The idea of undergoing a surgical procedure for the first time can be overwhelming for many, especially for those who are afraid of surgical scars and post-surgery pain, which are very often unavoidable.

According to Dr. Moon Hye-sung, who is the current head of the Robotic Surgery Center at Ewha Womans University Mokdong Hospital, the fear of pain and scars is especially common among women who are required to undergo a laparotomy -- a procedure involving a large incision through one’s abdomen -- for ovarian cysts or leiomyoma (fibroids). 

For fibroids patients with such fears, minimally invasive robotic surgery -- achieved through a small incision in the belly button or abdomen -- can be another treatment option, the surgeon said.
 

Some of the most significant benefits of the surgery include low blood loss, short hospital stay, less post-surgery pain and virtually scar-free results.

One of its drawbacks, on the other hand, is that it’s not covered by the national health insurance and therefore expensive.

“Fibroids can reoccur after a myomectomy, the removal of the lumps, and sometimes it is better to remove one’s uterus if she does not plan to have children,” Moon said.

“But for those who wish to have children in the future and want to avoid surgical scars, their needs must be taken seriously when they are being informed of their treatment options.”

Moon is considered a leading expert in the field of robotic surgery in South Korea, having successfully performed the procedure about 300 times since 2009, including a number of challenging cases.

The surgery is performed with one or more incisions in the abdomen with Moon controlling the robot’s movements, guiding the robotic arms and the endoscope to the site of the lumps that need to be removed.

The system provides enhanced vision using a 3-D, real-time and high-definition image of the patient’s anatomy and offers the surgeon the option of zooming in to magnify areas that he or she needs to see during the procedure.

“It needs very specific skills and techniques, and it can be an exhausting procedure for surgeons,” Moon said. “You are looking at the zoomed-in 3-D images through the screen while performing, not your patient’s real anatomy. It requires a very high level of concentration, superb spatial sense and solid surgical planning.”

Moon recently treated a patient in her 40s whose fibroid in her uterus was about 20 centimeters large by performing a myomectomy through the robotic surgery. It took Moon more than three hours to complete the procedure, as it required her to grind the lump before removing it as it was too large. The patient did not have children and wanted to keep her uterus.

“I told the patient that she had a difficult case, but she insisted that she wanted the single-site robotic surgery,” Moon said.

“I told her that I’d have to perform laparotomy if her tissue turns out to be cancerous during the grinding process. She still said she’d like to give the robotic surgery a try, and thankfully her lump turned out to be benign.”

Moon also recently treated a patient in her 30s who had 46 lumps across her uterus with the robotic surgery. The woman also had never had children before and did not want to remove her uterus, and didn’t want to undergo a laparotomy.

Fibroids are benign tumors found within the uterine walls, often resulting in a change in the size or even shape of the uterus. According to Moon, it is a fairly common condition among Korean women, with about a 25 percent occurrence rate. Once they enlarge, the lumps may cause heavy bleeding during periods and eventually anemia.

It can also cause pressure on other organs, including the kidney, bladder and rectum, causing constipation or frequent urination. Hormonal imbalance and poor circulation are also related to the development of fibroids.

“Women with fibroids are also likely to experience difficulties during pregnancy and delivery, as the lumps usually grow bigger as one’s pregnancy progresses, along with the baby,” Moon said.

Sometimes, fibroids cause no symptoms. Many women find out about their condition when the lumps are already too big and need to be removed, and are overwhelmed with the situation of suddenly having to undergo a surgical procedure.

Currently, the single-site robot surgery is not covered by Korea’s national health insurance, and a myomectomy through the robotic surgery currently costs about 5 million won ($4,366) or more.

Moon said the surgery still isn’t well known among the Korean public, and even those who are aware of it think it’s simply too expensive. “I think the specific technology has a number of very significant benefits for women who need to undergo myomectomy,” she said. “I think the most important thing is to let women know that this surgery exists and they have other options other than laparotomy if they don’t want a surgical scar and are scared of post-surgery pain.”



By Claire Lee (dyc@heraldcorp.com)