The Association of Minimally Invasive Gynecologic Surgeons

…dedicated to safe, state-of-the-art surgery and health life-styles for women of all ages

R. Wayne Whitted MD, MPH

Paul A. Pietro MD

8740 N Kendall Dr. Suite 101

Miami, Florida 33176

Phone: 305-596-3744

www.floridaamigos.com

Minimally Invasive Surgical Procedures for Women

Modern advances in surgical technique have rapidly changed women’s health

care. Traditionally, the sole solution to treating specific internal medical problems

was to perform invasive surgery, which involved a large abdominal incision and a

painful and lengthy recovery. Now, accomplishing the same goal with less

invasive procedures has become an alternative for countless women, and the

result is a shorter hospital stay and a quicker and less painful recovery. These

advanced methods result in minimal operative trauma to the surgical area’s skin

and muscles and little or no post-operative scarring. The workhorse of these

minimally invasive procedures is the laparoscope or Hysteroscope, which are used

for both diagnostic screening and operative procedures.

Laparoscopic surgery involves tiny ¼ inch abdominal wall incisions, through

which a harmless gas, e.g. carbon dioxide, is introduced to expand the abdomen,

and create a larger and more visible work area for the surgeon. A tiny lit

telescopic camera (laparoscope) is then inserted through another abdominal

incision. The camera is attached to a television monitor, which allows a physician

to visualize the pelvic organs. Then long narrow surgical instruments are inserted

through another incision, and, with the help of a video monitor, the surgeon is

able to manipulate the instruments and perform surgery.

Gynecologists trained and certified in advanced laparoscopy routinely use

this procedure to treat women’s health conditions, such as infertility,

pelvic pain, endometriosis, pelvic adhesions, fibroids, incontinence and

ovarian cysts.

Since the laparoscope permits pelvic visualization for

simple or advanced procedures, major and minor surgery can be

performed laparoscopically. Laparoscopy is also important in the

diagnosis and treatment of endometrial and ovarian cancers, as well as

other malignancies.

Some of the gyn procedures performed laparoscopically (through tiny abdominal

incisions) or hysteroscopically (through the vagina) are:

• Transvaginal hysterectomy: removal of the uterus and cervix, and possibly

the fallopian tubes and ovaries

• Supracervical hysterectomy: removal of detached uterus through a

laparoscopic incision, leaving a portion of the cervix

• Myomectomy: removal of fibroids from the uterine wall through a

laparoscopic incision

• Tubal ligation: blocking, for sterilization, both fallopian tubes by tying,

sealing or attaching a ring or a clip.

• Reverse tubal ligation

• Ovarian cystectomy: removal of ovarian cyst(s) through a laparoscopic

incision. Laparoscopy is considered an excellent procedure for diagnosing

and treating non-cancerous ovarian cysts

• Infertility: removal of infertility causing endometriosis or pelvic adhesions

through a laparoscopic incision

• Incontinence: anchor bladder neck and urethra to treat stress incontinence

laparoscopically

• Pelvic Reconstruction: repair of uterine prolapse, bladder prolapse, vaginal

prolapse with the laparoscope

Laparoscopy is used to cut or cauterize scarring or growths caused by

endometriosis. Laparoscopic surgery may be required when there is a large

amount of endometrial tissue outside of the uterus or when this tissue covers the

ovaries and interferes with egg production.

Most women who have a laparoscopic procedure are able to go home the same

day. The main benefits of laparoscopic surgery are:

• Less invasive

• Less risk with properly trained surgeon

• Less blood loss

• Less adhesions (scarring)

• Less pain

• Quicker recovery

• Small incisions

• Same day or overnight surgery stay

• Quicker return to work

Diagnostic hysteroscopy is the use of a telescopic video camera to visually

inspect, diagnose and treat problems affecting the lining of the uterus

(endometrium) such as polyps, fibroids and anomalies. A physician, guided by

the hysteroscope, can remove polyps and fibroids, correct uterine abnormalities

and remove the lining of the uterus. A hysteroscopy requires general or regional

anesthesia and can be performed as an outpatient procedure. Recovery is related

to the extent of surgery.

The majority of general women’s surgical procedures performed in a modern

hospital setting can be conducted laparoscopically. This reality provides women

with more choices to manage specific gynecologic problems. In other words, the

more a woman knows about these options, the more likely she will make the best

surgical choice in cooperation with her physician.

All About Hysteroscopy

What Is a Hysteroscopy?

Hysteroscopy is a non-invasive (no incisions) diagnostic or operative

procedure, which utilizes a hysteroscope - a thin-lit telescopic device inserted

through the vagina and cervix - to view inside the uterine cavity. It is used to

evaluate patients with infertility, recurrent miscarriages or abnormal bleeding

and to diagnose abnormal uterine conditions, such as fibroids, scarring, polyps

and cancerous or precancerous growths. Hysteroscopy can be used to confirm

the results of other tests, such as a hysterosalpingography (x-ray of uterus and

fallopian tubes).

Diagnostic Hysteroscopy

The first step in a diagnostic hysteroscopy involves slightly widening the

cervical canal with a series of dilators. Once the cervix is dilated, a

hysteroscope is inserted through the cervix and into the lower end of the

uterus. Carbon dioxide gas or special clear solutions are then injected into the

uterus, through the hysteroscope, to expand the uterine cavity, clear blood and

mucous and enable the physician to directly view the internal structure of the

uterus.

Diagnostic hysteroscopy is usually conducted on an

outpatient basis without anesthesia and is usually

performed soon after menstruation, since the uterine

cavity is more easily evaluated and there is no risk of

interrupting pregnancy.

Operative Hysteroscopy

Operative hysteroscopy can be used to treat many of the abnormalities found

during diagnostic hysteroscopy. Treatment may be performed at the same

time as a diagnostic hysteroscopy or at another time. Operative hysteroscopy

is similar to diagnostic hysteroscopy, except that the hysteroscope is used to

allow operating instruments such as scissors, biopsy forceps and electrosurgical

or laser tools into the uterine cavity via a channel in the hysteroscope. Fibroids,

scar tissue and polyps are then removed from inside the uterus.

Some of the gyn procedures performed hysteroscopically are:

• Hysteroscopic Resection of Sub mucous Fibroids Hysteroscopic

removal of fibroid located in the uterine cavity is extremely efficient

technique with excellent results in experienced hands.

• Hysteroscopic Lysis of Endometrial Scar Tissue

• Hysteroscopic Tubal Obliteration Ligation

• Hysteroscopic Tubo-Cornual Canulation

• Hysteroscopic Septum Resection

Endometrial ablation: electro-, thermal or microwave scarring of uterine lining

through a hysteroscope inserted into the uterus. This procedure can be used

to treat excessive uterine bleeding as an alternative to hysterectomy

Patients normally recover within 24 hours following most hysteroscopic

procedures, which is significantly less than the recuperation period for major

abdominal surgery. Hysteroscopy also decreases patient post-operative

discomfort. . Antibiotics and/or hormonal medication may be prescribed after

surgery to prevent infection and stimulate healing.

Conclusion

Diagnosing and correcting gynecologic disorders once required major surgery

and many days of hospitalization. Minimally Invasive Gynecologic Surgery now

allows physicians to diagnose and correct many of these problems on an

outpatient basis. Before undergoing any surgery, patients should discuss any

concerns about their condition and the procedure to improve their condition

with their health care provider.

Very Truly Yours,

Drs. Whitted and Pietro

The Association of Minimally Invasive Gynecologic Surgeons