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Pertinent Issues
After you read the following section, if you would like to compare Female Alternative Surgery to the more traditional myomectomy procedure, please visit the FAS vs. Myomectomy page.
Before Surgery
Our surgical approach starts with a pre-operative evaluation. Each patient spends a few hours learning about her disease process.
During the consultation a significant amount of time is spent reviewing the patient's history and previous medical records. This allows the Institute to learn more about the individual and the reasons behind her personal choice in wanting to keep her reproductive organs. The female anatomy is reviewed extensively, and we do our best to educate the patient about her reproductive system
The patient then spends time viewing an actual surgical procedure on video, which enhances her understanding of anatomy and the surgical procedure itself.
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During Surgery
The program allows the patient to have a family member, partner or close friend stay with her in the hospital for no additional charge. We feel the emotional support is helpful during the immediate post-operative period.
Anesthesia, in most cases, is given via an epidural (modified spinal anesthesia). This allows the patient to recover much faster and also enables the patient, at her discression, to view her surgery via video monitor while it’s being performed.
The patient’s family can also view the procedure via the closed circuit video transmitted into the patient’s room. This allows the family to learn about and understand exactly what their loved one is experiencing.
The surgical procedure is multi-dimensional as it addresses all the potential problems associated with fibroid disease. Many times abdominal hernias form as a result of very large tumors. Uterine prolapse can also develop as a result of the stretching of the uterine ligaments. Ovarian cysts are also a common finding. In traditional surgery, many of these issues are overlooked and therefore never addressed.
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Cosmetic Concerns
Most FAS procedures are done through a bikini incision for cosmetic purposes. As previously mentioned, abdominal wall hernias and abdominal wall prolapse may occur with very large tumors. These are all repaired and an attempt is made to strengthen the abdomen through this low incision.
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Lasers
The use of lasers in Female Alternative Surgery is common. A yag laser is used to make the initial incision in the uterus as well as to remove the tumors in the endometrial cavity. An argon beam laser is used to treat the uterine muscle prior to beginning uterine reconstruction. When Endometriosis is found in the pelvis, on the ovaries, fallopian tubes, intestine or on the uterus, the argon beam is used to ablate and treat the disease. The argon laser achieves this with minimal damage to normal tissue.
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Bleeding
This procedure incurs very little or no blood loss. In the many years this procedure has been performed by Dr. del Junco, Jr., there has never been the need to transfuse a patient. The mainstay of the procedure are the various techniques used to control blood loss.
As mentioned, we have developed a technique that allows the uterus to be drained of blood prior to the application of the tourniquet. In prior years when we applied the tourniquet, we frequently had to inject medications to aid in blood loss control. This is now required much less often. Since the tourniquet is only temporary, there is no damage to the uterine muscle. As mentioned above, in traditional myomectomy surgery, blood loss can be significant and transfusions are frequent.
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Formation of Adhesions
It is well documented in textbooks and modern literature that adhesions start to form eight hours after the abdomen is closed. Traditional surgeons take little or no effort to prevent these adhesions from forming. During Female Alternative Surgery, we apply several special techniques to help reduce adhesions from developing: irrigating fluids are applied during and after the reconstruction, a special mesh material is wrapped around the uterus, ovaries and fallopian tubes and finally a thick gelatin material is used to support and separate the organs.
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After Surgery
All surgical procedures are videotaped, allowing the patient to view her surgery on the second post-operative day in the privacy of her own room. This gives the patient the time and opportunity to formulate any questions she may have about the surgery, which can be answered during the post-operative visit in the office the following week.
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Post-operative Therapy
Massage therapy and light abdominal wall ultrasounds are performed daily by the physical therapy department at the hospital. Instructions are given to the patient so that the therapy can be continued at home after discharge.
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Recovery
Hospitalization is three full days. Recovery ranges from 2-3 weeks depending on the type of physical activity required by the patient's job; some patients require up to 5-6 weeks off from work.
Prior to leaving the hospital and doctor's care, a large packet of information is given to each patient. This packet includes:
- A post-operative instruction video that reviews wound care
- Instructions and medication regime
- A complete copy of all medical records, including:
- Operative report
- Pathology report
- All laboratory and x-ray results
- Most importantly, a complete copy of all the hormone studies done
These can be given to your primary care physician.
There is no extra charge to the patient or insurance company for these reports.
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2nd Look Laparoscopy
In certain circumstances, depending on the pathology found, the recommendation of a 2nd look laparoscopy may be made. This procedure is fully covered by insurance and must be performed 12-16 weeks post FAS.
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Recurrence Rates
The purpose of Female Alternative Surgery is to remove as many large and small fibroid tumors as we can detect. In one instance, we removed up to 169 tumors from a woman's uterus and successfully reconstructed the organ. This patient today is symptom free and has normal, regular periods. In our experience, we have found that recurrence rates range from 1-3%, possibly as low as 0.2%. We have seen, and frequently operate on, women who have had one and sometimes two previous traditional myomectomies.
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Fertility
Handling of tissue in a very gentle way is of great concern, especially when fertility is the primary reason for having Female Alternative Surgery. Reconstructive techniques and replacing reproductive organs in the most natural anatomical location is important. Two years ago, our program celebrated the delivery of the first child conceived post-FAS and recently, several of our former patients have conceived.
In closing, we feel that at the end of your experience with us you will be more educated about yourself and the female reproductive system. Most importantly you will have resolved your disease while sparing your organs.
Female Alternative Surgery is here to provide women an alternative to hysterectomy. We are dedicated to education and female organ preservation.
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