Understand your choices when it comes to gynecological surgery. This is the first in a series of FAQs about minimally invasive and open surgeries.
[3 MIN READ]
Many years ago, if a woman needed surgery because of gynecological health problems, surgeons would make a large incision (cut) in the skin and muscle. Then the surgeons could directly see and treat the problem in the woman’s body. This method is called “open surgery.” While doctors still do this type of procedure, they can now perform many gynecologic surgeries using minimally invasive methods.
To learn more about this procedure and how to select the right surgeon for your condition, we talked with Swedish gynecologist Dr. Brooke Winner. She is a board-certified and fellowship-trained advanced laparoscopic surgeon. By not practicing obstetrics, she is able to focus on gynecology and maintain a high volume of surgery. Although you may be referred by your doctor to a surgeon, it never hurts to do your research, learn more about your procedure, and consider seeking a second opinion.
What does “minimally invasive” mean?
Minimally invasive surgeries use methods that limit the size and number of incisions surgeons need to make so the procedure can be done more efficiently, with less scarring and downtime. According to Dr. Winner, the surgeries “use a camera that’s typically inserted through the belly button or in a small incision slightly higher than the belly button. Then a couple of smaller incisions are made off to each side,” she says.
Both laparoscopic and robotically assisted surgery are considered minimally invasive. (Look for FAQs about robotically assisted surgery, coming up in this series.)
What is laparoscopic surgery?
In laparoscopic surgery, the surgeon uses special long-handled tools and looks at magnified images on a video screen. The laparoscope (camera) is used to make those enlarged images.
Explains Dr. Winner, “The surgeon stands next to the patient, holds the camera and manually runs the surgical instruments while watching the image on a screen. When I am operating, I am right there at the patient’s side.”
Early on, laparoscopy was mostly used to diagnose health problems. But over the last 50 years, laparoscopy has become a tool that’s used for a wide variety of conditions and is one of the most common surgeries being done around the world.
What are the benefits of laparoscopic surgery?
“The benefits of laparoscopy include less pain and faster recovery,” says Dr. Winner. This is in comparison to open surgery, which may usually involve longer hospital stays and recovery times. Some laparoscopic surgeries are complete within a couple hours and you usually go home the same day or the next morning versus a standard open surgery that requires 3-5 days in the hospital. The smaller incisions help you heal faster than open surgery, depending on the type of surgery and your overall health. With laparoscopy, your incision(s) will be very small, vs. for an open surgery where your incision may be approximately up to 12 inches.
Are there any risks with laparoscopic surgery?
Just as with any surgery, there are risks with laparoscopy. Those may include bleeding, infection, pain, and damage to surrounding structures such as the bowel, bladder, ureter, blood vessels, and nerves, as well as risk of hernia or blood clot. After surgery, your healthcare team will pay close attention to your body as you recover. Make sure you discuss any unusual symptoms with your doctor.
What gynecologic surgeries are done using laparoscopy?
“I perform laparoscopic hysterectomies, where the uterus is detached from inside the body. If the ovaries are normal, they can be left in place so a woman can keep her hormones and not go into menopause. If the uterus is small, it can be removed through the vagina at the end of the procedure. If the uterus is enlarged due to fibroids, it may need to be placed in a bag and removed through the belly button,” notes Dr. Winner. Laparoscopic hysterectomies can be done as an outpatient procedure or with one overnight stay. “Seventy-five percent of my patients go home the same day after a laparoscopic hysterectomy, and almost 100% after other types of laparoscopic surgery.”
Other surgeries include laparoscopic myomectomy (removing fibroids from the wall of the uterus) and laparoscopic removal of endometriosis tissue. Fibroids often cause pain in the abdomen, pressure that leads to problems urinating, infertility and more. Fibroids can also cause heavy or irregular menstrual bleeding. Endometriosis tissue may cause pain in the pelvic and/or lower back region and pain with sexual activity or bowel movements. Removing either of these will relieve your pain and help restore your health.
Laparoscopy may also be used to learn what’s causing pelvic pain, a pelvic mass, or infertility. If a problem is found, it’s often treated during the same surgery.
What does Dr. Winner recommend about laparoscopic surgery?
If you’re considering laparoscopy, don’t hesitate to do your research. Dr. Winner advises you to keep these things in mind when choosing a surgeon:
- Did the surgeon receive general training in obstetrics and gynecology or does the surgeon have added years of training (called a fellowship) in gynecological surgery?
- How many surgical procedures is the surgeon doing per month or per year?
- Does the surgeon perform certain types of gynecological laparoscopic procedures more often than others? For instance, performing laparoscopic hysterectomies more often than laparoscopic myomectomies.
- Do you feel comfortable with the surgeon and feel you have a clear understanding of what to expect before, during, and after laparoscopy?
Dr. Winner emphasizes that when it comes to laparoscopic surgery, the number of surgeries a doctor has performed is key. She says, “It’s not the wand, it’s the wizard. Meaning, the surgical tools they choose to use is not as important as the skill level of the surgeon. A good outcome begins with a skilled surgeon who’s done many surgeries within their specialty. For instance, I operate about five times a week. A surgeon who does the same thing over and over knows the patient’s options and can clearly tell her what to expect. That’s what every woman considering a minimally invasive surgery like laparoscopy should look for.”
Find a doctor
Are you wondering what your options are for your next gynecologic procedure? You can find a Providence doctor using our provider directory. Or, you can search for a primary care doctor in your area.
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American College of Obstetrics and Gynecologists – Uterine Fibroids
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