Posts tagged ‘gynecologic surgery’

Learn more about Minimally Invasive and Robotic Surgery

I’d like to invite you to my website www.MinimallyInvasiveGYN.com

I’m a strong believer in laparoscopic and robotic surgery for a single, simple reason. It’s better for the patient. Minimally invasive surgery, a catch-all term which includes laparoscopy, hysteroscopy, and robot-assisted surgery, has proven benefits.

The benefits of minimally invasive surgery, compared to conventional “open” surgery include:

• less post-operative pain
• reduced need for pain medication
• faster return of normal appetite and bowel function
• smaller incisions
• less scarring
• faster recovery and return to work

Robotic surgery in particular has advantages which allow the surgeon to perform more complex procedures via a laparoscopic approach than might otherwise be possible. The robotic system gives the surgeon the benefits of:

• greater magnification with the laparoscopic camera
• 3 dimensional (3D) vision
• greater range of motion for laparoscopic instruments
• increased comfort, which may reduce a surgeon’s fatigue during long procedures
• reduction of biologic hand tremor

The robot doesn’t bear much resemblance to what we’ve come to expect from science fiction. It doesn’t have artificial intelligence and it cannot operate independently. In fact, the robot is just another instrument. It is controlled by the surgeon who sits at a console next to the patient.

The Da Vinci Robotic Surgical System

The robot has arms whose attachments are miniature versions of conventional surgical instruments (i.e. scissors, clamps, needle and suture-holders). These tiny instruments mimic the surgeon’s movements at the console (but on a much smaller scale). This allows the surgeon to perform surgical procedures with extraordinary precision.

Laparoscopy revolutionized surgery by making many major surgeries into outpatient procedures. Robotic surgery is revolutionizing laparoscopy by broadening the range of surgeries which can be performed with a minimally-invasive approach.

Take charge of your health by learning more about minimally invasive and robotic surgery. An educated patient is an empowered patient!

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February 25, 2012 at 12:51 am 4 comments

Demystifying Hysterectomy Part III: Risks and Benefits

Having a hysterectomy means that you will no longer have the ability to bear children.  It also means you should no longer experience menstrual bleeding (although you may experience other cyclic changes depending upon whether you still have ovaries).  Hysterectomy alone (ie without removal of or damage to the ovaries) does not result in menopause.  However, hormonal changes after hysterectomy are possible. 

Many women are concerned that removal of the uterus will adversely affect their sexual functioning and satisfaction.  There are no studies demonstrating that hysterectomy (with or without removal of the cervix) has a negative effect on patients’ sex lives.  Neither the uterus nor cervix itself contributes to vaginal lubrication or orgasmic response. Most patients’ male partners can not detect the presence or absence of a uterus or cervix and among those who can, few feel that it impacts their experience during intercourse.  Therefore, the best predictor of sexual satisfaction and functioning after hysterectomy is your sexual satisfaction and functioning prior to surgery.

You should discuss these concerns with your gynecologist before considering any kind of surgery to remove all or part of your uterus.

Complications from hysterectomy are uncommon but can be serious.  Although it is impossible to predict or list every possible problem, these infrequent complications may include infection, bleeding, thromboembolic events (blood clots), injury to adjacent organs, bladder or bowel dysfunction, nerve injury, postoperative pain, and anesthesia complications.  You should talk to your doctor about the possible complications of any treatment you consider undergoing.

Hysterectomy is permanent.  Even when performed via minimally invasive techniques, it is still a major surgery. 

Other options for managing certain gynecologic conditions may be appropriate.  These options may include expectant management (watchful waiting), therapy with hormonal or other types of medication, the use of interventional radiology (uterine artery embolization), targeted ultrasound ablation, or other fertility-sparing surgical procedures (myomectomy, ablation of endometrium or endometriosis).

The choice of whether hysterectomy is the right option for you depends on a number of factors.  Talk to your doctor about your condition and all of your options when considering hysterectomy as part of a treatment plan.

May 17, 2010 at 6:32 pm 3 comments

Demystifying Hysterectomy Part II: “How and why is hysterectomy performed?”

A hysterectomy can be performed in several ways. Minimally invasive surgical techniques include the removal of the uterus (and/or ovaries) through laparoscopy, a surgical technique which involves the insertion of long thin instruments through very small holes in the patient’s abdomen.  Hysterectomy can also be done via the vagina in a procedure called vaginal hysterectomy.  Despite the proven benefits of minimally invasive surgical techniques, the most common method of removing the uterus is still through an open abdominal incision called a laparotomy.  

Hysterectomy is used to treat a number of gynecologic conditions including uterine fibroids, adenomyosis, endometriosis, intractable pelvic pain, pelvic organ prolapse, and certain types of cancer.  It may also be required in certain types of emergencies (such as hemorrhage during childbirth) or electively (in persons undergoing gender reassignment).

May 14, 2010 at 3:42 pm 3 comments

Demystifying Hysterectomy Part I: What is a hysterectomy?

Hysterectomy is the most commonly performed gynecological surgical procedure. Over 600,000 hysterectomies are performed in the United States every year, most often for benign (non-cancerous) conditions. 

But what is hysterectomy?  Literally, the term means “removal of the uterus.”  But there are many types of hysterectomy and several ways in which it can be performed.

First, the types:

A total hysterectomy (often called a complete hysterectomy) means surgical removal of the uterine body or corpus, the dome of the uterus or fundus, and the neck of the uterus or cervix.

The term partial hysterectomy is often used to describe what doctors call a supracervical hysterectomy.  This surgery involves removal of the uterine body and fundus.  It leaves all or a portion of the cervix intact. 

Patients with certain types of cervical cancer may require a procedure called radical hysterectomy, which involves the removal of all parts of the uterus as well as other tissues adjacent to it the pelvis, including the upper vagina. 

The removal of the ovaries and fallopian tubes, called salpingoophorectomy, is not included in any of the terms describing hysterectomy, even if both procedures are done at the same time.

May 11, 2010 at 6:55 pm Leave a comment

Minimally Invasive Gynecologic Surgery: Pursuing a gentler path

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.

May 9, 2010 at 8:02 pm 5 comments

Understanding Ovarian Cysts

Ovarian cysts are very common and can affect women of all ages.  Most women will have an ovarian cyst at some time in their reproductive lives.  Although they are less common after a woman stops menstruating, they are present in up to 14.8% of postmenopausal women.

But what is an ovarian cyst?  An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary (one of a pair of organs in the pelvis responsible for producing female hormones and eggs).  Eggs normally mature within the ovaries in small, fluid filled spaces called follicles.  Any ovarian follicle larger than two centimeters can be called an ovarian cyst.  They vary greatly in size (as big as a cantaloupe or larger!) and in etiology.  Most ovarian cysts are benign (non-cancerous) in nature.  Several common types are

  1. functional (or simple) ovarian cysts, which are related to the menstrual cycle and often resolve on their own
  2. endometrioid cysts, which are due to endometriosis, are often called “chocolate” cysts or endometriomas
  3. dermoid cysts (or teratomas) which can have solid components like hair or teeth

 

Many ovarian cysts are asymptomatic and are discovered only incidentally at the time of an exam or ultrasound.  However, some ovarian cysts cause problems.  Rupture of an ovarian cyst can cause bleeding or pain.  An enlarged ovarian cyst can cause an ovary to twist on the stalk containing its blood supply, a condition called torsion.  Ovarian cysts may also interfere with fertility treatments and goals. 

Surgery may be required to remove large cysts or to make sure a cancer is not present.

If you think you have symptoms consistent with an ovarian cyst, it is important to be evaluated by a physician.  Ultrasound or other imaging as well as simple blood tests may be done to help determine whether treatment is necessary. 

 

May 8, 2010 at 2:57 pm 38 comments

I’m The Gynecologist!

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.

Continue Reading May 6, 2010 at 4:32 pm 13 comments


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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