An Alternative To Hysterectomy: A Doctor's Perspective
Surgical technique allows removal of large fibroid tumors
Women with sizable fibroid tumors that have enlarged the uterus often must undergo a hysterectomy because myomectomy, the standard surgical procedure to remove fibroids, results in too much blood loss with large tumors. An Allegheny General gynecologic surgeon has developed another option: "bloodless myomectomy" that, unlike a hysterectomy, does not require removal of the uterus, allowing the patient to possibly bear children later on.
Retaining uterine function
During the procedure, Jan Seski, M.D., director, Division of Gynecologic Oncology, isolates and clamps all blood vessels to the reproductive organs to temporarily shut off blood flow to the area. He then removes the fibroids, noncancerous growths in the muscle of the uterine wall. Next, Dr. Seski reconstructs the uterus, using tissue from the patient's abdominal wall to reduce the formation of adhesions that could later cause bleeding and infection, and releases the clamps before closing the incision.
"This procedure has great value when the uterus is very enlarged. In this case, most physicians are unable to do a myomectomy because the blood loss can be so significant that it can jeopardize the patient's life or require multiple blood transfusions," said Dr. Seski. "Also, large fibroid tumors do not respond well to drug treatment. Therefore, the woman's only option was a hysterectomy." For some women, it is important, both physically and psychologically, that the uterus is left intact, Dr. Seski added. "I've had some patients get pregnant later, although a Caesarean section is often recommended, depending on where the incision was made in the uterus," he said. "For many women, a Caesarean-section delivery is a small price to pay for the ability to have a child."
Procedure eliminates need for transfusions
As a specialist in gynecologic cancers, Jan Seski, M.D., faced a challenge in the late 1970s. A young patient needed extensive pelvic surgery but could not receive blood transfusions because she was a Jehovah's Witness. Her religious beliefs did not permit her to accept another person's blood, nor could her blood be totally separated from her body and then reinfused.
In response, Dr. Seski and his colleagues at the M.D. Anderson Hospital and Tumor Institute in Houston developed a technique called extracorporeal circulation that uses a cell separator, a machine that removes the blood from the patient's body, separates the blood properties and, in a diluted state, allows reinfusion of the blood during the surgery. This process is usually acceptable to Jehovah's Witnesses and others who do not want blood transfusions, saves money by eliminating the need for transfusions, and is generally very safe, Dr. Seski said.
Since coming to Allegheny General, Dr. Seski has used extracorporeal circulation many times to treat patients who require surgery without the use of blood.
