Minimally Invasive Solutions

What is Minimally Invasive Surgery?

Minimally Invasive Surgery (MIS) replaces the use of large incisions into the abdomen with smaller incisions (or in some cases, no incisions), which allow the surgeon to view the inside of the body with a small camera and manipulate the internal organs with small surgical tools. By taking this minimally-invasive approach, surgeons have been able to reduce the pain and blood loss associated with surgery, allowing patients to resume their normal routine 1-2 weeks instead of after more than a month as is the case with “open” surgeries.

There are two main types of minimally invasive gynecologic surgery:

  • Laparoscopic Surgery involves the use of 1-4 small incisions on the abdomen, through which tiny cameras, lights, and surgical tools are threaded by way of an entry “port” called a trocar. In laparoscopic surgery, the surgeon views the inside of the abdomen on a video screen in the operating room while also manipulating surgical tools like graspers and scissors from outside of the abdomen.
  • Robotic Surgery: In some cases, laparoscopic surgery may involve the use of a robot, in which case the surgeon sits at a video station near the patient and manipulates surgical tools that are connected to the arms of the robot remotely.
  • Hysteroscopic Surgery allows the surgeon to enter the body without any incision, most commonly through the vagina. In the case of hysteroscopy, the surgeon will thread a small camera and light through the vagina and cervix to view the inside of the uterus. Depending on the type of surgery, the surgeon may also thread other tools through the opening in order to complete the procedure.

You can learn more about MIS by visiting MIS for Women.

Laparoscopic Surgery

Laparoscopic surgery is a minimally invasive, video-guided technique that has revolutionized the field of surgery. Instead of making a large incision through the skin and underlying muscles (laparotomy), a laparoscopic surgeon makes just a few tiny incisions, one for a long, narrow telescope with a camera attached, and two or three others for the instruments needed. In pelvic laparoscopic surgery, the entry port for the camera is generally through the navel. The entry ports for the instruments are generally just half-inch or smaller incisions in the groin area.

The procedure begins with the introduction of a gas, usually carbon dioxide, into the pelvic cavity to provide adequate working space. Then the camera is inserted so that the surgeon can clearly see a magnified view of the pelvic organs. Specially designed instruments enable the surgeon to perform all the delicate maneuvers needed to remove diseased tissue, introduce needed materials (such as mesh in cases of pelvic floor repair) and suture.

Because there is less trauma to the body, recovery is much faster than with traditional, open abdominal surgery, and there is less pain. Patients can often get up and move around within a few hours of surgery. Hospital stay is reduced to a day if needed at all. Many procedures can be done on an outpatient basis.

Another advantage is reduced risk of infection because tissues are not exposed as they are in open surgery.

Because it requires sophisticated equipment, laparoscopic surgery is expensive, and not all hospitals are able to offer it. It also requires specialized training, even for surgeons who are experts at open surgery. They must learn to transfer their skills at working in a three-dimensional situation to working from a two-dimensional video screen. However, as more and more young surgeons who have grown up in the computer age enter the field, the supply of qualified laparoscopic surgeons will multiply.

Questions to ask your doctor
If you need surgery for a pelvic disorder, it is appropriate to ask your doctor everything you need to know. Most doctors welcome the chance to explain things to you because an informed patient is a better patient. Most doctors also welcome a second opinion to confirm their own conclusions. Never be afraid to ask questions.

  • What is causing my problem?
  • Do we need to confirm this diagnosis with other tests? What are their side effects, risks, and costs?
  • What treatment do you recommend?
  • Can my condition be treated with a minimally invasive surgical technique?
  • What is the risk if we “wait and see?”
  • Can you do this procedure, or do I need a specialist?
  • How many patients have you treated for a condition just like mine?
  • What are the success rates of this procedure?
  • What are the possible complications, and how often do they occur?
  • What will be involved in my recovery?
  • What is the impact of this surgery on my ability to have children?
  • Will this treatment affect my sexual function?
  • What is the risk of recurrence of my condition?
  • Should I get a second opinion?

What is da Vinci Surgery?

A Minimally Invasive Surgical Option Using the da Vinci Surgical System, surgeons operate through just a few small cuts (incisions). The da Vinci System features a magnified 3D high-definition vision system and tiny wristed instruments that bend and rotate far greater than the human wrist. As a result, da Vinci enables your surgeon to operate with enhanced vision, precision, dexterity, and control.

Since 2000, over three million patients have had minimally invasive da Vinci Surgery world wide.

Potential Patient Benefits of

da Vinci®Hysterectomy

for Benign Conditions(multi-port)

As a result of da Vinci®technology, da Vinci®Hysterectomy offers the following potential benefits as compared to traditional open surgery:

  • Reduced complication rate
  • Reduced length of hospital stay
  • Reduced blood loss and less likelihood for transfusion
  • Reduced readmission rate

As a result of da Vinci®technology, da Vinci®Hysterectomy offers the following potential benefits as compared to traditional laparoscopy:

  • Reduced complication rate
  • Reduced length of hospital stay
  • Reduced blood loss
  • Reduced chance of procedure converting to an abdominal procedure
  • Less likelihood of blood transfusion

As a result of da Vinci®technology, da Vinci®Hysterectomy offers the following potential benefits as compared to vaginal surgery:

  • Reduced length of hospital stay
  • Reduced blood loss

Source:http://www.davincisurgery.com

Hysteroscopy

Hysteroscopy is a technique for visually examining the cavity of the uterus using a long, thin telescope-like instrument (hysteroscope) that is inserted through the vagina and cervix. A small video camera attached to the end of the telescope gives the doctor a magnified view on a video monitor.

Hysteroscopy can be either diagnostic or therapeutic, or both. Therefore, it is sometimes referred to as diagnostic hysteroscopy (when used for viewing only) and sometimes as operative hysteroscopy (when used for treatment). It may be performed in the doctor’s office under local anesthesia, and a woman can return to her normal activities immediately that day or the next (if intravenous sedation is used).

As a diagnostic tool, hysteroscopy is useful in identifying the causes of abnormal uterine bleeding and dysmenorrhea, such as fibroids, adhesions, and polyps. It is also used to further evaluate abnormalities noted on certain diagnostic tests such as a hysterosalpingogram, sonogram or endometrial biopsy.

Surgical procedures to correct some of these problems can be carried out with operative hysteroscopy, using special instruments that fit through channels of the hysteroscope.

Operative hysteroscopy is also used to perform a minimally invasive procedure for women who choose sterilization as a means of permanent birth control.

Treatment Options

Cryotherapy
Cryotherapy is a procedure that uses freezing to destroy cells. The doctor uses a special instrument that delivers a dose of extreme cold precisely to the targeted abnormal cells on the cervix or endometrial cells in the uterus (endometrial cryoablation), effectively killing these cells in 95% of cases. 
Cystectomy
Cystectomy is the surgical removal of a cyst. Usually, a laparoscopic cystectomy can be done on an outpatient basis (you leave the hospital the same day) and normal activities can be resumed in a week or two. 
D&C
D&C stands for “dilatation and curettage”, a procedure in which your doctor dilates or opens the cervix and scrapes the lining of the uterus. A D&C is often performed in cases of heavy, abnormal uterine bleeding, only for diagnostic and not for therapeutic purposes. 
Endometrial Ablation
Women with menorrhagia who do not wish to have children and for whom medical therapy has not provided relief from their heavy bleeding may be candidates for a procedure called endometrial ablation, which stops or reduces heavy bleeding by destroying the lining of the uterus. 
Fibroid Treatments
Discusses a number of minimally invasive surgical options that can be used to treat fibroids. 
Hysterectomy
Hysterectomy is a surgical procedure that removes the uterus. The term is based on the Greek word for uterus – “hyster” – plus the suffix that means removal – “ectomy.” In everyday usage, hysterectomy may refer to the removal of not only the uterus, but also the cervix, but does not necessarily mean the removal of the ovaries. 
Hysteroscopy
Hysteroscopy is a technique for visually examining the cavity of the uterus using a long, thin telescope-like instrument (hysteroscope) that is inserted through the vagina and cervix. A small video camera attached to the end of the telescope gives the doctor a magnified view on a video monitor. 
Incontinence Treatments
Overactive bladder and urge incontinence (OAB/UI) are not treated surgically, although there are some medications available to help. For long-term management, non-surgical approaches include lifestyle and dietary changes, bladder training, pelvic floor muscle exercises, and electrical stimulation. 
Laparoscopic Surgery
Laparoscopic surgery is a minimally invasive, video-guided technique that has revolutionized the field of surgery. Instead of making a large incision through the skin and underlying muscles (laparotomy), a laparoscopic surgeon makes just a few tiny incisions, one for a long, narrow telescope with a camera attached, and two or three others for the instruments needed. 
Laparoscopy
Laparoscopy, the inspection of the pelvic organs through a tiny telescopic camera that projects a magnified view on a video monitor, can be used to diagnose abdominal and pelvic disorders and in some cases to treat them as well. 
Laparotomy
Laparotomy is an open abdominal surgery performed under either general or epidural anesthesia. It involves a 2 to 6-inch incision that is made either vertically, between the navel and the pubic bone, or horizontally, the so-called “bikini” incision just above the pubic bone. It requires a hospital stay and takes four to six weeks for complete healing. 
Laser Surgery
Laser surgery is sometimes used to destroy cervical cancer cells. Its high-energy light beam can target and cut out abnormal cells from the skin of the cervix with high precision. Laser surgery is used as a treatment for pre-invasive cervical cancer only. A laser may also be used as a cutting instrument in laparoscopic surgery. 
LEEP (Loop Electrosurgical Excision Procedure)
LEEP or loop electrosurgical excision procedure is an in-office technique for removing abnormal cervical cells that are suspected of being or becoming cancer. 
Oophorectomy
Oophorectomy means surgical removal of an ovary. A bilateral oophorectomy means the removal of both ovaries. 
Operative Hysteroscopy
Operative hysteroscopy allows many procedures that once required hospitalization to be performed in the doctor’s office with minimal discomfort and quick recovery. Patients are usually ready to resume normal activities after a day or two. Some of these procedures replace the need for hysterectomy. 
Ovarian Vein Embolization
Ovarian vein embolization is a procedure in which a damaged, varicose vein to the ovary is closed off, thereby alleviating the pain associated with pelvic congestion syndrome. 
Pelvic Organ Prolapse (POP) Treatment
Discusses treatment options for dealing with pelvic organ prolapse, or the weakening of the pelvic floor muscles resulting in the displacement of the pelvic organs through the vagina. 
Polypectomy
Polypectomy is the medical word for removing polyps, small finger-like growths that arise from the uterine lining and protrude into the uterine cavity. 
Presacral Neurectomy
Presacral neurectomy is a surgical treatment that may be used for rare cases of severe dysmenorrhea that cannot be resolved by medications or other means. Essentially it involves cutting the nerves that transmit the signal of pain from the uterus to the brain. 
Sterilization
Sterilization procedures can provide permanent birth control to women who no longer wish to become pregnant. Several options are available, including minimally invasive techniques. They all have the effect of blocking the Fallopian tubes so that sperm and egg cannot meet and, therefore, fertilization cannot occur. 
Transcervical Resection of The Endometrium
Transcervical resection of the endometrium or TCRE, like hysteroscopic endometrial ablation, was the treatment of choice for menorrhagia before the advent of newer endometrial ablation techniques. TCRE is operative hysteroscopy using a hysteroscope with a heated wire loop, called a resectoscope, to remove the endometrium.

We've Moved!

Our office has finally moved into our brand new, larger space in the Sobrato Pavilion.
Please allow yourself additional time to find our space, park in the Sobrato Parking Structure, and find our suite on the 6th floor!

We can't wait for you to see it!

Map of ECH campus and our new location