Amanda Wilde (Host): Ladies, have you ever noticed a small leak when sneezing, laughing or exercising? Do you ever find yourself planning your day around bathroom breaks? Well, you're not alone. VCU Health Community Memorial Hospital is expanding access to minimally invasive gynecologic procedures and providing relief for patients with bladder leakage and other gynecologic conditions. This shift, including robotic technology, is ensuring that women have access to quality care in rural communities.

Joining me to discuss this shift in care is Dr. Kwadwo Baryeh, an OB-GYN at VCU Health Community Memorial Hospital. We'll be discussing a scope of minimally invasive gynecologic procedures, including robotic surgery options, and explaining how these techniques translate into patients getting back to their lives faster with less pain - right here at home.

 This is Healthy with VCU Health. I'm Amanda Wilde. Hello, Dr. Baryeh. Welcome to the podcast.

Dr. Kwadwo Baryeh: Thank you. I'm happy to be here and to discuss these topics.

Host: Yes, especially as fields keep developing so quickly, and especially in terms of minimally invasive surgery. Can you describe what exactly is minimally invasive gynecologic surgery and how it differs from traditional surgery?

Dr. Kwadwo Baryeh: Minimally invasive surgery is trying to decrease the impact of the surgery on a patient's body. So instead of making large incisions that used to be done in the past, incisions about four or five of them that are about one centimeter or less will be made in the abdomen to facilitate these surgeries.

Sometimes, the surgery also can be done through a natural orifice like the vagina, and all of these forms of minimally invasive surgery. The latest to our area specifically is the robotic surgery where we use the robotic arms to facilitate the surgery through those small incisions that I spoke to you about.

Host: And what are some of the most common or complex gynecologic conditions that you are now treating using these minimally invasive techniques?

Dr. Kwadwo Baryeh: So, the common ones are just the simple hysterectomies. The more complex which we use the robotic arms for, if women have had other abdominal surgery and need gynecologic surgery because of scar tissue, the robotic arms help us have an extra arm. And also, the magnification from the robot helps us to be able to see normal structures from the abnormal in order to take the abnormal tissue out.

Host: So, you are able to work around scar tissue, and you mentioned magnification. You're able to be more precise overall. Is that true?

Dr. Kwadwo Baryeh: Yes. With the robot, you know, as humans, we have two arms. With the robot, you can have up to four arms to be used. And those arms are also steadier than the human arm. And the magnification that the lens in the robot gives is phenomenal and allows for seeing normal tissue from scar tissue and that helps in doing the surgery also.

Host: Let's talk about the main benefits of a minimally invasive procedure. You already mentioned there's a smaller incision or maybe no incision, and so recovery is easier. And we just mentioned how precise these minimally invasive procedures can be. What are other benefits of minimally invasive procedures?

Dr. Kwadwo Baryeh: So, the benefits are that because of the smaller size of the incisions and the precision with the surgery, there is less blood loss. And also, the recovery time is not as long as with open incisions, the larger incisions that used to be done in the past. So, you tend to recover from these surgeries much quicker than a surgery that has a large incision.

Host: So, quicker healing and getting back to a higher quality of life.

Dr. Kwadwo Baryeh: Yes. Getting back to work much quicker.

Host: How does a woman know if she is a candidate for a minimally invasive procedure?

Dr. Kwadwo Baryeh: I would say most women are candidates for it. It'll be a good thing to obviously discuss it with your OB-GYN or your primary care doctor to see if you'd be a candidate for that kind of surgery. But for most surgeries, most women are candidates for it.

Host: And how is that decision made if a woman needs this procedure?

Dr. Kwadwo Baryeh: The decision is made between the woman and her OB-GYN surgeon. And at that visit, the various forms of minimally invasive surgery will be discussed; the patient's particular problem will be discussed, and how that can or cannot be attacked with a minimally invasive procedure will be discussed. So, it's during a visit to a doctor after you have been diagnosed with a problem or you have a problem that you seek your doctor for.

Host: VCU Health has invested in robotic surgery at CMH, which is a type of minimally invasive surgery. Can you explain specifically what is robotic surgery and its benefits?

Dr. Kwadwo Baryeh: So, like we discussed, robotic surgery is a surgery that, uses robotic arms to accomplish a very difficult surgery. The robotic arms are controlled by your surgeons. So, it is not independent of your surgeon. And through very small incisions in the abdomen, those incisions are about one centimeter or less; we use the robotic arms to accomplish the surgery. As I discussed before, the other benefit is the magnification from the lens of the robot. And so, all of these are how the robot helps us accomplish the surgeries that we need to do.

Host: Good definition because robotic surgery uses a robot as a tool, but it's not the robot performing the surgery. And that's a distinction people need to hear.

Dr. Kwadwo Baryeh: Yes, exactly.

Host: And let's talk about what kind of procedures are performed with the robot and how does using robotic surgery affect patient outcomes. We've sort of touched on that second part of the question. Let's talk about, first of all, what procedures are performed with the robot.

Dr. Kwadwo Baryeh: I think, at this point, you know, complex hysterectomy, so like a hysterectomy in a patient that has had previous cesarean sections where you are expecting a lot of scar tissue or in a patient who has had previous abdominal surgeries not related to the female organs, that can sometimes cause some scarring in the abdomen where the robot can be very helpful in doing the surgery.

Also, sometimes when we have to remove an ovarian cyst and the ovary in someone who's had surgery before, the robot is very helpful because of the precise nature of it, helping with dissection and being able to visualize the pelvis to accomplish the surgery. So, just the robotic arms and the visualization helps a lot in these surgeries that I've discussed.

Host: What do you see in terms of outcomes? And how do you measure success for the robotic surgery?

Dr. Kwadwo Baryeh: The outcomes that we see are decreased pain that patients have and the quick return to their normal activities. So, people tend to return to their normal activities quicker. There tends to be less blood loss and also decreased pain after surgery.

Host: Dr. Baryeh, is robotic surgery becoming the norm or only used in exceptional cases?

Dr. Kwadwo Baryeh: It is not used in exceptional cases. It is becoming part of the tool and, I would say, an increasing part of the tool to do surgery, just because of the precise nature of it and the ability to have an extra arm, sometimes two extra arms, as opposed to your own two hands and the ability to see much better. So, it's becoming more increasingly part of the tool that we use.

Host: And why is it important that CMH offers these surgery options?

Dr. Kwadwo Baryeh: Yeah. Where we are located, CMH in South Hill, we are about two hours from any major medical center. So, having the robot here allows our patients to have the ability to have this minimally invasive option for them. And it's helpful to have it here because it's a long way to travel for our patients to go for a presurgical visit and then go for the surgery. And here, you can do it close to home. You can have your family with you, and they don't have to travel far to see you. Because of our small size, it is a small group of people that you get to know that will take care of you during your time here with us.

So, I think overall it's a good thing for our community, because it brings this high technology to this rural area. And we're grateful for VCU giving the community this opportunity so that people can have minimally invasive surgery like they do in the big cities also.

Host: So, for women living in rural areas, this is really a game-changer. You don't have to travel hours away from your family for appointments and the surgery itself.

Dr. Kwadwo Baryeh: Yes, yes.

Host: Dr. Baryeh, is there anything else you would like to share?

Dr. Kwadwo Baryeh: I would just like to talk about our hospital and the fact that we are a small hospital. Because of that, we get to know you very well, we get to know what your needs are. And our neighbors are the ones that come to our hospital, so we have a stake in them getting well and getting the best care and getting back quickly to their lives.

Host: Doctor, thank you so much for explaining the technology that is now available locally and how you're meeting the needs of people in the community.

Dr. Kwadwo Baryeh: Thank you. I was glad to be here to discuss this topic.

Host: We've been speaking with Dr. Kwadwo Baryeh, an OB-GYN at VCU Health Community Memorial Hospital about minimally invasive gynecologic procedures offered at CMH. You can schedule an appointment with Dr. Baryeh by calling 434-584-5567. To learn more about Women's Health Services in South Hill, visit vcuhealth.org/cmh. To listen to other podcasts from VCU Health, visit vcuhealth.org/podcasts. This is Healthy with VCU Health.