Spokane surgeon has begun performing cancer-related hysterectomies here using a minimally invasive laparoscopic procedure that has been used in non-cancer-related hysterectomies and a host of other surgeries for years.


The surgeon, Dr. Melanie Bergman, a gynecologic oncologist with Cancer Care Northwest PS, of Spokane, says she underwent extensive training to perform the surgery, performed her first gynecological laparoscopic procedure on a uterine cancer patient in April, and has done four others since then. She believes shes the first surgeon here to use laparoscopy in a cancer-related hysterectomy.


Laparoscopy involves making a number of small incisions in the skin and guiding a tiny camera, called a laparoscope, and long, slender surgical tools into the body to do the surgery. The surgeon manipulates the tools while watching a video monitor that displays images from inside the body that are captured by the tiny camera. Such minimally invasive surgeries are used as an alternative to procedures in which a larger incision is made so that a surgeon can work inside the body directly.


Gynecologic laparoscopy has been available for non-cancer (benign) patients for decades, but the procedure only has become a practical option for treating some cancer patients in recent years, Bergman says.


Tissues to be removed from benign patients are typically cut into smaller pieces for easy removal through the small incisions made for laparoscopic procedures. The difference between laparoscopy for cancer and for other laparoscopic gynecological procedures is that cancerous tissues must be removed from the body intact.


You dont want to break up the tissue and spread the cancer cells, Bergman says.


Its also important to examine the intact tissues following the surgery to determine the extent and severity of the cancer, an evaluation called staging, she says.


For those reasons, tissue removed from cancer patients are taken out through the vaginal opening rather than through the small incisionsa method that became possible with advances in laparoscopic tools and cutting implements.


It used to be fraught with complications, she says.


With the advent of new tools, studies have shown that laparoscopic gynecologic cancer surgery has the same success rate as conventional open abdominal surgery.


The bottom line is removing cancer and gathering staging information, she says. If it were a lesser cancer surgery, we wouldnt be offering it.


With gynecological cancer laparoscopy, the procedure requires five small incisions ranging in length from 5 millimeters to 12 millimeters. The specialized tools guided through those incisions then are used to detach the patients uterus, fallopian tubes, ovaries, and lymph nodes.


Bergman says the main benefit of a laparoscopic hysterectomy is that patients feel better faster.


We have good information that the benefits of laparoscopy include a quicker recovery time, she says.


Although a laparoscopic hysterectomy is less invasive than conventional surgery, the operation isnt minor surgery in either case.


Its still the same operation removing the same parts, she says.


If cancer of the uterus is caught in the early stagesbefore it spreads beyond the inner walls of the uterusthe cure rate is about 90 percent with surgery alone, Bergman says. The cure rate drops by 20 percent if a hysterectomy is not performed.


If the cancer has spread beyond the uterus, surgery should be followed by chemotherapy, she says.


Bergman received training on the laparoscopic procedure in San Diego and San Jose, Calif., then surgeons from Seattle and Texas came to Spokane to give her further instruction.


Its an evolving trend that will continue as more and more surgeons are trained, she says of the laparoscopic procedure. Its becoming more accepted as an approach to surgery.


Bergman says she will train Dr. Elizabeth Grosen, a colleague at Cancer Care Northwest, to conduct the procedure.


The laparoscopic operation isnt appropriate for all patients with cancer of the uterus, especially the elderly and those who have lung problems or are obese, she says.


The procedure typically takes longer than four hours to perform, including some prep time, while an open abdominal hysterectomy typically takes around 90 minutes. The length of time it takes to do the procedure isnt a determining factor when deciding which method to employ, Bergman says. If, however, a long period under anesthesia isnt appropriate for a patient, she recommends open abdominal surgery for that patient.


A laparoscopic hysterectomy requires a one- or two-night hospital stay, which is roughly half the typical stay following an open abdominal hysterectomy. Although patients who undergo laparoscopic hysterectomies tend to feel better faster than those who undergo an open abdominal hysterectomy, Bergman says she recommends a four- to six-week recovery period before the patient returns to work, following either type of surgery.


Bergman has been practicing in Spokane for about five years. She completed her residency at the Medical College of Virginia, in Richmond, Va., and completed a three-year fellowship at Yale University, in New Haven, Conn., in 2002.


She says it didnt take much time to persuade her to practice in Spokane.


The Spokane community brought me here, she says.


Contact Mike McLean at (509) 344-1266 or via e-mail at mikem@spokanejournal.com.