Less Pain, Easier Recovery 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 incisions 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 incisions at all. 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 lens into the vagina and uterus for examination. Saline is then used to distend the area, giving the surgeon room to see and, when necessary, operate. Using this technique, which does not involve any incisions, a doctor may be able to diagnose the cause of abnormal uterine bleeding and may be able to take tissue biopsies or operate on polyps or fibroids seen in 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, and correction of pelvic-organ prolapse.   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 reach 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.

In gynecology, robotic-assisted surgery has proven to be particularly useful in complex procedures treating gynecologic cancers, as well as for intricate repairs associated with pelvic-organ prolapse – two procedures that previously required open surgery.

There are still some conditions that cannot be treated through MIS – removal of some very large masses or cancers, or treatment of women with 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 by minimally invasive surgery.

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

Dr. Makai and Christiana Hospital have been designated part of the AAGL’s Center of Excellence in Minimally Invasive Gynecologic Surgery.

For more information or to schedule an appointment, call 302-623-6320.

The Christiana Care Center for Women’s Health offers a group of women’s health specialists focused 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. The Center for Women’s Health is located at 3706 Kennett Pike in Greenville.