Minimally Invasive Gynecologic Surgery: Pursuing a gentler path

May 9, 2010 at 8:02 pm 5 comments

Minimally invasive surgery includes a diverse and varied set of techniques which differ from traditional “open” surgery.  When open surgery occurs in the abdomen, it is performed through an incision called a  laparotomy.  Put simply, the goal of minimally invasive gynecologic surgery is to avoid unnecessary laparotomy.

Avoiding large incisions allows a surgeon to offer patients a faster recovery, decreased pain from surgical incisions, a more rapid return of bowel function, and decreased risk of certain types of complications.  Patients usually go home the same day or stay in the hospital only one night.

There are several common techniques used in minimally invasive surgery.  These include the use of laparoscopy (aka bandaid surgery, keyhole surgery, or pinhole surgery) and mini-laparotomy.

Laparoscopy is a type of sugery in which a camera is attached to a thin instrument (the laparoscope) which can be inserted into the abdomen through a very small incision.  This allows the surgeon to see the entire abdominal cavity without creating a large incision.  Additional small incisions may be made so that thin surgical instruments can be inserted into the abdominal cavity. 

Many types of surgery can be performed in this manner, including certain types of hysterectomy (removal of the uterus), removal of fibroids and ovarian cysts, treatment of endometriosis, and treatment of other kinds of gynecologic disorders.

Mini-Laparotomy is sometimes combined with laparoscopy to allow a much smaller abdominal incision in certain types of surgery which would otherwise have to be done by laparotomy.

When you need surgery, it is important to have a discussion with your doctor about how your recovery can be optimized.  Minimally-invasive surgery could be the best option for you.

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Entry filed under: Gynecology, Minimally Invasive Surgery. Tags: , , , , , , , , , , , .

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5 Comments Add your own

  • 1. John Tubbs  |  February 4, 2011 at 2:06 pm

    This is great blog really! Thank you very much for sharing such valuable information! You tell about those problems that most women are very much concerned about.

    Reply
  • 2. K.Uhlir  |  February 12, 2011 at 12:21 am

    I see in the research that some doctors are performing operative hysteroscopy in the office setting without anesthesia. How could I find such a doctor in my area?

    Reply
    • 3. drnicoll  |  February 15, 2011 at 12:47 am

      Hi there,
      Many doctors perform diagnostic hysteroscopy in their offices. Some use no anesthesia, some use local anesthesia, and others use oral medications. Some doctors do not have an office with the space, personnel, or patient volume to support a dedicated space for operative procedures. These doctors use surgi-centers or hospital facilities for hysteroscopy (even if they do not utilize anesthesia).

      As opposed to diagnostic hysteroscopy, operative hysteroscopy is less commonly perfomed in an office setting because an operative hysteroscope (the instrument used to remove fibroids and some polyps) has a wider diameter and often requires dilatation of the cervix. Because dilatation of the cervix can cause significant discomfort (and because operative hysteroscopy requires additional equipment and monitors as compared to diagnostic hysteroscopy) it is not as commonly performed in an office setting.

      If you desire for your procedure to be perfomed in a particular setting or in a particular way, you’ll have to spend some time seeking out a provider who offers what you seek. The best way to find a provider is to ask around. Look up doctors in your health insurance directory, on the website of a major medical center, or by asking your primary care provider. If you already have a gynecologist who doesn’t perform office hysteroscopy, ask her whether she might suggest a colleague who does.

      When you call for an appointment as a new patient, ask whether the doctor performs hysteroscopy. If so, you can ask whether it is performed in the office or at an outside facility (like an outpatient surgi-center or in the ambulatory/outpatient surgery division of a hospital).

      Just because a doctor performs hysteroscopy in his or her office doesn’t mean anesthesia isn’t used. Some gynecologists hire an anesthesiologist to care for patients during office-based surgery. And hysteroscopy that is performed in a surgi-center or hosptal can often be performed with minimal or no anesthesia.

      The key is to find a doctor who performs the procedure you require and to have a conversation which addresses the following questions

      1. what are the pros and cons of the setting offered (office vs. outside facility)?
      2. how much discomfort can you expect from the planned procedure?
      3. what do you want/expect from your desired form of pain management?
      4. what form of pain relief or anesthesia (if any) is available?
      5. what safeguards are in place to deal with complications (of both the procedure and the anesthesia)?

      You can also check websites and referrals through the American Association of Gynecologic Laparoscopists or the Society for Laparoendoscopic Surgery, two organizations which help gynecolgists stay current with techniques in minimally invasive surgery.

      Best of luck!
      -Dr. N

      Reply
  • 4. Minimal Access Surgery  |  September 20, 2011 at 7:24 am

    nice article …. got much info on minimally invasive surgery ..thnx

    Reply
  • 5. Paulmodi  |  May 17, 2014 at 7:23 am

    This approach is so informative. I enjoyed it because it includes all the necessary facts of minimally invasive surgery. Thanks for this post.

    Reply

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Linda M. Nicoll, MD

Welcome to my blog! Here you will find information about minimally invasive gynecologic surgery as well as some more general information about common gynecologic disorders such as endometriosis, ovarian cysts, fibroids, infertility, and pelvic pain.

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