Minimally Invasive Surgeries
For our patients whose gynecological disorders require treatment by surgery, the physicians at Oak Hills Women's Center, P.A. are excited to be able to offer the newest and most innovative techniques available, known as minimally invasive procedures (MIP). This type of operation allows the surgeon to perform procedures through small key-hole incisions in the abdomen, instead of long, open incisions which have previously been the standard of care. The benefits of this are numerous, including less pain, shorter hospital stay (usually one day or less), faster recovery, and smaller scars. In almost all cases, patients feel better sooner and can get back to their normal activities, including both work and play, much more quickly.
Fortunately, 90-95% of gynecological conditions that require surgical management can be treated by MIP. It is important for women who are considering surgery to learn about their options and to explore with the physician whether or not they are candidates for this new and advanced surgical technology.
When surgery is recommended to a patient, we realize that she will have many questions. Our physicians feel that it is of utmost importance that each patient be counseled thoroughly about any recommended procedure and that she be fully advised of the risks and anticipated benefits, as well as alternatives, both surgical and non-surgical. Open dialogue between the patient and physician is encouraged. This will enable patients to understand and participate in their care.
Several procedures can now be performed by the minimally invasive, or laparoscopic, technique. Contact us to learn more.
Hysterectomy is the most commonly performed major gynecological surgical procedure. The majority of them are performed by laparotomy, which requires a long incision. Fortunately, over the past two decades, advances in technology have made it possible to perform many, if not most, of these same procedures through an instrument called a laparoscope, which needs only key-hole size incisions. This advancement has lead to multiple benefits over the traditional techniques: shorter hospital stays (often less than one full day), less pain, less scarring, and quicker return to usual activities.
Even some of the most technically difficult hysterectomies which are indicated for the treatment of large fibroid tumors, endometriosis, and chronic pelvic infections may be carried out laparoscopically. However, not all patients are satisfactory candidates for this type of surgery, and may require the traditional open technique. The physician will evaluate each patient on an individual basis in order to recommend a reasonable approach. It is important for patients to understand that some surgeries which are begun laparoscopically will have to be converted to an open procedure for completion. Fortunately, this does not happen often when the surgeon is experienced in MIS and has extensive knowledge of pelvic anatomy.
Laparoscopic hysterectomies are typically performed with the patient under general anesthesia. Once the surgery is completed, the patient initially recovers in a post-surgical recovery room and then is transferred to the Gyn/Surgical Unit of the hospital where she is monitored by the nursing staff until she is dismissed home (usually within 23 hours). By this time, the patient has walked around the hospital unit without difficulty, is tolerating a regular diet, and requiring only oral analgesics for pain relief. Most patients have a post-op office visit in two weeks, and the majority of them are ready to return to their usual activities, including work, with few restrictions at that time.
Laparoscopic Ovarian and Tubal Surgery
The use of a laparoscope can provide the surgeon with an excellent view of the pelvis, which makes this instrument extremely helpful in treating many ovarian and tubal disorders, thereby avoiding the traditional laparotomy incision. Ovarian problems such as cysts, benign tumors, endometriomas, infection, and torsion may all be addressed in this way. Tubal problems such as ectopic pregnancy, cysts, and torsion, as well as sterilization procedures ("tubal ligation") are commonly approached laparoscopically.
These surgeries are typically performed with the patient under general anesthesia. Many of them can be done on an outpatient basis, and patients are often dismissed home within a few hours of recovery time. Oral analgesics are usually sufficient for adequate post-op pain relief. The majority of these patients return to their normal activities by two weeks or less.
Pelvic Prolapse and Urinary Incontinence Surgery
Pelvic prolapse is associated with weakening of the tissues of the "pelvic floor" which allows organs such as the vagina and uterus to lose their support and bulge downward, often protruding outside the vaginal opening. It is clearly related to childbirth and aging, and is becoming more of a problem as our population ages. This means that the demand for gynecologic services for this problem will increase greatly in the next decade. Advances in surgical technology are now making it possible for physicians to perform some of the corrective procedures through minimally invasive techniques. These in turn offer patients several benefits over traditional open procedures: shorter hospital stay, less pain, smaller incisions, less scarring, and quicker return to usual activities.
Some of the procedures for treatment of stress urinary incontinence are also now being done through minimally invasive techniques, with equal, if not better, long term success rates than the traditional open procedures. Selection of an appropriate surgical procedure can be made by the physician once a thorough history and physical exam are completed and the patient has undergone urodynamics testing, to study the bladders function.
Diagnostic and Operative Hysteroscopy
Hysteroscopy is a diagnostic and surgical procedure which allows the physician to look inside the uterus without having to make an abdominal incision. A hysteroscope is advanced through the cervix into the uterine cavity and attached to a light source and camera so the doctor can view the lining on a video screen. One of the most common indications for this procedure is to diagnose the cause of abnormally heavy, prolonged periods, or bleeding between periods. It is also frequently used to evaluate severe menstrual cramps, unexplained loss of periods, and as part of an infertility work-up.
Frequently, abnormalities such as polyps, fibroids, or an overgrowth of the uterine lining, endometrial hyperplasia, can be removed through the hysteroscope. This can effectively treat the bleeding caused by these growths. Unfortunately, on occasion, the problem may recur, and the patient will require a repeat procedure or perhaps a different treatment altogether.
Routinely, hysteroscopy is performed in an outpatient setting. Patients who are given local anesthesia can usually go home soon after the procedure. Those who are given regional or general anesthesia will be observed for a few hours, but also go home on the same day. Most patients have only minimal discomfort following the procedure and do quite well with oral analgesics. Generally they resume their normal activities within 24-48 hours.