The Modern Landscape of Gynecologic Surgery
New surgical techniques and technologies are rapidly changing the outlook for women with gynecologic disorders, giving them faster, easier and better solutions to persistent problems. In fact, nearly every major condition that once required open abdominal surgery can now be treated with a less invasive approach.
Gone are the days when a woman with fibroids, for instance, had only two choices: Continue to suffer the consequences or surrender her uterus. Even most large fibroids can now be removed minimally invasively, resulting in shorter hospital stays, less pain, and reduced complications like post-procedure bleeding, infection or clots. For women who also wish to preserve their fertility, today’s newer options are the perfect solution.
“We have a variety of approaches to myomectomy—removing fibroids while leaving the uterus intact—at our fingertips,” says James Robinson, MD, director of Minimally Invasive Gynecologic Surgery at MedStar Washington Hospital Center. “That includes laparoscopic surgery, which uses one or two tiny incisions, robotic-assisted laparoscopic surgery and, in some cases, the even less invasive hysteroscopic approach, which doesn’t involve any cutting of the abdomen at all since we reach the fibroids entirely through the cervix.”
Patients are up and about shortly after the minimally invasive procedures, with many going home the same day.
Endometriosis - Light At The End of the Tunnel
The outlook is equally good for women with endometriosis, the often painful condition in which tissue that normally lines the uterus somehow migrates beyond the organ’s walls, attaching to other pelvic structures.
“Endometriosis has the potential to wreak havoc on the reproductive organs, including diminishing a woman’s ability to conceive, through scarring, blocking the fallopian tubes, and even matting organs together,” Dr. Robinson explains. “Many women also experience abnormal bleeding and chronic, often debilitating pain. In the worst cases, endometriosis can sometimes affect every organ in the pelvis, including the rectum, bladder, and ureters.”
Depending upon the extent of the damage, surgeons often must restore the anatomy of the bowel and bladder in addition to removing the errant endometrial tissue, requiring a high degree of expertise. Despite the complexity, Dr. Robinson reports that even severe cases can be treated with laparoscopic or robotic-assisted methods.
Perhaps some of today’s most dramatic changes involve hysterectomies. Nearly 100 percent of the procedures can now be accomplished with minimally invasive techniques, avoiding many of the complications associated with older approaches.
“With today’s newer techniques, we don’t sever the ligaments that help support the pelvic floor,” Dr. Robinson explains. “As a result, women are much less likely to develop pelvic organ prolapse, one of the leading causes of female urinary incontinence.”
Ovaries, Fallopian Tubes, and Longterm Impact on Women's Health
Recent research has also shed light on the influence of the ovaries and fallopian tubes upon a woman’s overall health, positive or negative.
“We now know that ovaries fulfill a function well past the child-bearing years, affecting everything from a woman’s heart and bones to her skin and memory,” Dr. Robinson says. “Left in place, ovaries can even contribute to a longer life. So it’s often important to preserve them during a hysterectomy, even for a post-menopausal woman.”
Conversely, the fallopian tubes are now routinely removed during a hysterectomy to reduce the lifetime risk of ovarian cancer. With few symptoms, ovarian cancer is often not detected until it is advanced, making it the fifth most common cancer among women and one of the deadliest.
Despite the progress, Dr. Robinson is concerned that not all women are benefitting from the better, easier and safer techniques.
“I often find myself talking to a woman out of a larger surgery that I don’t think she needs,” he says, noting that not every Ob/Gyn is up-to-date on the latest minimally invasive procedures. “I urge every woman to do her own research in advance, and know what her options are before making a decision.”