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ANN ARBOR, MI -The Lintner family will have a wondrous reason to celebrate this holiday season: baby Maia, a gift Carrie and Brad Lintner hadn't thought possible when Carrie began fighting her second bout with Hodgkin's lymphoma.
She would need pelvic radiation treatment for her cancer, which was stage III Hodgkin's lymphoma and far more advanced than the stage I Hodgkin's she had conquered years earlier. “Immediately I started to wonder, ‘if I have to undergo radiation, what about a family?' ” recalls Lintner, 31, a dentist in Kalamazoo, Mich. “It was always one of my hopes to have kids.” She and her husband, Brad, came to the University of Michigan Health System to discuss their options with Arnold Advincula, M.D., clinical assistant professor and director of minimally invasive surgery in the Department of Obstetrics and Gynecology at the U-M Medical School. “With the radiation therapy, there was a huge concern that Carrie's fertility may be significantly impacted, particularly since her recurrence manifested itself in her pelvic area,” Advincula says. “Initially, she thought she had no options for maintaining her fertility. But she was motivated to look into what is available out there, and that prompted her to discover that there were several things available to her in the medical world that could potentially salvage her fertility.” Advincula worked with her radiation oncologist and presented the Lintners with one of those options: ovarian transposition, a process in which the ovaries are relocated as a way of potentially preserving a patient's fertility. In this case, the ovaries were relocated behind the uterus, allowing the uterus to act “as a makeshift shield” against the radiation since her Hodgkin's recurrence was in her groin, Advincula explains. While the procedure could be done with conventional laparoscopy, a technique in which a slender instrument with a light source and video camera is inserted below the belly button, Advincula opted for the use of robotic technology.
All of this was done in the hope that Carrie would be able to conceive with the ovaries left in this position, he says, because the integrity of the fallopian tube and the blood supply to the ovaries was not compromised. There was no guarantee that it would work, but Advincula hoped that his patient would at least preserve her ovarian function and not enter menopause at an early age. But would the procedure allow Carrie to conceive? Only time would tell – and, as it turned out, not much time was needed. Shortly after the ovarian transposition, the Lintners were preparing to go out of town for the Fourth of July. Before they left, Carrie thought she should take a pregnancy test – and it came back positive. She was stunned – so stunned, in fact, that she didn't trust the results. She followed with several more tests in the next two days, until she had a half-dozen tests showing that she was, indeed, pregnant. “I had a very, very easy pregnancy. I loved being pregnant. I had an easy labor, too. And on Feb. 25, Maia was born and everything went smoothly. She was just a healthy kid and I immediately said, ‘Are you OK?' That was the first thing I said to her,” she says, tears streaming down her face. “She is an absolute joy. She is the light of my life, and I feel complete. She was meant to be. I feel very much like it's a miracle.” Since then, Carrie has had a PET scan to check for recurring cancer that came back clean, adding another reason for holiday celebrations. Advincula is thrilled for the Lintners, and he is hopeful about further advances in technology that will help other women in the future. “We were extremely excited with Carrie's case,” he says. “There are things that are changing on an almost daily and weekly basis in the field of medicine that are helping physicians who take care of women with cancers to preserve their fertility.” Facts about Hodgkin's lymphoma and preserving fertility:
For more information about Hodgkin's lymphoma, preserving fertility, minimally invasive surgery and more, visit these Web sites: U-M Comprehensive Cancer Center: Hodgkin's and Non-Hodgkin's Lymphoma U-M Obstetrics and Gynecology Minimally Invasive Surgery Program www2.med.umich.edu/departments/obgyn/index.cfm?fuseaction=Obgyn.MISP American Cancer Society: The effects on fertility of radiation therapy to the pelvis www.cancer.org/docroot/MBC/content/MBC_2_3X_What_Side_Effects_Occur_ National Cancer Institute: Facts about radiation therapy U-M Comprehensive Cancer Center: Fertility Counseling and Gamete Cryopreservation Program U-M Comprehensive Cancer Center : Fertility and cancer information guide The Female Patient: “This is My Assistant, Dr. Robot.” Ob/GYN Editorial, July 2004
Written by Katie Gazella
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“Robotic surgery is essentially laparoscopy, but it utilizes technology that is far advanced when compared to conventional laparoscopy. The major advantages are that you're utilizing a three-dimensional visualization, which is a huge advantage to the surgeon, and that your instruments now move like the wrist on your hand,” Advincula says. 
