Dr. Devin Garza was one of the world’s first surgeons to use a single-site robotic approach for benign gynecology. Performing more than 1,200 robotic procedures and given the distinction of da Vinci mentor/epicenter surgeon by Intuitive Surgical Inc., he champions the use of minimally invasive surgery by training surgeons and lecturing nationally and internationally on robotic techniques. In 2016, Dr. Garza, a Board Certified OB/GYN, presented on the national stage as faculty at American Association of Laparoscopic Gynecologists and World Robotic Gynecology Congress. Dr. Garza is a referral specialist in the management of some of the most complex benign gynecology surgery, such as endometriosis resection, myomectomy and Acessa for fibroids, complex hysterectomy, pelvic-floor prolapse and abdominal cervical cerclage. He is among the most experienced minimally invasive robotic surgeons in the U.S.
WHAT IS THE BIGGEST CHALLENGE THAT MINIMALLY INVASIVE GYNECOLOGIC SURGEONS FACE TODAY?
A surgical technique called mechanical morcellation* has disappeared from the surgeon’s toolbox, and the conversation is now focused on alternatives. A morcellator would slice tissue into small pieces for removal through small incisions. Problems arose when the devise dispersed pre-existing unknown cancer cells in the specimen throughout the body. Many physicians have resorted to an open surgery with a large incision and the resulting prolonged recovery time and associated risks. Rather than resorting to open surgery, I teach surgeons how to safely remove tissue using a preferred minimally invasive approach, containing tissue within a pouch, and removing often very large specimens through a cosmetic 1-inch incision. This gives surgeons a tool with which to maintain MIS management of a large uterus for hysterectomy and myomectomy.
* Renaissance Women’s Group does NOT use morcellators for gynecologic surgery.
WHO IS AN IDEAL CANDIDATE FOR MINIMALLY INVASIVE SURGERY?
Women of all ages and conditions benefit from MIS, and you should discuss all viable alternatives with your physician. Complex pathology can be managed safely and effectively with a highly experienced surgeon who is equipped with the most advanced surgical armamentarium, either traditional laparoscopy or the da Vinci robotic platform.
ARE ALL SURGEONS TRAINED IN THE MINIMALLY INVASIVE APPROACH?
Most are, but some surgeons are more experienced than others. Obviously, you get really good at what you do a lot. For example, you would expect that the pilot of your airplane has logged many hours in the air and in-flight simulation and will continue to sharpen his or her skills and the competency to manage potentially complex situations. It’s the same with surgeons. I continue to enjoy sharing strategies and techniques that have served my patients well over many years as a high-volume MIS surgeon. The type of hands-on training that I teach throughout the U.S. and other countries as an epicenter/mentor surgeon prepares less experienced surgeons to perform the latest robotic techniques and safe tissue removal. Often they can apply what they learned the very next day. My hope is that a patient who was given no choice but an open surgery will now have the opportunity to have small incisions and a greatly reduced recovery time. I am convinced that as we further the knowledge of MIS, our patients benefit.
I AM CONSIDERING SURGERY. ARE THERE QUESTIONS THAT I SHOULD ASK MY PHYSICIAN?
You will, of course, have discussed all of the options to surgery, as surgery should be the last option after failed medical management.
1. “Will this be a minimally invasive surgery?” At Renaissance Women’s Group, our MIS rate approaches 99 percent.
2. If they are not comfortable offering an MIS approach, ask: “Is there a surgeon you trust in the local medical community that can perform this particular surgery using MIS either laparoscopic or robotic?” Collaboration among surgeons is key to maintaining a high MIS rate for our patients.
3. If you are not comfortable or have unanswered questions, always ask about obtaining a second opinion.
WHAT’S ON THE HORIZON IN MIS?
There continues to be a buzz around the new da Vinci Xi robotic platform, and I was very fortunate to be among the first to use it, as well among the first to perform single-site robotic surgery on the Xi. The new platform will continue to improve surgical outcomes in gynecologic surgeries, as well as other specialties with its improved vision, increased range of motion and access to complex pathology.
Also, a new treatment for fibroids called Acessa /RFA (Radio Frequency Ablation) is showing promise as an MIS approach with an even shorter recovery as an option to hysterectomy and to possibly help maintain fertility. I have enjoyed seeing how well my patients respond clinically after this treatment. I am certain this approach will help manage patients with fibroids as the technology continues to advance.