UNC GYN: Surgical Excellence

In the recent U.S. News and World Report rankings of America’s Best Hospitals, UNC Hospitals was nationally ranked in five of the 16 specialties. In this series, we profile these specialties to learn more about what makes them so outstanding.

The Da Vinci Surgical System at UNC Hospitals (Photo by Brian Strickland)
John Boggess, MD (Photo by Max Englund/UNC Health Care)

By providing one of the most comprehensive and innovative surgical programs in the state, UNC OB-GYN has distinguished itself as one of nation’s top referral centers for gynecologic care. Recently ranked 25th in the nation among gynecological programs in U.S News and World Report’s listing of the country’s best hospitals, two of the department’s doctors were also named among the nation’s top cancer doctors by Newsweek. The department’s residency program was also rated as one of the top in nation by Doximity.

As one of the largest and most well-respected gynecologic surgery programs in the area, UNC sees a high volume of patients, many of whom present surgeons with unique challenges, says Matthew Siedhoff, MD, director of UNC Minimally Invasive Gynecologic Surgery.

“Because of the kinds of referrals we see, we are able to push the envelope both in terms of how we employ the technology and our practical, hands-on skills. Every case is a challenge and we encounter enough unusual cases that we’ve learned to adjust to what the situation presents.”

The department’s use and development of emerging technologies has had strong influence on the many high-complexity referrals UNC’s gynecologic surgeons encounter. UNC OB-GYN has long been an early adopter of minimally invasive techniques, according to Siedhoff.

“In the 1990s, John Steege, who was the division director of Minimally Invasive Gynecologic Surgery at UNC before he retired, started using laparoscopy to address things like pelvic pain and to perform hysterectomies. This was at a time when most people were not picking up the laparoscope for these kinds of procedures, so we began well ahead of the curve and have remained ahead,” he says.

One of the most important features of laparoscopy and other minimally invasive techniques is the impact they can have on patient outcomes.

“We take on patients with very complex pathologies,” says Siedhoff, “like patients who have had several prior surgeries, or who might have very large masses or large fibroids, and we can take that out through a tiny little incision. That makes a big impact on a patient’s recovery. They spend very little time in the hospital compared with open incisions, they experience less pain and there are fewer of the complications typically associated with blood loss or wound infection.”

The largest change to the field in recent years has been the expansion of robotically-assisted surgery, and UNC OB-GYN is at the forefront of this development also.

In 2005, the robotic Da Vinci Surgical System was approved by the Food and Drug Administration for gynecologic surgery. That same year, the device was brought to Chapel Hill by John Boggess, MD, professor of gynecologic oncology and member of the UNC Lineberger Comprehensive Cancer Center.

Today, the department’s use of the latest technologies for minimally invasive procedures has made the program an international leader, says Boggess.

“UNC has hosted more than 1,000 surgeon visits to allow physicians from all over the world, including Japan and Canada, to see how this technology has developed,” he says. “The early success we had with robotic surgery in GYN put us on the world map and that success has allowed us to grow the Computer and Robotic Enhanced Surgery Center [CARES Center],”

The UNC CARES Center is a multidisciplinary team of surgeons working provide the latest in robotic-assisted surgical techniques to patients seeking treatment at UNC Hospitals. In addition to gynecologic surgery, the CARES team also has specialists in pediatric surgery, surgical oncology, otolaryngology, thoracic surgery, urologic surgery and gastrointestinal surgery.

The latest innovation that Dr. Boggess has brought to UNC is a procedure called the trachelectomy, a revolutionary treatment for cervical cancer that makes it possible for a woman to preserve her fertility.

Boggess is one of only a few surgeons in the nation qualified to perform this procedure. To date, he has performed trachelectomies on over 30 women, several of whom have carried children to term after having the surgery.

As new techniques are perfected at UNC, part of the challenge becomes ensuring that they can have as wide an impact as possible, says Boggess.

“When we first brought the robot to UNC, we had patients having procedures done in Chapel Hill that couldn’t be done elsewhere, but we’ve tried hard to make what we’ve accomplished here exportable,” he says.

Locally, this has meant widening access to robotically-assisted gynecologic surgery by equipping the new UNC Hospitals Hillsborough Campus with a Da Vinci system.

In spite of the rapid growth of the department and its capabilities over the past decade, the focus remains not just ensuring the best possible patient outcomes with the latest surgical techniques but also working with patients to ensure that the kinds of outcomes they would like are possible.

This includes not only techniques that can preserve fertility but those that make it possible for women to have access to the kinds of birth experiences they desire. Most recently this has meant making clear-drape caesarians available to patients so they can have a more direct birth experience, even when the baby is delivered via surgery.

“Whatever technique or technology we can use to get a successful outcome,” says Siedhoff, “we want to ensure that it’s made available to the patient.”

Boggess agrees. “We have an amazing team here doing very innovative and interesting work in a really solid clinical program. We’ve been able to achieve the kind of reputation we have by tirelessly pursuing our goal of growing great patient care here at UNC.”

To find out more about UNC OB-GYN, visit our website at https://www.med.unc.edu/obgyn.

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