In this episode, Dr. Byron Hapner gives us a hysterectomy 101 and goes into when hysterectomies are the answer, when they aren't, and the best method for uterus removal, including a deep dive into VNOTES, new advanced gynecologic technology.
Minimally invasive, less pain, and faster recovery? That sounds like the only way I’d like to have a procedure done!
Hysterectomies have been a common procedure for years, but there are a lot of misconceptions surrounding this serious procedure. They’re not for everyone, but with informed-consent and based on your personal goals, a hysterectomy is the best option.
We’re bringing you a mini hysterectomy 101 with OB/GYN Dr. Bryon Harper.
Think a hysterectomy will solve your painful periods? You might want to think again! And if you think are a perfect candidate for a hysterectomy, we have some exciting news for you: new minimally invasive technology.
Today we have the bearer of good news and all-around hysterectomy information, Dr. Byron Hapner.
Dr. Bryon Hapner is an expert in new and advanced surgical techniques and is certified as a Da Vinci robot surgeon, and is an ACOG certified, minimally invasive gynecologic surgeon. We dive into this hysterectomy 101 and cover the different types of hysterectomy procedures, and what does and doesn’t make you a good candidate for the procedure, and how you can ensure that your hysterectomy journey is going to be a good one! Dr. Hapner also gives us an inside look at groundbreaking advanced technology called VNOTES from Applied Medical. Could this be the future of minimally invasive vaginal and abdominal gynecologic procedures? We have our fingers crossed!
Lastly, we end on a fast, stylin’ high note... Hot rods require hot fits! Or at least safe ones.
Thanks for listening, learning, and being you. And join us back here every Tuesday for all things uterus, in service to you, uterinekind.
Repeat after me. The uterus is not a disposable organ, but when it needs to go. You want the best surgeon using the best technology? I'm Carol Johnson, and this is Hello Uterus.
Today we're joined by Dr. Byron Hapner. A high volume gynecologic surgeon specializing in minimally invasive techniques in modern technologies. If one needed a hysterectomy, Dr. Hapner is the one to trust for this common, delicate, and potentially problematic procedure for cancerous conditions. All signs are a yes for hysterectomy, but many people seek out hysterectomies for common symptoms like heavy bleeding and painful periods.
In some cases, the symptoms are not impacted by a hysterectomy. For instance, in the case of endometriosis, In the case of adenomyosis, a benign condition, it may be the only option that would provide meaningful relief. We'll get into when hysterectomies are the answer, when they aren't, and the best method for uterus removal, including a deep dive into V notes, a new technology.
The acronym stands for vaginal natural orifice, transluminal endoscopic surgery, and that alone makes me want to know. But first uterus in the news,
little East Palestines are everywhere, every day. I prioritize researching endocrine disrupting chemicals and connecting the dots on their impact. And what I found last week is crucial for you to know. And just one example of how we are at the mercy of chemical manufacturers and PS they have none. Mercy.
That is Cora makes products for menstruation pads, tampons cups, underwear. I thought I'd quickly examine why they're now calling their organic tampon. A tampon with an organic. The answer is infuriating, and the tip off was acute marketing term security veil. Wonder how many hours they burned? Coming up with that one.
The security veil is a covering over the tampon that prevents cotton fibers from remaining in the vagina after removal, which can lead to infection. The veil is composed of products that are produced with petroleum. These are known endocrine, disrupt. And now we land back where we started the vaginal membrane exposed to endocrine disrupting chemical.
For those with heavy periods, this ex exposure can be every day, all day for 10 to 14 days or more. This practice must stop, and our awareness of the number of endocrine disrupting chemicals we are exposed to daily needs to rise so that we can protect our health. 2023 is the year of the endocrine disrupting chemical in my calendar.
I hope it is in yours too after a quick. We'll be back with Dr. Byron Hapner of Axia Women's Health.
Follow the Uterine Kind team and me over on Instagram and TikTok at Uterine Kind.
Dr. Byron Hapner is board certified in Obstetrics and Gynecology. He graduated from Vassar College, earned his medical degree at New York College of Osteopathic Medicine, and completed his residency in obstetrics and gynecology at the Long Island College Hospital in Brooklyn. Dr. Hapner is an expert in new and advanced surgical techniques and is certified as a da Vinci robot surgeon, and is an ACOG certified, minimally invasive gynecologic surgeon.
A designation that we. Often on this show. So if you're a longtime listener, then you know how important that is. He is part of Axia Women's Health and Practices in New Jersey. If you live in the area, Dr. Hapner is compassionate and a very talented, highly trained surgeon. Seek him out. Welcome to Hello Uterus, Dr.
Hapner. Thanks for being with us. Thanks, Carol. That was too kind. Thank you, . I made it all up. No, I'm totally kidding. It was that it was 100% accurate, in fact, especially the compassionate part. So I'm really glad to have you on the show Today, we're gonna talk about hysterectomies and kind of break apart the different methods of conducting a hysterectomy, and we're gonna talk about a really exciting new technology that is courtesy of the team at Applied Medical called the notes.
Before we get to that though, let's just start with this idea that I believe people have, which is a misconception that removing the uterus is simple. That you just kind of grab it and take it out. And we know that that's not the case. The the pelvic area is a complicated area. There's a lot crammed in there, and it's, it's a complicated procedure.
So what are some of the complexities of the procedure that we as patients may not consider? Basically the pelvic anatomy involves, uh, a lot of other structures, not just the uterus, the tubes, the ovaries. You also have the bladder nearby, the uterus that supply urine to the bladder now. And so there's a lot of potential for, for complexity.
A lot of women have had. Previous surgeries such as cesarean sections and such, a lot of the reasons for having a hysterectomy may cause the anatomy to be distorted, such as endometriosis, fibroids, et cetera. So that presents unique challenges, uh, in G Y N surgery. So you mentioned, um, things like, uh, tendons and nerves and, and that, that whole pelvic structure, the pelvic floor structure when you're removing the uterus.
What might happen to that area? What might happen to those, um, tendons and nerves. We hoping to never see that. I mean, the chance of a major complication in the surgery is probably about 1%, but, uh, I, I don't know. Should we start off with the bad points first? Yeah, let's get em. Well, that's the good way to look at it.
No, it, it really, we, we have to take great care to avoid injuring blood vessels in that area. There are major blood vessels, and again, the bowel, the bladder, et cetera, are in that area. So when someone has any type of pelvic surgery, they, you know, the surgeon has to be comfortable with working in that area to avoid injury to the, to the, to the patient.
We wanna make people better, of course, who wanna improve their lives, not, not cause problem. . Absolutely. So let, let's talk a little bit about the different types of hysterectomies and, and maybe we could start with, I'm gonna use the word beneficial, least beneficial to most beneficial mm-hmm. in terms of benefits to the patient and the physician.
Um, as far as, you know, accessibility and sight lines and all of that stuff. So what would you consider to be the, the least beneficial type of a hyster? I don't know if I would call beneficial. Um, we're trying to do things in a minimally invasive way and sometimes what some people will refer to as least beneficial might be the most beneficial for them.
Uh, and that I think we're referring to, uh, an in a large incision called a. Total abdominal hysterectomy where we make an incision to do the procedure. A fairly large incision such as someone would have a C-section or sometimes even larger going up and down the entire abdomen. Uh, I don't know if I would say that's benefi not beneficial.
Maybe for certain patients, maybe for certain physicians performing the procedure. , that's their most beneficial. So what would be the reason why an open hysterectomy would be needed? Some types of cancer that would be in the hands of a subspecialist, a gynecologic oncologist, certain types of cancer should be, uh, performed with an open procedure.
Um, it depends also, I, if. On the expertise of the gynecologist. But for some, especially when I first trained, that was the way a hysterectomy was done. Everyone had an incision that was just the way to do it. So if someone is trained in that manner with, especially with complex anatomy, previous surgeries, they may choose to, uh, recommend what would be called a total abdominal hysterectomy.
Um, in my, in my view, uh, I don't do that very often. I try to find ways around that. The reasons for n. Doing an abdominal hysterectomy would be an increased pain, increase in pain, increase in infection, increase in complications, bleeding. It's a longer recovery, and what I try to do is find ways where we can avoid that.
Mm-hmm. . Yeah. Okay. And then, so in the case of let's say a an abdominal laparoscopic hysterectomy, in that case, who is a great candidate for that type of, I would say almost anyone who, who requires a hysterectomy, um, most of the hysterectomies can be performed laparoscopically where there are several small incisions.
Sometimes one actually sometimes can be done through one incision, but usually there are a few small incisions rather than one large incision. And that would be a laparoscopic hysterectomy. And so in that case, you're probably. Not, well, you're certainly not looking at cancer then. Is that accurate?
Certain cancer surgeries, the majority are still performed laparoscopically by a GN oncologist. There just might be occasions where they would, uh, recommend the traditional abdominal procedure with a larger incision. Got it. Okay. So a vaginal hysterectomy, how is that performed and how is that, like who is the best candidate for that kind of a hyster?
So vaginal hysterectomy is sort of a lost art, uh, among many, most of the gynecologists. Um, a lot of, uh, new graduates don't get much training in that. A lot of people don't feel comfortable doing that because when you're, uh, performing a his, uh, a procedure vaginally, it's like the target is at the end of a tunnel, and so you're not getting direct.
View of the entire pelvis, you have to be comfortable going in reverse. Whereas from with an abdominal hysterectomy or laparoscopic hysterectomy, you're working from the top down toward the vagina. This is where you're working from the vagina up and your view is totally different. It requires a different understanding of anatomy and, uh, a different skillset, which most people are not exposed to.
But the advantage of a vaginal hysterectomy is there are no inci. Wow. Okay. So, and then that of course means that your recovery time is faster. Generally, it's not that laparoscopic. Hysterectomy has, uh, for most people, a lot of pain or a slow recovery. Um, actually it is quite fast compared to abdominal, but vaginal hysterectomy with no incision has a potential, uh, to have a faster recovery.
And just the fact that there are no incisions, the potential for less pain. Yeah, and I guess less infection as well. I think the infection rate in both types of AST hysterectomy is fairly low. It's in a single digit. Great. So they both have the potential for infection, but they're quite. Excellent. And, and so if you had the option to pick between, um, laparoscopic abdominal, laparoscopic hysterectomy and a vaginal hysterectomy, and you're looking at a candidate that would be suitable for either, which would you prefer?
Uh, I, I think it really depends. Each, each decision has to be tailor made to the patient. It, it also, honestly, doctor's expertise has something to do with what would be recommended and the level of skill and, and comfort. But, um, I, I, I really think the goal, uh, American College of Obstetricians and Gynecologists, ACOG says that vaginal hysterectomy is the least invasive hysterectomy.
And so a lot of people use that as their. , um, because of that and when a patient is considering a hysterectomy, Dr. Heppner, how can a patient interview a surgeon to determine if they are the right fit for them from an expertise perspective? It's interesting that you ask that. I think that most of the patients whom I see have already vet.
In some way, um, either through a recommendation through a friend, a family doctor, internet. I have a feeling a lot of people just, uh, seek out someone through those means to begin with. So I think that, uh, that I get the feeling that most of the, um, women who I see have already. . Either read something or know something.
Many of them, mm-hmm. . Yeah, def, and especially because I would think that someone with your level of expertise, patients are drawn to that because they're aware of the benefits of minimally invasive gynecologic surgery, and they want to be with someone who's. Trained in minimally invasive gynecologic surgery.
So they end up with you. But what about somebody who's, you know, maybe doesn't have access to a variety of doctors from which to select their surgeon? What are some of the questions that they should ask that surgeon in order to make the best decision for themselves about the type of hysterectomy that they have?
It's funny that you ask that, because I try to preempt that by explaining, you know, the reasons for. Different options, not know necessarily hysterectomy to treat a problem. So I would start with that. But that comes from me. That's driven from me. Right. And if someone is interested in hearing about hysterectomy, you know, depending on the history, the anatomy, the reason, uh, I may recommend one route over another, and I would present the information.
Why at that point? I think that if, if you're not given this information upfront and have to. a lot of questions to me. I don't know if I will call that a red flag or not. It's, it, it, it's funny, it's interesting that you say that because one of the things that stood out about the conversations that you and I have had prior to this interview is that it's almost like, it's not that you're saying this, but the feeling is that like you can't imagine that some, that another doctor would actually.
Not provide that information to their patient and not, you know, go into detail and answer all of their questions. But a lot of times that happens where a doctor's like, this is the way you need to do it. This is how we're gonna do it. Go speak to scheduling, you know. Yeah, I, I, I don't know if that's the best way to do it.
I, I want someone to go into a procedure, even a, a minor procedure, thinking that she is doing this and making the, the right choice. Uh, not, it's not coming from me. I think the choice has to be from within. If you see there are, uh, there's one large. Antis Hysterectomy website, think it's hers. I can't remember.
And the impression I get is if someone isn't looking forward to this procedure, if they feel that it's been forced upon them or haven't been given enough choices, then I would see how upset someone would be over this. And, and there are a lot of people who won't have a hysterectomy. They'd rather have an alternative.
Uh, and I respect that. There's many reasons for that. So I, I just think it's important to, to make someone feel that it's coming from within. That's their, that's their choice, that's their decision, not mine. Then that gets at shared decision making and informed consent, which is, which are two aspects of quality care that we need to be able to embrace as a patient.
We need to be able to go in and it kind of, in a way it, it does put some responsibility on the patient to do learning on the issue that they have, the condition that they have, and on the treatment options that are recommended. You know, which I guess completes that circle, right? That if, if you provide the information to the patient so that the PA patient can do research and have conversations with their loved ones about their decision, then the two of you are arriving at that surgery on the same page together.
And while I'm sure there's no data on this, I think just having the peace of mind. That you've made the right decision, helps in the recovery and helps in the outcome. That's just my personal opinion. I would think going in, going in sketchy and nervous and concerned and not believing in your choice means that there, it might be difficult to recover from that, even if it's just.
Psychological. I agree. Especially the psychological component. I think that a, a lot of, uh, a lot of women report, not a lot, but a, the percentage of dissatisfaction with hysterectomy probably has to do with a decrease in libido, sex drive, decrease, feeling of self-worth, that they weren't given an another option.
They were kind of told to do that, and that's what I hear. I don't, I don't hear that in my patients very often. It's very, I don't recall the last time because of the shared decision. , right? Yeah. Well, you're, you're very committed to it. And it's clear, it's clear in how your patients talk about you. And then also just, again, in our conversations that, um, which is why I say like, if you are in New Jersey, seek out Dr.
Hafner because it's, it's that experience that you're committed to. And I understand why in certain environments it's not possible to have, because, uh, doctor might need to. Far too many patients in order to spend quality time with each and every one of them and, and give them this education that they need.
And there's so many complexities with gynecologic care today that it's a gift to find a surgeon who's structured their practice such that this is a priority. That having these conversations is a priority. So you mentioned this idea of dissatisfaction or maybe like there was, you know, a patient goes in thinking one thing and then something else happens.
Like, I kind of wanna get at this idea that I think some people have that the uterus is wholly disposable, right? Let's say. , I'm super healthy. I don't have any symptoms of abnormal uterine bleeding or fibroids or endo or adenomyosis, but I don't want my period anymore because I'm a yoga instructor and my favorite color is white.
So I go to you and I say, doctor, can we do something about this? It's really annoying. My period is annoying me and that person, that type of person. It makes me nervous because I don't think that they really understand this procedure. So can we talk about the idea that while for some, a hysterectomy is a fantastic option and we're so grateful to have it, but for others, maybe they need to look at the fact that the uterus is not disposable.
This isn't a casual decision. Well, that's correct. There is like, again, there is a, a risk of complication. It's, it's. It, it's very low, but, uh, you are undergoing a major procedure, even though it's minimally invasive and the recovery's quicker than a traditional abdominal hysterectomy, it's still a major procedure for most of the, uh, patients who I see have more complex pathology.
They're referred from other physicians because of that. So the people that I'm generally treating, they, there's a lot wrong. There's, there's. Problems, fibroids, adenomyosis, endometriosis. It isn't more a casual problem for them. It's like this is life altering what we're trying to do. Yeah. And, and that brings up again, another really cool distinction that I think is important for people to understand, which is what you just said, is that you're getting the complicated cases.
And so the person who's saying, Hey, I'm really tired of my period, and you know, from what I understand, the uterus is just for baby making. And since I'm done having a family, can't we just call this a day, like they're not getting referred to you. I, I hear that as a reason for opting for hysterectomy, but a secondary reason.
In other words, I have all these problems. I don't want any more children. This is what I'll do, rather than using birth control pills, using, uh, i u d such as marina, uh, or having an endometrial ablation, perhaps. Um, this is why they will choose that over less, um, more conservative options. Because there's these other complicating factors.
So you brought up adenomyosis, which I think is a condition that we don't talk about enough, and it's one of the, you know, while for instance with endometriosis, a hysterectomy is not a cure, especially if your endo isn't on your uterus. But with adenomyosis, it is the only option. Is that accurate? I, I see adenomyosis surprisingly, so much.
Especially in women in their late thirties, forties who have abnormal bleeding. The problem with adenomyosis, I guess the best way I explain is it's an overgrowth of menstrual glands, uh, to the point where there's bleeding and pain, possibly uterine enlargement. It can be miserable. The amount of bleeding and pain that it causes, it's.
Not always easy to make that diagnosis. It doesn't always show up on imaging such as ultrasound. Sometimes m r I will see it. So it's mostly a suspicion when someone has all these menstrual problems, but no obvious fibroids and endometriosis, et cetera. So I do see it a lot. Um, adenomyosis ultimately for many is, is their best treatment, but there are conservative ways to try to treat.
He can try to treat him medically. I try to treat. Um, a progesterone progestin containing intrauterine device. It's marina. Not everybody wants a hysterectomy, even with a definite diagnosis of adenomyosis, so we can try to treat it with birth control pills, IUDs, et cetera. I probably wouldn't treat it with endometrial ablation.
I think I see that happen. It's bit of a mistake. Endometrial ablation. , it only treats a superficial aspect of the uterus. It doesn't ablate far enough into the uterus to ablate the glands. And that's where I see more problems than not. But you can try to treat adenomyosis conservatively. It's not always easy.
And have you found in your experience with adenomyosis that you can, you can, you know, through a, a physical exam, you can feel whether or not that might be what's going. Sometimes there's uterine enlargement. Oh, well, first the history. You always listen to the, to what, um, my patient is saying is she's reporting heavy bleeding.
If she's reporting a lot of pain with her periods and, uh, and nothing is adding up except it, it just basically a lot of times leaves adenomyosis. Sometimes the uterus is significantly enlarged without having fibroids. That's a tip off, right. That adenomyosis is, uh, is potentially present. And then with regard to fibroids, is there like a line in the sand where you would opt for a hysterectomy over a myomectomy, which is the removal of fibroids?
Occasionally I, I try to, I, I do. When someone has fibroids, I do counsel them about, uh, myomectomy. It's technically many, most of the time feasible, but it just, for various reasons may or may not be a good option if someone is completed having children. I have no myomectomies for women who didn't want a hysterectomy who said, I, I'm completed.
I don't want anymore children, but they just don't want the idea of the hysterectomy. That's where it goes back to the feeling of self. Worth self value that they would feel less so, uh, yeah. Sometimes we'll do a myomectomy in, in in that instant. I think if there's adenomyosis and, and uterine fibroids, that's difficult to do a myomectomy and get results.
So I do my best to try to rule out if someone's contemplating a myomectomy, do my best to try to rule out adenomyosis. They, they frequently, you see the two to. . Yeah. And, and just to go back to adenomyosis for a second, to get, uh, a little bit more detailed on the description, the, the endometrial tissue is growing inside the muscle wall of the uterus.
Correct. So imagine your calf muscle has this pocket in it that's full of tissue, and, and along with your cycle, it grows swells and sheds, but there's no place for it to go. And you can imagine. How painful that is. Correct. The uterus is a dense muscle. It's, it's only designed to have things in the cavity and then only in certain times
It's not, it's not designed to just have a half a dozen fibroids and then pockets of, of endometrial tissue scattered throughout the muscle walls of the uterus. So these are are conditions that often patients hear about for. Time when they finally get to a doctor that hears their symptoms up until they reach that doctor, they can just be told, ah, it's just, you know, you're unlucky.
It's, you know, heavy periods and your mom probably had them. But when they reach someone like you, it's like this big aha moment because you recognize. Oh my gosh, there's like a half a dozen potential conditions that can impact my experience with periods, and that's a education that, um, you know, I really hope that we can do better helping people understand, understand these different conditions.
You had mentioned adenomyosis is common that you see it com, you know, regularly. Like can you just tell us a little bit more about that? Uh, I think it has to do with being referred or seeing women who have been seeing. GYNs who have been told exactly what you said, oh, try these birth control pills. Oh, we'll try an i u D Oh, we'll try an ablation.
And they may pursue these routes and just not get better. Maybe that's why I, I just seem to see a preponderance of that causing all these problems. Wow. Cuz I, I wonder now, and I wonder after talking to you even more so, um, how wildly underdiagnosed it. I think there is some, there is some controversy what really constitute adenomyosis as well.
Um, even imaging on an m r i there can be, can be missed. Or some people may, ea may be super under read. Pathologists may use different criteria, uh, to determine what is adenomyosis. I, I think if someone's truly suffering as if they hadn't had nom myosis, the ultimate pathology, as long as the person is treated properly and she gets.
The diagnosis, it's important, but the goal is to be better regardless of the diagnosis. Yeah. And also, um, which I love that jersey sensibility. That is, you know, connect the dots and use some common sense. And let's take some action , that's, that's a very New Jersey way of, uh, of handling something. And it's, it's appropriate here because so many people are left in limb.
That's correct. If they're fibroids, if you know there's endometriosis, definite diagnosis, adenomas is the one that seems to defy easy diagnosis, correct. You know when, when patients are going to see those doctors that they get to before they get to you, I wonder, and I'm concerned about the patients who get lost in between that first level of physician and you, the patients that are going to the gynecologist are going to their P C P.
And maybe they're getting bounced around to a GI doctor or to a therapist, and, and finally they just lose steam. Can you just give a pep talk to the patient who has not had success treating and possibly even diagnosing the cause of their bad periods? Oh, I, I definitely, I, I just think that, again, this, maybe you said this was a New Jersey thing.
Uh, your goal is to be better, and if someone's not making you better or not offering you a solution, which is working, keep keep looking. And I'm not saying that'll end up in a hysterectomy. There may be other ways to treat that person, but, you know, keep looking. Definitely. And I'm assuming this is, you know, causing a significant impact on someone's quality of life.
And if that's not getting better, yes, please keep. Yeah. And look for someone who, um, we say this a lot on this show, if you're with an obstetrician who delivered your mom and delivered you and delivered your child, maybe with complicated gynecologic conditions, you might wanna not see the obstetrician for that.
You might wanna see the gynecologist for that. Is that a safe, safe? I have to make sure I'm wear wearing my bulletproof vest. . Um, gynecology evolved. Um, you know, at first, uh, the ob it was obs, obstetrics and Gynecology. When I trained, you know, the, there's only one type of hysterectomy, abdominal you deliver baby, or the vaginal delivery of C-section and that, that was it.
I. pretty much, and dispense birth control for what it's worth, the fields become a lot more complex and many people talk about separating obstetrics from gynecology. I, I fully support that. Many of my colleagues do. Uh, they're, they're different fields and, um, that's perhaps why, um, some of this isn't, some of these issues aren't getting treated once the, your children are delivered and you start developing maybe other issues that that person may not have the time even to, uh, because of the obstetrics to address those.
Right. And then certainly, um, they would also need to be trained. So you've gone through additional training to be certified as a da Vinci surgeon, and then also certified as a minimally invasive gynecologic surgeon, and that, that requires time, I would imagine, right. Correct. You have to devote most much of your practice, if not most of it at some point.
So, um, so let's talk about this new technology v notes. I'm super interested in understanding how this advances your experience and the patient's experience and, and how are you using it in your practice? So, um, V notes stands for, and I have to read it because, Something doesn't roll off your tongue.
Transfer vaginal, natural orifice, transluminal endoscopic surgery. Basically the goal with V Notes is to make vaginal surgery simpler, uh, for the doctor and allow the patient to have a vaginal procedure, which again, there's no incision, a faster recovery. Less pain. What it does is, is you're using, uh, applied medical as the company, uh, develop the device which fits through the vagina, which allows you to put traditional, laparoscopic instruments through it.
So you can essentially perform a laparoscopic procedure through the vagina using laparoscopic instruments, which, you know, uh, heart is much that you don't need a large incision, you can see much better because you can place a camera through the vagina rather than just use your eyes. So the, that long tunnel comes to you now.
Wow. Okay. So it's kind of like, let me paraphrase this. For the non-clinician, it's laparoscopic surgery, but through the. Absolutely. That's exactly what it. So when you talked about doing a vaginal hysterectomy, hysterectomy before, are you not, you do not have a camera in the cervix, correct? There's no camera.
We're just using our eyes. We're sitting vaginally. We're sitting right there and trying to bring the uterus to us. Vaginally, which sometimes is very easy. If someone has uterine prolapse, the uterus is falling out, the uterus is there removing the uterus. Vaginally is actually very, it's technically for a gynecologist, not difficult, but if, if there is no significant prolapse and you have the uterus at the end of the vagina, at the end of this tunnel and you can't see what you do, V Notes allows.
To place an instrument which allows us to put these laparoscopic instruments, including a camera. So again, we're going to the uterus with the camera and, and seeing gray up there. That's amazing. So when you first saw this, was it like an aha moment? Like, wow, you, you all solved a problem? Absolutely. Now the, the people who are older than I am who have been doing vaginal hysterectomies forever, will probably laugh at me and say, I can do anything vaginally, no problem.
Uh, I don't have any problem, but that's, that's in their skillset. and I challenge that they could do everything vaginally. This allows you to expand and do a lot more vaginally. And so the device, I checked it out and it kind of looks like it, it looks almost from what they show, like it's a, how would you call it?
Like a, A cup, like the bottom of a cup, and it's got three holes in it that you would, I assume, insert the laparoscopic devices into them. Is that. Actually this device, it's called uh, uh, gel Point. The gel point allows you to, um, place multiple devices, multiple, uh, instruments, 3, 4, 5, even. It's, it's amazing.
You can poke this. Device and put an instrument in it, take it out and it seals, uh, the whole seals itself. So this is unique to Applied Medical. It's, it's their, it's an instrument that they developed, which just seals, its, you can just place something through and take it out. It just seals. Felt sealed. Oh wow.
So it, so it doesn't have like specific holes in it. You can put it through there at any point in time. In, in any place. And then when you pull it out, it reseals itself. Absolutely. It, it, it's very versatile. Can we just take a small moment to pause Be, this is a public service announcement. To the people at Applied Medical.
I just wanna personally thank you because without people like you, innovation in female health dies. You know, it's, it's really important that people understand that how difficult it is and how much money it costs to develop a technology for gynecologic health. To have it tested then to make sure that it gets adopted in the healthcare system and that it gets utilized.
I mean, it is a, it can. Decade long process and it can cost so much money. And as a result, like they could go somewhere else in some other type of medicine, oncology or what have you, and, and, and have much greater returns. And I hope that this is changing. I hope Applied Medical does swimmingly well with this.
But the reason why I'm pausing is because it's really important that we understand that in order to get innovation, we have to support the companies that are doing the research and making the tech. I agree. Applied medical, not only that, has been very instrumental in training doctors to do this procedure and supporting us when we're doing this procedure.
Um, so, uh, they've been integral for the, to try to make this procedure expand to more doctors and, and make it more successful. And I, and my understanding is they're continuing to improve the device by, uh, introducing some improvements in the near. That was my next question. I know I have, not to spill any like secrets or anything, but where, from, from your own perspective, where do you think this can go?
A technology like this? Uh, I, I think it also can go to other surgeries too. Uh, I've talked to my surgeon colleagues, they're interested in re doing appendectomies through, uh, thenot. There's no reason that you, you really can't do any intra, I shouldn't say any, but many intraabdominal surgeries can be done vaginally with this technology.
Never even crossed my mind, that idea never crossed my mind. I know if you have access, if you can put a camera through the vagina, you basically see the, see the same abdomen and pelvis just from a different perspective. That's fantastic. And reminds me of, um, the, I think it was a Utah congressperson. I don't know if you heard this, but he, he asked a question that like, if you can swallow a camera and see your stomach, then um, couldn't women swallow?
So that doctors could see the inside of their uterus and somebody was like, yeah, just no, Ana anatomy doesn't work that way. Ok, , I dunno. Yeah, maybe, but, but it does work from the other direction. So you can put a camera in the vagina and you can make other surgeries, incisionless. Absolutely. You can tie tubes through, uh, a vaginal approach.
You can remove ovarian cysts. You can remove an ovary that has a problem. You can remove an ectopic pregnancy. And there are really other, other uses for V notes as well, not just hysterectomy. That's fantastic. So since you've been using it, what's your opinion on how it improves the surgical process for you and for the patient?
Not having an incision and leaving the hospital with no incision is, is and less pain is really the bonus. Absolutely. Uh, every vs person I've spoke to has had at least one person tell them, I forgot I had surgery. Because I didn't see an incision. I think we all have that, uh, quote from someone in common.
Wow, that's great. And, you know, we might, we might minimize that and think, well, gosh, it doesn't, you know, an incision doesn't really bother me. And I think we maybe underestimate just that, you know, we, we underestimate the post-surgical experience with incisions and, and even scar tissue. Right. Like less opportunity for scar tissue to.
Correct. I do wanna emphasize it. Uh, v Notes is not necessarily appropriate for everybody. There are some things that just, it may have to do with being where the doctor is on the learning curve for V Notes, there is a learning curve for every procedure, so some things may be acceptable for one doctor and the other doctor will say, I can do that through V Notes.
And there's just some conditions that probably shouldn't be treated that, or can't be used for V notes or just some, some, and that's, that's a, that's more a patient to patient individual discussion. But I, I don't wanna give the impression that every hysterectomy, every procedure can be done through V Notes, but it, it's a potential option that wasn't there both before.
Yeah. And, and that kind of innovation is something that we wanna support and, and champion for sure. And you bring up a great point, I think in, in closing, that no matter what the surgical procedure is, there's this, on the patient side, there's this idea that anybody's good for that. Anyone is a fit for that, but the outcomes rely upon how good of a candidate you are for the treatment.
Is that an accurate state? Correct. Yeah. With any surgery that you have to have a match, the doctor's expertise, the patient's problem, what they would prefer or she would prefer, I'm sorry. There has to be a match. I don't wanna, not one size fits alls we get went back, you said the least desirable hysterectomy for someone which will be an abdominal strike, may be the most desirable for that particular person.
Right, based on their situation and, and based on the access that they have to care. If you have uterine cancer and you don't have access to a da Vinci robot, you, you still are going to benefit from a hysterectomy. Correct. , that's the stating the common sense thing. So I, I, this has been super informative.
Is there anything else that you'd like to add about v notes? I just think that if you go to the, the website, I believe. V notes, v n o t e s.com/slash patience, plural. I believe that gets you to, um, the website. It also gets to a list of other doctors who are performing v notes. Excellent. And how can people follow you or contact you?
Just use Google , right. Dr. Dr. Byron Hoffner practicing in Jersey in New Jersey, and, uh, affiliated with, um, Axia Women's Health and the hospitals that you are, uh, associated with. In Jersey, it's a hospital called Inspira Medical Center, and it's, it's South Jersey. It's more close to Philadelphia. So we really draw from Southern New Jersey and Philadelphia.
and Philadelphia. Excellent. Well, thank you so much for spending time with us today. We really appreciate your insights. I have one suggestion. Yeah. Uh, this is called Hello Uterus. Yes. Uh, this should be goodbye uterus for today. No. Oh, well, for today. Okay, good. Yes. Because in some cases saying goodbye is the right thing to do,
Right. I mean, we all, we all know that we all have experience with, with the need to say goodbye. Thank you, Dr. Hapner. Oh my pleasure. Goodbye. After this quick break, we'll be back with ending on a high note
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