Gynecology Minimally Invasive Surgery
Gynecology Minimally Invasive Surgery
Today, minimally invasive surgeries are very common in gynecology thanks to advances that allow surgeons to work with tiny incisions (in some cases only a few millimeters long).
Hysterectomy is a gynecological surgery to remove the uterus. It is a very common treatment for patients with severe uterine health problems. Often (far too often, if you ask me), this procedure is done as a “traditional open surgery” with hospital admission, multi-day hospital stay, a large abdominal incision, and a recovery that can last multiple months.
Nowadays, hysterectomies don’t have to be like that. With advances in women’s healthcare, we can (and should!) turn hysterectomies into minimally invasive procedures where the patient goes home the same day and can return to normal activities in just a few weeks.
Many patients choose a hysterectomy after they have exhausted all other treatment options. However, it’s not uncommon to wait to have a hysterectomy until you’re finished having children. Because any hysterectomy involves surgical removal of the uterus, you can no longer become pregnant after a hysterectomy.
Some women with a family history of some cancers may choose this procedure to help reduce the chances of such problems as they age.
Some gynecological conditions that may be treated with a hysterectomy include:
- Severe endometriosis
- Uterine fibroids
- Uterine prolapse
- Cancer of the uterus or other nearby reproductive organs
- Abnormal uterine bleeding
- Chronic pelvic pain
Uterine fibroids — also known as myomas — can be removed with a myomectomy. This surgical technique treats fibroid symptoms and improves fertility outcomes while leaving the uterus intact.
With our minimally-invasive laparoscopic myomectomy procedure, we can relieve your fibroid symptoms and have you back on your feet with minimal pain and scarring and extremely decreased recovery time.
A myomectomy removes uterine fibroids and relieves their symptoms. A myomectomy can treat the following symptoms of uterine fibroids:
- abnormal uterine bleeding
- menorrhagia (heavy menstrual bleeding)
- pelvic pain and pressure that cannot be managed with medication
- infertility or recurring miscarriages
Unlike a hysterectomy, a myomectomy leaves the uterus intact, making it a popular choice among patients who still wish to get pregnant.
Salpingectomy surgery is the surgical removal of either one fallopian tube (unilateral salpingectomy) or both (bilateral salpingectomy). Your doctor may recommend having your Fallopian tube(s) removed as a treatment for fertility problems or tubal disease, including cancer or infection.
The Fallopian tubes are the two narrow tunnels extending from the uterus to the two ovaries. During menstruation, an egg is released from the ovaries and guided into the Fallopian tubes by the tiny finger-like fimbriae. The egg then travels through the Fallopian tube into the uterus. An egg can either be fertilized by a sperm in the Fallopian tube, prompting a pregnancy, or it will be shed with the uterine lining during the woman’s next period.
Removal of both Fallopian tubes makes natural conception impossible but other fertility options, such as in-vitro fertilization (IVF), may still be available. Some patients may be able to preserve their Fallopian tubes with alternative tubal surgery.
A salpingectomy or salpingostomy can be performed to treat several serious gynecological conditions.
- Infection due to sexually transmitted or other diseases
- Tubal adhesions
- Scarring or blockage due to previous tubal surgery
- Ectopic pregnancy
- Blocked fallopian tube
- Ruptured fallopian tube
- Fallopian tube cancer. Though fallopian tube cancer is rare, it’s more common in women who carry the BRCA gene mutation. Almost half of women with BRCA gene mutations have fallopian tube lesions. A prophylactic salpingectomy can be performed on women who are at a high risk of developing ovarian cancer.
- Infertility. Although it may seem counter-intuitive, removing one or both Fallopian tubes can often lead to better fertility outcomes than repairing the tubes. For some infertile women, having a salpingectomy has been shown to increase the chances of implantation via IVF. Furthermore, defective Fallopian tubes may put you at risk for ectopic pregnancy or adhesions.
Diagnostic laparoscopy is a surgical procedure that allows a doctor to view a patient’s pelvic organs directly through an instrument called a laparoscope.
A laparoscope is a thin, flexible tube with a lighted lens at the end. When inserted into the body, the doctor can use the laparoscope to see the internal tissue, including the uterus, fallopian tubes, ovaries, bladder, and bowel.
Laparoscopy is often used when other less-invasive tests, like X-ray, MRI, or ultrasound, are unable to confirm a diagnosis.
Laparoscopies are very low-risk medical procedures. About 0.3% of women will experience complications during their laparoscopy. Complications may include:
- Damage to nearby tissue (uterus, fallopian tubes, ovaries, bowel, or bladder)
- Possible scarring to pelvic organs, known as adhesions
- Internal bleeding
Your surgeon will discuss the possible risks and answer any additional questions.
DILATION AND CURETTAGE (D&C)
Dilation and curettage (pronounced “dye-LAY-shun” and “KYUR-uh-tedge”) is a surgical procedure to scrape the uterine lining, either to remove tissue or take a sample for testing. The procedure involves dilating the cervix and scraping the inside of the uterus with a surgical tool. Dilation and Curettage (D&C) can be used for several different reasons:
- Remove tissue following a miscarriage
- Extract residual pieces of the placenta following childbirth
- Terminate an early pregnancy
It also is used to diagnose and treat conditions such as:
- Abnormal bleeding
- Uterine polyps
- Uterine fibroids
- Uterine cancer
- Imbalances of hormones
Dilation and curettage can be performed in a hospital setting, but they are also routinely performed at your gynecologist’s office as an outpatient procedure. The procedure usually only takes about 10-15 minutes, but you may need to remain in recovery for a few hours before going home.
Depending on your medical history and the extent of the D&C, your doctor may choose one of three types of anesthesia for your procedure:
- Local anesthesia – Your cervix will be numbed to minimize your discomfort
- Nitrous Oxide (laughing gas) – This is often used for many in-office procedures to minimize pain
- General anesthesia – You will be asleep during the procedure and won’t feel any pain
During the procedure, you will be positioned on your back with your feet in stirrups. The doctor will place an instrument called a speculum into the vagina so that the other instruments can access the cervix and uterus.
A hysteroscopy is a procedure that allows a surgeon to diagnose or treat uterine problems. The procedure involves inserting a narrow, lighted lens through your vagina and cervix in order to view the inside of the uterus projected on a screen.
Your gynecologist may recommend a hysteroscopy for one of several reasons:
- Determine the cause of abnormal or heavy bleeding
- Remove adhesions (scar tissue) that formed during a previous surgery or disease
- As part of a sterilization procedure
- Diagnose problems with fertility or recurring miscarriages
- Locate an IUD (an intrauterine device for birth control)
Every gynecological surgery carries some inherent risk, but complications due to hysteroscopy are very uncommon. Risks may include:
- Adhesions (scarring)
- Blood loss
- Perforation and/or burns of the uterus
- Damage to other pelvic tissue, including fallopian tubes, bladder, or bowel
LAPAROSCOPIC OVARIAN CYSTECTOMY
First, you should be having regular gynecology exams. These are your opportunity to talk about any (and ALL) unusual, painful, new, or just curious symptoms you may be experiencing. Even seemingly minor symptoms can indicate an issue.
Your gynecologist or general health care provider can recommend any necessary follow-up tests to find the cause of your symptoms.
These regular check-ups are generally where we discover signs of ovarian cysts. Early detection of issues can make a world of difference in your long-term health.
Ovarian cysts are fairly common. Most cysts are not harmful and usually resolve on their own. However, some cysts can cause infertility, cause painful symptoms, or become cancerous.
A laparoscopic ovarian cystectomy may be a recommended treatment option if:
- The patient has cysts or other masses in both ovaries.
- An ovarian cyst has not shrunk or disappeared after three months.
- A cyst is larger than three inches in diameter.
- A cyst appears to be abnormal or malignant.
- Your doctor suspects ovarian cancer.
If you have an ovarian cyst, your OB/GYN may recommend an ovarian cystectomy if you also:
- Take birth control pills.
- Have not yet started your period (children or teenagers).
- Have already undergone menopause.
LEEP PROCEDURE & COLD KNIFE CONE BIOPSY
LEEP PROCEDURE & COLD KNIFE
If your doctor finds precancerous cell changes in your cervical tissue, also known as cervical dysplasia, the area around the tissue may need to be surgically removed to reduce the risk of cancer and the spread of cancer. There are two common ways that this can be done: a cold knife cone biopsy and a Loop Electrosurgical Excisions Procedure (LEEP Procedure).
Both of these procedures can be used to treat abnormal tissue that your doctor has found during a colposcopy or cervical biopsy, including:
- Moderate-severe precancerous cell changes
- Low-grade squamous intraepithelial lesions (LSIL). These are minor cell changes that do not resolve after a few months.
As far as surgical procedures go, these techniques are quite safe. There are, however, some risks involved that you should discuss with your doctor, including:
- Cervical stenosis. This is a complication in which the cervix narrows, making it more difficult to become pregnant naturally.
- Premature birth. Studies have shown that LEEP and Cold Knife Cone Biopsy can lead to a syndrome known as an incompetent cervix, which may result in a premature delivery if you become pregnant.
- Cervical scarring. Adhesions on the cervix may cause pain during your period, fertility problems, and delivery problems.
- Tissue damage, including damage to the bladder or bowel.
An oophorectomy (pronounced “oh-uff-uh-RECK-tomy”) is the surgical removal of one or both ovaries. Oophorectomies can be performed alone, but they are often performed alongside a hysterectomy (removal of the uterus) or salpingectomy (removal of the fallopian tubes). This is because many diseases that affect the ovaries will also affect the surrounding tissue.
The ovaries are the small, round organs that lie on either side of the uterus, at the end of each fallopian tube. The ovaries hold a woman’s eggs and are also responsible for producing the hormones associated with menstruation and pregnancy: estrogen and progesterone.
Removal of one ovary is called unilateral oophorectomy. Most patients will continue to menstruate and could conceive naturally following surgery. The removal of both ovaries is called a bilateral oophorectomy. Patients will no longer have periods and will enter early menopause.
Oophorectomies are performed as a treatment for several different gynecological conditions, including:
- Ovarian cancer
- Noncancerous ovarian tumors
- Ovarian cysts
- Tubo-ovarian abscesses – pockets of pus that develop on the ovaries and fallopian tubes
- Ovarian torsion – a condition in which the ovary twists over itself
Patients who are at an increased risk for breast or ovarian cancer may choose to have an oophorectomy as a preventative measure.
VAGINAL REJUVENATION SURGERY
Vaginal rejuvenation surgery refers to procedures that can be performed for cosmetic reasons or to relieve symptoms of vaginal relaxation. Vaginal rejuvenation, or vaginal reconstruction, involves the repair of loose, stretched, or torn tissue to tighten, strengthen, and support the vaginal walls and pelvic organs.
Vaginal walls are naturally elastic and supple, thanks to the hormone estrogen. Over time, and after childbirth, the vaginal muscles can stretch and loosen. If a woman’s body stops producing estrogen, due to a hormonal imbalance or menopause, the vaginal tissue can atrophy. This weakened and loose vaginal tissue can cause pelvic organ prolapse and incontinence. Also, some women find that sex becomes less pleasurable, or even painful.
Vaginal rejuvenation surgery can treat many of these unpleasant symptoms. Here are some reasons why patients seek vaginal rejuvenation:
- Restoring vaginal tightness following multiple births or a large birth
- Repairing torn tissue due to injury, childbirth, or an inadequately healed episiotomy
- Treating pelvic organ prolapse
- Treating urinary incontinence
- Tightening the vaginal opening for improved sexual pleasure for a woman and her partner
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