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We were both in shock, but just delighted. We have to let them know that it worked!
During a routine gynecological exam 10 years ago, Sophia Watson, then 26, was told that she had a large benign tumor within her uterus. The gynecologist assured Sophia that this uterine fibroid wasn’t a threat to her health and recommended that they leave it alone. Several years later, a specialist who examined Sophia described her fibroid as being “very large,” but also didn’t see a need to treat it. In 2008, however, yet another specialist told her that her uterine fibroid was “giant,” not done growing, and possibly cancerous.
Sophia and her husband, David, wanted to remove the fibroid quickly, but they also wanted it done in a manner that would preserve her fertility. Their search for a remedy that would achieve both of their goals eventually led to Brigham and Women’s Hospital and, Dr. Antonio Gargiulo, a reproductive surgeon whose team has pioneered an innovative technique for removing large uterine fibroids and preserving fertility — a technique that includes assistance from a surgical robot.
Uterine fibroids can lead to uterine bleeding, incontinence, and pain, but in many cases, women with uterine fibroids don’t exhibit any symptoms. “It wasn’t painful. It just wasn’t alarming at all,” said Sophia, explaining why she initially wasn’t in a rush to get the fibroid removed.
But even without obvious symptoms, fibroids can pose a significant obstacle to fertility by affecting the size and shape of the uterus and probably its chemical environment. This heightened Sophia’s concern after she met David. “I wanted to conceive,” she said. “And it wasn’t working.”
That’s when Sophia and David went to see a fertility specialist, who ordered an MRI and returned with an ominous report. The specialist told Sophia and David that this was the first time he had ever heard a radiologist use the term “giant” to describe a uterine fibroid. He explained that the fibroid was growing and was not only a threat to her fertility, but also to her overall health. It was already impacting surrounding organs and causing frequent urination. “The images were really stark,” said Sophia. “It was the first time I got to see that the tumor was so big.”
Sophia and David were convinced that the fibroid needed to be removed – but who would do it and how?
As a medical device analyst in the financial industry, David had become familiar with the company that makes the da Vinci surgical robot. His research found that it had been broadly applied for treating prostate cancer, and less commonly for uterine fibroid removal. Among the select few physicians who were routinely performing robotic myomectomy (uterine fibroid removal) procedures in New England in 2008 were Dr. Gargiulo, Director of Robotic Surgery at the Center for Infertility and Reproductive Surgery, and his partner, Dr. Serene Srouji, Associate Director of Robotic Surgery.
As a reproductive surgeon, Dr. Gargiulo’s ultimate goals are to preserve and enhance a woman’s fertility. Therefore, to him, open surgery should be a last resort.
“The opening of the abdomen is not ideal for a woman in reproductive age,” said Gargiulo. “There is no doubt that open surgery is the standard of care. But standard of care is only a statistical concept. That doesn’t mean that it’s the best surgical care, and it doesn’t mean that it’s the most advantageous to the patient. The superiority of laparoscopic myomectomy over open myomectomy in women of reproductive age has been clearly established."
“In ten years, most myomectomies will be done robotically,” he proclaimed. “It’s the new face of reproductive surgery.”
A traditional open myomectomy requires one large incision and retraction to accommodate human hands, but only a few tiny incisions in the abdomen are required for the slender robotic arms and tiny surgical tools used in a robot-assisted myomectomy. A 3-D magnification camera affixed to one of the robotic arms gives the surgeon enhanced detail, true depth of field, and a panoramic view, and the robotic hands’ broad range of movement – even greater than a human hand - enables great precision when removing a fibroid and delicately reconstructing the uterus.
Although robotic surgery is a relatively new technique, Drs. Gargiulo and Srouji have collectively performed almost 500 major robotic procedures at Brigham and Women’s Hospital and Brigham and Women's Faulkner Hospital since 2007. As of 2011, none of these procedures have resulted in conversion to open surgery or loss of uterine function.
After considering Dr. Gargiulo’s teams experience and success, the benefits of the procedure, and watching videos of Dr. Gargiulo performing robotic myomectomy, Sophia made her choice.
Sophia’s fibroid was indeed giant, so Dr. Gargiulo used a special instrument to divide the fibroid into sections that were small enough to remove through the tiny surgical incisions. Following a five-hour surgery, Dr. Gargiulo informed Sophia that he had successfully removed the fibroid and that her prospects for getting pregnant were now much better.
Sophia was impressed with her recovery, so much so that she had to be reminded that she recently had major surgery. “The recovery was pretty amazing,” said Sophia. “I was on my feet comfortably within five days.” And she was similarly impressed with the scarring, or the lack thereof. “Some of them you can’t even see right now,” she gleefully declared.
Sophia and David were pleased that the fibroid was out, but they quickly shifted their focus to their next goal. Five months after the surgery, Dr. Gargiulo gave them the go-ahead to start trying to have a baby.
It didn’t take long. “The first time we tried, she was pregnant,” said David.
“We were both in shock, but just delighted,” added Sophia. And soon after the shock and the tears subsided, they started calling their loved ones. “We have to let them know that it worked!” she explained.
Less than two years later, it worked again. On September 22, 2011, Anna’s baby sister, Alexandra, arrived. Shortly after the delivery, Dr. Gargiulo came by to visit and offered his professional assessment: “She’s precious.”
It is this sort of personal touch that helped Sophia commit to Dr. Gargiulo’s care and a new technology. “He’s obviously skilled,” said Sophia. “But on a personal level, I think that he’s everything you would want in a doctor.”
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