Surgical team offers unique treatment for gynecological disease
By Danielle Pereira
(from left) Drs. Andrea Simpson, Deborah Robertson, Sari Kives and Alysha Nensi. (Photo by Yuri Markarov)
Grace Vosilla had never had a surgery in her life. After cancer cells were discovered in the lining of her uterus, she was referred to St. Michael’s Hospital and told she had grade 1 endometrial cancer. She would need a hysterectomy – a surgery to remove her uterus.
“I wasn’t really panicking when they mentioned cancer because all the ladies in my family had some form of cancer, but I’d never had any kind of surgery,” says Vosilla, 52. “I didn’t know what to expect, but it was caught early and there was a good chance they could remove all of the cancer, so that gave me hope.”
She says being overweight made her anticipate the surgery would be challenging and require a long recovery but the team informed her she was a candidate for a minimally invasive option offered at St. Michael’s.
Drs. Sari Kives, Deborah Robertson and Andrea Simpson are the all-female surgical team leading the way across the province with the use of the technique to treat gynecological disease.
The team uses the da Vinci®System surgical robot to provide hysterectomies and myomectomies (surgery to remove uterine fibroids) to women who fall into two specific categories.
The first is women who have a body mass index greater than 40 and have early stage cancer of the endometrium or endometrial hyperplasia – pre-cancer of the lining of the uterus. The other is young women who want to preserve their fertility but have a large fibroid or fibroids that need to be removed.
“Women with a high body mass index are at a higher risk for endometrial cancer and their weight makes other surgical techniques challenging and increases the chance for complications,” says Dr. Robertson, director of the Minimally Invasive Gynecological Surgery Fellowship at St. Michael’s.
These women can also experience longer wait times to receive treatment because the robot technology is not available at their local hospital and they may not be seen at an oncology centre because of the early stage of their disease.
That’s where the team at St. Michael’s is stepping in. The team has seen an increase in the number of referrals received each year and cases come from both rural and urban communities across Ontario.
“With the addition of the robotics, we do not have to move the instruments in and out of the abdomen, we can keep our pressure extremely low and there’s full range of motion,” says Dr. Kives, deputy chief of Gynecology at St. Michael’s.
“The robot doesn’t make the surgery easy at all but it makes it possible. And it allows us to operate through small incisions but under less ideal circumstances.”
The result is less wound infections, less post-operative pain, less blood loss and patients can return home faster.
“Having the option to have a minimally invasive surgery was wonderful because I’m self-employed, so being able to get back on my feet quickly was something I worried about,” says Vosilla, who works as a dog walker.
“The day after the surgery I was up, walking and able to go home. The first couple of weeks I was moving a bit slower and being more careful but soon I was back to being with the animals.”
Dr. Kives was one of the first non-oncologists in Ontario to perform robotic surgery. She trained Dr. Robertson and Dr. Simpson and the team continuously has one to two fellows working with them in the hopes that the technique can become more widely available.
Dr. Alysha Nensi, a clinical fellow in minimally invasive gynecologic surgery, has been training with the team since July 2018. She says it has been rewarding to be able to offer this patient population a minimally invasive treatment option.
“It’s more than just the surgery we’re providing these patients – they’ve come to a centre with a group of providers who are very comfortable managing their care needs, speaking to them with what I hope is less stigma, seeing them quickly and we have a minimally invasive technique we can offer,” she says.
St. Michael’s acquired the da Vinci Robotic Surgical System in 2008 through philanthropic donations and they continue to rely on donor support to run their minimally invasive programs.
“We’ve ended up having this team that’s quite unique,” says Dr. Robertson. “We’re very passionate about providing this treatment option because it’s about the right surgery, for the right person, at the right time.”
About St. Michael’s Hospital
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.
About Unity Health Toronto
Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.