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Pedro Ramirez, MD
PedroRamirezMD (Physician (Verified) )| Communities: Ovarian Cancer | Answers: 8 |
| Member Since: Feb. 2012 |
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Professional Statement
Pedro T. Ramirez, M.D. is a Professor and the Director of Minimally Invasive Surgical Research and Education in the Department of Gynecologic Oncology at MD Anderson Cancer Center. He graduated residency in Obstetrics and Gynecology from Columbia-Presbyterian Medical Center in New York in 1998. He then completed his fellowship in Gynecologic Oncology at MD Anderson Cancer Center in 2001.
As director of Minimally Invasive Surgical Research and Education, Dr. Ramirez oversees training of surgeons in the use of techniques such as laparoscopy and the da Vinci Robotic Surgical System. These techniques not only enhance surgeons’ skills but also improve patients’ quality of life by decreasing pain and blood loss, reducing hospital stays and facilitating quicker returns to daily activities when compared with conventional open surgical techniques.
Dr. Ramirez has had a great deal of hands-on experience with such techniques. Specifically, he is known for his use of total laparoscopic radical hysterectomy and laparoscopic extraperitoneal lymph node dissection in patients with early and locally advanced cervical cancer, respectively. Furthermore, he has a great deal of experience in performing robotic radical hysterectomies, radical trachelectomies, radical parametrectomies and staging procedures. He is also recognized as one of the leading surgeons in this country in the field of fertility preservation in young women with early cervical cancer.
He has authored and co-authored over 125 scientific publications and has written numerous book chapters, monographs, and invited articles. He also has served on various committees and academic societies including President of the Houston Gynecologic and Obstetrical Society and Chair of the Gynecologic Oncology Special Interest Group of the American Association of Gynecologic Laparoscopists.
Dr. Ramirez is also committed to the education of physicians throughout the world. For example, he frequently speaks at international surgical conferences. In addition, Dr Ramirez serves as a mentor and host to numerable international surgeons who seek to expand their expertise and skills. He is a frequently invited lecturer for national and international conferences and meetings where he continues to foster international scientific collaboration.
As director of Minimally Invasive Surgical Research and Education, Dr. Ramirez oversees training of surgeons in the use of techniques such as laparoscopy and the da Vinci Robotic Surgical System. These techniques not only enhance surgeons’ skills but also improve patients’ quality of life by decreasing pain and blood loss, reducing hospital stays and facilitating quicker returns to daily activities when compared with conventional open surgical techniques.
Dr. Ramirez has had a great deal of hands-on experience with such techniques. Specifically, he is known for his use of total laparoscopic radical hysterectomy and laparoscopic extraperitoneal lymph node dissection in patients with early and locally advanced cervical cancer, respectively. Furthermore, he has a great deal of experience in performing robotic radical hysterectomies, radical trachelectomies, radical parametrectomies and staging procedures. He is also recognized as one of the leading surgeons in this country in the field of fertility preservation in young women with early cervical cancer.
He has authored and co-authored over 125 scientific publications and has written numerous book chapters, monographs, and invited articles. He also has served on various committees and academic societies including President of the Houston Gynecologic and Obstetrical Society and Chair of the Gynecologic Oncology Special Interest Group of the American Association of Gynecologic Laparoscopists.
Dr. Ramirez is also committed to the education of physicians throughout the world. For example, he frequently speaks at international surgical conferences. In addition, Dr Ramirez serves as a mentor and host to numerable international surgeons who seek to expand their expertise and skills. He is a frequently invited lecturer for national and international conferences and meetings where he continues to foster international scientific collaboration.
Professional Info
Credential: MD
Medical school: Albert Einstein College of Medicine
Residency: Columbia Presbyterian Medical Center
Fellowship: MD Anderson Cancer Center
Board certifications: American Board of Obstetrics and Gynecology: Special Qualification in Gynecologic Oncology
Research interests:
Minimally invasive surgery
Fertility preservation in women with gynecologic malignancies
Novel approaches to the surgical staging of patients with gynecologic cancers
Hospital affiliation: MD Anderson Cancer Center
Practice address:
1515 Holcombe Blvd. Unit Number: 1362
Houston, TX
77030
Practice phone number: 1-877-MDA-6789
PedroRamirezMD Activities
Minimally invasive surgery offers patients the benefits of a much faster recovery and quicker return to daily activities. It also provides a quicker return of bowel function and less requirements for pain medications. Robotic surgery is the latest technology in the minimally invasive approach.
Patients with early stage (stage IA2-IB1) cervical cancer are traditionally treated by radical hysterectomy. This procedure removes the cervix, uterus, the parametria (tissue immediately adjacent to the cervix) and the pelvic lymph nodes. It is now commonly performed by the laparoscopic or the robotic approach. This has been associated with less blood loss, transfusion rates, and shorter length of hospitalization. It has also been associated with lower postoperative complication rates.
For patients with early stage cervical cancer who are interested in future fertility, there is the option of a radical trachelectomy. In this procedure, the cervix and parametria are removed, along with pelvic nodes, but the uterus is intact and reattached to the vagina so that the patient will be able to get pregnant in the future. A select number of centers around the country are now also performing this procedure by the robotics approach. Results show that the blood loss and hospitalization after the robotics approach is less than when the procedure is performed through the open approach.
Patients with early stage (stage IA2-IB1) cervical cancer are traditionally treated by radical hysterectomy. This procedure removes the cervix, uterus, the parametria (tissue immediately adjacent to the cervix) and the pelvic lymph nodes. It is now commonly performed by the laparoscopic or the robotic approach. This has been associated with less blood loss, transfusion rates, and shorter length of hospitalization. It has also been associated with lower postoperative complication rates.
For patients with early stage cervical cancer who are interested in future fertility, there is the option of a radical trachelectomy. In this procedure, the cervix and parametria are removed, along with pelvic nodes, but the uterus is intact and reattached to the vagina so that the patient will be able to get pregnant in the future. A select number of centers around the country are now also performing this procedure by the robotics approach. Results show that the blood loss and hospitalization after the robotics approach is less than when the procedure is performed through the open approach.
New answer by PedroRamirezMD (Physician - (Verified))
1
Answer |
1 year ago
The range of reported lymphedema in patient who undergo pelvic lymph node dissection is between 5-30%. However, it is important to note that the range varies widely based on several factors such as the tools to measure lymphedema or the medical comorbidities of the patient such as obesity, diabetes, hypertension, and cardiovascular disease.
New answer by PedroRamirezMD (Physician - (Verified)) in topic(s) Endometrial Cancer Treatment Side Effects, Uterine Cancer Treatment, Gynecologic Surgery, Side Effect, Lymphedema, Uterine Cancer Treatment Side Effects, Endometrial Cancer Treatment, Ovarian Cancer Treatment Side Effects, Lymph Node Dissection, Cervical Cancer Treatment Side Effects, Ovarian Cancer Treatment, Lymph Node Surgery, Post-surgery Complications, Lymph Nodes, Lymph Node Procedures, Cervical Cancer, Lymph Node Dissection Or Biopsy, Cervical Cancer Treatment, Surgery, Surgery Side Effects
1
Answer |
1 year ago
In what situations would you recommend using the da Vinci Surgical system for gynecologic surgeries?
The robotic system is generally recommended in the setting of early-stage cervical cancer to perform a radical hysterectomy or radical trachelectomy. It is also very commonly used to perform simple hysterectomy and lymph node removal in the setting of uterine cancer. It may also be used when performing prophylactic removal of the tubes and ovaries in patients with hereditary breast and ovarian cancer syndromes.
The robotics approach may also be used in very select cases of patients with isolated recurrent disease.
The robotics approach may also be used in very select cases of patients with isolated recurrent disease.
New answer by PedroRamirezMD (Physician - (Verified)) in topic(s) Uterine Cancer Treatments, Hysterectomy, Uterine Cancer Surgery, Gynecologic Surgery, Cervical Cancer Treatment Options, Treatment Options, Prophylactic Hysterectomy, Endometrial Cancer Treatment Options, Radical Hysterectomy, Ovarian Cancer, Ovarian Cancer Treatment Options, Robotic Surgery, Trachelectomy, Da Vinci Surgical System, Prophylactic Surgery, Uterine Cancer, Radical Trachelectomy, Cervical Cancer, Cervical Cancer Surgery, Ovarian Cancer Surgery, Endometrial Cancer Surgery, Surgery, Uterine Cancer Treatment Options, Endometrial Cancer
1
Answer |
1 year ago
Laparoscopic surgery is generally not indicated in the setting of advanced disease. In other words, when patients have wide spread of disease the indicated approach is a laparotomy. This means an open abdominal incision. Typically, only patients with early cervical or endometrial cancer are candidates for laparoscopic surgery. It is important to emphasize that patients with advanced-stage ovarian cancer are not candidates for laparoscopic surgery.
There are other potential contraindications to laparoscopic surgery. These include multiple prior abdominal surgeries, history of multiple bowel surgeries, severe cardiopulmonary disease, or extreme obesity.
There are other potential contraindications to laparoscopic surgery. These include multiple prior abdominal surgeries, history of multiple bowel surgeries, severe cardiopulmonary disease, or extreme obesity.
New answer by PedroRamirezMD (Physician - (Verified)) in topic(s) Surgery Options, Uterine Cancer Treatment, Ovarian Cancer Treatment, Gynecologic Surgery, Surgery Contraindications, Cervical Cancer Treatment, Laparoscopic Surgery Contraindications, Lapraroscopic Surgery, Surgery, Endometrial Cancer Treatment
1
Answer |
1 year ago
Having one gynecologic cancer does not increase your risk of having other types of gynecologic cancer. However, women with a hereditary cancer syndrome are at increased risk of developing a gynecologic cancer. These syndromes include Hereditary Breast and Ovarian Cancer (HBOC) caused by a BRCA mutation as well as Lynch syndrome, also called hereditary nonpolyposis colorectal cancer (HNPCC). Women with HBOC syndrome have markedly elevated risks of breast cancer and ovarian cancer, with a lifetime risk of breast cancer of 50 to 85 percent and a 15 to 40 percent chance of developing ovarian cancer. There is also an increased risk of a second breast cancer diagnosis.
Lynch syndrome is associated with cancer diagnosis at an early age and the development of multiple cancer types, particularly colon and endometrial cancer. Until recently, the majority of attention and research related to Lynch syndrome has focused on colorectal cancer. However, women with Lynch syndrome have a 27 to 71% risk of endometrial cancer, which equals or exceeds their risk of colorectal cancer. This is significantly higher than the 3% risk of endometrial cancer in the general population. In addition, women with Lynch syndrome have a 8-11% risk of ovarian cancer, compared with 1.5% in the general population. The management of endometrial and ovarian cancer risks in women with HBOC or Lynch syndrome includes surveillance, chemoprevention and risk-reducing surgery.
Lynch syndrome is associated with cancer diagnosis at an early age and the development of multiple cancer types, particularly colon and endometrial cancer. Until recently, the majority of attention and research related to Lynch syndrome has focused on colorectal cancer. However, women with Lynch syndrome have a 27 to 71% risk of endometrial cancer, which equals or exceeds their risk of colorectal cancer. This is significantly higher than the 3% risk of endometrial cancer in the general population. In addition, women with Lynch syndrome have a 8-11% risk of ovarian cancer, compared with 1.5% in the general population. The management of endometrial and ovarian cancer risks in women with HBOC or Lynch syndrome includes surveillance, chemoprevention and risk-reducing surgery.
New answer by PedroRamirezMD (Physician - (Verified)) in topic(s) Ovarian Cancer Risk Factors, Cancer Genetics, Increased Risk Of Colorectal Cancer, Increased Risk Of Ovarian Cancer, HNPCC (Hereditary Nonpolyposis Colorectal Cancer), Breast Cancer Risk, HBOC (Hereditary Breast And Ovarian Cancer), Ovarian Cancer, Risk Factors, Cervical Cancer Genetics, Cancer Syndromes, Ovarian Cancer Risk, Increased Risk Of Breast Cancer, Endometrial Cancer, Endometrial Cancer Risk, Cervical Cancer Risk Factors, Gynecologic Cancer Risk Factors, Ovarian Cancer Risk Assessment, Endometrial Cancer Genetics, Gynecologic Cancer Genetics, Increased Risk Of Endometrial Cancer, Cancer Risk, Breast Cancer Risk Factors, Endometrial Cancer Risk Factors, Breast Cancer Risk Assessment, Lynch Syndrome
1
Answer |
1 year ago
Cervical cancer is staged clinically. This means that if the tumor is very early and only detected by a biopsy, then a cold-knife cone is performed to determine the depth of tumor invasion and thus the stage. If the patient has a visible lesion, then the tumor is staged based on a pelvic examination. During that examination, the physician is trying to assess tumor size and extent within the pelvis. A chest x-ray is commonly obtained to assure that there is no evidence of spread of disease. Surgery is not routinely used to stage cervical cancer.
New answer by PedroRamirezMD (Physician - (Verified)) in topic(s) Biopsy, Cold-knife Cone, Excisional Biopsy, Gynecologic Cancer, Cancer Staging, Cervical Cancer, Cervical Cancer Staging, Chest X-Ray, Tumor Staging
1
Answer |
1 year ago
You should have a Pap smear and pelvic exam every 3 months for 1 year, then every 4 months for the second year, and then every 6 months up to 5 years from your initial diagnosis.
New answer by PedroRamirezMD (Physician - (Verified))
1
Answer |
1 year ago
If a patient is diagnosed with stage IA1 cervical cancer, the patient has the option of treatment by a simple cone biopsy. If the patient has stage IA2 or IB1, then the patient is a candidate for a radical trachelectomy. This procedure removes the cervix, uterus, the parametria (tissue immediately adjacent to the cervix) and the pelvic lymph nodes. It is now commonly performed by the laparoscopic or the robotic approach. The pregnancy rates after the procedure are approximately 50-60%. In addition, the first and second trimester pregnancy loss are the same as the general population. Also, when a patient does get pregnant, she will have a 75% chance of reaching the third trimester. Patients undergoing radical trachelectomy have an excellent survival rate (95%). All patients undergoing this procedure do require a cerclage (suture around the lower segment of the uterus) to maintain the pregnancy and all patients must be delivered by a Cesarean section.
New answer by PedroRamirezMD (Physician - (Verified))
1
Answer |
1 year ago
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