New advances in minimally invasive gynecologic surgery have made common procedures for women, such as hysterectomy and myomectomy, easier to recover from with smaller incisions, less bleeding and scarring, and a shorter hospital stay.
Dr. Gerardo Bustillo explains how, with the precision of the da Vinci surgical system and a skilled gynecologic surgeon, there are more options than ever before if you need to have one of these procedures.
Selected Podcast
Advances in Minimally Invasive Gynecologic Procedures: Robotic - Assisted Hysterectomy & Myomectomy
Featured Speaker:
Gerardo Bustillo, MD
Gerardo Bustillo, M.D., received his medical degree from Well Medical College at Cornell University in 1982 and completed his residency at Harbor – UCLA Medical Center in 1986. He has been board certified in obstetrics and gynecology since 1988, and is currently Medical Director of Minimally Invasive Surgery at Orange Coast Memorial. With more than 25 years of experience in minimally invasive gynecologic procedures, Dr. Bustillo is one of only a few gynecologists in California trained in single-site robotic surgery.Organization: Orange Coast Memorial Medical Center
Transcription:
Advances in Minimally Invasive Gynecologic Procedures: Robotic - Assisted Hysterectomy & Myomectomy
Deborah Howell (Host): Welcome to the show, we are so pleased to have you here. I am Deborah Howell and this is your weekly dose of wellness. Today’s guest is the wonderful Dr. Gerardo Bustillo, medical director of minimally invasive surgery at Orange coast Memorial Medical Center. With more than 25 years of experience in minimally invasive gynecologic procedures, Dr. Bustillo is one of only a few gynecologists in California trained in single-site robotic surgery. Welcome Dr. Bustillo.
Dr. Gerardo Bustillo (Guest): Good morning, Deborah. How are you?
Deborah: I am great because you now today there are more options than ever before if you need to have a hysterectomy or a myomectomy. Let’s talk about of the options. First of all what is minimally invasive surgery?
Dr. Bustillo: Well, minimally invasive surgery is surgery that is performed through much smaller incisions than in the past. Now actually, we’ve had minimally invasive surgery for quite a long time, but the exciting thing is that now with the advent of robotic surgery, we are able to do so much more in this way.
Deborah: Excellent. It’s always a good piece of news, if you’re a patient to have a much smaller incision. What are some other gynecologic procedures that can be performed in minimally invasive way?
Dr. Bustillo: There is a variety of procedures. Apparently, the most common would be a hysterectomy or removal of the uterus and a myomectomy which is removal of only fibroids and leaving the uterus intact. There are other procedures that we do in our field for example surgery to correct pelvic prolapse, but these kinds of procedures are less common, so the two main ones would be hysterectomy and myomectomy.
Deborah: Okay. And then in terms of the robotics, how does the robotic surgery work?
Dr. Bustillo: Well, as I said before minimally invasive surgery has been around for quite a long time and what we do is we make small incisions and we put a small instruments through these incisions and as a consequence, you know there is less scarring, the patient has much less pain postoperatively and can return to normal life. The exciting thing with robotic surgery is that we use these same small incisions, but we use very-very accurate precise instruments to basically make it possible to do much more complex surgeries and for example to so much more effectively and to do surgeries that in the past would have required a much-much larger incisions, so the patients are really benefit from this new technology.
Deborah: It really is awesome. What are the differences in the traditional hysterectomy and myomectomy surgeries compared to robotic assisted?
Dr. Bustillo: Well, in the traditional hysterectomy and myomectomy, the patient typically would have a bikini-cut type of incision like we do for a cesarean section, but with the robotic procedure again as I mentioned we use a few small incisions and now with the single-site surgery, we can actually use one incision which is just incredible.
Deborah: That is incredible.
Dr. Bustillo: But the majority of these procedures are performed through several small incisions and you know small instruments, very precise instruments are placed through these incisions and with the three-dimensional optics that we have and the ability to zoom in, we can certainly do much-much finer work and really extend the benefit of minimally invasive surgery to women who in the past who would have always had a larger incision and consequently you know would have healed much more slowly.
Deborah: Slowly and your chance of infection if you have four incisions instead of one you know is much larger.
Dr. Bustillo: Exactly, so you know in terms of the surgery itself, the incisions are smaller, there is less scarring as a result, there is less bleeding, and then in the immediate postoperative time, there is less pain, the hospital stay is shorter than in the past and then in terms of recovery, there is a much-much shorter recovery time with a much quicker return to normal life for these patients, so it’s really a win for everyone.
Deborah: It really isn't and sometimes you can even do it without any hospital time.
Dr. Bustillo: Exactly, there are some physicians who will send the patient home you know the day of surgery or certainly usually by the next morning.
Deborah: Wonderful. It’s a great day to be a patient.
Dr. Bustillo: Well, it’s never good to be a patient, but if you have to be a patient is certainly wonderful to have these options.
Deborah: Absolutely, but we can’t really get better than single-site because you have to have at least one incision, so I am sure improvements now are going to have to be with the instruments themselves and the things that they do in robotics.
Dr. Bustillo: Exactly, the single-site is a challenge and you know again there are not that many surgeons trained to do this, but it’s really incredible cosmetically for the patient to have just one scar which you know sometimes is almost not even visible, but again that’s not something that a lot of gynecologists can do, but we do offer that here at MemorialCare.
Deborah: Lovely. How common are hysterectomies?
Dr. Bustillo: Well, hysterectomies are very common and really in the past too many hysterectomies were performed, but you know we definitely feel that surgery for removal of uterus needs to be something that’s indicated, but there is probable about half a million performed in the United States every year and it’s certainly the most commonly performed gynecologic surgery.
Deborah: That I hadn’t realized was that many. We will then, let’s talk a little bit about uterine fibroids as well because it seems to be they are definitely on the rise. Do they always need to be removed?
Dr. Bustillo: No, no. They do not and in fact, fibroids are also extremely common, so fibroids are benign growth of the muscle of the uterus. They are usually very firm, but all tumors do not cancer, but there are benign tumors of the wall and they are very common up to 80% of women will have them sometime in their lifetime, but the majority of those fibroids do not have be removed. They become a problem when they cause abnormal bleeding or pelvic pain or symptoms, what we called bulk symptoms were just by being there. The patient has a sensation of fullness and discomfort, sometimes having trouble with her urinary functions and also they can affect fertility and pregnancy as well.
Deborah: Never a good thing.
Dr. Bustillo: No and again you know the beauty of the minimally invasive robotic techniques with regard to fibroids is that we can now remove fibroids through the small incisions where in the past it was extremely difficult to do that simply because you have to do a lot of sowing, when you remove the fibroid, you know you want to conserve the uterus and you have to do a lot of sowing in multiple layers and very-very few gynecologists could ever master that, so the vast majority of patients in the past would have a bikini cut incision for their myomectomy, will now you know with this wonderful technology we can offer them the benefits of the minimally invasive techniques and again the recovery and everything, this is wonderful.
Deborah: Okay, so I want to do over.
Dr. Bustillo: You want to do over, what you know it is, myomectomy is in the majority of the patients performed in women who of course want to keep their uterus for childbearing and the beauty one of the added benefits is that because the surgery is minimally invasive, the recovery is shorter and they can get on to the business of attempting to get pregnant sooner than in the past.
Deborah: Well, I know you are very gung ho on it, but is robotic surgery always the best option with these procedures?
Dr. Bustillo: No, no. You know I think it’s extremely important to take every case individually and you know certainly ideally, it’s nice to avoid any surgery whatsoever, but it’s very important you know when you sit down with the patient as to understand exactly what her situation is and to go through the options of treatment for you know some people basically just need to be observed and monitored and nothing needs to be done. Other patients will benefit from medicine, but then other patients will best benefit from surgery and when the physician and the patient as a team together come to the conclusion that surgery would be the best option while it’s wonderful to have these minimally invasive techniques as an option because patients do so much better.
Deborah: For sure. So, how does someone pick the right surgeon?
Dr. Bustillo: Well, I think it’s important to do your homework. Certainly, robotic surgery is not easy to do. I mean it really takes some special training and experience, so I would say look for a surgeon who has done quite a few cases and who has a good reputation in the community. You know ask around, do some investigation online even though sometimes that’s a little bit dangerous, you know there are reputable websites where doctors are reviewed by other patients and by you know the medical community in general, so you know there are organizations that doctors belong to that kind of guaranteed that they have the proper training and experience as well.
Deborah: Fabulous. Well you have been such a wonderful guest. I wish we had another 30 minutes to talk to you about all things gynecological, but we wanted to just thank you in the meantime for being on the show.
Dr. Bustillo: Well, thank you so much, Deborah. I really enjoyed it.
Deborah: Great different options for today’s patients in this great age of medicine and that’s Dr. Bustillo. To learn more about Dr. Bustillo or to listen to a podcast of the show, you can visit memorialcare.org. I am Deborah Howell. Join us again next time as we explore another weekly dose of wellness. Have yourself a fantastic day.
Advances in Minimally Invasive Gynecologic Procedures: Robotic - Assisted Hysterectomy & Myomectomy
Deborah Howell (Host): Welcome to the show, we are so pleased to have you here. I am Deborah Howell and this is your weekly dose of wellness. Today’s guest is the wonderful Dr. Gerardo Bustillo, medical director of minimally invasive surgery at Orange coast Memorial Medical Center. With more than 25 years of experience in minimally invasive gynecologic procedures, Dr. Bustillo is one of only a few gynecologists in California trained in single-site robotic surgery. Welcome Dr. Bustillo.
Dr. Gerardo Bustillo (Guest): Good morning, Deborah. How are you?
Deborah: I am great because you now today there are more options than ever before if you need to have a hysterectomy or a myomectomy. Let’s talk about of the options. First of all what is minimally invasive surgery?
Dr. Bustillo: Well, minimally invasive surgery is surgery that is performed through much smaller incisions than in the past. Now actually, we’ve had minimally invasive surgery for quite a long time, but the exciting thing is that now with the advent of robotic surgery, we are able to do so much more in this way.
Deborah: Excellent. It’s always a good piece of news, if you’re a patient to have a much smaller incision. What are some other gynecologic procedures that can be performed in minimally invasive way?
Dr. Bustillo: There is a variety of procedures. Apparently, the most common would be a hysterectomy or removal of the uterus and a myomectomy which is removal of only fibroids and leaving the uterus intact. There are other procedures that we do in our field for example surgery to correct pelvic prolapse, but these kinds of procedures are less common, so the two main ones would be hysterectomy and myomectomy.
Deborah: Okay. And then in terms of the robotics, how does the robotic surgery work?
Dr. Bustillo: Well, as I said before minimally invasive surgery has been around for quite a long time and what we do is we make small incisions and we put a small instruments through these incisions and as a consequence, you know there is less scarring, the patient has much less pain postoperatively and can return to normal life. The exciting thing with robotic surgery is that we use these same small incisions, but we use very-very accurate precise instruments to basically make it possible to do much more complex surgeries and for example to so much more effectively and to do surgeries that in the past would have required a much-much larger incisions, so the patients are really benefit from this new technology.
Deborah: It really is awesome. What are the differences in the traditional hysterectomy and myomectomy surgeries compared to robotic assisted?
Dr. Bustillo: Well, in the traditional hysterectomy and myomectomy, the patient typically would have a bikini-cut type of incision like we do for a cesarean section, but with the robotic procedure again as I mentioned we use a few small incisions and now with the single-site surgery, we can actually use one incision which is just incredible.
Deborah: That is incredible.
Dr. Bustillo: But the majority of these procedures are performed through several small incisions and you know small instruments, very precise instruments are placed through these incisions and with the three-dimensional optics that we have and the ability to zoom in, we can certainly do much-much finer work and really extend the benefit of minimally invasive surgery to women who in the past who would have always had a larger incision and consequently you know would have healed much more slowly.
Deborah: Slowly and your chance of infection if you have four incisions instead of one you know is much larger.
Dr. Bustillo: Exactly, so you know in terms of the surgery itself, the incisions are smaller, there is less scarring as a result, there is less bleeding, and then in the immediate postoperative time, there is less pain, the hospital stay is shorter than in the past and then in terms of recovery, there is a much-much shorter recovery time with a much quicker return to normal life for these patients, so it’s really a win for everyone.
Deborah: It really isn't and sometimes you can even do it without any hospital time.
Dr. Bustillo: Exactly, there are some physicians who will send the patient home you know the day of surgery or certainly usually by the next morning.
Deborah: Wonderful. It’s a great day to be a patient.
Dr. Bustillo: Well, it’s never good to be a patient, but if you have to be a patient is certainly wonderful to have these options.
Deborah: Absolutely, but we can’t really get better than single-site because you have to have at least one incision, so I am sure improvements now are going to have to be with the instruments themselves and the things that they do in robotics.
Dr. Bustillo: Exactly, the single-site is a challenge and you know again there are not that many surgeons trained to do this, but it’s really incredible cosmetically for the patient to have just one scar which you know sometimes is almost not even visible, but again that’s not something that a lot of gynecologists can do, but we do offer that here at MemorialCare.
Deborah: Lovely. How common are hysterectomies?
Dr. Bustillo: Well, hysterectomies are very common and really in the past too many hysterectomies were performed, but you know we definitely feel that surgery for removal of uterus needs to be something that’s indicated, but there is probable about half a million performed in the United States every year and it’s certainly the most commonly performed gynecologic surgery.
Deborah: That I hadn’t realized was that many. We will then, let’s talk a little bit about uterine fibroids as well because it seems to be they are definitely on the rise. Do they always need to be removed?
Dr. Bustillo: No, no. They do not and in fact, fibroids are also extremely common, so fibroids are benign growth of the muscle of the uterus. They are usually very firm, but all tumors do not cancer, but there are benign tumors of the wall and they are very common up to 80% of women will have them sometime in their lifetime, but the majority of those fibroids do not have be removed. They become a problem when they cause abnormal bleeding or pelvic pain or symptoms, what we called bulk symptoms were just by being there. The patient has a sensation of fullness and discomfort, sometimes having trouble with her urinary functions and also they can affect fertility and pregnancy as well.
Deborah: Never a good thing.
Dr. Bustillo: No and again you know the beauty of the minimally invasive robotic techniques with regard to fibroids is that we can now remove fibroids through the small incisions where in the past it was extremely difficult to do that simply because you have to do a lot of sowing, when you remove the fibroid, you know you want to conserve the uterus and you have to do a lot of sowing in multiple layers and very-very few gynecologists could ever master that, so the vast majority of patients in the past would have a bikini cut incision for their myomectomy, will now you know with this wonderful technology we can offer them the benefits of the minimally invasive techniques and again the recovery and everything, this is wonderful.
Deborah: Okay, so I want to do over.
Dr. Bustillo: You want to do over, what you know it is, myomectomy is in the majority of the patients performed in women who of course want to keep their uterus for childbearing and the beauty one of the added benefits is that because the surgery is minimally invasive, the recovery is shorter and they can get on to the business of attempting to get pregnant sooner than in the past.
Deborah: Well, I know you are very gung ho on it, but is robotic surgery always the best option with these procedures?
Dr. Bustillo: No, no. You know I think it’s extremely important to take every case individually and you know certainly ideally, it’s nice to avoid any surgery whatsoever, but it’s very important you know when you sit down with the patient as to understand exactly what her situation is and to go through the options of treatment for you know some people basically just need to be observed and monitored and nothing needs to be done. Other patients will benefit from medicine, but then other patients will best benefit from surgery and when the physician and the patient as a team together come to the conclusion that surgery would be the best option while it’s wonderful to have these minimally invasive techniques as an option because patients do so much better.
Deborah: For sure. So, how does someone pick the right surgeon?
Dr. Bustillo: Well, I think it’s important to do your homework. Certainly, robotic surgery is not easy to do. I mean it really takes some special training and experience, so I would say look for a surgeon who has done quite a few cases and who has a good reputation in the community. You know ask around, do some investigation online even though sometimes that’s a little bit dangerous, you know there are reputable websites where doctors are reviewed by other patients and by you know the medical community in general, so you know there are organizations that doctors belong to that kind of guaranteed that they have the proper training and experience as well.
Deborah: Fabulous. Well you have been such a wonderful guest. I wish we had another 30 minutes to talk to you about all things gynecological, but we wanted to just thank you in the meantime for being on the show.
Dr. Bustillo: Well, thank you so much, Deborah. I really enjoyed it.
Deborah: Great different options for today’s patients in this great age of medicine and that’s Dr. Bustillo. To learn more about Dr. Bustillo or to listen to a podcast of the show, you can visit memorialcare.org. I am Deborah Howell. Join us again next time as we explore another weekly dose of wellness. Have yourself a fantastic day.