Many conditions requiring surgery can be performed in the doctor’s office with local anesthesia. This includes simple procedures, such as inserting an IUD as well as biopsies of the uterus, vagina or external genital tissues.
Other relatively minor surgeries usually require more anesthesia and take place in a day surgery facility. These include dilation and curettage of the uterus (D & C), hysteroscopy, LEEP of cervix, CO2 laser, and endometrial ablation or sterilization with the ESSURE technique. All of these procedures can be performed in an office setting if proper anesthesia is available.
Intra-abdominal surgeries using either laparoscopy or a large incision are used to treat any number of conditions involving the uterus, fallopian tubes or ovaries. These are typically performed at a day surgery facility or hospital in order to maximize safety through resources for anesthesia and the facility’s experience.
Over the past decades, surgical methods have greatly improved, along with advances in anesthesia and antibiotics. Through technology, “minimally invasive surgery” has evolved, emphasizing increased safety and effectiveness. Surgeons perform procedures through tiny incisions, which can also lead to faster recovery times and less discomfort for patients. In a hysterectomy, for example, a surgeon would use a laparoscope instead of making a large incision, the norm 20 or more years ago. For some large fibroid tumors of the uterus, however, the “minimally invasive” approach might in fact be a large incision, for the patient’s safety. Individual surgeon skill is also key to the approach. In gynecology, the most common minimally invasive surgeries are laparoscopy and hysteroscopy.
Laparoscopy is a minimally invasive surgery where a long, slender device is inserted into a woman’s abdomen through a small incision, usually no more than half an inch long. This instrument, a laparoscope, has a camera attached that allows the surgeon to view the patient’s abdominal and pelvic organs on an electronic screen. If there is a problem, other instruments can be inserted by making additional small incisions in the abdomen.
While using these advanced instruments results in a better surgical outcome, the cost is often higher for this surgery. The cost though is outweighed by improved surgical outcomes, faster recovery and reduced hospitalization.
Compared to open abdominal surgery, patients who have a laparoscopy can have:
Laparoscopy can take longer to perform than open surgery. The longer time under anesthesia may increase the risk of complications. As with open surgery, laparoscopic complications may not be readily apparent, but fortunately care in the technique can detect most unintended consequences so they can be corrected at the time.
Here’s what to watch for after surgery:
Laparoscopy is usually performed with general anesthesia, putting you to sleep. Once you are positioned properly on the surgery table and the antiseptic is applied, a small incision is made in or below your navel. The laparoscope is inserted through this small incision. Your abdomen is filled with a CO2 gas, allowing your pelvic reproductive organs to be seen more clearly. The camera attached to the laparoscope shows your pelvic organs on a screen. Other small incisions may be made in your abdomen if additional surgical instruments are needed for the purpose and scope of your surgery.
Hysteroscopy is used to examine the inside of your uterus. The hysteroscope, a thin instrument with a lens and a light source and camera attached to one end, allows your surgeon to carefully and thoroughly examine your uterine cavity.
Hysteroscopy may be performed to examine abnormal uterine bleeding, including:
Hysteroscopy can help to discover causes of the bleeding, such as polyps or fibroids. It can also be used to perform a biopsy of the uterus to check for cancerous growth, especially in postmenopausal women. This procedure may also be used to treat the problem, such as removing small polyps or fibroids. Prior to hysteroscopy, certain fibroids required a hysterectomy. Now a hysteroscopy (called hysteroscopic myomectomy) accomplishes this without losing the uterus and with much less risk, recovery time and pain.
Each year approximately 600,000 hysterectomies are performed in the United States, a little more than one uterus every minute of the year. The vast majority (90 percent) are performed for noncancerous conditions, such as fibroids, abnormal uterine bleeding and prolapse of the pelvic organs, with fibroids the most common (30 to 35 percent). This means that approximately one-third of American women will have had a hysterectomy by the age of 60. Surprisingly, 60 percent of hysterectomies in the United States are still performed through a large abdominal incision (laparotomy). This occurs despite convincing scientific evidence that an abdominal hysterectomy is associated with more pain, more blood loss, a longer hospital stay and a longer recovery period than the minimally invasive alternatives, laparoscopic hysterectomy and vaginal hysterectomy.
Dr Lee has been performing laparoscopic hysterectomies since the early 1990s.
…And don’t worry. We won’t limit the number of medical issues you can bring for evaluation at your appointment.