Doctor creates "road map" to aid common surgery

Hysterectomy is the second most common surgery performed on women in the U.S. and every surgeon has his or her own way of doing it. Now, one doctor is trying to change that.

When Mary Lou Olszewski was diagnosed with uterine cancer, her dogs helped her through it.

"They took good care of mom. They were there for me," she said.

Mary Lou had a hysterectomy. Doctor Dwight Im used an approach he created and named the IMSWAY, a step by step plan that guides surgeons like a map.

"It's almost like saying, well New York is Northeast of Baltimore, I'll see you there. Well, how do I get there?" said Dwight D. Im, M.D., F.A.C.O.G., Director and Gynecologic Oncologist at Mercy Medical Center.

Surgeons often have trouble locating the ureter, which connects the kidney and bladder. They typically stay far away from it, which puts the patient at risk for injury. IMSWAY guides them closer to the ureter, so they can see it.

"You know you can see it. That's how you know you are not touching or injuring it," SAID Dr. Im.

The result: a shorter surgery - about 30 minutes instead of several hours - and less bleeding. Dr. Im teaches the technique to surgeons all over the world, and hopes it will become the standard.

"In the end, it's the patients who benefit," said Dr. Im.

"To me it was, this is not your mother's hysterectomy," said Olszewski. "I really feel that I got a lease on life."

Doctor Im has been using the IMSWAY technique for two and a half years and has performed more than 1,000 surgeries. The approach can be used for open, laparoscopic or robotic hysterectomies.

BACKGROUND: Hysterectomies are surgeries to remove a women's uterus or womb. Sometimes the whole uterus is removed and other times just a part of the uterus is taken out. Sometimes during hysterectomies, a woman's fallopian tubes and ovaries may also be removed. After having a hysterectomy, women will no longer have menstrual cycles and are not able to become pregnant. If the ovaries are removed they will enter menopause if they have not already done so. Hysterectomies are very common and are the second most common surgery among women in the United States, just after childbirth by cesarean section delivery.

TYPES: There are 3 different types of hysterectomy that can be performed:
* Partial, subtotal, or supracervical hysterectomy - In these types of hysterectomies, only the upper part of the uterus is removed and the cervix is left in place.
* Total hysterectomy - In a total hysterectomy, the entire uterus and cervix is surgically removed.
* Radical hysterectomy - In a radical hysterectomy the whole uterus is removed as well as tissue on both sides of the cervix and the upper part of the vagina. This type of hysterectomy is typically only done when there is cancer present.

REASONS FOR: There are many reasons why a hysterectomy may be recommended for certain women. Below are some of the more common reasons for hysterectomies:
* Fibroids - Non-cancerous, muscular tumors that grow in the wall of the uterus that can cause some women prolonged heaving bleeding or pain.
* Cancer of the uterus, ovary, cervix, or endometrium
* Prolapse of the uterus - This is when the uterus slips from its usual place down into vagina causing urinary or bowel problems and pelvic pressure.
* Endometriosis - This occurs when the tissue that lines the uterus grows outside the uterus on your ovaries, fallopian tubes, or other pelvic or abdominal organs causing pain during menstrual periods and sex, bleeding between periods, and some other symptoms. (Source:

"IMSWAY": IMSWAY is a robotic surgical alternative to the traditional surgical approaches, like hysterectomies, for addressing different types of serious gynecological conditions. The approach was pioneered by Dr. Dwight Im who uses the robot as a tool to enter the retroperitoneal space, identify vital organs, big blood vessels and veins, and then to remove the affected area without injuring the vital organs. (

"What this technique allows you to do is stay calm, follow the steps, and be able to do a surgery that you are really happy about. In the end it's the patients who benefit," Dr. Dwight Im, Director for Gynecologic Oncology at Mercy Medical Center, told Ivanhoe.

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