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Scarless Gynecologic Surgery

What is Scarless 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 a gynecological condition such as gynecological cancer. Hysterectomy (surgical removal of the uterus) is the most common gynecologic surgery for the treatment of uterine cancer.

Scarless gynecologic surgery is a minimally invasive surgery in which a single incision of about three-fourths of an inch is made in the belly button and a laparoscope and miniature surgical instruments are passed through the incision to access an organ of the female reproductive system and perform the required repair for treatment of a gynecologic condition. Once the single-site incision is closed and healed, it is hardly noticeable, hence the surgery is referred to as scarless gynecologic surgery.

Indications for Scarless Gynecologic Surgery

Scarless gynecologic surgery is indicated for the treatment of various gynecologic conditions, such as uterine cancer, uterine fibroids, endometriosis, uterine prolapse, and menorrhagia (excessive bleeding).

Some of the common gynecologic surgeries that can be performed through the single-site (or scarless) incision approach include:

  • Excision (removal) of abnormal growths from the cervix (the bottommost section of the uterus that attaches to the vagina)
  • Excision of the uterus, ovaries, or other parts of a female’s reproductive system
  • Excision of ovarian cysts (noncancerous growths on an ovary)
  • Excision of fibroids or cysts (noncancerous growths) in the uterus
  • Surgical treatment of gynecological (ovarian, uterine, or cervical) cancers
  • Tubal ligation (tying of the fallopian tubes as a method of birth control)

Preparation for Scarless Gynecologic Surgery

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

  • A thorough examination is performed by your doctor 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, vitamins, or supplements that you are taking or any conditions you have such as lung or heart disease.
  • You may be asked to stop taking medications such as blood thinners, aspirin, or anti-inflammatory or vitamin or herbal supplements for a specific period if medically indicated.
  • 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 Scarless Gynecologic Surgery

Scarless gynecologic surgery is usually performed under general anesthesia. Your surgeon makes a small single-site incision at the navel or belly button. A 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 have 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 with 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.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after scarless 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 pureed and solid diet, as tolerated.
  • It is important to keep the surgical site clean and dry. Instructions on surgical site care and bathing restrictions will be provided.
  • Refrain from smoking for a specified period of time as it can hinder the healing process.
  • Refrain from strenuous activities and lifting anything heavier than 10 pounds for the first couple of months. A gradual increase in activities over a period of time 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 Scarless Gynecologic Surgery

Some of the benefits of scarless gynecologic surgery include:

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

Risks and Complications of Scarless Gynecologic Surgery

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

  • Infection
  • Bleeding
  • Hematoma (accumulation of blood in the wound)
  • Seroma (accumulation of clear fluid in the wound)
  • Damage to surrounding soft tissue structures, such as nerves, vessels, and organs
  • Post-procedure pain
  • Blood clots
  • Pneumonia
  • Allergy/anesthetic reactions
American College of Obstetricians and Gynecologists American College of Surgeons American Board of Obstetrics and Gynecology