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What Procedures Can Be Performed?
It is possible to offer a patient a less invasive, less painful surgery in the vast majority of cases. Some of these procedures include:
Hysteroscope- The hysteroscope is a small scope that is inserted through the cervix and into the uterine cavity to remove fibroids, polyps, or perform infertility surgery. Because there are no abdominal incisions, the recovery after hysteroscopic surgery is faster than after laparoscopy, and much faster than an abdominal incision. In some cases, a woman may have to have a combined hysteroscopic and laparoscopic surgery.
For certain conditions H/S surgery is a great procedure. A scope is inserted through vaginally through the cervix and into the uterine cavity. The operation is performed without an incision. The recovery is even faster than with L/S surgery. H/S surgery is possible for uterine polyps, small fibroids close the cavity, as an alternative to hysterectomy for abnormal bleeding and certain reproductive problems.
How is minimally invasive surgery different from general OB/GYN surgery?
Minimally invasive surgery reduces the healing time to days or weeks instead of weeks and months. Because of the tiny size of the incisions, or possibly no incisions, the woman is able to go home the same day, and will have a much faster recovery than if a large abdominal incision were made. Laproscopic surgery is less painful and has a faster recovery than traditional open abdominal surgery. However, there is always the risk of complications in any surgical procedure, whether it is open abdominal surgery or minimally invasive surgery.
In this website you will not see any robotic procedures described. The reason is because the most accurate scientific publications have concluded that robotic surgery takes longer, cost more to perform and, since the trocars are larger, is more painful.
Why have open surgery when L/S surgery has the same outcome? Why pay more for a robotic L/S surgery that offers no advantage and hurts more?
L/S surgery can be performed using 4 access ports. Trocars are the ports that are placed through the wall of the abdomen so surgical instruments can be inserted and removed easily and rapidly. A 5 mm trocar is placed at the base of the belly button so a scope can be inserted and contents of the abdominal cavity are then seen on an HD monitor a few feet away. On the left and right, just above the pubic bone, we insert 5 mm trocars. The largest trocar is 12 mm and is in the midline just above the pubic bone. Using the scope to see we perform the GYN operation the woman needs. Instead of days in the hospital and weeks off work our procedures are outpatient with only days off work. A woman can have a hysterectomy on Thursday and return to a desk job on Monday.
Minimally Invasive Surgery: What is It?
Minimally invasive surgery is performed using scopes rather than large incisions. A laparoscope or hysteroscope is used to perform the particular minimally invasive surgery.
If a medical therapy is not available or fails the GYN surgical literature demonstrates that at Gynecologic Endoscopic Surgery(GES) sub-specialty centers up to 95-99% of women with fibroids, abnormal bleeding, adenomyosis, endometriosis, benign appearing ovarian cysts, pelvic prolapse, and other GYN indications for surgery or hysterectomy are candidates for GES instead of open abdominal surgery. A more commonly used term for GES is minimally invasive surgery. We offer the most minimally invasive of minimally invasive surgeries.
Laparoscope- The laparoscope is a narrow scope with multiple lenses used to look inside the abdomen. The scope has a video camera attachment so that the surgeon can view the abdominal and pelvic cavity without a large incision. The picture of the internal structures is projected onto a video monitor like a TV. Other instruments can be inserted through 2-3 accessory ports. The incisions are 1/4 to 1/2 inch or smaller. Because there are only a few small incisions rather than a single large incision, the patient is usually able to go home the day of the operation.
Open abdominal surgery requires in incision of 4-8 inches( 1 inch = 25 mm) .
Do I Need General Anesthesia?
For hysteroscopic surgery, a general anesthetic is not necessary. The patient may choose this form of anesthesia, but it is possible to perform hysteroscopic surgery under an epidural or spinal block, or with IV sedation.
Laparoscopic surgery almost always requires general anesthesia. In selected cases of pelvic pain management, IV sedation is used so that the patient might participate in conscious pelvic pain mapping. This is performed with a micro-laparoscope (less than 1/8 inch incision). The patient is well sedated so that she is not in pain, but she is not unconscious so that she can help identify the trigger point of her pain. This allows for more precise identification and more successful treatment of pelvic pain problems.
Minimally Invasive Surgery: yes it is for you
Since February, 1997 surgical cases have been entered into a prospective outcomes database for various gynecologic problems, including abnormal bleeding, fibroids, endometriosis, ovarian cysts, and other diagnoses. Minimally invasive surgery has been possible in 99 % of the cases. There are over 1,000 cases involving laparoscopic fibroid management. Even large fibroid tumors up to the umbilicus(belly button) can be removed with minimally invasive surgery if the conditions are correct. Minimally invasive surgery does not mean less risk. The incisions are small so there is less pain and a faster recovery but it is still the same surgery inside. Complications are possible in any surgery.