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Minimally Invasive Gynecologic Surgery

What is Minimally Invasive Gynecologic Surgery?

Gynecologic surgery is a surgical procedure performed on any organs of a female’s reproductive system located in the pelvis area, such as the uterus, cervix, ovaries, fallopian tubes, and vagina for treatment of gynecological conditions such as gynecological cancers. Hysterectomy (surgical removal of the uterus) is the most common gynecologic surgery performed for the treatment of uterine cancer.

Minimally invasive gynecologic surgery refers to the use of less invasive techniques, such as hysteroscopy or laparoscopy, to surgically treat gynecological disorders. These techniques may involve a single incision or a few small incisions or no incisions to access the organs of the female reproductive system and perform the required repair using specialized tools for the treatment of a gynecologic condition. Minimally invasive techniques provide an effective and safer alternative to the traditional or standard open surgical technique that involves a large abdominal incision to access the woman’s reproductive system.

Conditions Treated with Minimally Invasive Gynecologic Surgery

Some of the gynecologic conditions that can be treated with minimally invasive gynecologic surgery include:

  • Uterine Polyps: Non-cancerous tissue overgrowths of the endometrium, the innermost lining layer of the uterus.
  • Uterine Fibroids: These are also known as leiomyomas and are noncancerous growths in the uterus.
  • Ovarian Cysts: Sacs filled with fluid that form inside or on the ovaries.
  • Gynecologic Cancers: Cancers that affect the female reproductive system, such as the uterus, cervix, and ovaries.
  • Pelvic Inflammatory Disease (PID): This is characterized by infection of the female reproductive organs, such as the uterus, fallopian tubes, and ovaries.
  • Endometriosis: A painful gynecological disorder in which the tissue that normally lines the uterus (endometrium) grows outside the uterus.
  • Ectopic Pregnancy: A pregnancy that is not in the usual place within the uterus but develops outside the uterus (womb).

Types of Minimally Invasive Gynecologic Surgery

Minimally invasive gynecologic surgery can be performed by the following less invasive approaches, such as:

  • Hysteroscopy: In this procedure, a thin telescopic instrument with a lighted camera called a hysteroscope is inserted through the vagina to access the uterus.
  • Laparoscopy: This surgical technique involves a few small incisions in the pelvic area and insertion of a laparoscope - a thin fiber-optic instrument with a camera and lens attached to it - and miniature surgical instruments to access the operative field.
  • Single-Port Surgery: This is an approach in which a single incision is made through the belly button to access the surgical site rather than multiple keyhole incisions on the abdomen as in standard laparoscopy surgery.
  • Vaginal Technique: In this technique, your surgeon makes a small surgical cut in the vagina to access the operative site.
  • Laparoscopic-Assisted Vaginal Technique: This is a surgical technique that utilizes a laparoscope as a guide for removal of the reproductive organs, such as the uterus, fallopian tubes, and/or ovaries, through the vagina.
  • Robotic-Assisted Laparoscopy: In this approach, your surgeon utilizes a robotic system consisting of a console that offers magnified, high-resolution 3D images of the operative field, and controls robotic arms with special instruments to carry out a laparoscopy.

Procedures Performed with Minimally Invasive Gynecologic Surgery

A wide range of gynecologic surgeries can be performed using minimally invasive techniques. These surgeries include:

  • Hysterectomy: A surgical procedure for the removal of the uterus, and in some instances, fallopian tubes and ovaries.
  • Ovarian Cystectomy: A surgical procedure to remove a cyst or cysts from one or both of the ovaries.
  • Myomectomy: A surgical procedure to remove uterine fibroids, benign or non-cancerous growths appearing in your uterus, and reconstruction of the uterus.
  • Tubal Ligation: A permanent birth control method that involves the surgical blocking of the fallopian tubes, the region of fertilization.
  • Cancer Surgery: Removal of cancerous tumors from the reproductive organs such as uterus, cervix, and ovaries.
  • Endometrial Ablation: A procedure to destroy (ablate) the uterine lining, also referred to as the endometrium, to stop or reduce heavy menstrual bleeding.

Preparation for Minimally Invasive Gynecologic Surgery

In general, pre-procedure preparation for minimally invasive gynecologic surgery will involve the following steps:

  • A review of your medical history and a physical examination to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications or supplements you are taking or any conditions you have such as lung or heart disease.
  • You may be asked to refrain from certain medications such as blood thinners or aspirin for a week or two prior to the procedure.
  • You should refrain from alcohol or tobacco at least a week prior to surgery and several weeks after surgery.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • You will be placed on a special diet prior to surgery and laxatives may be used to clean out your bowel.
  • You may be instructed to shower with an antibacterial soap the night before or the morning of surgery to help lower your risk of infection post surgery.
  • You should arrange for someone to drive you home after surgery.
  • A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Minimally Invasive Gynecologic Surgery

Minimally invasive gynecologic surgery most often involves the following common techniques:

Single-Incision Laparoscopic Surgery (SILS): This type of minimally invasive gynecologic surgery is usually performed under general anesthesia in which your surgeon makes a single small incision at the navel or belly button. A SILS port is inserted through the single incision at the belly button to create a single entry point for the laparoscope and instruments. The port is a flexible and soft instrument enabled with features to perform the surgical procedure. A laparoscope (tube with a light and a miniature camera) is introduced into the abdomen. The camera is connected to a monitor, which allows your surgeon to get a magnified view of the operating field. A harmless gas is pumped into the abdominal cavity to expand the viewing area of the abdomen giving the surgeon a clear view and room to work. Miniature surgical instruments are inserted and through the help of images displayed on the video monitor your surgeon carries out the required surgical correction accordingly. After the procedure, the single incision is closed with stitches and covered with bandages.

Laparoscopic Gynecologic Surgery: This surgical technique is similar to the SILS procedure and is done under general anesthesia. A few small keyhole incisions are made just below your belly button. The abdomen is inflated with gas and a fiber-optic instrument called a laparoscope is inserted through an incision to view the internal pelvic organs. Miniature surgical instruments are inserted through other incisions and with the help of images displayed on the video monitor your surgeon carries out the required surgical correction such as removal of the uterus, cervix, or other reproductive organs accordingly. After the procedure, the incisions are closed with stitches and covered with bandages.

Robotic-Assisted Gynecologic Surgery: Most of the complex gynecologic surgical procedures can be performed with the da Vinci robotic system. The da Vinci® robotic surgical system offers a minimally invasive alternative option to traditional open and laparoscopic surgery.

The da Vinci® surgical system consists of a surgeon’s console, a patient-side cart with four interactive robotic arms, a high-performance vision system (3D camera), and miniaturized EndoWrist surgical instruments.

While performing the surgical procedure, your surgeon will be seated at the da Vinci® console and is able to view a magnified, high-resolution 3D image of the area to be operated on. To access the surgical site, your surgeon introduces miniaturized EndoWrist instruments through a few tiny incisions. These instruments help your surgeon perform the procedure with precision and control. Your surgeon uses master controls that function similar to forceps and in turn da Vinci® responds by immediate translation of the surgeon’s directions into precise movements of the miniaturized instruments.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after minimally invasive gynecologic surgery will involve the following steps:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
  • You may experience pain, inflammation, and discomfort in the operated area. Medications are provided as needed to keep you comfortable. Antibiotics may also be given to address the risk of surgery-related infection.
  • Walking and moving around in bed is strongly encouraged as it lowers the risk of blood clots and pneumonia. It also helps to stimulate your bowels and assist with passing gas.
  • Your diet is slowly advanced post-surgery. You will start with clear liquids and then progress to a pureed and solid diet, as tolerated.
  • Instructions on incision site care and bathing will be provided to keep the wound clean and dry.
  • Refrain from smoking for a specified period of time as it can hinder the healing process.
  • Refrain from strenuous activities and lifting heavy weights for the first couple of months. A gradual increase in activities is recommended.
  • You will likely be discharged within a couple of days. You will need to take off from work for at least a couple of weeks to rest and promote healing.
  • You will be able to resume your normal activities in a couple of weeks but may have certain activity restrictions.
  • Walking is a good exercise and is strongly recommended to improve your endurance.
  • Refrain from driving until you are fully fit and receive your doctor’s consent.
  • Periodic follow-up appointments will be scheduled to monitor your progress.

Benefits of Minimally Invasive Gynecologic Surgery

Some of the benefits of minimally invasive gynecologic surgery over traditional open surgery include:

  • Faster recovery time
  • Minimal pain/discomfort
  • Minimal trauma to skin and muscles
  • Minimal bleeding
  • Lower risk of infection
  • Lower risk of nerve or blood vessel injury
  • Minimal to no visible scar
  • Shorter hospital stay
  • Better overall cosmetic results

Risks and Complications of Minimally Invasive Gynecologic Surgery

Minimally invasive gynecologic surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, including:

  • Infection
  • Bleeding
  • Post-procedure pain
  • Bowel/bladder issues
  • Blood clots
  • Pneumonia
  • Allergy/anesthetic reactions
  • Damage to adjacent structures, such as nerves, vessels, and organs
American College of Obstetricians and Gynecologists American College of Surgeons American Board of Obstetrics and Gynecology