Four tiny incisions is all it takes.

That is as much as gynaecologist Jose Roman needs to perform hysterectomies and other major operations at Braemar Hospital in Hamilton. In his skilful hands four small cuts are made into a patient’s abdominal wall. One of these “keyholes” has a camera inserted through it, sending an image to a screen, while he operates through two of the remaining ones, with an assistant using the fourth. The concentration is intense as they observe the operation via the two dimensional image on the screen in one of Braemar’s state of the art Digital Operating Theatres. No clamps here – this is radically different from conventional surgery.

The entry points of the surgery may be small, but the benefits to the patient are immense.

The laparascopic procedure, which avoids the need to open up the abdomen, is safer, with less use of drugs after surgery and less blood loss. Recovery is quicker, time in hospital is reduced, there is less chance of infection and discomfort is far less than with conventional surgery. After major surgery patients can often return home after a day or two. And at Braemar the complication rate for keyhole hysterectomy is extremely low at less than one per cent, with a similarly low rate for excision of endemetriosis.

It is precision surgery which Jose Roman has pioneered in the Waikato, and he has been performing such operations at Braemar for over 10 years.

He is among just 15 per cent of gynaecologists in Australasia using the technique for major surgery, and to do so had extensive training on top of his qualification as a gynaecologist. During his time he has seen the technology continuously improving, including the introduction of high definition imaging.

“Techniques have evolved. Experience has evolved. We are doing much more difficult procedures than at the very beginning,” he says. “For example, in the ’80s perhaps the only procedure done was tubal ligation, which is very, very simple. Now we do laparoscopic repair of prolapses, we do laparoscopic hysterectomies of massive uteri.”

Jose Roman has a wide experience of medicine. He was born in Peru, where he trained as a doctor before migrating to the UK and qualifying as a gynaecologist. He arrived in the Waikato from the UK 16 years ago, after turning down job offers in Canada and London. He knew about Hamilton from a friend who had enjoyed living in the city in the 1970s. Coming here was, Jose Roman admits, a culture shock but it has been a happy move for him and his wife who now have two school age daughters.

He is also happy about the culture at Braemar, saying the family atmosphere has been preserved in the shift from its previous much smaller premises to the new state of the art hospital on Ohaupo Rd, with its six operating theatres.

Jose Roman values the fact Braemar is a charitable hospital, so that the surpluses are ploughed directly back into the hospital and the community. He has a leading part to play in that as a trustee of the Braemar Charitable Trust. Jose is also a member of the hospital’s Clinical Committee that oversees all aspects of clinical governance. Both are unpaid jobs that took up a great deal of time last year (2009) when the new hospital was being built. “It is practically the only hospital in New Zealand where everybody – nurses, doctors – has made an input. There was communication with everybody to know exactly what they want.”

As for his routine as a surgeon, Jose Roman typically operates at Braemar in the morning, starting between 7.30 and 8 o’clock after visiting patients at the hospital. He usually does two procedures, and then consults at his Clarence Street rooms in the afternoon.

And what’s the best thing about his job? “The satisfaction of seeing the patient recover so quickly.”

5 Commonly Asked Questions:

1. Are gynaecologists doing more abdominal hysterectomies (big incisions) or more keyhole hysterectomies?

A recent survey among gynaecologists in the United States in 2009 revealed abdominal hysterectomies were done in 83 % of patients. However, when the same gynaecologists were asked for the preferred type of hysterectomy for themselves or their spouse only 8 % chose abdominal hysterectomy, with a laparoscopic or vaginal hysterectomy as the preferred choice.

2. Is it true that endometriosis is rare in teenagers?

The simple answer is no. The youngest patient operated on by us in Hamilton and found to have endometriosis confirmed by histology was only 14 years old.

3. Are the ovaries routinely removed at the time of a hysterectomy?

No, the ovaries are very important in the production of hormones called oestrogens. There is recent evidence revealing the importance of oestrogens to prevent coronary artery disease and strokes. Exceptions are women with a high risk of developing ovarian cancer or women who are well past their menopause.

4. Is keyhole important for the repair of prolapses?

Keyhole surgery has opened a new dimension for the surgical repair of prolapses, providing a better view of the pelvic anatomical structures that are often difficult or impossible to visualize when using only the vaginal approach.

5. Is surgery always needed to treat urinary leakage or incontinence?

Not always. Some cases of urinary leakage are not amenable to surgery, for example the case of an overactive bladder. Symptoms do not always indicate if surgery would be useful or not. The urodynamic computerized test to assess the pressures inside the bladder and the muscle of the bladder at the time of leakage is indispensable to reveal the need for surgery and to plan the surgical procedure if needed.