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Minimally Invasive Solution to Uterine Fibroids

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da Vinci ® Myomectomy

Each year, roughly 65,000 myomectomies are performed in the U.S. The conventional approach to myomectomy is open surgery, through a large abdominal incision. After cutting around and removing each uterine fibroid, the surgeon must carefully repair the uterine wall to minimize potential uterine bleeding, infection and scarring. Proper repair is also critical to reducing the risk of uterine rupture during future pregnancies.

While myomectomy is also performed laparoscopically, this approach can be challenging for the surgeon, and may compromise results compared to open surgery.  Laparoscopic myomectomies often take longer than open abdominal myomectomies, and up to 28% are converted during surgery to an open abdominal incision. Myomectomy can be a uterine-preserving alternative to open abdominal hysterectomy.

da Vinci ® Myomectomy

A new category of minimally invasive myomectomy, da Vinci ® Myomectomy, combines the best of open and laparoscopic surgery. With the assistance of the da Vinci ® Surgical System – the latest evolution in robotics technology – surgeons may remove uterine fibroids through small incisions with unmatched precision and control. Among the potential benefits of da Vinci Myomectomy as compared to traditional open abdominal surgery are:

  • Opportunity for future pregnancy
  • Significantly less pain
  • Less blood loss
  • Fewer complications
  • Less scarring
  • A shorter hospital stay
  • A faster return to normal daily activities

da Vinci ® Myomectomy is performed with the da Vinci ® Surgical System, which allows your surgeon to perform a minimally invasive, yet remarkably precise, comprehensive reconstruction of the uterine wall, regardless of the size or location of your fibroids. The unique level of control and precision provided by da Vinci ® can also help your surgeon provide the most precise and thorough reconstruction possible, helping to prevent possible uterine rupture (tearing) during future pregnancies.

As with any surgery, these benefits cannot be guaranteed, as surgery is both patient- and procedure-specific. While myomectomy performed using the da Vinci Surgical System is considered safe and effective, this procedure may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

State-of-the-art da Vinci Surgery carries big benefits in Hysterectomy procedures

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The da Vinci System enables your doctor to perform a minimally invasive hysterectomy even for complex conditions — with enhanced vision, precision, dexterity and control. da Vinci Hysterectomy offers women many potential benefits over traditional surgery, including:

  • Less pain
  • Fewer complications
  • Less blood loss
  • Shorter hospital stay
  • Low risk of wound infection
  • Quicker recovery and return to normal activities

Learn why da Vinci Hysterectomy may be your best treatment option for a range of gynecologic conditions.

Bunching-induced optical nonlinearity and instability in cold atoms [Invited].

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Bunching-induced optical nonlinearity and instability in cold atoms [Invited].

Opt Express. 2011 Nov 7;19(23):22535-49

Authors: Greenberg JA, Schmittberger BL, Gauthier DJ

Abstract
We report a new nonlinear optical process that occurs in a cloud of cold atoms at low-light-levels when the incident optical fields simultaneously polarize, cool, and spatially-organize the atoms. We observe an extremely large effective fifth-order nonlinear susceptibility of χ(⁵) = 7.6 × 10⁻¹⁵ (m/V)⁴, which results in efficient Bragg scattering via six-wave mixing, slow group velocities (∼ c/10⁵), and enhanced atomic coherence times (> 100 μs). In addition, this process is particularly sensitive to the atomic temperatures, and provides a new tool for in-situ monitoring of the atomic momentum distribution in an optical lattice. For sufficiently large light-matter couplings, we observe an optical instability for intensities as low as ∼ 1 mW/cm² in which new, intense beams of light are generated and result in the formation of controllable transverse optical patterns.

PMID: 22109132 [PubMed] ]]>

Folic Acid supplementation and pregnancy: more than just neural tube defect prevention.

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Folic Acid supplementation and pregnancy: more than just neural tube defect prevention.

Rev Obstet Gynecol. 2011;4(2):52-9

Authors: Greenberg JA, Bell SJ, Guan Y, Yu YH

Abstract
Folate (vitamin B(9)) is an essential nutrient that is required for DNA replication and as a substrate for a range of enzymatic reactions involved in amino acid synthesis and vitamin metabolism. Demands for folate increase during pregnancy because it is also required for growth and development of the fetus. Folate deficiency has been associated with abnormalities in both mothers (anemia, peripheral neuropathy) and fetuses (congenital abnormalities). This article reviews the metabolism of folic acid, the appropriate use of folic acid supplementation in pregnancy, and the potential benefits of folic acid, as well as the possible supplementation of l-methylfolate for the prevention of pregnancy-related complications other than neural tube defects.

PMID: 22102928 [PubMed] ]]>

Outcomes for critically ill patients with HIV and severe sepsis in the era of highly active antiretroviral therapy.

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Outcomes for critically ill patients with HIV and severe sepsis in the era of highly active antiretroviral therapy.

J Crit Care. 2012 Feb;27(1):51-7

Authors: Greenberg JA, Lennox JL, Martin GS

Abstract
RATIONALE: With the advent of highly active antiretroviral therapy (HAART), sepsis has become a more frequent ICU diagnosis for patients with HIV infections. Yet, little is known about the etiologies of acute infections in critically ill patients with HIV and the factors that affect in-hospital mortality.
METHODS: Cases of patients with HIV requiring intensive care specifically for severe sepsis were identified over 27 months. Demographic information, variables related to acute illness severity, variables related to HIV infection, and all acute infections contributing to ICU stay were recorded.
RESULTS: Of 990 patients admitted to the ICU with severe sepsis, 136 (13.7%) were HIV-infected. There were 194 acute infections among the 125 patients with full data available; 112 of the infections were nosocomial/health care-associated, 55 were AIDS-related, and 27 were community-acquired. Patients with nosocomial/health care-associated and AIDS-related infections had lower CD4 counts and were less likely to be on HAART (P < .05). The inpatient mortality was 42%. In a multivariable logistic regression model, only the APACHE II score (odds ratio, 1.12; 95% confidence interval, 1.02-1.23) was significantly associated with hospital mortality, although any HAART use (odds ratio, 0.53; 95% confidence interval, 0.22-1.33, P = .18) approached statistical significance.
CONCLUSIONS: In this large cohort study, nosocomial/health care-associated infections were common in ICU patients with HIV and severe sepsis. Hospital mortality was associated with acute illness severity, but not clearly associated with variables related to HIV infection. Interventions that aim to prevent or more effectively treat nosocomial infections in critically ill patients with HIV may favorably impact clinical outcomes.

PMID: 22033058 [PubMed – in process] ]]>

Is an episiotomy necessary with a shoulder dystocia?

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Is an episiotomy necessary with a shoulder dystocia?

Am J Obstet Gynecol. 2011 Sep;205(3):217.e1-3

Authors: Paris AE, Greenberg JA, Ecker JL, McElrath TF

Abstract
OBJECTIVE: The objective of the study was to determine whether a decrease in the use of episiotomy was associated with a change in the frequency of brachial plexus injury.
STUDY DESIGN: All births at Brigham and Women’s Hospital from Sept. 1, 1998, through Aug. 31, 2009, were reviewed. The total number of births, mode of delivery, shoulder dystocias, episiotomies with and without shoulder dystocias, and brachial plexus injuries were recorded. A nonparametric test of trend was performed.
RESULTS: There were a total of 94,842 births, 953 shoulder dystocias, and 102 brachial plexus injuries. The rate of episiotomy with shoulder dystocia dropped from 40% in 1999 to 4% in 2009 (P = .005) with no change in the rate of brachial plexus injuries per 1000 vaginal births.
CONCLUSION: Despite historical recommendations for an episiotomy to prevent brachial plexus injury when a shoulder dystocia is encountered, the trend we observed does not suggest benefit from this practice.

PMID: 21620364 [PubMed – indexed for MEDLINE] ]]>

A comparison of barbed and smooth sutures for ovine cesarean delivery.

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A comparison of barbed and smooth sutures for ovine cesarean delivery.

Int J Gynaecol Obstet. 2011 Jun;113(3):215-7

Authors: Greenberg JA, Walden S, Hammer CM, Grazul-Bilska AT, Vonnahme KA

Abstract
OBJECTIVE: To determine the adequacy of barbed and smooth sutures for closing the uterus and fascia in pregnant ewes.
METHODS: Nine ewes that underwent cesarean delivery were randomized to each receive 2 different suture materials for both the uterus and the fascia. The sutures used were: barbed poliglecaprone 25, smooth poliglecaprone 25, braided polyglactin 910, and smooth chromic sutures on the uterus; and barbed polydioxanone (PDO), barbed poliglecaprone 25, braided polyglactin 910, and smooth chromic sutures on the fascia.
RESULTS: In 4 of the ewes, the fascia suture line failed prematurely, leading to dehiscence prior to planned euthanasia and necropsy. The remaining 5 ewes were euthanized on days 2, 7, or 28. All suture materials (smooth and barbed) were adequate for uterine closures. Barbed PDO, smooth poliglecaprone 25, and braided polyglactin 910 were adequate for fascia closures, whereas both barbed poliglecaprone 25 and smooth chromic resulted in premature suture line ruptures and fascia dehiscence.
CONCLUSION: In a small pilot study, absorbable knotless barbed suture was adequate and equivalent to absorbable knotted smooth suture for closing the uterus following ovine cesarean delivery. On the rectus fascia, however, sutures-whether barbed or smooth-with lower tensile strength resulted in fascial dehiscence.

PMID: 21457976 [PubMed – indexed for MEDLINE] ]]>

The use of barbed sutures in obstetrics and gynecology.

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The use of barbed sutures in obstetrics and gynecology.

Rev Obstet Gynecol. 2010;3(3):82-91

Authors: Greenberg JA

Abstract
Despite the multitude of different procedures performed with a host of different wound closure biomaterials, no study or surgeon has yet identified the perfect suture for all situations. In recent years, a new class of suture material-barbed suture-has been introduced into the surgeon’s armamentarium. This review focuses on barbed suture to better understand the role of this newer material in obstetrics and gynecology.

PMID: 21364859 [PubMed] ]]>

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