Complicated Cancer Surgery With Minimal Blood Loss

When Sarah Guman of Olyphant, Pa., was diagnosed with a large ovarian tumor in late April 2021, she learned she would need a complete hysterectomy. Doctors wouldn’t know until they operated if it was malignant, but after months of constipation and urinary leakage, Guman, then 69, was grateful to finally have a plan of action.

She had one condition, though: As one of Jehovah’s Witnesses, she would not accept a blood transfusion and required bloodless surgery. “My doctor didn’t offer it,” Guman says, “but she referred me to Lehigh Valley Health Network’s Patient Blood Management Program. I immediately called them and was told they could accommodate me. It took such a weight off my mind.”

Shortly afterward, Guman received a call from Kelly Frinzi, patient liaison for the blood management program, who quickly contacted gynecologic oncologist Christine Kim, MD, with Lehigh Valley Topper Cancer Institute, to schedule an appointment. Kim rearranged her schedule to see Guman the same day at LVPG Gynecologic Oncology–Pocono in East Stroudsburg, close to Guman’s home.

“The ovarian mass was the size of a watermelon and was pressing on her colon and bladder,” Kim says. “We needed to perform surgery quickly to obtain a diagnosis and ensure it didn’t spread if it was malignant. Bloodless surgery was definitely doable.”

Kim was able to operate on Guman May 11 at nearby Lehigh Valley Hospital–Pocono.

To avoid a blood transfusion, Kim’s team brought in a cell salvage machine to collect drops of Guman’s own blood lost during surgery and return red blood cells to her if necessary.

“LVHN offers many blood conservation techniques for a variety of procedures,” says Cancer Institute hematologist-medical oncologist Bradley Lash, MD, who helped develop the blood management program. “We partner with patients and their medical team to create a personalized care plan for their specific blood needs, whether due to religious beliefs or health concerns. Bloodless surgery is just good medicine for everyone and improves outcomes.”

Next, the anesthesia team, led by Benoy Paul, MD, placed an epidural catheter in Guman’s spine to minimize use of opioid medication during and after surgery, which can cause constipation, vomiting and other complications.

Kim then made a large vertical incision extending above Guman’s navel and removed her ovaries, fallopian tubes, uterus, cervix and omentum (a fatty tissue that hangs over the abdominal organs). The ovarian mass turned out to be a slow-growing type of cancer called a mucinous borderline tumor. Kim also discovered a second mass in Guman’s appendix – a different type of cancer – that required additional removal of her appendix, small bowel and part of her colon.

Despite undergoing complex surgery, Guman went home four days later without pain or opioid side effects. Best of all, because blood loss was minimal (about 6 ounces), the cell salvage machine was never needed.

“Our expert team is specially trained to perform complicated gynecologic surgeries with minimal blood loss so we can accommodate Jehovah’s Witness patients and others seeking bloodless surgery close to home,” Kim says.

Guman is now feeling great and hopes to soon resume riding her motor scooter with her husband. She attributes her successful surgery to quick action by the blood management team and her surgical team’s expertise.

“To find a local medical team that’s both skilled and who respects my beliefs is priceless,” Guman says. “Kelly was my advocate every step of the way, and Dr. Kim carefully explained everything beforehand – I trusted her completely. When I think of my experience at LVHN, phenomenal is the word that comes to mind.”

LVHN’s Patient Blood Management and Bloodless Surgery Program can answer your questions about how blood is conserved during surgery.

You also can call 888-402-LVHN (5846) for more information.