WRNMMC, Bethesda, Md.  –   Empowering Patients to Make Informed Decisions by Building Trust

When you meet Dr. Candice Jones-Cox, the Women's Health Services director at Walter Reed National Military Medical Center, you will learn that she's a fierce patient advocate and a meticulous surgeon, passionately learning cutting-edge techniques to adapt to an ever-changing medical landscape. She's an obstetrician-gynecologist (OBGYN), highly adept at performing complex women's surgeries – especially hysterectomies.

According to the Centers for Disease Control and Prevention (CDC), approximately 600,000 hysterectomies are performed annually in the United States. A hysterectomy is a type of surgery in which a woman's uterus (or womb) is removed, sometimes along with the ovaries, cervix, fallopian tubes, or other structures.

"My patients are in their 40s and early 50s, and that's when we see most of the gynecologic (GYN) conditions start to worsen during the peri-menopausal time after childbearing," shared Jones-Cox.

Jones-Cox builds a rapport with her patients by sharing her personal connections with Walter Reed, where she gave birth to her son and daughter, who often accompany her to the hospital when called in for emergencies.

Military Medical Milestone

Earlier this year, Jones-Cox became the first surgeon in the Department of Defense medical community to perform a robotic minimally invasive natural orifice transluminal endoscopic surgery (vNOTES), vastly reducing a patient's recovery time and discomfort while minimizing hospital stays.

"One of the limits of a strictly vaginal hysterectomy is that you can't see the upper abdomen," explained Jones-Cox. "Now, with vNOTES, we can evaluate the upper abdomen and the ovaries and uterus," on an operating room monitor with images transmitted by a camera.

Pre-Surgical and Post-Surgical Discussions with Patients

Jones-Cox conducts extensive interviews with patients before recommending a hysterectomy, asking questions about a patient's quality of life, including menstruation cycles and sleep patterns. "Once the patient decides that she believes a hysterectomy is the right choice, then it's all about supporting them.”

Elizabeth C., one of the first patients to undergo the vNOTES surgery at Walter Reed, where she previously gave birth to all her children said, “I felt terrific after the procedure, I was not in any pain at all and have never felt any pain at or around the site since.”

Prior to the surgery, Elizabeth C. spent a year dealing with the debilitating effects of heavy bleeding, fibroids, painful cramping, and restless sleep. “I did not expect to snap back so quickly. Without an abdominal incision my recovery was quick and painless. I did not return to the gym for 4-6 weeks - as directed - but I felt great,” confided Elizabeth C.

Jones-Cox, who relies on her staff to arrange preoperative appointments and set up telemedicine check-ups 24 to 48 hours after the procedure, and an in-office visit three to four weeks after the surgery, praises her team for their tenacity in providing excellent patient care.

"When I see the patients postoperatively, they have energy, are smiling, and are pain-free." That's gratifying for Jones-Cox, who enjoys empowering patients to make transformative decisions.

Family Planning Options

Jones-Cox advises patients to consider their family planning aspirations before opting for a hysterectomy. "Oocyte (egg) preservation has become a very hot topic as women are delaying childbearing until they're much older or because medical problems requiring them to preserve their fertility," explained Jones-Cox.

Some research shows that bilateral oophorectomy (removal of both ovaries) as part of a hysterectomy may increase a woman's risk of fatal and non-fatal coronary heart disease and colon cancer. That's why Jones-Cox painstakingly discusses with patients the pros and cons of each contemplated procedure so that patients may make informed medical decisions.

Implications for Developing Cancer Following a Hysterectomy

"So oftentimes when people hear hysterectomy, they automatically assume that everything is removed: the uterus, the cervix, the fallopian tubes and ovaries," detailed Jones-Cox. "But for medical personnel, when we say hysterectomy, we're simply referring to the uterus plus or minus the cervix."

According to Jones-Cox, removing the tubes is a separate procedure that may or may not occur during a hysterectomy. The prevailing standard, explained Jones-Cox, is to remove the fallopian tubes to decrease the risk of ovarian cancer in the future. However, OBYGNs believe that there is some merit in a patient's retaining her ovaries for hormonal production and good cardiovascular health.

"We see some literature showing decreased rates of dementia with preserving the ovaries," detailed Jones-Cox. "So, we try to preserve the ovaries when possible and provide a patient with quality of life for a safe procedure and an uncomplicated recovery."