Dr. Ribot, the managing partner of Cartersville (Ga.) OB/GYN
Associates, had one thought after reviewing Dr. Levy's study: If she can
do it, so can we.
As it turns out, he was right. Of the nearly 1,800 hysterectomy
cases his practice completed from January 2006 through March
2017, nearly 99% of those patients went home the same day. The
remaining 1% had pre-existing conditions that contraindicated out-
patient surgery, he says. In May 2010, Dr. Ribot founded the
Georgia Advanced Surgery Center for Women, an ambulatory facil-
ity in Cartersville, Ga., where he and his fellow surgeons perform
every hysterectomy, unless a patient's insurance coverage dictates
it must be done in a hospital. Since opening their ASC, they've per-
formed more than 800 consecutive hysterectomies there without
hospital transfers, conversions to open surgery, blood transfusions
or significant complications.
"When we first started doing minimally invasive hysterectomy, it
was 2 or 3 days in the hospital, and then it was an overnight stay,"
says Dr. Ribot. "I now need a good reason to keep someone in the
hospital. One of the big concerns you hear from surgeons is: 'What if
there's a post-operative hemorrhage and you have to rush back in to
tie it off?' But if you're obsessive and meticulous about hemostasis,
that's not been an issue."
His protocol for outpatient laparoscopic hysterectomy mirrors Dr.
Levy's for vaginal hysterectomy. This includes pre- and post-operative
interventions to prevent nausea and vomiting, as well as a preemptive
local block — "an injection of a special cocktail of long-acting local
anesthetic" into each uterosacral ligament, he says — prior to making
the incision. For patients who are not candidates for vaginal hysterec-
tomy, Dr. Ribot has adapted a method for delivering the paracervical
block in laparoscopic cases, using a butterfly needle through a trocar.
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