St. Luke’s shares innovation in women’s health care at medical conference

 Jolene Toves | The Guam Daily Post

 Dec 21, 2024 Updated Dec 21, 2024

 Original site:St. Luke’s shares innovation in women’s health care at medical conference | Guam News | postguam.com

CRUZ-JAVIER: Dr. Marie Cruz-Javier gives a presentation during the Pioneering HealthCare, Discover St. Luke’s Edge event on Tuesday, Dec. 17, 2024, at the Dusit Thani Guam Resort in Tumon. Jonah Benavente/The Guam Daily Post

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As women’s health care is in a crisis, local health professionals attended the Pioneering HealthCare, Discover St. Luke’s Edge medical conference Tuesday, which included a presentation on the latest innovations for gynecologic conditions involving noninvasive and minimally invasive procedures.

The presentation was given by Dr. Marie Cruz-Javier, who provided a brief overview of the advantages and limitations in gynecology care and shared St. Luke’s experience with high-intensity focused ultrasound (HIFU) and robotic surgery.

“So, conventionally, such procedure is being approached by an open procedure or laparotomy, but with advances in health care, there are several options which we offer at St. Luke's Medical Center for our patients. So I will be discussing the two specific procedures that we do at St. Luke's Medical Center that is the noninvasive and the minimally invasive procedures for gynecology,” Cruz-Javier said.

She explained that HIFU is a form of treatment that uses sound waves to heat and destroy tissue or cells.

“So, it's a noninvasive thermal ablation technique wherein the beams of the ultrasound waves penetrate deep into the tissues, hence creating a focal temperature in the inner core where you want to target the mass to 65 degrees, thereby inducing thermal coagulation necrosis. So the applications for these procedures are malignant tumors, such as in the pancreas, liver, kidney, bone, prostate and even the breast,” she said.

In gynecology, it’s used to treat malignant tumors like adenomyosis.

“It causes very minimal pain and the infection rate, since there’s no incision, is low. There's less anesthesia requirement, and most patients it's just an outpatient procedure. Hence, this is suitable for patients who are high risk for surgical procedures and those … people (who are) traveling all the way off island just to have this treatment done, because this can be done as outpatient. The recovery time is faster,” she said.

Unlike an MRI, HIFU does not use ionized reduction, which means limited side effects.

"You can go back to work after. It's a day-to-day procedure compared to traditional surgery. Unlike MRI, it has no ionized reduction, and the energy is precisely delivered to the target area. Hence, there's limited side effects or effects on the surrounding tissues, such as the bowels. And with the aid of the ultrasound, it allows real-time visualization of the target organ,” Cruz-Javier said.

However, the HIFU does have limitations.

“Patients are placed on composition when the bladder is full, hence you have to stay still and be sensitive. It is sensitive to movement,” she said.

HIFU procedures can take one to three hours, depending on the size of pathology and number of pathologies.

“You may have some occasional postprocedural side effects, which is pain and vomiting, but these are very minimal. Actually, during the procedures, patients are just given light sedation so that the HIFU specialist can still talk to the patient and determine … the pain score of the patient. … And the only drawback is that there are certain areas which cannot be targeted by HIFU because of the surrounding tissues for safety reasons, and also the bone,” she said.

Cruz-Javier also spoke about robotic gynecologic surgery, a minimally invasive procedure to treat gynecologic conditions that uses an articulated robotic arm controlled by the surgeon.

“I think this is very common. Robotic surgery is still a form of minimally invasive surgery. Actually, it's also a form of laparoscopic surgery, but with the robot assistance,” she explained.

The doctor from St. Luke’s, who is a pioneer in the field, said robotic surgery provides better visibility with a three-dimensional view.

“The movements are finer because you have a micro … instrument, so you (are) able to target deeper tissues, deeper dissection, and especially for those difficult cases like adhesions, and also bigger pathology. So it's best approached by a robotic system. … It's superior compared to laparoscopic surgery,” she said.

However, the cost of the device is a limitation.

“The limitation is the cost. … All the other limitations was just the bulkiness, the lack of tactile strength, feedback and the need (for) additional training for staff at St. Luke's Medical Center,” she said.

Having broken down the procedures, Cruz-Javier stressed that the application of either should be individualized.

“The choice between noninvasive and minimally invasive surgery should be based on the specific case patient reproductive plans and thorough consultation with the specialist that is your gynecologist regarding the best treatment plan,” she said.

She encouraged local doctors to be open to the procedures and offer the services to their patients.

The conference was hosted by the Guam Medical Association.