for Endometriosis, Hysterectomy, Myomectomy & Ovarian Cysts
In the early to mid-1980's operative laparoscopic surgery (now known as Minimally Invasive Surgery or "MIS") was establishing its foothold in the United States. During this time I was in my residency which had several very progressively thinking trainers who performed numerous laparoscopic cases. This provided me the opportunity to become very familiar with the technique by doing 10-20 cases every week. I accumulated approximately 3,000 cases during my four years of OB-GYN residency. I expanded on this foundation as more advanced laparoscopic principles spread to our shores from Europe. I saw the unique opportunity to enhance my skills and knowledge by continuing my training. Simultaneously, I was constantly updating my inventory of technologically advanced equipment.
This led to several significant landmarks for my surgical skills. In 1991, I performed my first laparoscopic total hysterectomy which was the first one done at the hospital where I practiced. In 1996, and after accumulation of adequate number of cases, I became certified in Operative Laparoscopy by what is now known as the American Association of Gynecologic Laparoscopists (AAGL). In today's world of medical training, this certification takes two years of fellowship training above and beyond the initial four years of OB-GYN residency. Needless to say I am very proud of my surgical skills and have confidently taken these principles to the next level several years ago by adding robotic assistance to my surgical armamentarium.
Although I still ascribe to my holistic training using surgery as only a last resort to other measures, there are many cases needing surgical attention.
Preparations for Surgery and a Quick Recovery
When having surgery you will have any necessary tests several days before the procedure and usually have been cleared by your private physician. The day of your surgery you usually arrive at the hospital in the morning, meet the surgical team and are taken to the operating room where you are put to sleep. When the surgery is completed, you are usually observed in the recovery department for a short time. Some surgeries may allow you to go home directly from there. For other types, you may spend one night in the hospital. Prior to leaving the hospital, you will be given written instructions for your care at home leading to a quick and easy recovery. It also includes how to schedule your post-op appointment and how to contact the office, should the need arise.
What's Removed during a Hysterectomy?
There are a variety of reasons you may need to have a hysterectomy. Just a few include problems with abnormal bleeding, fibroids (benign growth on the uterus also known as myomas), endometriosis, uterine or pelvic organ prolapse, or precancerous or cancerous cells.
Removal of the uterus and cervix. This the most common type of hysterectomy.
Removal of the uterus, but leaving the cervix. This may provide better support of the vagina and bladder. Some patients believe the cervix is important to sexual satisfaction. If there has been no history of Pap smear abnormalities, the decision to keep the cervix is often based upon patient preferences.
Depending on the patient's health, age and patient's desire, removal of the tubes and ovaries may also be recommend at the time of hysterectomy.
How is a Hysterectomy Performed?
Studies show the manner in which the hysterectomy is done will impact hospital stay, post operative pain, recovery time and even your risk of complications.
An incision is made in the vagina through which the uterus is removed and then the incision is closed.
An abdominal hysterectomy (open surgery) is done through a large incision in the abdomen. The single, bikini style incision is usually large enough to fit the surgeons hands to pass through and also allows the visualization of the uterus.
Total Laparoscopic Hysterectomy
Using a few small incisions, long instruments are inserted through the abdomen one of which is a small endoscopic camera. Images from the camera allow the uterus to be removed, replacing the need for a larger incision through which the surgeon's hands fit. The uterus can be removed through an incision that's made to separate the cervix from the vagina or instead through a single incision either in the navel or in the bikini line.
The surgery is enriched by augmenting the training and skill of the surgeon and transmitting it through the precision of state of the art computerized movements while visualized with the clarity of HD technology.
Other Surgeries that can be done through these incisions and using the techniques through the Abdomen, with Operative Laparoscopy or with the Robot include:
- Ovarian Cysts