If you suffer from a painful gynecologic disorder, and medicine, lifestyle changes and other non-invasive treatments cannot ease your symptoms, it may be time to consider surgery.
Suzanne Greenidge, MD, OB/GYN at St. John's Riverside Hospital, discusses minimally invasive gynecologic surgery with robotic technology, and the treatment options for women suffering from a painful gynecologic disorder.
Minimally Invasive Gynecologic Surgery with Robotic Technology
Featured Speaker:
Dr. Greenidge is also the co-author of “Black, Pregnant, and Loving it!”, a book that will walk you through the multiple stages of pregnancy, offer advice on how to best avoid common health issues and dispel rumors, all with authority and personality. With month-by-month overviews, cultural recipes beneficial to pregnant women, checklists for doctor visits, a play-by-play of delivery options and even tips for keeping the romance alive, this book has everything you’ll need for the next nine months and beyond.
Suzanne Greenidge, MD FACOG
Suzanne Greenidge, MD OB/GYN, and Author, trained at Columbia University College of Physicians and Surgeons and has over 26 years of experience as a board-certified obstetrician and gynecologist. Dr. Greenidge is the founder and director of Woman To Woman OB/GYN, a comprehensive medical practice for women based in Yonkers and Riverdale. Under Dr. Greenidge’s skilled management, Woman To Woman employs a staff of 20 women who provide superior quality, personalized OB/GYN care. The practice offers an all-inclusive approach to women’s gynecological and obstetrical care to the community.Dr. Greenidge is also the co-author of “Black, Pregnant, and Loving it!”, a book that will walk you through the multiple stages of pregnancy, offer advice on how to best avoid common health issues and dispel rumors, all with authority and personality. With month-by-month overviews, cultural recipes beneficial to pregnant women, checklists for doctor visits, a play-by-play of delivery options and even tips for keeping the romance alive, this book has everything you’ll need for the next nine months and beyond.
Transcription:
Minimally Invasive Gynecologic Surgery with Robotic Technology
Melanie Cole (Host): When medicine, life style changes, and other noninvasive treatments can’t ease your gynecological symptoms, it might be time to consider surgery and what questions should you ask? My guest today is Dr. Suzanne Greenidge. She’s an obstetrician/gynecologist at St. John’s Riverside Hospital. Dr. Greenidge, let’s start with some of the most common conditions that you see that a woman might suffer from that might require surgical intervention.
Dr. Suzanne Greenidge (Guest): Oh great, thanks for having me. The conditions that I see that might require surgery have to do with patients who have chronic pelvic pain, patients who may have an ectopic pregnancy, they may also have fibroids, they may have ovarian cysts, and sometimes they may have some bleeding problems going on in the abdomen.
Melanie: So, are there symptoms of some of these things, like fibroids, or any of these others that you’ve mentioned that would send someone to see a gynecologist in the first place?
Dr. Greenidge: Yes, we have patients who have bleeding issues, they’re not sure what’s going on and they may come in because they’re having some bleeding problems. Pain brings in patients a lot of times. Pressure, doesn’t always have to be pain, sometimes pressure, sometimes frequency going to the bathroom brings in patients to investigate why they’re going to the bathroom all the time, and which condition fibroids are noted because it’s pressing on the bladder. So these are some of the reasons why patients would come in to see a gynecologist to find out what’s going on.
Melanie: What about diagnosis because that seems to be the starting place, so what do you do to diagnose some of these conditions?
Dr. Greenidge: Well first thing we do is take a great history and physical. We examine the patient, and then really the gold standard after that to find out what’s going on inside is we will do an abdominal or transvaginal ultrasound and see if we can identify what the problem is such as a cyst or fibroids, or sometimes there are also tubal problems that are going on that we may see. If a patient may be pregnant, there may be an ectopic pregnancy. So besides a history and physical, we would again do the ultrasound, and sometimes we require MRI, which can also give us further information in terms of what’s going on inside when a patient has fibroids.
Melanie: So what types of surgeries are available for your patients, which of these can be done minimally invasively and how has robotics and the technology change the landscape of what you do for a living?
Dr. Greenidge: Well pretty much the standard for most surgeries is laparoscopy, which is also minimally invasive surgery, surgery in which we use small incisions to go in with a scope and look inside and see what’s going on, and once we’re inside, we’re able to operate through other incisions and remove sometimes what the problem is. For example in ovarian cysts, we may go in, look in, see the cyst, which is what I just did today actually, and drain out whatever fluid may be in the cyst and then take out the cyst wall and leave the ovary so that the ovary is still there with the patient. So we remove the pathology, which is causing – which is the cyst, which is causing the patient’s symptoms of pain possibly in this particular patient’s case.
Melanie: So tell us about robotics, what’s that like for the patient? And what does it change for you as a physician as well?
Dr. Greenidge: So one way we do minimally invasive surgery has to do with conventional laparoscopic hysterectomy. Another way that we can do which is the lapro – the conventional way has to do with a 2D approach where we’re just – where we’re actually taking our hands and we’re actually going inside a patient’s abdomen and doing the work. There’s also another way, which is, as you mentioned, robotic gynecological surgery, where we are working through a robot, DaVinci is the robot that we have at St. John’s, and we’re able to do hysterectomies with this robot. We’re able to dissect more in detail. For example, dermoid cysts, we’re able to peel out everything that’s going on because we’re able to see better with the robot. The robot has advantages in that it is a 3D approach, so it’s able to visualize enhanced visualization of all the planes. It can visualize blood vessels better, nerves, we’re able to see right up and close. Not to mention, your surgeon is actually sitting down for this procedure and is away from your belly at the time. We use a robot that has arms on it, and it’s able to be attached through, what we call trocars, we put the holes in, put the trocar in, and then we attach the trocars onto the robot, and then we’re able to control through a console, a master console where we’re comfortably sitting and able to work from a chair and see better and work to remove, for example, in a cyst situation, we’re able to remove the cyst because we have basically hands in your abdomen and we’re able to do whatever surgery we need to do. In the case of a hysterectomy, we’re able to remove everything related to a hysterectomy, ovaries to the uterus, the cervix and pull everything out the vagina. So there is no major incision on your belly, and it’s cosmetic, so patients love the fact that they’re able to have an approach that would not only give them a cosmetic result, but also would get them back to work right away. So, in this day and age, patients want to be – to have their surgery and then be able to get back to work as soon as possible. So the robotic DaVinci robot helps us do that. It doesn’t give pain after we remove the trocars and the incisions, so patients feel like we really didn’t do too much to them using the robotic approach. So this is really great for patients.
Melanie: Dr. Greenidge, are there some times when surgery is not necessarily indicated, whether its uterine, fibroids, or ovarian cysts, are there some times when surgery is not necessarily needed?
Dr. Greenidge: No fibroids can be – there are several approaches that we can do with fibroids. We also with St. John’s offer interventional radiology services, which they can embolize, or uterine artery embolization. They can block the blood supply to the fibroids and shrink the fibroids. So we don’t always use a surgical approach. We basically discuss it with patients. It depends on the size of the uterus and the fibroids. If the fibroids look really big, then a surgical approach probably is better, but if the fibroids are not so bad, we offer patients uterine artery embolization as an option. We also used medical treatment to solve some of these issues such as bleeding that patients may have from fibroids. We may give them progesterone or other agents to calm the bleeding down or birth control pills. We even use Mirena IUD to control bleeding in patients with fibroids as well, so we discuss these situations with the patients. We go over the anatomy, we go over the imaging, and then we sit down and give the options for the patient, and allow the patient do sometimes try noninvasive – nonsurgical rather approaches first and see if those approaches will work, and sometimes just a birth control pill can help a patient and they don’t have to go to surgery.
Melanie: Dr. Greenidge, as women need to be their own best health advocate, and certainly when it comes to their own bodies, tell the listeners as a wrap up what you would like them to know about the questions that they should ask should surgery be mentioned in any of these conditions, what you would like women to know about being their best health advocate and what you want them to know about gynecological surgeries.
Dr. Greenidge: Well I would say to the patient, listen to your body. If something doesn’t feel right, get to your gynecologist and get an evaluation, and if you’re not happy with that evaluation, there’s always second opinions. That you can go to another gynecologist and get an opinion, but the patient needs to be their best advocate because if they know something’s not working, they should go back maybe to their gynecologist and say you know what, this pill that you put me on is not working, I’m still bleeding, I’m still having problems. So one visit just doesn’t – doesn’t cut it. We need to know as physicians whether something worked or it didn’t work. So you must have communication. You must also come with questions. Come with lots of questions for your gynecologist, have them written down, think of them ahead of time; doctor is this normal? Is this the way I’m supposed to do this? Is this the right way? Am I supposed to bleed for 2 weeks or should I only be bleeding for 3 or 5? These are the questions that will be helpful in your visits so that the doctor can help you the best, and let them offer all the suggestions that they have. Not only surgery is an options. Medical could be the option. Ask them can I do medical treatment? Can I do noninvasive treatment? Ask them for other options so that they can give you all your options, and then I would say do your homework. We have Google and you can read about some of the conditions that your doctor is telling you that you have. Be knowledgeable and go – then go back and say well I’ve read this and I understand this, and this is what I think I want to do and then have a 2 way dialogue with your doctor when you’re informed, and that way your doctor can help you the best. Surgery is a great option, but it’s not only – the only option, and certainly minimally invasive surgery is one of the best options for most conditions, so make sure your doctor offers you and ask them if that’s an option for you to have a minimally invasive surgery so that you can get back to work and also be comfortable and happy after your surgery.
Melanie: Thank you so much Dr. Greenidge for coming on with us today and sharing your expertise and helping women to understand minimally invasive gynecological surgery and even robotic surgery, so that they can really help themselves and understand what it is that they’re going through. Thank you again for being with us. You’re listening to Riverside Radio Health Cast. For more information please visit riversidehealth.org, that’s riversidehealth.org. This is Melanie Cole, thanks so much for listening.
Minimally Invasive Gynecologic Surgery with Robotic Technology
Melanie Cole (Host): When medicine, life style changes, and other noninvasive treatments can’t ease your gynecological symptoms, it might be time to consider surgery and what questions should you ask? My guest today is Dr. Suzanne Greenidge. She’s an obstetrician/gynecologist at St. John’s Riverside Hospital. Dr. Greenidge, let’s start with some of the most common conditions that you see that a woman might suffer from that might require surgical intervention.
Dr. Suzanne Greenidge (Guest): Oh great, thanks for having me. The conditions that I see that might require surgery have to do with patients who have chronic pelvic pain, patients who may have an ectopic pregnancy, they may also have fibroids, they may have ovarian cysts, and sometimes they may have some bleeding problems going on in the abdomen.
Melanie: So, are there symptoms of some of these things, like fibroids, or any of these others that you’ve mentioned that would send someone to see a gynecologist in the first place?
Dr. Greenidge: Yes, we have patients who have bleeding issues, they’re not sure what’s going on and they may come in because they’re having some bleeding problems. Pain brings in patients a lot of times. Pressure, doesn’t always have to be pain, sometimes pressure, sometimes frequency going to the bathroom brings in patients to investigate why they’re going to the bathroom all the time, and which condition fibroids are noted because it’s pressing on the bladder. So these are some of the reasons why patients would come in to see a gynecologist to find out what’s going on.
Melanie: What about diagnosis because that seems to be the starting place, so what do you do to diagnose some of these conditions?
Dr. Greenidge: Well first thing we do is take a great history and physical. We examine the patient, and then really the gold standard after that to find out what’s going on inside is we will do an abdominal or transvaginal ultrasound and see if we can identify what the problem is such as a cyst or fibroids, or sometimes there are also tubal problems that are going on that we may see. If a patient may be pregnant, there may be an ectopic pregnancy. So besides a history and physical, we would again do the ultrasound, and sometimes we require MRI, which can also give us further information in terms of what’s going on inside when a patient has fibroids.
Melanie: So what types of surgeries are available for your patients, which of these can be done minimally invasively and how has robotics and the technology change the landscape of what you do for a living?
Dr. Greenidge: Well pretty much the standard for most surgeries is laparoscopy, which is also minimally invasive surgery, surgery in which we use small incisions to go in with a scope and look inside and see what’s going on, and once we’re inside, we’re able to operate through other incisions and remove sometimes what the problem is. For example in ovarian cysts, we may go in, look in, see the cyst, which is what I just did today actually, and drain out whatever fluid may be in the cyst and then take out the cyst wall and leave the ovary so that the ovary is still there with the patient. So we remove the pathology, which is causing – which is the cyst, which is causing the patient’s symptoms of pain possibly in this particular patient’s case.
Melanie: So tell us about robotics, what’s that like for the patient? And what does it change for you as a physician as well?
Dr. Greenidge: So one way we do minimally invasive surgery has to do with conventional laparoscopic hysterectomy. Another way that we can do which is the lapro – the conventional way has to do with a 2D approach where we’re just – where we’re actually taking our hands and we’re actually going inside a patient’s abdomen and doing the work. There’s also another way, which is, as you mentioned, robotic gynecological surgery, where we are working through a robot, DaVinci is the robot that we have at St. John’s, and we’re able to do hysterectomies with this robot. We’re able to dissect more in detail. For example, dermoid cysts, we’re able to peel out everything that’s going on because we’re able to see better with the robot. The robot has advantages in that it is a 3D approach, so it’s able to visualize enhanced visualization of all the planes. It can visualize blood vessels better, nerves, we’re able to see right up and close. Not to mention, your surgeon is actually sitting down for this procedure and is away from your belly at the time. We use a robot that has arms on it, and it’s able to be attached through, what we call trocars, we put the holes in, put the trocar in, and then we attach the trocars onto the robot, and then we’re able to control through a console, a master console where we’re comfortably sitting and able to work from a chair and see better and work to remove, for example, in a cyst situation, we’re able to remove the cyst because we have basically hands in your abdomen and we’re able to do whatever surgery we need to do. In the case of a hysterectomy, we’re able to remove everything related to a hysterectomy, ovaries to the uterus, the cervix and pull everything out the vagina. So there is no major incision on your belly, and it’s cosmetic, so patients love the fact that they’re able to have an approach that would not only give them a cosmetic result, but also would get them back to work right away. So, in this day and age, patients want to be – to have their surgery and then be able to get back to work as soon as possible. So the robotic DaVinci robot helps us do that. It doesn’t give pain after we remove the trocars and the incisions, so patients feel like we really didn’t do too much to them using the robotic approach. So this is really great for patients.
Melanie: Dr. Greenidge, are there some times when surgery is not necessarily indicated, whether its uterine, fibroids, or ovarian cysts, are there some times when surgery is not necessarily needed?
Dr. Greenidge: No fibroids can be – there are several approaches that we can do with fibroids. We also with St. John’s offer interventional radiology services, which they can embolize, or uterine artery embolization. They can block the blood supply to the fibroids and shrink the fibroids. So we don’t always use a surgical approach. We basically discuss it with patients. It depends on the size of the uterus and the fibroids. If the fibroids look really big, then a surgical approach probably is better, but if the fibroids are not so bad, we offer patients uterine artery embolization as an option. We also used medical treatment to solve some of these issues such as bleeding that patients may have from fibroids. We may give them progesterone or other agents to calm the bleeding down or birth control pills. We even use Mirena IUD to control bleeding in patients with fibroids as well, so we discuss these situations with the patients. We go over the anatomy, we go over the imaging, and then we sit down and give the options for the patient, and allow the patient do sometimes try noninvasive – nonsurgical rather approaches first and see if those approaches will work, and sometimes just a birth control pill can help a patient and they don’t have to go to surgery.
Melanie: Dr. Greenidge, as women need to be their own best health advocate, and certainly when it comes to their own bodies, tell the listeners as a wrap up what you would like them to know about the questions that they should ask should surgery be mentioned in any of these conditions, what you would like women to know about being their best health advocate and what you want them to know about gynecological surgeries.
Dr. Greenidge: Well I would say to the patient, listen to your body. If something doesn’t feel right, get to your gynecologist and get an evaluation, and if you’re not happy with that evaluation, there’s always second opinions. That you can go to another gynecologist and get an opinion, but the patient needs to be their best advocate because if they know something’s not working, they should go back maybe to their gynecologist and say you know what, this pill that you put me on is not working, I’m still bleeding, I’m still having problems. So one visit just doesn’t – doesn’t cut it. We need to know as physicians whether something worked or it didn’t work. So you must have communication. You must also come with questions. Come with lots of questions for your gynecologist, have them written down, think of them ahead of time; doctor is this normal? Is this the way I’m supposed to do this? Is this the right way? Am I supposed to bleed for 2 weeks or should I only be bleeding for 3 or 5? These are the questions that will be helpful in your visits so that the doctor can help you the best, and let them offer all the suggestions that they have. Not only surgery is an options. Medical could be the option. Ask them can I do medical treatment? Can I do noninvasive treatment? Ask them for other options so that they can give you all your options, and then I would say do your homework. We have Google and you can read about some of the conditions that your doctor is telling you that you have. Be knowledgeable and go – then go back and say well I’ve read this and I understand this, and this is what I think I want to do and then have a 2 way dialogue with your doctor when you’re informed, and that way your doctor can help you the best. Surgery is a great option, but it’s not only – the only option, and certainly minimally invasive surgery is one of the best options for most conditions, so make sure your doctor offers you and ask them if that’s an option for you to have a minimally invasive surgery so that you can get back to work and also be comfortable and happy after your surgery.
Melanie: Thank you so much Dr. Greenidge for coming on with us today and sharing your expertise and helping women to understand minimally invasive gynecological surgery and even robotic surgery, so that they can really help themselves and understand what it is that they’re going through. Thank you again for being with us. You’re listening to Riverside Radio Health Cast. For more information please visit riversidehealth.org, that’s riversidehealth.org. This is Melanie Cole, thanks so much for listening.