Gynecology

Over the past decade, a technique has been developed that can reduce or stop your periods without a hysterectomy. This surgery can be done in women who have flooding either with or without fibroid tumors. Dr. Dott was one of the surgeons who introduced this minimally invasive procedure in Atlanta. He has performed this procedure many times and is certified by the Accreditation Council for Gynecological Endoscopy in Advanced Hysteroscopic Surgery. He has taught this procedure in training institutions both in the United States and Russia.

Laparoscopy, looking inside the abdomen through a tube placed through a small incision, is a procedure commonly used by gynecologists to diagnose and treat a number of medical conditions. Since the early 1900's when rudimentary laparoscopes were used to visualize, but not treat, abdominal diseases, advancements in this technique have led to the ability to perform complex surgical procedures through a few small incisions, rather than the larger incisions used in the past.

Laparoscopy is a form of minimally invasive surgery. The surgeon inserts a tiny telescope (laparascope) though a small incision at the umbilicus (belly-button). The laparoscope allows the surgeon to visualize the pelvic organs on a video monitor. Several additional smaller incisions are made in the abdomen for the surgeon to place specially designed surgical instruments, which help the surgeon carry out the same procedure as in open surgery.

Many gynecologists will remove laparoscopically ovaries/ovarian cysts and treat ectopic pregnancies as well as endometriosis. Hysterectomies, bladder suspension surgeries and pelvic floor repair can also be treated by laparoscopy but these procedures are more advanced and may require additional training.

Hysteroscopy is a form of minimally invasive surgery. The surgeon inserts a tiny telescope (hysteroscope) through the cervix into the uterus. The hysteroscope allows the surgeon to visualize the inside of the uterine cavity on a video monitor. The uterine cavity is then inspected for any abnormality. The surgeon examines the shape of the uterus, the lining of the uterus and looks for any evidence of intrauterine pathology (fibroids or polyps). The surgeon also attempts to visualize the openings to the fallopian tubes (tubal ostia).

Questions on Laparoscopy & Hysteroscopy

More than half of the 600,000 hysterectomies performed in the 1900s involved bilateral salpingo-oophorectomy, and it has been estimated that many of those were performed solely to reduce the risk for ovarian cancer. While there has been increased knowledge in the risk in women with familial history, a knowledge gap still exists for other women, which could lead them down the path of potentially unnecessary surgery

In Part 3, the speakers address the question: Is there a place for robot-assisted laparoscopy? They also discuss the benefits that should not be ignored and what role robot-assisted laparoscopy might play in clinical practice in the future.

In Part 2, the authors discuss how robotic laparoscopic hysterectomy compares with traditional laparoscopic hysterectomy. They also explore the clinical implications of one treatment versus the other.

Optical coherence tomography (OCT), a new imaging technology that allows noninvasive cross-sectional imaging, has high sensitivity for diagnosing cervical cancer, but low specificity, according to a study published in the March issue of Lasers in Surgery and Medicine.

Cementless modular total hip arthroplasty together with subtrochanteric osteotomy appears to be a satisfactory treatment for patients with prior Crowe Group-IV dysplasia of the hip, according to research published in the March 16 issue of The Journal of Bone & Joint Surgery.

To prevent over-distention of the bladder, clinicians rely on indwelling catheters for several days. However, little is know about the ideal length of time for catheter use. Although short-term catheterization can reduce hospital stays and urinary tract infections, it can also lead to increased postoperative voiding problems such as obstructive voiding and large residual volumes; these in turn can result in urinary tract infections and bladder dysfunction.

Performing surgeries laparoscopically offers patients faster recovery, decreased blood loss and transfusion rates, and less postoperative pain, but laparoscopic procedures in gynecologic oncology can be very challenging and requires significant technical expertise and experience. It is believed that the integration of robotics into these surgeries might offer a significant advantage in the learning curve, thus allowing more surgeons to offer this procedure to their patients. . . but is this an effective and safe alternative?

That’s what one team of researchers sought to determine as they explored its use in the case of laparoscopic hysterectomy.

Women are willing to wait longer with their symptoms to delay a more invasive procedure for uterine fibroids compared to how long they would delay a noninvasive one, according to a study published online March 1 in Radiology.

Prenatal surgery for myelomeningocele decreases the need for shunting and improves motor outcomes at 30 months, though it is linked to an increased risk of preterm delivery and uterine dehiscence at delivery, according to a study published online Feb 9 in the New England Journal of Medicine.

Women who receive false-positive results from routine breast cancer screenings may experience a low quality of life and feelings of anxiety for at least one year, according to a study published online Dec. 20 in the British Journal of Surgery.

Male urinary symptoms do not improve and erectile issues worsen after gastric banding surgery

The American Institute of Minimally Invasive Surgery (AIMIS) today announced a partnership with the American Society for Women’s Health (ASWH). AIMIS will contribute both expertise in minimally invasive techniques as well as a much-needed business practice component to ASWH’s continuing education curriculum.

The Hysterectomy Resource Center has been created to provide surgeons with the most up to date information on minimally invasive hysterectomy techniques.

Total Laparoscopic Hysterectomy using a new hand activated advanced bipolar device, the HALO™ PKS™ Cutting Forceps

What type of hysterectomy do you suggest for my condition? Is it minimally invasive or an abdominal hysterectomy?

Dr. William von Almen, M.D., FACOG is an experienced minimally invasive gynecologic surgeon who has been in private practice for 28 years.