The hour-long surgery was performed on December 28 by David Kimble, M.D., chief of urogynecology and pelvic reconstructive surgery at Albany Medical Center. The patient, who was 17 weeks pregnant, was able to go home the next day, and she and the fetus continue to do well.
According to Dr. Kimble, ovarian cysts are not uncommon during pregnancy and if removal is necessary, it can sometimes be done laparoscopically. But it was not an option for this patient. “Because of its size and location, removing this cyst laparoscopically would have been extremely dangerous, as the instrumentation is very limited in its dexterity and we would have had to physically displace the uterus in order to detach the blood supply. This would have placed obvious risk on the fetus.”
He says robotic surgery presented the safest and best option for the patient. “It was important for us not only to protect the mother, but also the fetus. Aside from the obvious benefits of decreased pain and recovery time, performing this procedure robotically resulted in less manipulation and tissue damage on the uterus, and decreased risk to the fetus by not opening the womb, and also not exposing it to large amounts of anesthesia,” said Dr. Kimble. A traditional open procedure would have required several hours of anesthesia as well as stronger pain medications for the mother.”
The patient, Jessica Drake, 26, visited a physician in Texas (where she previously lived) when she began feeling discomfort at the start of her pregnancy. The cyst was detected, but surgeons there refused to operate, citing risk to the fetus. Upon relocating to Queensbury, Drake’s physicians in Glens Falls referred her to Scott Dexter, M.D., of Albany Med’s Maternal Fetal Medicine Group, who determined that the benign cyst had to be removed due to its size and the pain it was causing. If it twisted, emergency surgery might pose risk to the fetus. Dr. Dexter approached Dr. Kimble about removing the cyst robotically.
“We thought, we’ve got the team, the skills and the technology, why not use those to our advantage for the benefit of this patient?” said Dr. Kimble.
During the surgery, Dr. Kimble was able to view 3D images of Drake’s womb from a console, from which he could manipulate the surgical arms of the robot with the same precision as the human wrist to “disconnect” Drake’s ovary and fallopian tube from her uterus and remove those, as well the cyst, which measured 11 centimeters (about the size of a large grapefruit), section by section in the confines of a nephrectomy bag, which is traditionally used for minimally invasive kidney removal. The surgery required five small incisions.
“Having undergone a previous C-section, I know how difficult recovery from a large incision can be,” says Drake. “I was up and moving that same night of my surgery. It was pretty amazing. It’s important that other patients in similar situations know that this is possible.”
Dr. Kimble joined Albany Med in the fall from St. Peter’s Hospital and the Capital Region Institute for Pelvic Medicine. He is one of few surgeons in the country trained in the use of the da Vinci robot to perform minimally invasive surgery to repair pelvic organ prolapse. Dr. Kimble also treats urinary and bowel incontinence as well as other general gynecological and urological issues.
Albany Medical Center, northeastern New York’s only academic health sciences center, is one of the largest private employers in the Capital Region. It incorporates the 651-bed Albany Medical Center Hospital, which offers the widest range of medical and surgical services in the region, and the Albany Medical College, which trains the next generation of doctors, scientists and other healthcare professionals, and which also includes a biomedical research enterprise and the region’s largest physicians practice with 325 doctors. Albany Medical Center works with dozens of community partners to improve the region’s health and quality of life. For more information: www.amc.edu or www.facebook.com/albanymedicalcenter.
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