No woman really relishes the idea of having an annual gynecologic examination, but it’s one of the most important things that she can do. Many female organ diseases are undetectable without this vital yearly process. If a problem is discovered, early diagnosis and treatment are associated with a better outcome. If the gynecologic condition requires surgery, how that surgery is performed can also determine a patient’s outcome.
What gynecologic surgeons have learned over the past 20 years is that the size of the incision made to the abdomen — not the actual magnitude of the surgery — most often determines how easy a patient’s recovery is. Traditional surgery with a large abdominal or pelvic incision usually requires days of inpatient hospitalization and a prolonged recovery that’s more painful than what would have been experienced with minimally invasive surgery.
Minimally invasive, or laparoscopic, surgery requires a few tiny keyhole incisions and sometimes can even be done with a single surgical cut made inside a patient’s navel. Small instruments and a camera are inserted through these incisions, and the surgeon sees the surgical site on a television screen, as he or she maneuvers the instruments. Because the patient’s pelvis and abdomen remain closed, there is much less risk for infection or blood loss.
When gynecologic procedures are performed as minimally invasive laparoscopic surgeries, they can be done on an outpatient basis. Recovery with a return to normal life is significantly faster than with traditional open surgery. Rather than being out of commission for four to six weeks — as one often is with an open procedure — many patients who have had minimally invasive surgery report being able to return to work in about a week.
Not insignificantly, the cosmetic results with minimally invasive surgery are better as well. Instead of a prominent pelvic scar, patients who have had a minimally invasive procedure usually have smaller, almost unnoticeable scars that are often hidden in the navel or bikini line.
Almost all major gynecologic surgeries can now be performed using laparoscopy or robotically assisted laparoscopic methods. The list of conditions that require a traditional open surgery approach is growing shorter every day. In all cases, when performed by skilled and specifically trained GYN surgeons, women can enjoy the benefits of minimally invasive surgery.
If your doctor determines that you need gynecologic surgery, be sure to ask if he or she is trained to do it with a minimally invasive method. If not, you owe it to yourself to seek another opinion from a gynecologist with expertise in minimally invasive surgery.
The American Association of Gynecologic Laparoscopists published a position statement in 2010: “It is the position of the AAGL that most hysterectomies for benign disease should be performed either vaginally or laparoscopically and that continued efforts should be taken to facilitate these approaches. Surgeons without the requisite training and skills required for the safe performance of VHs [vaginal hysterectomies] or LHs [laparoscopic hysterectomies] should enlist the aid of colleagues who do, or [they] should refer patients requiring hysterectomies to such individuals for their surgical care.”
In this modern era, women should demand minimally invasive surgical care or be given a reason if their doctor won’t do so. Women deserve no less.
David L. Zisow, M.D., F.A.C.O.G., is a gynecologist and the associate chief of the Division of Minimally Invasive Surgery at Northwest Hospital, as well as its director of the Fellowship in Minimally Invasive Gynecologic Surgery.