Advancing Women’s Care

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With Minimally Invasive Gynecology Surgery

By Gretchen Makai, M.D.

Good news for women – an increasing number of gynecological conditions that once required open surgery and hospitalization now can be treated with minimally invasive techniques that require just a few incisions or no incision at all.

To perform a minimally invasive surgical procedure (MIS), a doctor uses specialized tools — such as miniature cameras, fiber optics and robotic devices — inserted into the body through small incisions in the abdomen, or through the vagina with no visible incision. As a result, patients usually have an easier time healing, with less pain and potentially fewer complications, because the inflammation and scarring caused by traditional incisions have been minimized.

Many MIS procedures can be performed on an outpatient basis, and even for the most complex procedures women may have just a short overnight hospital stay.

MIS can be used both to diagnose and to treat gynecological conditions, ranging from uterine fibroids and ovarian cysts to pelvic organ prolapse and even some types of cancer. Hysteroscopy, laparoscopy and robotic-assisted surgery are commonly used MIS procedures.

For women with abnormal uterine bleeding, a hysteroscopy procedure can visually help diagnose the problem with no incisions 

The hysteroscopy procedure involves inserting a small camera into the vagina and uterus. Saline is then used to distend the inside of the uterus and give the surgeon room to see and, when necessary, operate. Using this diagnostic technique, without making any incisions, a doctor may be able to determine the real cause of abnormal uterine bleeding and may be able to take tissue biopsies or even remove polyps or fibroids seen within the uterus.

Laparoscopy requires making small incisions in the abdomen 

Used to diagnose and treat other causes of pelvic pain and abnormal bleeding, laparoscopy involves looking into, and possibly operating in, the abdomen. A doctor inserts a camera and surgical instruments to perform procedures such as removal of endometriosis, ovarian cysts, or uterine fibroids. Though the number and size of incisions vary by procedure, most incisions are 1 centimeter or smaller and cause minimal scarring.

Robotic-assisted surgery is further expanding the reach of MIS 

In robotic-assisted surgery, rather than the surgeon holding instruments at the patient’s bedside, the surgeon operates the robotic arms (which in turn hold the instruments). One benefit of robotic surgery is that the robotic instruments have a range of motion and articulation beyond that of hand-held laparoscopic instruments, allowing the doctor to observe from different angles and get into smaller spaces than is usually possible in laparoscopy. Also, the robotic instruments do not wiggle or fatigue, as a person’s hands may, which may come into play during complex or lengthy surgeries.


Research into newer techniques and approaches to treating fibroids, pain, and other gynecologic problems continues. Doctors at Christiana Care are participating in research studies to advance women’s health care and provide the best and safest treatments for women.

There are, however, still some conditions that cannot be treated through MIS – removal of some very large masses or cancers, or treatment of complicated medical problems, for example – but the potential of MIS is far-reaching enough at this point that any woman who has been told she requires surgery for a gynecological condition should ask her doctor whether the procedure can be performed through a minimally invasive surgery approach.

You should always consult with your doctor before making important medical decisions.

Gretchen Makai, M.D., is Christiana Care’s Director of Minimally Invasive Gynecologic Surgery. She is recently joined in practice by Nima Patel, M.D., Christiana Care’s newest fellowship-trained MIGS surgeon. 

For more information or to schedule an appointment, call 302-623-4410. 

Christiana Care’s Minimally-Invasive GYN surgeons focus on gynecologic issues that may become more complex for women within and beyond their child-bearing years – conditions that often can be addressed only by special consultations, advanced treatment or surgery.
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