Dr. Resnik has broad expertise in gynecologic oncology and a well-established reputation for effective management of complex patient cases. Now, he offers a wide range of gynecologic procedures close to home.
Ephraim Resnik, MD, FACS, FACOG, conducts a patient consultation to discuss a minimally invasive surgical procedure.
In his practice, Dr. Resnik treats conditions ranging from benign fibroids to ovarian cancer. He is especially proficient in assisting patients who have comorbidities, such as obesity or previous abdominal surgeries, which may complicate care. At Nyack Hospital, he is leveraging his rich background in academic medicine to expand access to advanced medical surgical interventions.
Dr. Resnik is a familiar face at the hospital, having first served there from 1999 until 2012, during which time he was also on the faculty at Columbia University. He then focused exclusively on academic medicine for several years but recently resumed his work at Nyack Hospital. With Dr. Resnik on site, gynecologic oncology care is again available at the hospital. Patients also benefit from the depth and breadth of his experience, which enhances the type and complexity of surgeries performed there.
“Gynecologic oncology is a rare specialty,” Dr. Resnik says. “At community hospitals, it’s the exception, not the rule. There was no gynecologic oncologist in Rockland County or Orange County. Now, any woman who has reproductive tract cancer can see a trained subspecialist in the field. This makes a big difference because outcomes and survival are superior when a subspecialist in gynecologic oncology performs the surgery. Additionally, many general gynecologists don’t feel comfortable operating on people who have multiple previous surgeries or other comorbid conditions. With a subspecialist on staff, those patients no longer have to journey to the city for surgery.”
Colleagues and former patients alike welcomed Dr. Resnik with open arms.
“It was a sweet homecoming,” he says. “It boosted my spirits to come home and get that reception after being away for five years.”
Laparoscopic Surgery for a Range of Conditions
Approximately half the time, Dr. Resnik says, patients are referred to him with a benign condition or suspicion of cancer. In the remaining cases, cancer has already been diagnosed by a primary gynecologist. The most frequent condition he treats is endometrial cancer, which is typically diagnosed in the early stages due to excessive bleeding or bleeding after menopause. Other gynecologic conditions treated at Nyack Hospital include ovarian cancer, cervical, vulvar and vaginal cancer, fibroids, and ovarian cysts. As often as possible, Dr. Resnik performs surgeries minimally invasively, using laparoscopy to identify and remove the cancer or mass.
Dr. Resnik is assisted by Adrienne Fueg, MD, FACS, during a procedure.
Dr. Resnik performs a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy.
“Our standard of care is minimally invasive surgery,” he says. “The techniques are difficult to master and require a high volume of cases to become proficient in, but they result in benefits including faster recovery and higher survival rates.”
Dr. Resnik has performed about 1,000 minimally invasive laparoscopic gynecologic procedures. He enjoys highly challenging procedures. Patients benefit from the already-established relationship between him and the surgical and nursing team, which has long familiarity with his standards and procedures. He is especially gratified to be operating again with laparoscopic surgeon Aleksandr Rakhlin, MD, FACS.
“It’s crucial for sophisticated minimally invasive surgery to be performed by a team of physicians who work together regularly,” Dr. Resnik says. “Laparoscopy requires two sets of hands and eyes. Dr. Rakhlin is a superb minimally invasive surgeon, and it’s a tremendous advantage to my patients that he can join me in the OR.”
Though difficult to master, laparoscopic techniques offer numerous benefits to patients. Surgeons perform procedures through tiny incisions, leading to less pain after surgery. Patients also experience fewer complications and more rapid healing, allowing them to go home and resume their daily activities sooner than with open surgery.
“We’ve been able to protocolize early discharge, depending on whether patients meet certain strict criteria,” Dr. Resnik says. “For example, patients who undergo hysterectomy can go home the same day — the majority within five or six hours postoperatively — if they’re free of complications. We’re adopting protocols from Europe involving early feeding and early ambulation. Patients benefit from lower infection rates, a quicker return to functionality and an overall better experience.”
Ovarian Cancer: A Perennial Challenge
When patients present early in the disease process, surgery and recovery can often occur rapidly, and Dr. Resnik is dedicated to returning patients home swiftly. However, some gynecologic conditions have few symptoms in the early stages, making prompt detection extremely difficult. Ovarian cancer, for instance, accounts for more fatalities than any other gynecologic cancer in the U.S. — about 14,000 each year. The disease is typically diagnosed at stage 3 or 4, Dr. Resnik says, and his patient population closely mirrors this national trend.
Aleksandr Rakhlin, MD, FACS, an expert in single-incision laparoscopic surgery, frequently assists Dr. Resnik.
“With ovarian cancer, and sometimes cervical and vulvar cancers, the situation is not so simple,” he explains. “Patients may be sent to me with a suspicion of disease but without a diagnosis or full knowledge of how far the cancer has spread. These patients need a full diagnostic workup. It’s heartbreaking when a disease like that is diagnosed at so advanced a stage; cure is far more difficult to achieve.”
In response to these challenges, Nyack Hospital offers infusion and radiation therapy in addition to surgery for ovarian cancer. Practice Administrator Regina Byrnes helps coordinate care and assists patients in navigating through a multidisciplinary approach to treatment. When appropriate, oncologists at Nyack Hospital offer therapy tailored to individual patient or tumor genetic makeups. Genetic mutations that sometimes cause ovarian cancer include the BRCA1 and BRCA2 mutations — which are also responsible for certain breast cancers — as well as Lynch syndrome, which is linked to colon cancer. Some mutations can be addressed by immunotherapy.
“Immunotherapy has really grown over the past several years,” Dr. Resnik says. “The drugs target very specific molecules and are administered to patients who have certain cancers, an innovative medical approach that destroys specific cells and spares healthy tissue. Several medications on the market have been proven effective in clinical trials for ovarian and cervical cancer, and our medical oncologist offers those as appropriate.”
Advanced Pelvic Surgery: Skill Leads to Hope
Some types of patients may have trouble finding surgeons qualified to operate on them. These include patients with comorbidities or risk factors such as multiple previous surgeries. In fact, Dr. Resnik says, patients who present with endometrial cancer very often do have comorbidities such as obesity, high blood pressure and diabetes, and even benign conditions such as fibroids pose extra problems for larger patients and their surgeons. For example, a patient may have a uterus size equivalent to that of late-stage pregnancy due to fibroids or other enlarged organs due to comorbidity, leaving the surgeon little room to operate.
Members of the Nyack Hospital OR: Teri Egitto, BSN, RN, MBA, Director of Perioperative Services; Dr. Resnik; Joy Zaharia, BSN, RN, CNOR, GYN Service Leader; Susheela Matthews, MSN, RN, CNOR–Nurse Manager OR, PACU, ENDO
“I strategize in advance how to avoid damage to surrounding organs,” Dr. Resnik says. “The surgeon has to plan the approach from the entry point through the whole procedure to the method of exiting.”
In such cases, Dr. Resnik performs open surgery, selecting the best entry points to minimize the length of the incision and the duration of the procedure.
“The longer the body cavity is open, the more likely complications are,” he says. “Speed of surgery directly relates to a surgeon’s experience, and it’s very important to patient outcomes. At Nyack Hospital, we’ve been performing these surgeries for years, and our outcomes are superior to those of a community hospital without a dedicated gynecologic service.”
Dr. Resnik welcomes new and returning patients from area providers, many of whom are familiar with his work. Referring gynecologists play an important role in his patients’ care, he says, and he takes steps to return patients seamlessly to their original physician as they recover.
Highland Medical Gynecologic Oncology staff Nancy Bello, Authorizations Specialist; Neka Hayles, Medical Assistant; Ephraim Resnik, MD, FACS, FACOG; and Regina Byrnes, Practice Administrator
“I love my patients. I love to interact with them individually and also with their extended families. They are often older women who come with their children and spouses, who all care very much about their wives, mothers and grandmothers. It is a nice feeling to help them. At the same time, I enjoy the highly technical and challenging aspects of surgery.”
— Ephraim Resnik, MD, FACS, FACOG
“I’ve made it a rule that once I provide the service for which a patient was referred to me, I put together a follow-up plan with alternating visits, so the primary referring physician doesn’t lose touch with the patient,” Dr. Resnik says. “After five years without recurring disease, the patient is considered clinically cured, and she has retained her relationship with her referring physician. After surgeries for benign conditions, I typically see patients for two follow-up appointments and then send them back for routine annual care with their referring physician.”
In this way, Dr. Resnik nurtures ongoing relationships among his patients, their referrers, Nyack Hospital and the community that so eagerly welcomed his return.
For additional information, visit www.nyackhospital.org/highland/gynecologic-oncology.