A Gentler Approach
As a child, Assia Stepanian, MD, knew that she would make a difference in the field of medicine. The daughter of two renowned physicians, the Moscow-raised founder of Atlanta-based Academia Women’s Health & Endoscopic Surgery has brought a wide variety of Minimally Invasive Gynecologic Surgery (MIGS) options to patients in metro Atlanta and devoted herself to sharing her specialized knowledge with physicians worldwide. An active member of the American Association of Gynecologic Laparoscopists (AAGL), she proudly follows in the footsteps of her mother, Dr. Leila Adamyan, who developed some of the most advanced techniques in the practice of MIGS. Here, Best Self Atlanta talks to Dr. Stepanian about MIGS, her commitment to providing compassionate care and how it can completely change the patient experience.
Q: What is Minimally Invasive Gynecologic Surgery (MIGS)?
A: Laparoscopic, robotic, vaginal and hysteroscopic surgery are all forms of Minimally Invasive Gynecologic Surgery. These are surgeries performed through small incisions or sometimes require no incision at all.
Q: Why has it been important for you to devote so much of your career and life to learn, teach and implement MIGS approaches?
A: A doctor’s sense of fulfillment in medicine comes from seeing our patients happy for many years to come. Minimal intervention, combined with early recognition and successful treatment of the disease are, in my opinion, the keys of our patients’ long-term health. With early recognition of and attention to gynecologic diseases and the risks in their development, the least degree of the intervention will be required. The more we know about minimally invasive approaches in treatment, the more open will we be as physicians to intervene earlier. It is hard for physicians and patients to believe that minimally invasive surgeries can be offered even to patients with very advanced states of gynecologic conditions.
Q: What kinds of conditions can be treated with MIGS approaches?
A: It is impressive that essentially all gynecologic conditions that require surgery can be treated with one or more MIGS approaches, including uterine fibroids of sometimes very large sizes, pelvic pain, endometriosis, pelvic floor surgery (including cases in which the uterus descends completely outside of the vaginal canal), urinary incontinence, ovarian masses and adhesions (scar tissue), among other conditions. In addition, multiple forms of genital anomalies can be treated laparoscopically and hysteroscopically.
Q: What are the main benefits of MIGS?
A: Laparoscopy, whether or not it is performed robotically or with laparoscopic instruments, allows for superior visualization of the targeted tissue in surgery and outstanding performance of the surgery through small incisions.
Therefore, the precision of surgery increases and tissue handling becomes more intricate and gentle, with less tissue manipulation and less blood loss. In most surgeries the blood loss is of 25 – 50 ml, which is less than experienced during menstruation. The result includes decreased risk of perioperative infection and an early return to normal activities both in life and work as compares with open surgery. Some people return to work in only one or two weeks after surgery, even if the surgery is performed for an advanced disease. Additionally, there is hardly any use of narcotic medications post-operatively.
Motrin is used as the primary medication for pain. Patients who receive the vaginal approach to surgery, which is the oldest of all minimally invasive approaches, have no abdominal incisions whatsoever and experience the same excellent recovery rates as laparoscopy. It is used when evaluation of the abdomen and upper aspect of the pelvis is not required. And hysteroscopy…what can I say? Hysteroscopy became our inspectional and operative window into the woman’s uterus. It allows for early intervention in the office setting or surgical suites and often prevents the need for more invasive uterine surgery.
Q: Have you had formal training in MIGS?
A: The American Association of Gynecologic Laparoscopicsts (AAGL) has a very strong fellowship in MIGS and offers formalized training. I have completed my formal fellowship with Dr. Thomas Lyons, an exceptional surgeon and visionary who founded one of the first Minimally Invasive Fellowships in AAGL. My initial training and continuous training in laparoscopy, hysteroscopy and vaginal surgery was performed by my mother, Professor Leila Adamyan, the author of surgical techniques, classifications, books, who has taught many beautiful surgeons in Russia and in various countries. She is my primary mentor in life and surgery, and through her I have met and learned from our many good friends and superb surgeons worldwide.
Q: Your practice has been certified as a Center of Excellence in Minimally Invasive Gynecology Surgery. What does this mean?
A: The concept of a Center of Excellence in MIGS has been established in an effort to encourage development in MIS approaches in gynecology. We are hoping that with the opening of more Centers of Excellence, there will be more commitment to minimally invasive surgery.
Q: Your practice is also known for offering truly compassionate care. Why is this important to you?
A: It defines the entire purpose of my work. I am in the medical field because of my love for patients. I treat my patients as my family—with love, expectation, understanding, attention and compassion. I hope to always be able to empower and remind them that the world is beautiful and that whatever goes on with their heath is just a small hiccup in their life journey. I am truly blessed by my patients, and I am thankful to them for their trust, love and support.
Q: Can patients come to your practice even if you are not their current physician?
A: Yes, we are always accepting new patients and we are also very fortunate to receive referrals from many wonderful physicians. We evaluate those patients and establish a care plan. I always communicate with the referring physicians about any questions in order to make sure that the best strategies are selected and the risks are minimized for patients. If we select non-surgical approaches, we agree on parameters, after which additional intervention may need to be considered.
Q: What do you see for the future of MIGS and women’s healthcare?
A: MIGS will continue to develop in its applications and advancements. Performance of MIGS involves advanced training, and I would like to see more gynecologists obtain formal training in minimally invasive approaches to surgery. I also see us collaborating with other specialties, engaging integrative approaches in studying and treating a disease. Unification of the world of MIGS will be yet another advancement: we need patients, doctors, nurses, hospitals, insurance companies and manufacturers to combine their knowledge and abilities to serve the needs of the patients.
Q: Is there any place for an open surgery in benign gynecology, then?
A: Absolutely, there is! There are very rare times when MIGS is contraindicated or would not be the method of choice. A consultation with a specialist in MIGS would be able to address this most effectively.
