Gynecology

Asherman’s Syndrome is an extremely common and occasionally complicated disease entity. It takes many forms and can follow a routine D&C, a hysteroscopy, a delivery or even a surgical procedure such as a myomectomy or polypectomy. This case study from Dr. Alan Copperman reviews diagnosis and treatment options.

Traditional open gynecologic surgery using a large incision for access to the uterus and surrounding anatomy has for many years been the standard approach to many gynecologic procedures. Yet, with open surgery can come significant pain, trauma, a long recovery process, risk of adhesions, risk of incision breakdown, and threat to surrounding organs and nerves. For women facing gynecologic surgery, the period of pain, discomfort, and extended time away from normal daily activities that usually follows traditional surgery can understandably cause significant anxiety.

Neena Agarwala, MD, MSc, FACOG, performs an endometriosis excision using robotic surgery.

Neena Agarwala, MD, Msc, FACOG performs a robotic supracervical hysterectomy on a 20-week uterus.

Neena Agarwala, MD, Msc, FACOG performs robotic hysterectomy in a patient with a large uterus.

Laparoscopic Myomectomy uses a small telescope placed through the belly button along with several small instruments to remove fibroids from the uterus. The technique of actually removing the fibroid from the uterus is similar to that of an abdominal myomectomy except we use small instruments placed through the abdominal wall. Once the fibroid is freed from the uterus it needs to be removed from the abdomen. In order to remove a large fibroid from a small incision we use an instrument called a morcellator, to cut it into pieces small enough to be removed through the small incisions.

Surgery in the medical office setting can confer benefits for both the physician and the patient, as it can control costs, allow for flexibility in scheduling, and increase overall convenience.

As operative laparoscopy becomes more widely accepted, new techniques are being developed and more surgeons are utilizing this type of surgery in practice. Naturally, complication rates are also expected to rise.