019s Care, PLC, have been teaming up to bring a third, minimally invasive alternative called laparoscopic supracervical hysterectomy (LSH) to women in Hampton Roads. Laparoscopic supracervical hysterectomy is performed by making three half-inch long incisions in the patient\u2019s abdomen through which the upper two thirds of the uterus is removed. The bottom third of the uterus \u2014 the cervix \u2014 is left in place and therefore no incision is made in the vagina.<\/p>\n

While not an appropriate option for women with malignancies, LSH offers a number of benefits for the patient with benign disease including a short, one night or less hospital stay, significantly shorter recovery time of 7-14 days, less scarring, less risk of injury to surrounding organs, fewer post-surgicalncomplications such as infection, better long-term support of the top of the vagina and maintenance of sexual health, including earlier resumption of sexual activity. \u201cWith this procedure, we\u2019re not seeing the GI complications or the infection complications,\u201d said Dr. Groves. \u201cWe don\u2019t have the wound problems we had before. For obese patients this may actually be better than the other options.\u201d<\/p>\n

Equipment Advances Increase Safety<\/strong><\/h3>\n

LSH uses specialized equipment including a laparoscope, a thin lighted endoscope connected to a camera that allows the surgeon to see the patient\u2019s organs on a monitor, a harmonic scalpel for cutting and a uterine morcellator with a thin rotating barrel that removes the organs in tiny pieces through a long, cylindrical tube.<\/p>\n

\u201cGiven recent advancements in technology and new instruments on the market we are able to accomplish a large operation inside the body through small, minimal incisions,\u201d said Dr. Crockford. \u201cWe now have the technology to do this procedure safely and quickly.\u201d<\/p>\n

Both physicians affirm that wasn\u2019t always the case, given the equipment of yesteryear. \u201cIt was dangerous when they first started doing laparoscopy in the 1950s,\u201d said Dr. Groves. \u201cGetting the initial point of entry used to be the most dangerous part of the surgery and they used monopolar electricity which resulted in burns.\u201d<\/p>\n

But with advances in equipment and technique, incandescent lights gave way to fiberoptics, blades for entry were set aside in favor of blunt, clear-tipped trocars, and air pumps were replaced with computerized equipment to monitor the precise amount of air being injected.<\/p>\n

\u201cWe used to put our eye to the eyepiece and now we have a camera and digital images so it\u2019s actually better than the naked eye,\u201d said Dr. Crockford.<\/p>\n

Unique Learning Curve<\/strong><\/h3>\n

Dr. Crockford and Dr. Groves trained in LSH at Florida Hospital Celebration Health in Orlando under the medical direction of Steven McCarus, M.D., nationally recognized for laparoscopic surgical expertise.<\/p>\n

\u201cThe learning curve with this procedure is a little different,\u201d explained Dr. Groves, who earned his medical degree from Marshall University in Huntington, West Virginia and completed both internship and residency with Eastern Virginia Medical School. He practiced with\u00a0The Group for Women<\/strong>\u00a0early in his career and returned in 2000 to log a total of 12 years there.<\/p>\n

\u201cNormally with surgery things are very tactile, but this is a very visual thing, very remote,\u201d he said, zeroing in on one of the major challenges physicians face in using robotic techniques. \u201cWe\u2019re outside of the body so we have to work with visual cues without the benefit of the sense of touch.\u201d<\/p>\n

Dr. Crockford earned his medical degree from the University of Virginia and completed both internship and residency in obstetrics and gynecology at Barnes Hospital, Washington University School of Medicine in St. Louis, Missouri. He has been practicing with\u00a0The Group for Women<\/strong>\u00a0for 26 years.<\/p>\n

Since completing their training in LSH, Dr. Crockford and Dr. Groves have performed 270 of these procedures with consistently positive outcomes and an estimated one percent conversion rate to abdominal hysterectomy. They perform an average of 2-5 per week, the vast majority of them at Sentara Leigh Hospital. While national averages indicate that 65% of women continue to have traditional abdominal hysterectomy, the frequency and demand for LSH at Sentara Leigh Hospital during 2003 actually reduced this figure to 45%.<\/p>\n

To aid physicians like Dr. Crockford and Dr. Groves in their work, Sentara Leigh Hospital is in the process of developing a state-of-the-art operating room equipped for advanced laparoscopic procedures with voice-activated robotics.<\/p>\n

Do No Harm<\/strong><\/h3>\n

Leaving the cervix unharmed has many benefits for the patient. The cervix provides key support to the upper vagina. The uterosacral ligaments attach the vagina to the spine via the cervix and with LSH these supports are left intact.\u00a0\u201cWhat we\u2019re doing with this surgery is we are saving the cervix,\u201d said Dr. Groves. \u201cThe first rule of medicine is \u2018do no harm\u2019 and I think that applies very nicely here. With the availability of regular pap smears to screen for cervical cancer, there\u2019s no reason to remove a healthy cervix. If it\u2019s diseased, by all means take it out. But why increase infection rate, bleeding and the possibility of complications unnecessarily?\u201d
\nOne of the primary complications following total abdominal hysterectomy is posthysterectomy vaginal vault prolapse which results from not maintaining support to the top of the vagina.<\/p>\n

\u201cLSH preserves the pelvic floor so we\u2019ll see fewer complications and less need for corrective surgery down the road by maintaining the cervix than we would by taking it out,\u201d said Dr. Crockford.<\/p>\n

Benefits for the Patient<\/strong><\/h3>\n

By minimizing pain and trauma to the body, LSH provides significant benefits for the patient. The procedure reduces pain, minimizes scarring and significantly shortens recovery time. The patient can be home within 24 hours and back to their normal activities in just 1-2 weeks.<\/p>\n

Kathryn Hall, 46, a patient of Dr. Crockford\u2019s, elected to have the procedure in 2002 for severe uterine fibroids when she learned the recovery time with regular hysterectomy would require 4-6 weeks of missed work.<\/p>\n

A regional manager with Landmark Property Services, Hall said, \u201cI\u2019m a work-aholic. The number one reason I chose the surgery was they told me I could be back to work in a week. My employer didn\u2019t believe me at first.\u201d<\/p>\n

\u201cThe next day after surgery our patients are up and dressed, eating their breakfast and waiting on us,\u201d said Dr. Crockford. \u201cThis procedure has fewer complications and patients are back living their lives sooner and they\u2019re loving it.\u201d \u201cIt was the most amazing thing,\u201d said Hall. \u201cI was stunned at how well I did and how easy the surgery was. I stayed in the hospital one night and when I came home I took Ibuprofen one time. You\u2019re sore and you have a little bit of a problem getting up and down, but you don\u2019t feel pain.\u201d<\/p>\n

The Bottom Line<\/strong><\/h3>\n

Hall said in conducting Internet research prior to surgery she learned that LSH is somewhat more costly to perform than traditional hysterectomy because of the technology and equipment investment.<\/p>\n

\u201cIt is more expensive,\u201d said Dr. Crockford. \u201cBut we have to look at the long run and gross national product. These women are back to work 4-5 weeks sooner and that\u2019s got to have a tremendous economic impact. Not to mention, how do you put a dollar figure on the overall impact of recovery time on their families?\u201d\u00a0 Hall expressed concern that many women, despite being better educated health care consumers via the Internet, don\u2019t seem to know about LSH.<\/p>\n

\u201cI know someone who had a regular hysterectomy and I was telling her about laparascopic and she had no idea what I was talking about,\u201d said Hall. \u201cShe had never heard of it. This is an option for women and I believe physicians should learn about it and offer it to their patients.\u201d<\/p>\n

Physician Awareness and Training<\/strong><\/h3>\n

Research presented in the Journal of Obstetrics and Gynecology last year suggests that few OB\/GYN physicians in our region of the country discuss laparoscopic alternatives to total abdominal hysterectomy with their patients. In an effort to change that, Dr. Crockford and Dr. Groves serve as consultants for Ethicon, Inc. and GYNECARE, subsidiaries of Johnson and Johnson Company who manufacture minimally invasive equipment used in the procedure.<\/p>\n

They offer half-day to full-day training sessions for physicians every 2-3 months at Sentara Leigh Hospital. The sessions involve viewing a live surgery with twoway audio-visual feed so they can discuss techniques with their colleagues during surgery.<\/p>\n

\u201cWe\u2019re happy to share. We\u2019re trying to get people trained,\u201d said Dr. Groves. \u201cGynecologists are slowly coming on board. I never thought we\u2019d have a professional relationship with a surgical equipment company, \u201c he added. \u201cBut we really feel passionate about this.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

by Tina D. Fries Abnormal bleeding. Uterine Fibroids. Pelvic pain disorder. Endometriosis. These are some of the most common reasons more than 600,000 total abdominal hysterectomies are performed on women each year in the United States, making hysterectomy one of the most commonly performed surgical procedures. By age 60, one in three women will have […]<\/p>\n","protected":false},"author":3,"featured_media":614,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[2],"tags":[],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/thegroupforwomen.com\/wp-json\/wp\/v2\/posts\/479"}],"collection":[{"href":"https:\/\/thegroupforwomen.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/thegroupforwomen.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/thegroupforwomen.com\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/thegroupforwomen.com\/wp-json\/wp\/v2\/comments?post=479"}],"version-history":[{"count":1,"href":"https:\/\/thegroupforwomen.com\/wp-json\/wp\/v2\/posts\/479\/revisions"}],"predecessor-version":[{"id":2501,"href":"https:\/\/thegroupforwomen.com\/wp-json\/wp\/v2\/posts\/479\/revisions\/2501"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/thegroupforwomen.com\/wp-json\/"}],"wp:attachment":[{"href":"https:\/\/thegroupforwomen.com\/wp-json\/wp\/v2\/media?parent=479"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/thegroupforwomen.com\/wp-json\/wp\/v2\/categories?post=479"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/thegroupforwomen.com\/wp-json\/wp\/v2\/tags?post=479"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}