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Minimally-Invasive Surgery Options for Women
Dr. Benjamin White discusses minimally-invasive surgery for gynecologic conditions.
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Learn more about Benjamin White, MD
Benjamin White, MD
Dr. Benjamin White is a board-certified obstetrics and gynecology physician. He has clinical interests in minimally invasive surgery and patient education. He attended medical school at the University of Connecticut School of Medicine in Farmington, Connecticut, and completed his residency at the University of North Carolina at Chapel Hill in Chapel Hill, North Carolina.Learn more about Benjamin White, MD
Transcription:
Minimally-Invasive Surgery Options for Women
Caitlin Whyte: When we think of surgery, we often think of traditional open surgery techniques, but as technology advances, there are more options available, including minimally invasive surgery for gynecologic conditions. To talk more about minimally invasive surgeries. We are joined by Dr. Benjamin White. He is a Physician at WakeMed, OB GYN. This is WakeMed Voices, a podcast by WakeMed Health and Hospitals. I'm your host, Caitlin Whyte. So Dr. White starting off here, what is minimally invasive surgery?
Dr. White: Sure. So minimally invasive surgery refers to a method of performing surgery that has the least possible impact on the patient. And it's in contrast to a traditional or open surgery that uses bigger incisions and has more complications and a longer recovery. So the most common type of minimally invasive surgery technique used in gynecology is a laparoscopy. In laparoscopy, small incisions are made in the abdomen and small instruments are used to perform the surgery through those incisions. And this would be in contrast to a more traditional approach where a large incision is made in the abdomen. And the surgeon is actually able to use his or her hands to perform the surgery through that incision. There's a second type of minimally invasive type of surgery that's special to gynecology and that's called the vaginal approach. And so this is where procedures are actually done all or in part just through the vagina.
Host: Now, what kinds of conditions should you consider minimally invasive surgery?
Dr. White: Minimally invasive procedures have been applied to basically almost all gynecologic conditions. It's important that, you know, you obviously work with your doctor to determine what the cause of your symptoms is. And once you've identified the cause of your symptoms, then there's often a variety of different ways to treat the condition. Some of those might be, you know, medicine, even sometimes physical therapy devices or other approaches, but once you've decided that you're appropriate for surgery, then I think it's important to consider a minimally invasive approach. Some of the most common conditions that we treat with minimally invasive surgery are ovarian cysts, uterine fibroids, and sometimes the symptoms that come along with those, whether that's pelvic pain or abnormal or heavy vaginal bleeding, we can also use minimally invasive techniques to remove benign growths in the uterus, which we call polyps.
We can also do surgical sterilizations for people who have decided that they have completed their childbearing and want permanent birth control. We can do [inaudible02:56] through a minimally invasive approach as well. And most common procedure that people will think of when they're thinking about a minimally invasive procedure would be something called a laparoscopic hysterectomy. And hysterectomies are done for a variety of reasons once you and your doctor had decided that, you know, hysterectomy is the right thing for you. Then in many cases, a laparoscopic approach or a vaginal approach can be a good way to remove the uterus. And in most cases we would be removing the cervix, the uterus and the fallopian tubes. And then in certain circumstances, we may also remove the ovaries.
Host: So, are there alternatives to minimally invasive surgery that women should consider?
Dr. White: Yeah, I think it's important to know that not everyone is a good candidate to have a minimally invasive surgery. There are certain circumstances where it's not possible to do a minimally invasive case and the main alternative would be what's called an open surgery. Again, that means just making a much larger incision on the abdomen, performing the surgery through that. And in certain cases, whether, you know, the patient's had a really expensive or complicated surgery in the past or their actual abnormalities lead them to need an open case like, you know, really big fibroids and, you know, may just not be possible to do that through a minimally invasive approach. Certain cases you know, they may not be eligible for a minimally invasive approach and open surgery maybe the best route. And the idea that really in the end is to do the surgery in the safest and effective way for the patient, you know, in a discussion with your surgeon.
And you can definitely discuss all these different options, but together you should come to a decision about what the best and safest way for you to have the surgery is. It's also really important that you consider non-surgical approaches too, and as gynecologists, we are trained and we commonly use a variety of different methods to treat common conditions. And so, you know, many people often think, you know, if I have fibroids or bleeding or pain, that surgery is the best way to go, but a lot of times symptoms can be very adequately treated with just medicine, you know, with pills or possibly with something called the intrauterine device, which is a device that's placed in the uterus. And, you know, the big advantage of these non-surgical approaches is that generally speaking, they have much lower risk of those complications and can be done in a in the office type setting without having the patient have to take off time from work and the recovery that kind of comes with surgery.
Host: So, you touched on this earlier, but what is involved and what are some of the risks for the surgery?
Dr. White: Sure. So in most cases, when you have this type of surgery you'll need anesthesia. You have an anesthesiologist to give you medicine to make you basically sleep during the procedure. We usually do these procedures either in an ambulatory surgery center or in the hospital where we can administer anesthesia and obviously have all of our surgical equipment with us. We usually start by positioning patients and examining her anatomy and confirming that she is appropriate for this type of surgery. And then when we start, we typically will make an incision around the belly button and use that to actually inject a carbon dioxide gas into the abdomen. And this kind of opens up area, separates the tissue, allows us to actually see with our laparoscope, the anatomy that we're operating on. Once we have established access to the abdomen through that incision, we've made our survey, identified all the anatomy that's relevant.
We usually make additional incisions kind of near the hip bones in the abdomen so that we can pass our actual instruments that we use to perform the surgery. We, you know, do all of our cutting and tying all the removal of the, of the relevant anatomy through those small incisions. And then when we're done, we use usually suturing the skin and just to close the small incisions, we obviously let all the guests out of the abdomen. And then, and that's the conclusion of the surgery. Risks are similar to all types of surgery. There's a risk that we could cause bleeding in the areas where we're operating and rarely in our cases, the patients have enough bleeding that they require a blood transfusion, but we always discuss that possibility with the patient before surgery, just so that they're aware. We can know whether they're comfortable with that. There's also the possibility that the patient could develop an infection, either in the skin where we're making incisions or inside the abdomen or pelvis.
It's also possible that as a part of the surgery, you could develop infection and the urinary tract. So oftentimes we will give patients a dose of antibiotics around the time of surgery to try to minimize that. The final risk is injury to some of the organs that we are not removing. And just with the position of the gynecological organs in the body, there are several important things that are very close by, there's, you know, the bladder parts of the bowel structures, such as nerves and blood vessels that run in that area. And so in a small number of patients who are having this type of surgery, they may sustain an injury to any one of those things. We typically take care to try really hard to identify those injuries and repair them right away, if it does happen. The good thing about minimally invasive surgery is it really minimizes all of these risks. So in comparison to the open or traditional approach, all of those important risks are lower and complications really, truly are less common.
So while a lot of people think about minimally invasive surgery as having a more cosmetic outcome using just know small incisions or sometime, you know, in some cases, if you're having a vaginal hysterectomy having, you know, no incisions on your abdomen and just an incision on the vagina, you know, which does will lead to less scarring and a better overall appearance. And in many cases, it's really the lower risk of complications and the faster recovery that make this surgery worthwhile. So, you know, all surgery has risks, and it's important to talk to your doctor about those risks so that you understand what risks are inherent to the procedure. But one of the great things about minimally invasive surgery is it really minimizes all of those risks.
Host: Well, thanks for joining us Dr. White, and for sharing this information. Visit wakemed.org to find more information and more podcasts, just like this one. I'm Caitlin Whyte with WakeMed Voices, brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina.
Minimally-Invasive Surgery Options for Women
Caitlin Whyte: When we think of surgery, we often think of traditional open surgery techniques, but as technology advances, there are more options available, including minimally invasive surgery for gynecologic conditions. To talk more about minimally invasive surgeries. We are joined by Dr. Benjamin White. He is a Physician at WakeMed, OB GYN. This is WakeMed Voices, a podcast by WakeMed Health and Hospitals. I'm your host, Caitlin Whyte. So Dr. White starting off here, what is minimally invasive surgery?
Dr. White: Sure. So minimally invasive surgery refers to a method of performing surgery that has the least possible impact on the patient. And it's in contrast to a traditional or open surgery that uses bigger incisions and has more complications and a longer recovery. So the most common type of minimally invasive surgery technique used in gynecology is a laparoscopy. In laparoscopy, small incisions are made in the abdomen and small instruments are used to perform the surgery through those incisions. And this would be in contrast to a more traditional approach where a large incision is made in the abdomen. And the surgeon is actually able to use his or her hands to perform the surgery through that incision. There's a second type of minimally invasive type of surgery that's special to gynecology and that's called the vaginal approach. And so this is where procedures are actually done all or in part just through the vagina.
Host: Now, what kinds of conditions should you consider minimally invasive surgery?
Dr. White: Minimally invasive procedures have been applied to basically almost all gynecologic conditions. It's important that, you know, you obviously work with your doctor to determine what the cause of your symptoms is. And once you've identified the cause of your symptoms, then there's often a variety of different ways to treat the condition. Some of those might be, you know, medicine, even sometimes physical therapy devices or other approaches, but once you've decided that you're appropriate for surgery, then I think it's important to consider a minimally invasive approach. Some of the most common conditions that we treat with minimally invasive surgery are ovarian cysts, uterine fibroids, and sometimes the symptoms that come along with those, whether that's pelvic pain or abnormal or heavy vaginal bleeding, we can also use minimally invasive techniques to remove benign growths in the uterus, which we call polyps.
We can also do surgical sterilizations for people who have decided that they have completed their childbearing and want permanent birth control. We can do [inaudible02:56] through a minimally invasive approach as well. And most common procedure that people will think of when they're thinking about a minimally invasive procedure would be something called a laparoscopic hysterectomy. And hysterectomies are done for a variety of reasons once you and your doctor had decided that, you know, hysterectomy is the right thing for you. Then in many cases, a laparoscopic approach or a vaginal approach can be a good way to remove the uterus. And in most cases we would be removing the cervix, the uterus and the fallopian tubes. And then in certain circumstances, we may also remove the ovaries.
Host: So, are there alternatives to minimally invasive surgery that women should consider?
Dr. White: Yeah, I think it's important to know that not everyone is a good candidate to have a minimally invasive surgery. There are certain circumstances where it's not possible to do a minimally invasive case and the main alternative would be what's called an open surgery. Again, that means just making a much larger incision on the abdomen, performing the surgery through that. And in certain cases, whether, you know, the patient's had a really expensive or complicated surgery in the past or their actual abnormalities lead them to need an open case like, you know, really big fibroids and, you know, may just not be possible to do that through a minimally invasive approach. Certain cases you know, they may not be eligible for a minimally invasive approach and open surgery maybe the best route. And the idea that really in the end is to do the surgery in the safest and effective way for the patient, you know, in a discussion with your surgeon.
And you can definitely discuss all these different options, but together you should come to a decision about what the best and safest way for you to have the surgery is. It's also really important that you consider non-surgical approaches too, and as gynecologists, we are trained and we commonly use a variety of different methods to treat common conditions. And so, you know, many people often think, you know, if I have fibroids or bleeding or pain, that surgery is the best way to go, but a lot of times symptoms can be very adequately treated with just medicine, you know, with pills or possibly with something called the intrauterine device, which is a device that's placed in the uterus. And, you know, the big advantage of these non-surgical approaches is that generally speaking, they have much lower risk of those complications and can be done in a in the office type setting without having the patient have to take off time from work and the recovery that kind of comes with surgery.
Host: So, you touched on this earlier, but what is involved and what are some of the risks for the surgery?
Dr. White: Sure. So in most cases, when you have this type of surgery you'll need anesthesia. You have an anesthesiologist to give you medicine to make you basically sleep during the procedure. We usually do these procedures either in an ambulatory surgery center or in the hospital where we can administer anesthesia and obviously have all of our surgical equipment with us. We usually start by positioning patients and examining her anatomy and confirming that she is appropriate for this type of surgery. And then when we start, we typically will make an incision around the belly button and use that to actually inject a carbon dioxide gas into the abdomen. And this kind of opens up area, separates the tissue, allows us to actually see with our laparoscope, the anatomy that we're operating on. Once we have established access to the abdomen through that incision, we've made our survey, identified all the anatomy that's relevant.
We usually make additional incisions kind of near the hip bones in the abdomen so that we can pass our actual instruments that we use to perform the surgery. We, you know, do all of our cutting and tying all the removal of the, of the relevant anatomy through those small incisions. And then when we're done, we use usually suturing the skin and just to close the small incisions, we obviously let all the guests out of the abdomen. And then, and that's the conclusion of the surgery. Risks are similar to all types of surgery. There's a risk that we could cause bleeding in the areas where we're operating and rarely in our cases, the patients have enough bleeding that they require a blood transfusion, but we always discuss that possibility with the patient before surgery, just so that they're aware. We can know whether they're comfortable with that. There's also the possibility that the patient could develop an infection, either in the skin where we're making incisions or inside the abdomen or pelvis.
It's also possible that as a part of the surgery, you could develop infection and the urinary tract. So oftentimes we will give patients a dose of antibiotics around the time of surgery to try to minimize that. The final risk is injury to some of the organs that we are not removing. And just with the position of the gynecological organs in the body, there are several important things that are very close by, there's, you know, the bladder parts of the bowel structures, such as nerves and blood vessels that run in that area. And so in a small number of patients who are having this type of surgery, they may sustain an injury to any one of those things. We typically take care to try really hard to identify those injuries and repair them right away, if it does happen. The good thing about minimally invasive surgery is it really minimizes all of these risks. So in comparison to the open or traditional approach, all of those important risks are lower and complications really, truly are less common.
So while a lot of people think about minimally invasive surgery as having a more cosmetic outcome using just know small incisions or sometime, you know, in some cases, if you're having a vaginal hysterectomy having, you know, no incisions on your abdomen and just an incision on the vagina, you know, which does will lead to less scarring and a better overall appearance. And in many cases, it's really the lower risk of complications and the faster recovery that make this surgery worthwhile. So, you know, all surgery has risks, and it's important to talk to your doctor about those risks so that you understand what risks are inherent to the procedure. But one of the great things about minimally invasive surgery is it really minimizes all of those risks.
Host: Well, thanks for joining us Dr. White, and for sharing this information. Visit wakemed.org to find more information and more podcasts, just like this one. I'm Caitlin Whyte with WakeMed Voices, brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina.