Spring 2011
Robot-Assisted Fibroid Fix


Kim Bassett of Newtown admits, “It was so worthwhile to take a few weeks off to ‘fix’ something that had been sapping my emotional energy for 18 months.”

Like many busy working mothers, Kim Bassett of Newtown often put her family, her career and daily demands before her own needs.

In her mid-40s, she started spotting—“breakthrough bleeding”—between menstrual cycles, but didn’t give it much thought. “I attributed it to stress,” says Kim, a Language Arts Educational Assistant at Sandy Hook Elementary School. “I had a lot going on at the time. In addition to my daily schedule and the tension that comes with balancing a job and a family, my mother had recently passed away and I was helping care for my father.”

She then developed painful cramping along with the bleeding, but Kim still wasn’t worried. “I thought maybe I was close to menopause or just getting older. I had many excuses to explain away what was going on.”

Over the next year or so, her cramps worsened. During a particularly agonizing episode one afternoon at work, she mentioned her pain to a colleague. “My friend asked me how long it had been going on. I sheepishly told her it was close to a year and a half. She answered, ‘Are you kidding me? You need to go to a doctor!’ She was right,” Kim now admits. “That was the wake-up call I needed.”

Spotting Between Cycles and Other Changes in Your Period: When to Call Your Doctor

Many women will occasionally bleed between periods—or notice a change in flow every once in a while. But what is cause for concern? “Whenever a woman notices any new bleeding, or an increase or decrease in flow, she should call her doctor, especially if she is concerned about it,” says Obstetrician and Gynecologist Robert Deal, MD. “For women in their 30s and 40s, uterine fibroids are often the cause, especially if the bleeding is accompanied by new pain.” Ignoring vaginal bleeding could lead to anemia, he adds. Anemia is a decrease in healthy oxygencarrying red blood cells. Occasionally, vaginal bleeding could be a sign of uterine cancer. “It’s important to talk to your doctor and rule out all of the possible causes,” he says.

Kim made an appointment to see Certified Nurse Midwife Katy Despot at Women’s Health Care, LLC, in Trumbull, whom she sees for routine exams. “After Katy examined me, she immediately sent me for an abdominal ultrasound, which was done right in the office,” remembers Kim. Within moments, the technician detected a large mass. “At that point, Katy recommended I talk to Dr. Deal right away.”

Obstetrician and Gynecologist Robert Deal, MD, quickly confirmed that Kim’s baseball-size mass was a large uterine fibroid. “Uterine fibroids are noncancerous tumors that can develop in a woman’s uterus at any time,” says Dr. Deal. “Some fibroids are so small that women don’t even realize they have them. Larger fibroids are not harmful to a woman’s health, but they can cause symptoms such as heavy menstrual bleeding, pelvic pressure or intense pain. For all those months, Kim had been ignoring many of the telltale symptoms of a large fibroid, which the ultrasound confirmed.” (See sidebar: What’s “Heavy” Bleeding?)

Dr. Deal discussed various treatment options with Kim, including:

  • hormone medication
  • uterine fibroid embolization (a procedure to stop the blood supply to the fibroid)
  • myomectomy (surgery to remove fibroids, leaving the uterus intact)
  • hysterectomy (surgery to remove the uterus)

“Before considering surgery, there are many other options available to try to reduce the symptoms a woman is experiencing and/or the size of a fibroid or fibroids,” Dr. Deal says. Kim first tried a hormone medical treatment called a progestin-releasing intrauterine device (IUD) to relieve her pain and discomfort.

What’s “Heavy” Bleeding?

“What defines ‘heavy’ bleeding varies from woman to woman,” says Dr. Deal. “For some women, it’s the number of consecutive days they have their periods. Some patients tell me they have a menstrual period for up to seven days with the first two days heavier than the rest. Others experience such a heavy flow over two or three days that they have to take off from work because they bleed through their clothes. The bottom line is, how is the bleeding affecting the patient? If they are dreading when their period comes, it’s probably time to talk to their doctor about it.”

After a few months, Kim was still in significant pain and the bleeding hadn’t stopped. “Dr. Deal laid out the options for me,” she says. “I knew surgery was the next step, and I was ready for it.” Dr. Deal recommended a hysterectomy with the da Vinci® “S” robot-assisted minimally invasive surgery system. Kim didn’t hesitate. “I could have elected myomectomy,” she says, “but there was a good chance that the fibroids would grow back, and I didn’t want that. Why go through this twice? I had already had two children and my husband and I didn’t plan to have another. I didn’t have a lot of sentimental attachment to my uterus. It did its job, and now it had to go!” Kim chuckles. (See sidebar: Myomectomy or Hysterectomy?)

“Compared to traditional open surgery, robot-assisted minimally invasive surgery is an excellent option,” says Bridgeport Hospital Chief of Gynecologic Oncology Masoud Azodi, MD, who has performed hundreds of robot-assisted minimally invasive gynecologic procedures. “Most women who undergo this procedure have less blood loss during surgery, less scarring and a shorter hospital stay. Many can go home the next morning. The miniature instruments on the robot provide excellent access to the tiny areas of that region of the body,”

During the next several weeks, Kim couldn’t wait until the day she’d be symptom-free. Adding to her excitement was the support she received from friends prior to the procedure. Kim’s co-workers threw her a Surgery Shower. “They gave me everything they could think of to make my overnight fun: magazines, books, snuggly blankets and mints,” she remembers.

“I didn’t have a lot of sentimental attachment to my uterus. It did its job, and now it had to go!” Kim chuckles.

On an early January morning, accompanied by her husband Brian, Kim arrived at Bridgeport Hospital a couple of hours before surgery. “The nurses who prepared me for the procedure were wonderful,” Kim says. “They took such good care of us.”

In the operating room, Dr. Deal guided the da Vinci robot’s miniature mechanical fingers through several tiny incisions with exceptional precision. These surgical instruments, which are half the thickness of a dime, can be moved as little as a millimeter at a time. “I made the incisions less than one centimeter long, about the length of a grain of rice,” says Dr. Deal. “The sophisticated three-dimensional imaging system and high-powered magnification the da Vinci provides allows me to see the surgical area up close.”

Myomectomy or Hysterectomy?

For Kim, who did not want any more children, a hysterectomy made sense. “If I had been in this situation 15 years earlier, having to choose between a hysterectomy or myomectomy definitely would have been an issue for me,” she says.

What’s the difference? “The primary difference between the two procedures is that with a hysterectomy, the uterus is removed,” says Dr. Deal. “The fibroids are completely gone and will never grow back. It is a permanent solution for treating fibroids and vaginal bleeding.” In a myomectomy surgery, only the fibroids are removed. “Myomectomy is a very good option for women who plan to have more children or who want to keep their uterus for personal reasons. Fibroids are removed and some women experience an improvement in symptoms,” Dr. Deal says. “The downside is that there is a chance that new fibroids will grow and further treatment will be needed in the future. But for younger women with fibroids, myomectomy can be a blessing.”

Just a few hours later, Kim was awake and recovering in the hospital’s Women’s Care Center. “I was so well cared for after surgery,” says Kim. “Getting out of bed and walking to the bathroom was initially just as challenging as it had been right after I had children. The nurses were attentive to my needs. They were patient and kind and really helped me. They did so much to make me feel better about my progress.”

The next afternoon, Kim was ready to recover at home. Dr. Deal and the nurses provided her with the instructions she needed to heal properly during the next few weeks. Her daughter, son and husband helped out with everything, from doing laundry to making dinners to driving Kim to her follow-up appointments.

The thoughtful help kept on coming. Members of her book club in Stratford cooked and delivered meals. Other friends sent gift cards to local eateries. A girlfriend from Milford came up and spent the day with Kim during her first week of recovery. “She offered to do housework, but I really wanted to just drink coffee, chat and act ‘normal,’” remembers Kim. She received a gift certificate to her favorite spa in town for a manicure and facial from her family, and cards and chocolates by the dozens. “My daughter kept saying, ‘You have the best friends,’ and I do. I really do,” Kim says. While she was home, Kim decided to finally tackle sorting and scrapbooking the hundreds of family photos stored on her computer. “These were photos I hadn’t done anything with for years and years,” she says. “It felt good to have a project I could accomplish in a short period of time!”

She decided early on not to keep the need for her surgery a secret from her co-workers and friends. “Some people feel funny talking about having a hysterectomy—it still has a stigma attached to it,” Kim says. “I don’t see it as something to hide. I found that once I started talking about my surgery, others open up about theirs. It’s amazing how many women have had hysterectomies, and are so happy that they did.”

Now, a few months since the surgery, Kim is feeling well. And best of all, she says, she has no spotting and no pain. “Now I never have to worry about birth control of any sort and will never have a period again—and that’s kind of nice! It was so worthwhile to take a few weeks off to ‘fix’ something that had been sapping my emotional energy for 18 months,” she admits. “I suffered in pain for too long.”

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For information about robot-assisted surgery please visit www2.bridgeporthospital.org/surgery/robotic