MINIMALLY INVASIVE GYNECOLOGICAL SURGERY FOR YOUR WOMEN MARYANN PREWITT, MD, FACOG MASTER ROBOTIC SURGEON “I am most gratified by collaborating with you to empower your patients to improve their quality of life using minimally invasive technology.” 11970 North Central Expressway, Suite 300 | Dallas, TX 75243 P 972.380.1099 | F 972.380.0955 | www.drprewittmd.com Da Vinci Robotic Surgery ROBOTIC ASSISTED LAPAROSCOPIC HYSTERCTOMY This minimally invasive procedure is the latest in health technology for women facing a hysterectomy. The advantages for the referred patient include: rapid return to work, little to no requirement for narcotics, minimal to no blood loss, and short hospital stay. Other surgical procedures using the Da Vinci system include: ovarian cystectomy, oophorectomy, ectopic pregnancy, endometriosis resection, prolapse, and sacrospinous colpopexy. In contrast to traditional open surgery, the Da Vinci system uses only three or four 8 mm incisions. Also, the patient has the ability to return to work in as little as 4 days, as opposed to standard six to ten weeks recovery. The Da Vinci system features a magnified 3-D, high definition vision system and special wristed instruments that bend and rotate far greater than the human wrist. This allows a surgeon to operate with enhanced vision, precision, dexterity and control. All of which result in a superior patient experience, superior outcome and greater personal satisfaction. ACOG HYSTERECTOMY STATS Abdominal - 66% Vaginal - 22% Laparoscopic - 12% URODYNAMICS Urodynamics is a test to assess female urinary incontinence and lower urinary tract dysfunction. It will provide you and your doctor with an accurate diagnosis. This will help your doctor to advise how your problem should be managed. It is an in-office evaluation of the bladder, recommended for women who suffer from incomplete bladder emptying, urinary leakage, frequent urges or intermittent urine streams. Urinary leakage in women is far more common than believed. 24% of women ages 18-44, 23% of women over age 60, and 50% of nursing home residents all report leakage of some extent. Leakage issues often result in costly pads & diapers, the constant search for restrooms, or women avoiding exercise or being out of the home for long periods of time. All of which can cause embarrassment, depression, and frustration sexually. Your patient is offered an evaluation, behavior modification therapies, kegal vaginal weights, pessaries, medication and surgery if necessary. Health Care For Women PROLAPSE VULVAR BIOPSIES Da Vinci Robotic This is a sensitive issue that many patients feel Lesions and skin conditions are biopsied to diagnose the uncomfortable discussing. Prolapse results when the pathology and appropriately treat with proper medication or Surgery pelvic floor becomes weakened by pregnancy, childbirth, proceed with surgical or CO2 ablation. obesity, menopause, prior surgery, coughing and chronic Robotic Assisted heavy lifting. Many women find themselves refraining from VAGINAL REJUVENATION Laparoscopic intercourse, physical activity and are frequently coping with When questioned, approximately 70% of woman desire Hysterectomy urinary and fecal incontinence. We offer evaluation, kegal vulva-vaginal rejuvenation. vaginal weights, pessary and surgery if necessary. MENOPAUSE Myomectomy ABNORMAL PAP SMEARS As a Certified Menopausal Specialist through NAMS the COLPOSCOPY & LEEP referred patient’s symptoms and labs are evaluated. The Urinary Leakage We offer in-office consultation for abnormal pap smears patient is counseled as to whether she is pre-menopausal (ASCCP ALGORITH GUIDELINES) with colposcopy and LEEP or menopausal and a management plan is instituted. She is if indicated. The referred patient is then returned to her educated on the risks and benefits of using, as well as, not Prolapse primary care physician with a treatment plan for frequency using HRT. Many diseases are accelerated in the absence of follow-up pap smears. of estrogen, and it is essential that women are educated Abnormal Pap Smears: thoroughly on the pros and cons of HRT. Colposcopy & Leep ULTRASOUND In-office transvaginal probe ultrasound allows immediate HYSTEROSCOPY & HYSTEROSCOPIC evaluation of the pelvis. The patient enjoys viewing the ENDOMETRIAL ABLATION Ultrasound ultrasound as the pathology is explained. It offers the This is a minimally-invasive surgical technique that is used patient an immediate sense of security that her issues are in the evaluation and treatment of intrauterine pathology Evaluation of being addressed. (polyps, fibroids), ESSURE insertion (tubal blockage with coil- contraception), biopsies and treatment of heavy bleeding Abnormal Bleeding patterns with ablation as an alternative to hysterectomy. Problems Ultrasound with HORMONE REPLACEMENT THERAPY Sexual Dysfunction As a longtime member of the North American Menopause intrauterine polyp Society (NAMS), we employ cutting edge use of individualized FDA approved bioidentical hormone therapy Osteoporosis for our referred patients during their consultation. The Management patient then returns to their Physician who can continue management of their patient’s HRT. Hormone Replacement CO2 LESION ABLATIONS In office with/without IV anesthesia. Certain lesions are UTERINE POLYPS (Endometrial polyp) Therapy (HRT) treated by CO2 laser ablation: nevi, sebaceous cysts, Uterine polyps can be responsible for chronic mucous condyloma, molluscum contagiosum, skin tags, calluses discharge, irregular and sometimes heavy menstrual Menopause and warts. bleeding and can interfere with conception. HEMORRHOIDECTOMY VIA CO2 LASER BREAST MASS PAIN OR DISCHARGE Vulvar Biopsies In office with/without IV anesthesia. Hemorrhoids are All of these symptoms are evaluated with physical exam, easily ablated (vaporized) without need of knife or stitches. lab work appropriate radiological imaging and referral as Hysteroscopy & Patients heal rapidly and enjoy the cosmetic results. needed if surgery is required. Hysteroscopic Endometrial Ablation LABIOPLASTY SEXUAL DYSFUNCTION This in-office CO2 laser procedure is used to trim excess Referred patients are educated, counseled and instituted labial tissue that is congenitally elongated or acquired after therapy to assist them in returning to a successful and Breast Pain, Mass or obstetric trauma or edema. fulfilling sexual relationship. Discharge EVALUATION OF ABNORMAL BLEEDING Referred patients undergo physical and lab evaluation, Labioplasty Do you have EMR? in-office transvaginal ultrasound and endometrial biopsy if indicated. Medical therapy includes oral contraception, Vaginal Rejuvenation intrauterine device, Nuvaring, Nexplanon (single rod Yes, you and your authorized inserted in the upper arm). Ultrasound frequently reveals physician can log in to view ovarian pathology, fibroids, uterine polyp, or a thickened Hemorrhoidectomy via your medical records 24/7 endometrial lining. CO2 Laser over my HIPPA-compliant patient portal. CO2 Lesion Ablations Ask Dr. Prewitt Our very own My Primary Physician referred me to you because I have an ovarian mass. How concerned should I be? very approachable Good news! Less than 1% are cancer. 90% resolve, which walking, talking, means only 9% require surgical intervention. medical My Family Doctor found a lump in my breast during a encyclopedia routine exam. I have no family history of breast cancer. Should I be worried? answers all of your Over 80% of breast lumps are not cancer. But, don’t get lulled into complacency. If you have a lump at any age, get it health questions checked. I am 21 years old. My pap came back with something called ASCUS (atypical cells of undetermined significance). Do I need to see a gynecologist? No, trust your PCP. You simply need an additional pap smear in 1 year. 11970 North Central Expressway Suite 300 Dallas, TX 75243 P 972.380.1099 F 972.380.0955 www.drprewittmd.com MARYANN PREWITT, MD, FACOG Y Board Certified Fellow, American College of Obstetrics & Gynecology Y Master’s Certification in the Da Vinci Surgical System Y Credentialed Menopausal Specialist through the North American Menopause Society (NAMS) Y Certified Bioidentical Hormone Replacement Y Clinical faculty member at St. Louis University Medical School serving as Director of Laparoscopy and Hysteroscopy Surgery Y Internship and residency in Obstetrics and Gynecology at Washington University Medical Center, Barnes Hospital, St. Louis, Missouri.