CAPE GAZETTE, Friday, April 5 -April 11, 1996 - 35
Health & Fitness
Part III: Surgical series
Laparoscopes, hys
By Kerry Kester
Open gynecological surgery,
with its history of being traumatic
both physically and emotionally,
has undergone a change that eases
women' s suffering. Now,
because of technological develop-
ments, women may have less
invasive operations that not only
ease the trauma, but provide sur-
geons with more accurate data
with which to assess their
• patients' conditions.
Surgery through scopes allows
physicians to examine the abdom-
inal cavity. "It's a way to get
inside and look inside without
opening them up," said Steven
Berlin, M.D., an obstetrician
/gynecologist with Bayside
Health Association. Actual pro-
cedures can also be performed
through the scopes.
Berlin compared performing a
surgery without the scopes to
mowing a lawn blindfolded. "If
you mowed a parcel of land while
wearing a blindfold, the chances
are that when you took the blind-
fold off, you would see that you
missed a lot of the grass," said
Berlin. "If you mowed another
parcel without the blindfold, you
probably wouldn't miss much."
The camera [of a scope] allows a
physician to see much more than
with only the naked eye, he
explained.
Gynecologists use both laparo-
scopes and hysteroscopes. A
laparoscope is a small lighted
tube equipped with a magnifying
device. Like with scopes used in
other surgeries, only small inci-
sions are required to insert the
scope through the small punctures
in the abdomen.
teroscopes provide new medical
A hysteroscope, similar in that it
allows the physician a closer look
at the inside of a patient, requires
no external incisions. The hys-
teroscope is inserted through the
vagina, past the cervix and into the
uterus. Both scopes project
images onto television monitors
on which surgeons rely for their
visuals.
Scopes used in diagnosis
In the early morning of a Thurs-
day in March, Berlin stood masked
and gowned over a 24-year-old
anesthetized patient who had been
experiencing pelvic pain and
abnormal uterine bleeding. Berlin,
scope in hand, was ready to solve
the mystery of why she was having
problems.
Poised with the hysteroscope,
Berlin searched through the
woman's uterus until he located
one of the sources of her problems.
Small polyps were growing in the
uterus. While watching his move-
ments on the television monitor
stationed above the patient, Berlin
carefully removed the small
growths that were causing his
patient bleeding and discomfort.
Armed next with the laparo-
scope - which allowed Berlin to
approach the uterus through the
abdomen, he began searching for
signs of endometriosis, or some
growth of uterine tissue outside of
the uterus. What he found was
some scar tissue that was the result
of her previous cesarean sections.
He also found an ovary bound by
scar tissue and was able to cut the
tissue and free the ovary.
"That should help with the
pain," he explained as he carefully
snipped away. "At one time,
someone would have just removed
the ovary," said Berlin, explaining
that an important advantage of
surgery through scopes is that
there is a greaterflkelihood of sav-
ing reproductive organs.
As he continued exploring and
searching for other problems, he
paused when he found some' indi-
rect indications that his patient
might have endometriosis.
"Endometriosis has often been
called the big masquerader,
because is presents in so many
ways," said Berlin. "At one time,
women would have had to have
major surgery for this," said
Berlin, who was clearly enthused
that his patient was benefiting
from Beebe Medical Center's
state-of-the-art operating room.
Berlin carefully delivered differ-
ent tissue samples to his operating
room assistants, who later sent
them for pathological testing. (He
later learned that his patient did
not have cancer.) "We'll follow
her and see how she does, and
we'll offer her some alternative
treatments," said Berlin as he deft-
ly began closing the operation.
Hysterectomy alternatives
One of the things Berlin most
likes about doing procedures with
scopes, he said, is that they allow
physicians "to conserve reproduc-
tive organs." Endometrial ablation
is a procedure that was first intro-
duced to the Cape Region when it
was performed at Beebe Medical
Center on October 12, 1994. Doc-
tors Berlin, Vincent Killeen and
Newell Washburn were the first to
bring the procedure to Sussex
County, and for many women it is
an alternative to a hysterectomy.
vistas
Kerry Kester photo
Using scopes during operations has revolutionized many dif-
ferent types of surgery. Steven Berlin, M.D., a
gynecologist/obstetrician with Bayside Health Association,
performs a laparoscopic diagnostic procedure on a 24-year-old
patient who suffered from pain and abnormal bleeding prior
to her surgery. Berlin learned that one of his patient's prob-
lems was that her ovary was "trapped" by some scar tissue. He
was able to snip the tissue away to free the ovary.
A hysterectomy is the complete
removal of the uterus. Having the
uterus removed - especially if the
operation removes the cervix,
ovaries, and fallopian tubes
(reproductive organs) - can create
severe problems for women. Hor-
mone levels are disrupted, recov-
ery time is lengthy, and women
may experience discomfort or pain
for a relatively long time.
An endometrial ablation
involves removing the uterine lin-
ing through a hysteroscope. The
women who need the procedure
are usually those for whom other
treatments to cure bleeding dys-
function have failed, but who are
not being treated for cancer and
are past the child bearing stage of
life.
It is a procedure that Berlin said
cannot be performed at all without
scopes. "It's too dangerous," said
Berlin, who explained that without
the magnification and increased
visual field, there would be a risk
of puncturing the uterus. Prior to
the option of the procedure, a
woman's only choice was for the
hysterectomy.
Scopes increase accuracy
When women experience dys-
functional menstrual bleeding,
pelvic pain, or when they need a
uterine disease diagnosed, physi-
cians may need to scrape the lining
of the uterus.
Prior to the use of scopes, if a
woman needed the uterus scraped,
Continued on page 36
Cellex-C: A new skin rejuvenating agent
There is little we can do to stop
the process of aging; however,
with the use of antioxidants we
can slow aging down and even
reverse the aging process of the
skin. Antioxidants are a group of
chemicals that neutralize free rad-
icals. Free radicals are a group of
chemicals that over our lifetime
will damage cells, the building
blocks we are all made of.
Several vitamins have antioxi-
dant properties including vitamins
A, E and C. When applied to the
skin in their regular form, these
vitamins do not penetrate the skin.
The vitamins just sit on the sur-
face and can do little if any good.
Many cosmetic companies add
Vitamin E to their products but
limited benefit is derived because
the vitamin does not penetrate the
skin's surface. In fact, many
HEALTH TOPICS
Dr. Mitchell Stickler
patients will present to the derma-
tology office with allergic reac-
tions to Vitamin.E containing
creams.
Cellex-C is a new formulation of
Vitamin C, developed by a derma-
tologist at Duke University. What
makes Cellex-C different is that
Vitamin C has been coupled to an
enzyme that allows it to penetrate
the skin providing levels of the vit-
amin 20 times what is normally
found in the skin.
.Cellex-C becomes incorporated
into the skin; it cannot be washed
or rubbed off. The vitamin lasts
for up to three days after it is
applied. Like other vitamins, Vit-
amin C is not made by the body; it
is only available through the diet.
Aside from being an antioxidant,
Vitamin C is also known to be
important in the body's manufac-
turing of collagen, which gives the
skin strength and flexibility.
Cellex-C has been shown to
have several positive effects when
applied to the skin. First, if the
skin gets an overdose of sunlight,
applying Cellex-C as soon as pos-
sible can decrease the severity of
the sunburn and will shorten the
time required for healing. Cellex-
C provides a broad spectrum of
photoprotection against UVA and
UVB type sunlight.
However, it is not a sunscreen
because it does not absorb ultravi-
olet light. Cellex-C should be
used with a sunscreen because it
does not absorb ultraviolet light.
Cellex-C should be used with a
sunscreen to give added protec-
tion. Several leading dermatolo-
gists think Cellex-C will be a com-
mon ingredient in sunscreens
within the next few years. If used
daily for a three to six month peri-
od, Cellex-C can also improve
Bateman's purpura (bruising on
the arms of people over fifty years
of age) and will lighten brown sun
spots on the skin.
The best way to keep the skin
looking young and healthy is to
avoid direct sunlight as much as
possible and to use daily sun-
screen on sun-exposed skin areas.
Until recently, once sun damage
occurred, there was no way to
reverse this damage. In the past
few years, medical researchers
have made some small but signifi-
cant steps in our ability to reverse
sun damage. CeUex-C represents
one of these steps. Over the next
few months I will discuss some of
the other treatments that are now
available for the treatment of sun
damaged skin, including Renova
and alpha hydroxyacids.
Editor's Note: Mitchell Stickler,
M.D., is a board certified derma-
tologist at Cape Henlopen and
Nanticoke Dermatology.
