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Gynecologists treat gynecologic conditions, such as fibroids, heavy menstrual periods, endometriosis, or ovarian cysts, with medicine, surgery, or both. Once you and your doctor have decided that surgery is the best treatment for your condition, it is important to consider the route or type of surgery that you will have. In most cases, minimally-invasive surgery is preferred because it can reduce the risk of complications, shorten your recovery, and give you a more cosmetic result.
Minimally-invasive gynecologic surgery refers to two categories of surgery:
The first type of minimally-invasive surgery is laparoscopy, in which small incisions are made in the abdominal wall and a fiber-optic telescope, called a laparoscope, is used to look inside. Long, thin instruments can then be inserted through small incisions to perform the steps of the procedure. This route of surgery is used to diagnose conditions such as endometriosis, remove abnormal tissues such as ovarian cysts or fibroids, and perform more extensive surgeries such as hysterectomy or surgery for gynecologic cancers. A hysterectomy performed in this way is called a laparoscopic hysterectomy.
The second route of minimally-invasive surgery is vaginal surgery, in which an incision is made in the vagina only, and the steps of the procedure are performed through this incision. A hysterectomy performed this way is called a vaginal hysterectomy. These routes of surgery can also be combined, such as with a laparoscopically-assisted vaginal hysterectomy. Additionally, a robotic instrument has been developed which can help your surgeon. This is referred to as a robotic hysterectomy or a robotic-assisted laparoscopic hysterectomy.
The main alternative to the minimally-invasive route is called the abdominal route or approach, in which a large (often 15 cm/6 inches or greater) incision is made in the abdominal wall and the steps of the surgery are performed through this incision. A hysterectomy performed in this way is referred to as an abdominal hysterectomy.
Compared to the minimally-invasive routes, abdominal surgery carries higher risks of complications, a longer recovery time, and will usually result in a larger scar. However, not all patients are eligible for minimally-invasive surgery, and in certain cases, the abdominal approach may be the safest way to perform your surgery.
Your surgeon will consider your medical and surgical history, your anatomy, and any past, present, or anticipated gynecologic conditions, to choose the best route for your surgery. Patient and surgeon preference may also be taken into account.
It is also important to know also that on certain rare occasions, your surgeon may need to change the route of surgery to keep you safe. This is referred to as conversion to the abdominal approach, and while rare, it is an important option to have so that your surgery can be completed safely.
Once you and your gynecologist have decided that surgery is needed, he or she will explain to you the proposed procedure, including the route of surgery. You should make sure that you understand why surgery is needed, what route of surgery will be used, and what the risks, benefits, and alternatives to the proposed procedure are.
Make sure you ask your surgeon how you can best prepare for surgery, how long you are expected to be in the hospital, and what your recovery time at home will be like.
If a minimally-invasive surgery is planned, you can expect a shorter time in the hospital and a faster recovery.
In fact, many patients who undergo minimally-invasive surgery do not need to stay overnight and can be safely discharged to recover at home.
Dr. Benjamin White is a board-certified obstetrics and gynecology physician. He has clinical interests in minimally invasive surgery and patient education. He attended medical school at the University of Connecticut School of Medicine in Farmington, Connecticut, and completed his residency at the University of North Carolina at Chapel Hill in Chapel Hill, North Carolina.
Schedule an appointment with Dr. White.
3000 New Bern Ave.
Raleigh, NC 27610