Easy Recovery After Tubal Ligation Reversal Surgery

Pam Mills, a Certified Registered Nurse Anesthetist (CRNA), shares her story of working as part of the anesthesia care team at Chapel Hill Tubal Reversal Center. Pam has been working with Dr. Gary Berger spanning two decades and believes her experience with Dr. Berger has given her the opportunity to work one-on-one with tubal reversal patients in an outpatient setting and to ensure they receive the best medical care they have ever experienced. Ms. Mills explains that the anesthesia team talks with patients individually so gather information about past anesthesia experiences and to develop a personalized anesthesia plan. But Pam is also a believer in the power of positive thinking and works closely with patients to ensure they are calm and informed, with the seed of positive thought planted. She and the rest of the anesthesia staff go the extra mile to ensure the patient's safety, comfort, and sense of well-being before, during, and after the tubal reversal procedure.

Anesthesia for Tubal Ligation Reversal

Submitted by Pam Mills, CRNA

Being part of the anesthesia care team at Chapel Hill Tubal Reversal Center has given me the opportunity to work one on one with tubal reversal patients in an outpatient setting and to assure they receive the best medical care they have ever experienced.

For anesthesia purposes, we record pain scores and the incidence of postoperative nausea for all of our patients. We conduct comprehensive reviews of our data and implement changes to our anesthesia protocol, if necessary. This performance improvement activity is the beauty of working in a small private setting.

All of our patients receive individual attention and care. We have had patients tell us, “This is the first time in my life I have not been sick after anesthesia!” and “This was the easiest anesthesia I have ever had!”

I can’t think of anything more rewarding than to have helped our patients have a safe and pleasant experience while they are here for their tubal ligation reversal procedures.

Personalized Anesthesia Plan

If a patient tells me that she experienced nausea after an anesthetic in the past, I sit down with her and discuss our anesthesia plan and how it is designed to optimize her comfort and well being during her postoperative recovery. I want her to be confident that she will be well taken care of and that we will do everything in our power to make this anesthetic different from what she experienced previously. Our patients receive two medications through their IV to prevent nausea, and for patients with special needs I give what is is fondly referred to as my “special cocktail”. This cocktail has a combination of two additional anti-nausea medications, also given through the IV before the patient wakes up. This covers all the possible trigger centers in the body that can cause nausea.

Power of Positive Thinking

I usually end our discussion of postoperative nausea by telling the patient and family member that this will be the last we will mention of this subject, as I am a firm believer in planting the seed of positive thought. So from then on I want them to focus on positive thinking, knowing that she will be well taken care of and anticipating that she will wake up feeling well and free of pain or nausea.

Patient Care at Chapel Hill Tubal Reversal Center

Our dedication to patient care and outcome is evident in our patient follow up care. Every patient is entered into our computerized database. This database includes information from the day of surgery, their postoperative recovery, follow upcontacts by our nurses, as well as every pregnancy following the tubal reversal procedure through to its outcome. There is no better place for women to have tubal reversal surgery than at Chapel Hill Tubal Reversal Center. Our anesthesia staff goes to extra lengths to ensure the patient’s safety, comfort, and sense of well-being during and after the tubal reversal procedure.

Tags: anti-nausea medications, chapel hill tubal reversal center, nausea, outpatient anesthesia, pain, performance improvement, postoperative recovery, sick after anesthesia, tubal reversal procedure

1. May 5th, 2008 at 6:19 pm
   One of the benefits of having tubal reversal performed at Chapel Hill Tubal Reversal Center is the excellence and dedication of our professional staff that ensures safe and comfortable surgery for our patients. I believe we pay much more attention to the small details that make this a positive experience for each patient. I have received many messages from patients who have said it was the best medical experience they ever had. Pam’s explanation of the anesthesia component helps to explain why this is so.
   


2. Julia Smith RN Says:
   May 5th, 2008 at 6:45 pm

For many women, anesthesia is the scariest part of the surgical experience. I hope that reading about the anesthesia team at Chapel Hill Surgical Center - their experience, compassion, and professionalism - will go a long way toward alleviating some of those fears for our patients.

1. Rhonda Brown RN Says:
   May 5th, 2008 at 8:10 pm
   I think that this is wonderful information for our potential patients wanting to become pregnant after tubal ligation. I think one of the biggest fears that patients have is being put to sleep. I think that we have the best anesthesia team around. They truly put their patients’ safety first. They are dedicated to the best experience for all tubal reversal patients.
   
   
2. Charles Monteith MD Says:
   May 5th, 2008 at 10:09 pm
   The anesthesia team at the Chapel Hill Surgical center is very professional and impressive. It is a pleasure to come to work and experience the positive energy of Pam Mills. She is the best CRNA I have worked with!
   


3. Ericka Pamplin Says:
   May 6th, 2008 at 6:12 am
   Personalized anesthesia plans, documenting pain scores and constant review of performance is evident in the anesthesia team at Chapel Hill Tubal Reversal Center!
   


4. jgokun Says:
   May 6th, 2008 at 8:04 am
   All surgery patients are normally apprehensive about being put to sleep with general anesthesia. Chapel Hill Tubal Reversal patients may rest assured that they are receiving the best possible anesthesia care by a team that works with only our tubal reversal patients. Performing anesthesia for the same surgery and the same type of patient population allows the anesthesia team to provide the most specialized and highest quality anesthesia care possible.
   


5. Dr. Hertz Says:
   May 6th, 2008 at 9:03 am
   The Anesthesia Department works together with Dr. Berger and Dr. Monteith as team to provide the best individualized care for our patients. We look forward to meeting each of our patients, and personalizing their experience!
   


6. Sally Muncy RN Says:
   May 6th, 2008 at 10:44 am
   It is the personal attention and the attention to detail that most of the patients mention when I see them post operatively and in the post operative phone calls that I make. They really appreciate that they were free of nausea and acute pain even though this hasn’t been true for them in the past.
   


7. Stephanie Duncan RN Says:
   May 6th, 2008 at 11:32 am
   Pam and the whole anesthesia team do put a lot of time and thought into making the plan of care specific for each patient. Not everyone is alike and it is great that so much attention to detail is given to everyone who comes to Chapel Hill Tubal Reversal Center.
   


8. Brandon Martin-Williams ST Says:
   May 6th, 2008 at 12:02 pm
   I see it everyday and it still amazes me how well the patients do after their procedure. The anesthesia team here really knows their patients.
   


9. Matt Murphy ST Says:
   May 6th, 2008 at 1:49 pm
   Patients are always say that after there tubal ligation reversal surgery that they are amazed at how well they feel! The extra attention the patients receive is one of the many benefits of having their tubes untied here at Chapel Hill Tubal Reversal Center.
   


10. Donna Blalock RN Says:
    May 6th, 2008 at 2:06 pm
    Having the time to devote to each patient and give such personal attention,is one of my top reasons for working at Chapel Hill Tubal Reversal Center. The entire anesthesia team here is unlike any other facility I know.
    


11. Sarah Meachem RN Says:
    May 7th, 2008 at 10:54 am
    I have had many patients tell me that they can’t believe how easy the tubal reversal surgery was, particulary the anesthesia. The anesthesia department here definitely works as a team and strives to provide the best patient care for each and every woman.
    


12. Kathy Scrone ST Says:
    May 8th, 2008 at 8:30 am
    Pam has written an extensive and thoughtful description of exactly how individualized each patient is cared for at Chapel Hill Surgery Center. Patients can and do feel rest assured of their anesthesia experience and on their way to a positive recovery from their tubal reversal surgery.
    

Chapel Hill Tubal Reversal Center Introduces Dr. Hertz

At Chapel Hill Tubal Reversal Center, the close coordination between the surgical and anesthesia teams makes tubal reversal surgery the safest and most comfortable surgery that is possible. Performing 4 tubal reversal operations together every day, 5 days a week, is unique in the medical field and is one of the factors that makes the tubal reversal experience at Chapel Hill truly exceptional.

Dr. Caryn Hertz, Director of Anesthesia says, “I am dedicated to making each patient’s surgery comfortable and safe. Working regularly with Dr. Berger has enabled me to truly optimize and continually improve the Tubal Ligation Reversal experience for our patients.”

In the Chapel Hill Tubal Reversal Center Blog Dr. Berger welcomes Dr. Split.

Dr. Caryn M. Hertz - Director of Anesthesia

Caryn M. Hertz, MD is a Board Certified Anesthesiologist and has worked in the field for over 20 years. She has devoted her professional career to the subspecialty of ambulatory (outpatient) anesthesia. She has been working with Dr. Gary Berger at Chapel Hill Tubal Reversal Center since 1995.

Originally from Queens, New York, Dr. Hertz attended college at The Cooper Union for the Advancement of Science and Art, graduate school at The University of Pennsylvania, and medical school at the University of Rochester. She completed her residency in anesthesiology at Beth Israel Hospital in Boston (a Harvard affiliate) and at the University of North Carolina at Chapel Hill. After finishing her residency, she was employed at Duke University Medical Center for 5 years, specializing in preoperative assessment and ambulatory surgery. Dr Hertz has worked at Chapel Hill Surgical Center ever since.

Dr. Hertz says, “I am dedicated to making each patient’s surgery comfortable and safe. Working regularly with Dr. Berger has enabled me to truly optimize and continually improve the Tubal Ligation Reversal experience for our patients.”

Dr. Hertz and her family have lived in Chapel Hill since 1989. Having relocated from the Northeast, they very much enjoyed the mild weather, beautiful environment, and remarkable community here in Chapel Hill.

Dr. Berger’s Comment

One of the many things that makes tubal reversal surgery safe and comfortable at Chapel Hill Tubal Reversal Center is the close coordination among the professional staff who work together every day. This makes the tubal reversal procedure go smoothly and without any unnecessary waste of time for the patient who is under anesthesia. It is like a finely tuned orchestra, with each player knowing exactly what the other is doing. This coordinated team work comes only with constant repetition. The surgical and anesthesia staff at Chapel Hill Tubal Reversal Center practice together each day, and doing four procedures a day allows us to work toward the goal of perfection in patient care. It is the goal that we all strive for each day, with each patient, and each tubal ligation reversal. Other doctors and nurses who have visited our facility are amazed at how quickly patients recover from their operations.

6 Responses to “Meet Dr. Caryn Hertz”

1. Rhonda Brown RN Says: April 22nd, 2008 at 6:39 pm I think that it is comforting to patients to know that the person who is in charge of their anesthesia sees each patient as an individual and develops a plan of care specifically for that patient. Teamwork is an important element in exceptional patient care and that is the one thing that comes to mind when I think of Chapel Hill Tubal Reversal Center.


2. jgokun Says: April 22nd, 2008 at 6:47 pm I have had the pleasure of working with Dr. Hertz for the past 10 years. She is an excellent doctor and very conscientious in her practice. Patients coming to our facility for tubal reversal surgery may rest assured that they will be very well taken care of by Dr. Hertz and her anesthesia department.


3. Julia Smith RN Says: April 22nd, 2008 at 9:24 pm I have worked with Dr. Hertz since 1995 and know that she always keeps patient safety as a priority!


4. Matt Murphy ST Says: April 23rd, 2008 at 6:32 am I have had the pleasure of knowing Dr. Hertz for many a year and I have worked with her for 3 years. She plays a very important role in keeping the safety and comfort of our patients first.


5. Ericka Pamplin Says: April 23rd, 2008 at 6:51 am It’s a pleasure to work with Dr. Hertz! Her dedication and concern for patient safety and comfort, will assist in meeting the daily goal of striving towards perfection in patient care.


6. Kathy Scrone ST Says: April 23rd, 2008 at 12:50 pm Dr. Hertz is an expert in her field and puts the safety and care for her patients first. I would not hesitate to receive anesthesia care from Dr. Hertz. Her work is valued at Chapel Hill Tubal Reversal Center.

Chapel Hill Tubal Reversal Center Welcomes Dr. Split

Dr. James Split, a board certified anesthesiologist, is the newest member of the Chapel Hill Tubal Reversal Center staff. Although only 4 tubal reversal surgeries are performed each day at Chapel Hill Tubal Reversal Center, there are 2 anesthesiologists and a nurse anesthetist on staff. The primary responsibility of the anesthesia department is to ensure patients' safety during surgery and comfort during recovery. Many of Dr. Berger's patients who are having their tubes untied will be speaking with Dr. Split as a part of their preoperative evaluation and will meet him on the day prior to or on the day of their tubal ligation reversals.

In the Chapel Hill Tubal Reversal Center Blog Dr. Berger welcomes Dr. Split.

It is a happy occasion to introduce another new member of the staff of Chapel Hill Surgical Center. Dr. James Split is a Board Certified Anesthesiologist. He has worked at Chapel Hill Surgical Center since December 2007. He previously lived and worked in Greensboro, North Carolina for the last 18 months. Before moving to North Carolina, Dr. Split practiced medicine in Michigan for 25 years. He obtained his medical degree at the University of Michigan in 1979 and practiced Emergency Medicine for the first 11 years of his career. He both practiced and taught Emergency medicine in an Emergency Medicine Residency and held a clinical faculty position at Michigan State University. In 1990, he returned to the University of Michigan to train in anesthesiology. He completed his anesthesiology residency in 1993 and has been in the full time practice of anesthesiology since then. Dr. Split is a member of the American Society of Anesthesiologists and The Society for Ambulatory Anesthesia.

Dr. Split will be speaking with many of you as part of your pre-operative evaluation. If you have any general questions about anesthesia, you can add comments to this blog or post them on the Tubal Reversal Message Board and he will to answer them. If you have specific questions that require privacy, or that may not be of interest to others, please send Dr. Split an e-mail to DrSplit@tubal-reversal.net and he will respond.

Dr. Berger’s Comment

The highest priority for patients who come to me for tubal reversal surgery to untie tubes is patient safety during and after surgery. This is ensured by the involvement of medical professionals who are the most highly trained and qualified specialists. Our two anesthesiologists are certified by the American Board of Anesthesiology. The anesthesiologist is the physician responsible for the monitoring and care of patients while they are asleep during their tubal reversal procedure and for their safe and comfortable recovery in the post anesthesia care unit (PACU). Dr. Split’s background in Emergency Medicine gives him an added dimension of knowledge and experience. On behalf of all of our staff, I am very pleased to welcome Dr. Split to Chapel Hill Surgical Center and Chapel Hill Tubal Reversal Center.

1. Rhonda Brown RN Says:
   
   April 18th, 2008 at 9:37 pm
   

   Dr. Split is a positive addition to the anesthesia team at Chapel Hill Tubal Reversal Center. His interaction with the patients during their preop consultation has made it obvious of his desire for optimal patient care.



2. Stephanie Duncan RN Says:
   
   April 19th, 2008 at 8:58 am
   

   It is a pleasure to work with Dr. Split in the operating room each and every day! He goes the extra mile to make patients feel safe and well cared for before going to sleep. His experience and background makes him a good fit for Chapel Hill Tubal Reversal Center.



3. Julia Smith RN Says:
   
   April 20th, 2008 at 9:15 am
   

   We are excited to have Dr. Split with us. I know that our patients will appreciate his skill as an anesthesiologist as well as his professional and compassionate bedside manner.



4. Ericka Pamplin Says:
   
   April 21st, 2008 at 6:20 am
   

   It is a pleasure to work with you, Dr. Split!



5. Pamela Mills CRNA Says:
   
   April 21st, 2008 at 6:29 am
   

   It is a pleasure to work with Dr. Split; he is a terrific addition to our team!



6. Matt Murphy ST Says:
   
   April 21st, 2008 at 6:52 am
   

   I’m so glad to have him on our team! He is an excellent anesthesiologist and is great with the patients.



7. jgokun Says:
   
   April 21st, 2008 at 9:24 am
   

   Patients are often very apprehensive about their anesthesia for the tubal reversal surgery. Dr. Split is extremely friendly and I think he does a great job of putting patients fears aside and helping them to feel comfortable about their upcoming procedure.



8. Kathy Scrone ST Says:
   
   April 21st, 2008 at 11:36 am
   

   Patients at Chapel Hill Surgery Center feel reassured and comfortable that they are taken care of in such a professional and caring manner by Dr. Split. I enjoy working with him.



9. Sarah Meachem RN Says:
   
   April 21st, 2008 at 2:44 pm
   

   It has been a pleasure to work with Dr. Split - he has been a great addition to our staff!

Making Tubal Reversal Comfortable For The Patient

The Best Surgical And Anesthetic Techniques Traditionally, tubal reversal surgery is a major operation with several days of recovery in a hospital. This is due to surgical techniques that result in post-operative pain and disability.

Postoperative pain after abdominal surgery is due primarily to injury to the muscles and other tissues that occurs when using standard surgical techniques. For example, abdominal retractors (metal instruments that pull back on the skin and muscles to provide wide exposure for viewing the pelvic organs) cause reduced blood flow to tissues during the entire time they are being held apart by the retractors.

In my experience with over 6000 outpatient tubal reversals, the operation is best performed using no retractors at all, just the surgeon's fingers which are the gentlest of all instruments.

Traditionally, surgical packs (large gauze pads) are placed into the abdomen to push the intestines away from the pelvic organs. These are unnecessary in most cases.

Most surgeons don't think about how to minimize the pain of surgery. They just prescribe strong pain killers afterwards that make the patient sleepy and often unable to move take care of themselves. Since the traditional approach results in hospital care, this doesn't seem to be a problem (from the surgeon's point of view).

By injecting a local anesthetic in all areas where surgery is performed (including the skin), patients can awake in comfort and be alert since they won't need repeated doses of narcotic medications.

These are some of the methods that I use that make tubal reversal comfortable as outpatient surgery. Making the surgery comfortable avoids the need for hospital care and reduces the cost to the patient.

Outpatient Anesthesia at Chapel Hill Tubal Reversal Center