Safer, simpler hysterectomies

Michael Clark, D.O., develops new device, minimally invasive technique

By Tom Riggs and Anita Martin

Photo by John Sattler

Darla Stanley had heard stories about what to expect from her hysterectomy. “I was scared to death,” she says. “I thought there’d be a lot of pain.” As a patient of Michael Clark, D.O., though, Stanley was pleasantly surprised.

Clark performed her vaginal hysterectomy with the 65-millimeter endocutter, an innovative tool he developed in collaboration with medical manufacturer Ethicon Endo-Surgery, Inc. As the instrument cuts, it instantly seals both sides of the incision with simultaneous stapling. Compared to the standard clamp-cut-suture technique, the endocutter procedure greatly limits bleeding and decreases complications.

“The average vaginal hysterectomy with this device takes 25 to 30 minutes—even with a resident doing the case—compared to two hours for an abdominal procedure,” Clark says.

Hardly two hours passed since the beginning of Stanley’s midday surgery when she awoke, and by 5 p.m. she was home—a vast improvement from typical abdominal hysterectomies, which often keep women in the hospital for three days.

The best part: there was no real pain to speak of. “I highly recommend this procedure to any woman who needs a hysterectomy,” Stanley says.

Clark, an OU-COM faculty member who sees patients from across Ohio and Kentucky, began developing the endocutter for vaginal hysterectomies in the early 1990s. However, he has only been using the latest version of the tool, adapted from a similar tool used for gastric surgery and pulmonary surgeries, for a couple years.

Clark and his colleagues recently conducted a study of the endocutter using 250 cases, the preliminary data of which show that the procedure is safe and decreases complications of surgery.

Clark estimates that at least 75 percent of the hysterectomies he performs are vaginal, as opposed to the more common abdominal and laparoscopically assisted vaginal procedures. Typically, about 70 percent of hysterectomies in the U.S. are abdominal, Clark says.

The ease of the endocutter allows for a faster learning curve, according to Clark’s resident Megan Porter, D.O. (’06). Porter began assisting Clark with vaginal hysterectomies during her first year of residency. Now in her third year, she has performed or assisted with more than 100 vaginal hysterectomies—at least half of which she has completed on her own.

“The (endocutter) is truly better for the patient,” Porter says. “It reduces recovery time, decreases complications. If I were having a hysterectomy, I would definitely want this procedure.”

Porter, who plans to stay in Ohio and serve smaller communities, appreciates the surgical advantage she has gained from her residency. “Normally, you have to wait a few years to do this kind of surgery, but this (endocutter) innovation makes it a lot safer and easier to learn.”

According to Clark, minimally invasive techniques like this one are quickly catching on. He now travels “coast-to-coast” and conducts international teleconferences from his operating room to demonstrate his endocutter surgery technique. About once a month, surgeons visit Clark’s office to observe surgeries and receive training.

“This innovation was really driven by patient needs,” Clark says. “It cuts down on complications, (in-hospital) infections and, most importantly, increases patient satisfaction.”