Minimally Invasive Surgery
Traditionally, many gynecological surgeries involved large incisions, greater blood loss, longer hospital stays, and longer recovery. Technological advances however have enabled us to perform these same procedures with less morbidity, less pain, shorter recovery times, and less risk of infection.
Robotic surgery is a minimally invasive approach to surgery that uses highly advanced technology. The da Vinci Surgical System allows complex surgery to be performed through small incisions with improved vision, dexterity and control. The robotic arms precisely mimic the surgeon's hands for excellent surgical control, thereby minimizing blood loss, and allowing for faster recovery.
These are some examples of minimally invasive procedures
Endometrial ablation- The rmachoice and Novasure (registered trademarks) offer an alternative to hysterectomy.
Total Laparoscopic Hysterectomy (What is Hysteroscopy)
With this hysterectomy (TLH) method, a thin, lighted, telescope-like instrument called a laparoscope along with small surgical instruments are inserted through 3 to 4 tiny incisions in the navel and abdomen to detach and remove the uterus. Unlike more traditional methods, laparoscopic hysterectomy usually requires only 1 day or less in the hospital and only 6 days of recovery time. Patients also experience less scarring and pain compared to other hysterectomy methods.
Laparoscopic Supracervical Hysterectomy
In a laparoscopic supracervical hysterectomy (LSH), the surgeon leaves the cervix intact. The cervix connects the upper portion of the vagina to the uterus. The ligaments attached to the cervix provide support for both organs. For this reason, many gynecologists feel that leaving the cervix in place is important to maintain good pelvic floor support.
One of the most common pelvic floor support problems is pelvic organ prolapse, a condition in which organs in the pelvic region drop out of their normal position (prolapse). Prolapse can be uncomfortable both physically and emotionally, causing women to limit their movements because of pain, urinate more frequently and avoid sex. In addition, some research suggests the cervix may play a role in sexual arousal and the ability to achieve orgasm in some women.
Keeping the cervix means you may still experience some periodic bleeding. Like women who have not had a hysterectomy, you should continue to have an annual Pap smear to screen for cervical cancer.
Myomectomy is the surgical removal of fibroid tumors while leaving the uterus intact. Traditionally this required a large abdominal incision and a prolong hospital stay. Now many pt can have these fibroid tumors removed through the laparoscope. However there are many cases where it is more prudent to have an open surgical procedure. It is very important if there are deep fibroids in the wall of the uterus and the patient wants to maintain here fertility a strong uterine closure needs to be obtained, so as the uterus does not rupture in the later stages of pregnancy. Every patient needs a very careful evaluation before recommending any particular procedure.
Laparoscopic treatment of ectopic pregnancy
At any stage of development, surgical removal of an ectopic growth and/or the fallopian tube section where it has implanted is the fastest treatment for ectopic pregnancy. Surgery may be your only treatment option if you have internal bleeding. When possible, surgery is done through a small incision using laparoscopy. This type of surgery usually has a short recovery period.
Laparoscopic Treatment for Pelvic Pain, Endometriosis, Infertility
Endometriosis is chronic condition in which endometrial tissue is implanted outside its normal anatomic position in the lining of the uterus. The diagnosis is made with the assistance of a laparoscope where the surgeon can visualize the entire pelvis and take appropriate biopsies. Endometrial lesions can be cut away (excised) or burned away using a high-energy heat source, such as a laser (ablated). Treatment with laparoscopy is more difficult with advanced disease that involves large areas of the rectum or larger lesions.
LAVH- Laparoscopic assisted Vaginal Hysterectomy
Laparoscopically assisted vaginal hysterectomy (LAVH) is a surgical procedure using a laparoscope to guide the removal of the uterus and/or Fallopian tubes and ovaries through the vagina (birth canal). (A different procedure, called a laparoscopic hysterectomy, is entirely performed using a laparoscope and other instruments inserted through tiny abdominal incisions, and the uterus, Fallopian tubes etc. are removed in tiny portions.)
Not all hysterectomies can or should be done by LAVH. In certain situations, a laparoscopic hysterectomy (see above) may be sufficient. In other cases, an abdominal hysterectomy or a vaginal hysterectomy (without laparoscopy) is indicated. The surgeon determines the appropriate procedure for each individual case based upon the reason for the hysterectomy and the medical history and condition of the patient.
How is LAVH performed?
During LAVH, several small incisions (cuts) are made in the abdominal wall through which slender metal tubes known as "trocars" are inserted to provide passage for a laparoscope and other microsurgical tools. The laparoscope acts as a tiny telescope. A camera attached to it provides a continuous image that is magnified and projected onto a television screen for viewing.
In the course of LAVH, the uterus is detached from the ligaments that attach it to other structures in the pelvis using the laparoscopic tools. If the Fallopian tubes and ovaries are to be removed, they are also detached from their ligaments and blood supply. The organs and tissue are then removed through an incision made in the vagina.
Dilation and curettage (D&C)
D&C, also known as dilation and curettage, is a surgical procedure often performed after a first trimester miscarriage. Dilation means to open up the cervix; curettage means to remove the contents of the uterus. Curettage may be performed by scraping the uterine wall with a curette instrument or by a suction curettage (also called vacuum aspiration), using a vacuum-type instrument.
Loop Electrosurgical Excision Procedure (LEEP)(D&C)
The loop electrosurgical excision procedure (LEEP) uses a thin, low-voltage electrified wire loop to cut out abnormal tissue. LEEP can:
Cut away abnormal cervical tissue that can be seen during colposcopy.
Remove abnormal tissue high in the cervical canal that cannot be seen during colposcopy. In this situation, LEEP may be done instead of a cone biopsy.