Laparoscopy, Hysteroscopy, Robotic Myomectomy
Laparoscopy is the most direct way to assess pelvic anatomy, and to proceed with surgical correction if necessary. Under general anesthesia with you completely asleep, a small telescope (the laparoscope) is inserted through the navel, through which we view your internal pelvic anatomy, and in many cases, intervene to correct suboptimal conditions.
Often the chief reason for infertility or miscarriage may involve the presence of scar tissue, endometriosis, fibroids, ovarian cysts or other pelvic disorders. These same conditions may also result in pelvic pain, abnormal bleeding or other gynecologic complaints. Your laparoscopy will define whether these or other conditions involve your cervix, uterus, fallopian tubes, ovaries or entire pelvis.
More importantly, in most cases laparoscopy also provides the means for effective treatment of any disorder that may exist. This is critical not only in treating the problem, but also in defining the overall conditions so additional non-surgical therapies may also be considered after your surgery.
How long does the surgery usually take?
It depends on what is found, but the average laparoscopy/hysteroscopy takes 60-90 minutes. Following that, your recovery in the recovery room is generally 2-3 hours, and shortly thereafter you will be discharged home. In less then 1% of surgeries, admission to the hospital for observation, pain management or other reasons is necessary.
In almost every instance laparoscopy / hysteroscopy is an outpatient procedure, which means “in and out”. In instances where something is found which necessitate more involved surgery (i.e., a larger incision, which would require admission to the hospital for recovery), this more extensive surgery would not be performed unless you had specifically given consent in advance.
Are special preparations needed?
In addition to our checking preoperative blood work and reviewing consents, there is very little else that you need to do, other than to get some sleep the night before. It is not necessary to donate blood in advance, since the likelihood of transfusion is well under 1%. You must remember to eat or drink nothing after midnight the night before surgery, although it is okay to brush your teeth the following morning with little water.
You should arrive for your surgery one hour before its scheduled time, at which time you will be greeted by the nurses and eventually by your doctor. Wear comfortable clothing, and no nail polish, so that the monitor, which the anesthesiologist will place on your fingertip, can function optimally. The person accompanying you can wait with you until minutes before the surgery is to begin, and he/she may join you in the recovery room shortly after the surgery is over.
When will the findings be known?
Immediately after the surgery, your doctor will explain the findings (if you wish) to your husband or partner. After anesthesia, you will not remember much of the conversation. We will explain the findings in detail and even show photographs taken during the surgery at your post-operative visit one to two weeks later in the office. We will discuss the next steps in your treatment plan.
What kind of recovery should be expected?
Following laparoscopy, 3-4 days of recovery is the average time most patients need to feel basically back to normal. Some amount of abdominal pain often persists for a few days, so please take the narcotics given to you to control this pain before it gets severe, rather than letting it get to out of control. The anesthesia effect (“feeling washed out”) can also last several days. Most people return to work after 3-4 days, though there is a wide range of variation.
Do insurance companies cover the surgery?
Almost always, yes. Our insurance coordinators assist you with any questions you may have regarding insurance coverage. Each plan varies, and you need to know in advance the terms of your specific policy. Pre certification for surgery is required.
Uterine Surgery, Operative Hysteroscopy:
What is hysteroscopy?
Hysteroscopy involves the placement of a small (typically 4 mm) telescope (the hysteroscope) through the cervix, directly into the uterine cavity. No incisions are required for hysteroscopy.
Abnormalities inside the uterine cavity such as scar tissue (from prior infection or pregnancy), fibroids, polyps, proximal tubal block (we perform tubal cannualization), or uterine malformations (such as uterine septum) can be both evaluated and treated surgically at the time of hysteroscopy.
The recovery from a hysteroscopy alone is generally only 24-48 hours, since no incision is required. The risks associated with hysteroscopy are very minimal, and include very low chances of bleeding, infection, or uterine perforation.
How long does the surgery usually take?
It depends on what is found, but hysteroscopy usually takes about 15-45 minutes to perform. If only a diagnostic procedure is performed (without surgical removal of any tissue), the length of the procedure is even shorter. Following the surgery itself, your recovery in the recovery room generally lasts about 2-3 hours; shortly thereafter, you would then be discharged home.
In less then 1 % of cases, admission to the hospital for observation, pain management, or other reasons may be necessary. In almost every instance hysteroscopy is an outpatient procedure, which means “in and out” without the need for overnight observation in a hospital.
What is robotic myomectomy?
The da Vinci surgical system is a recent major advancement in laparoscopic surgery. The da Vinci robot enables fibroids to be removed through the use of several small dime-sized incisions rather than a large, open abdominal incision. Compared to traditional laparoscopy, the system provides surgeons with magnified, high definition, three-dimensional views of unprecedented detail. During robotic surgery, the surgeon sits at a special console with hand and foot controls that move the robotic arms during the operation. Surgeons can perform robotic myomectomies with far more precision, flexibility and dexterity than traditional open and standard laparoscopic techniques. The hand movements of the surgeon are duplicated in the patient by the robot, but on a much smaller scale. The robotic myomectomy procedure can produce less post-operative pain, less tissue trauma, less blood loss, decreased scarring and provide a faster return to normal, routine activities compared to more traditional open or laparoscopic surgery.
(Please Note: This video describes and shows details of a surgical procedure.)
(At right, the typical OR setup, with the surgeon at the console, controlling the robot that is docked to the patient.)
How long do robotic surgeries take?
Abdominal myomectomies can take approximately 1 hour to perform, but performing the same surgery with the robot can take 2-3 hours. It takes significantly longer to set up for the surgery, as multiple small incisions need to be strategically placed on the abdomen, and the robot device needs to be “docked” to the patient after the incisions are made.
(At left, the da Vinci robot, with a camera and 3 robotic arms.)
How long isthe recovery period?
Most patients will go home on the same day as the surgery. Patients will experience significantly shorter recovery periods compared to abdominal myomectomy. Most patients will recover from surgery over the course of 7 to 14 days, rather than 4 to 6 weeks typically seen for abdominal myomectomy.