Minimally Invasive Surgery
I have been all over this since the 1990′s. It is so cool! It has so much promise to make things easier for you – less pain, smaller incisions. My first in office hysteroscope was in 1990 and my first postgraduate course in laparoscopic surgery was in 1991. Then the first time I performed a laparoscopic hysterectomy was in 1994. In those days, the devices were crude and the surgeries took longer and required more skill. I think of my cell phone in 1990. It was the size of a paperback novel and the coverage was so spotty
Now…… well you know! Technology has come such a long way. In the OR, the incisions are fewer and smaller, the instruments are much more precise. If something in your pelvis is giving you pain, bleeding or infertility, it can often be fixed with minimal down time. Even a laparoscopic hysterectomy has become a “short stay” procedure. Most postoperative pain vanishes with IV “advil” or tylenol.
Thus new technology makes these surgeries easier and safer for you. It’s been a pleasure following, evaluating, and embracing each new innovation. Of course, WHEN an operation is needed is really the important question. And that takes experience and a thorough understanding of the problem. Ultimately, the decision to have an operation is up to you. What you need is education, gentle guidance and respect. After you understand your options, you should go home and sleep on it. Then decide. Of course I will go over the nonsurgical alternatives. For information on them, please read “Problem Periods”.
Here are some clips of minimally invasive surgeries that I frequently perform. In the first clip, an endometrial polyp is viewed with an office hysteroscope the size of a flexible bic pen. A hysteroscope is a thin fiber optic tube inserted up through the vagina, then through the cervix and into the uterus. Abnormalities like polyps and fibroids on the lining of the uterus can cause minor or major vaginal bleeding. They are easily removed under sedation with no incisions on your body. This is possible because a hysteroscope uses the natural pathway by which the period gets out in order to get into the uterus.
Below is a laparoscopic supracervical hysterectomy. This may be the right answer for you. Check it out. Then, if you want, come in and talk about it. Or talk to your own doctor. Or do both. There is no pressure in this office.
When doing a hysterectomy, I usually want to leave in the “normal parts”. It’s the uterus which cramps and bleeds. If the ovaries are normal, shouldn’t they be left in most of the time? Ovaries make our hormones. The uterus bleeds and houses our babies. If you are done having babies and have years to go until menopause, consider this. No more periods but no menopause. Then if your pap smears are normal, why take the cervix out? All the support ligaments for the bladder, vagina, and rectum are tied together at the level of the cervix. And for intercourse, it is nice to preserve the entire local environment. So conservative “partial” hysterectomy may be the right answer for you. Technically that’s a laparoscopic supracervical hysterectomy. We just take out what is broken and leave what is normal.
Just imagine no more periods…..
Then there is an ovarian cystectomy. Most cysts of the ovary are physiologic. It’s the ovary’s job to make these cysts, and it does so all the time to your benefit. So don’t be afraid of ovarian cysts! Occasionally one grows too large or just won’t go away. Then it needs to be removed but usually the rest of the ovary can stay. Again, just remove the problem and leave what is normal.