Laura Lentenbrink, Minimally Invasive Surgery

Laura Lentenbrink considers herself fortunate as she looks back at perimenopause she experienced in her late 40s and early 50s: Her symptoms were minor -- a small amount of bleeding and no pain.

Still, a biopsy of cells taken from her reproductive tissue showed modest changes that ultimately would have led to the need for a hysterectomy.

Lentenbrink, 55, a registered nurse and vice president for Human Resources at Borgess Medical Center, took her concerns to Dr. Janice Werbinski, a gynecologic surgeon at Borgess Women's Health in Portage.

Werbinski said she could perform a routine hysterectomy, although the need was not pressing. The innovative surgeon, however, offered another option: She was about to be trained to do a minimally-invasive hysterectomy that required only four small incisions, less pain and quicker recovery.

"I wasn't in any distress," Lentenbrink said, "so we decided that I could wait."

Later, in November 2003, Lentenbrink was Werbinski's first patient to undergo the minimally-invasive procedure.

"I was her pilot project," Lentenbrink said.

Some years earlier, Lentenbrink had undergone a surgery that required an abdominal incision and she was well aware of the discomfort and prolonged recovery time. "With the minimally-invasive procedure there was less pain, less trauma to the muscle wall and it reduced a whole gamut of complications associated with major surgery," she said.

Lentenbrink remained in Borgess overnight, although she thinks her stay was a little longer than needed simply because it was the first time Werbinski has done the surgery and the physician wanted to make sure everything went well.

"I was back to work within two weeks," Lentenbrink said. "I felt so good after the first 10 days that I started doing a little work-related stuff at home."

Recovery time for a hysterectomy that involves an abdominal incision is about six weeks.

Lentenbrink, who has worked at Borgess for more than 30 years, said a quick return to work was a real benefit since there were some tasks only she could do. A prolonged absence would only mean a bigger backlog of work once she returned to the hospital.

Hysterectomy, which is the surgical removal of the uterus, is the second most common major surgery among women, with some 600,000 performed in the United States each year. About one-third of American women have had a hysterectomy by age 60.

A hysterectomy traditionally has been done through an incision in the abdomen or the vagina. Over the last two decades, there has been an increased use of laparoscopic hysterectomies, which can reduce the size of the incision and make recovery easier and quicker.

A laparoscope is a flexible tube with a camera that allows the surgeon to see inside the body. Other small tools can be used to cut away the uterus for removal.

About 15 years ago, Werbinski began doing the laparoscopic-assisted hysterectomies, which allowed her to eliminate the abdominal incision. Still, an incision was needed in the vagina to allow for removal of the uterus.

The training Werbinski underwent prior to operating on Lentenbrink was for an updated laparoscopic hysterectomy that eliminated the need for even the vaginal incision.

"The new procedure is exactly the same technique except at the end," Werbinski said.

In the new procedure, she said, a device called a morcellator is used to cut the uterus into pieces small enough to be removed through a 1-inch incision, one of three 1-inch incisions made during the procedure. One 1-inch incision is for the laparoscope and the other two are for other tools, including the mocellator. A fourth incision -- only 5 millimeters or about one-fifth of an inch -- allows a surgical assistant to move the intestine or other abdominal features aside if needed.

Werbinski said that she has since done about 60 of the minimally-invasive morcellator procedures.

"There's a learning curve," Werbinski said of the procedure. "It took me about 2- to 2 1/2-hours that first time. Two I did around Thanksgiving took 1 hour and 1 hour and 15 minutes.

"I definitely see less pain with the new procedure."

Abdominal hysterectomies typically require a hospital stay of three to five days and a six-week recovery, she said. Vaginal laparoscopic hysterectomies require a shorter hospital stay and a four-week recovery. With the new procedure, patients often leave the hospital in less than 24 hours and can be back at work or normal routine within two weeks.

Lentenbrink said she had complete trust in both her surgeon and the surgical team at Borgess when she made the decision to be Werbinski's "pilot" project. "It made perfect sense to me," she said, "especially knowing and having complete confidence in my surgeon."

Lentenbrink said that she may have some bias toward Borgess since she is a hospital employee. Still, as someone who has worked there for 30-plus years, part of the time as a registered nurse, she said that gave her an insight into the high level of competence of the staff.

"I absolutely trusted the staff," she said, "and that made it a lot easier to be willing to try something different.

"I've had absolutely no problems since."