Operative Gynecology

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Barbara Nesbitt:  “I’m Barbara Nesbitt, I’m at the AAGL in Orlando, Florida, and it’s the year 2000.  I’m with a good friend that I met last year in Las Vegas, Professor Rudy De Wilde from Germany, and we’re going to talk about hysterectomy options that one would have, questions one should ask, and we’re going to gear this for you women who are facing a possible hysterectomy.  Professor, tell me about yourself and your practice and what you do in Germany.”

Prof. Rudy De Wilde:  “My name as you heard is Rudy De Wilde, I’m working as a Professor in Obstetrics and Gynecology for ten years now in the northern part of Germany.  We’re working in an academic clinic and the specialty I’m working in is operative gynecology so we would like to talk about hysterectomy and alternatives to hysterectomy by hysteroscopy and laparoscopy.”

Barbara Nesbitt:  “Then you will explain what those two mean and the approaches that you would use when you would do the surgery that way.  I had a hysterectomy back about fifteen years ago when it was the up and down large incision, six weeks to recuperate, and the whole thing.  Now there are new things and you want to explain this to our viewers of options that they would have.  Tell me about that laparoscopy and how you would do it.”

Prof. Rudy De Wilde:  “Very often the physician tells the patient that the womb or uterus has to be extirpated - it has to be cut out.  You want it done because of bleeding or a myoma, and up until a few years ago, every time we had to make a large incision in the abdominal wall to take the uterus out.  The last ten years we started with alternative therapy, the first alternative therapy was keeping the women’s uterus in place where it belongs with hysteroscopy. Hysteroscopy is looking into the womb by means of a transvaginal way, that means we look through the vagina, go through the womb, and look into the womb.  Then we can see, for example, a myoma and we can cut it out leaving the uterus in place.  After we have cut out the myoma, the uterus is as new so it can stay in place.”

Barbara Nesbitt:  “So this is in the lining of the uterus, you remove it and then what?  There are other options you were talking about, possibly removal through a vaginal approach, tell me about it.”

Prof. Rudy De Wilde:  “Yes, another vaginal approach could be opening the posterior wall of the vagina and taking the myoma out.  During the last, let’s say, twenty years operating upon a myoma took the laparoscopic way, that means through the abdomen but using small incisions less than 1 cm, and taking the myoma out.  This is the same procedure as through the vagina but it is made to reach a myoma that you can’t reach through the vagina, myomas that are not lying in the inner part of the uterus but lying in the middle or the outer part of the uterus.  So you go in through the abdomen but through minimal incisions you cut out the myoma, you suture the uterus, and then you leave the uterus in place again.”

Barbara Nesbitt:  “Now how long would recuperatory time be for something like this?  How long before, say, I would be able to get up and around and do my daily things?”

Prof. Rudy De Wilde:  “The normal time to be in the hospital or an outpatient basis is 1-3 days, that’s the normal time and afterwards you need approximately 14 days to be new again.”

Barbara Nesbitt:  “It sure beats six weeks which was the old way, you couldn’t drive a car for six weeks, you couldn’t vacuum, I mean, it was major abdominal surgery.  Tell me, Professor, I’m going to the doctor, I have been told that I need a hysterectomy or possibly need a hysterectomy, what questions should I ask?  What should I say when I go in to my physician?”

Prof. Rudy De Wilde:  “There are some important questions.  The first question is - do I have complaints?  It’s a very important question because when you have a myoma and you have no complaints, the next question is - why should it be operated upon?  I think that’s a very important question.  The next question is - where is the myoma lying?  Is it in the inner part of the uterus so the way through the vagina is possible and that is even more minimally invasive or is it lying in the middle or the outer part of the uterus so a laparoscopic operation, a minimal invasive operation is necessary?  The third question I think could be important too is - how many myomas are there?  If you have one, two, or three myomas, it is easy to take them out.  If you have twenty myomas, it will become difficult because there is an end at the technical possibility at this time.  Operating upon twenty myomas is very difficult but there we can come to the next point that when it is really necessary to take the womb out, and that would be in approximately 20% of the cases, we can take the womb out without the scar you had several years ago.  We can take the womb out using this minimal invasive surgery which makes the recovery time very short.”

Barbara Nesbitt:  “Now you told me when we were talking before we did the interview that they use a vacuum procedure which is like a vacuum.  Is that what you’re saying, is that how you would…?”

Prof. Rudy De Wilde:  “It is, when we perform the minimal invasive surgery we go to three small incisions in the abdominal wall and we take the myoma out using a morcellator which is sort of like a mixer.”

Barbara Nesbitt:  “It chews it up and sucks it out actually.”

Prof. Rudy De Wilde:  “Yes, we have a myoma from, let’s say, 7-8 cm then we put in the morcellator and we pull it through in small cigars.  So it comes out in cigars of 10-15 cm so the incision stays as small as that, although you take a womb out that is as big as an apple.”

Barbara Nesbitt:  “So in the old days or even if somebody is not familiar with this procedure, they think there has to be an incision large enough to get whatever it is that’s coming out.”

Prof. Rudy De Wilde:  “Not necessary.”

Barbara Nesbitt:  “While we’re here I’d like to tell you all that Professor De Wilde is also joining the Editorial Advisory Board of Alternatives to Hysterectomy which this is an alternative to hysterectomy and also on the Laparoscopy Section which this is also something that goes in that area.  I welcome you and look forward to working with you in the years ahead.”

Prof. Rudy De Wilde:  “Thank you very much, Barbara.”