Minimally Invasive Procedures

Minimally Invasive Procedures

Many types of surgeries are safely offered as a minimally invasive alternative, including (but not limited to) these categories:

  • Women’s Health
  • Breast Care
  • General Surgery
  • Bariatric

Women’s Health

TLH —  Total Laparoscopic Hysterectomy

Total Laparoscopic Hysterectomy involves disconnecting the uterus, and other structures as needed, by operating only through the laparoscopes in the abdomen, starting at the top of the uterus. The entire uterus is disconnected from its attachments using long thin instruments through the “ports.” Then all tissue to be removed is passed through the vagina or through the tiny half-inch abdominal incisions.

A massive ovarian cyst can be removed without rupturing it inside the abdominal cavity by placing it in a sturdy surgical-grade pouch and passing the pouch out the vagina or, after collapsing the cyst inside the pouch, passing it out through the “port” incision. If the uterus is massively enlarged it can be disconnected from its attachments, then cut into tiny pieces and passed down the vagina. If a cancer is present, it can be removed with the staging procedures such as lymph node sampling, appendectomy, and omentectomy done safely.

Abdominal scars consist of two to four tiny one-half inch incisions, one inside the belly button, one in the top portion of the pubic hair just above the pubic bone, and one each just to the middle side of the front of the hip bone. Two days in the hospital and two weeks away from work are usual. Because there is no operating through the vagina (though tiny pieces of tissue can be passed down through it), there is no requirement for a wide vagina or loose ligaments. TLH can thus be performed on women who have never had children, women with narrow or long vaginas, women with previous surgeries, women with cancer, and women with massive organs. This technique is the least painful and least debilitating route of surgery for women who need a hysterectomy.

LSH — Laparoscopic Supra-Cervical Hysterectomy

The Laparoscopic Supra-Cervical Hysterectomy is a procedure where tissue is removed from the body through a tiny incision of about 14 mm. The procedure doesn’t require the surgeon to suture and with no stitches required, the healing process for the patient is often easier. Patients seldom need pain medication after the laparoscopic supracervical hysterectomy because the procedure is so simple.

Doctors find the procedure for this hysterectomy easier to perform and often recommend it above any other hysterectomy for the patient. The LSH procedure doesn’t require the woman to lose her cervix which seems to be a major concern for many women who need to have a hysterectomy. Naturally, the LSH is not a procedure women with a family history of cervical cancer will consider.

Patients who have the LSH procedure normally have discovered their need for a hysterectomy because of ongoing medical problems. The patient may need the LSH because of heavy monthly menstrual periods, ovarian cysts which have become problematic, pain in the pelvic region, endometriosis or fibroids.

Laparoscopic Myomectomy

Laparoscopic Myomectomy refers to the surgical removal of uterine fibroids, also known as myomas. In contrast to a hysterectomy the uterus remains preserved and the woman retains her reproductive potential. Fibroids that are attached to the outside of the uterus by a stalk (pedunculated myomas) are the easiest to remove laparoscopically. Many subserous myomas (close to the outer surface) can also be removed through the laparoscope. The presence of a fibroid does not mean that it needs to be removed. Removal is called for when the fibroid causes pain, abnormal bleeding, or pressure.

Laparoscopic Treatment of Chronic Pelvic Pain and Endometriosis.

Endometriosis attacks female patients in their reproductive years. Endometriosis causes pelvic pain, pain with intercourse and infertility. Laparoscopic treatment has shown to effective with improved outcomes and increased quality of life scores.

Urinary Incontinence

Urinary Incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition.

TVT sub-urethral sling – An innovative tension-free sling procedure may be appropriate for some women with stress urinary incontinence. A sling is created using a synthetic mesh ribbon-like strip that is surgically inserted through the vagina to provide support at the middle of the urethra (the section under the most strain during normal activities) whenever you stress this area, such as during a cough or a sneeze. This allows the urethra to remain closed, preventing the involuntary release of urine. Placing the support at the middle of the urethra (as opposed to a position closer to the bladder, as in traditional sling procedures) more closely simulates natural support at a crucial pressure point, and helps to maintain the urethra in its proper position.

Mini ARC sub-urethral sling – Sling procedures are performed partly through the vagina and partly through one or more small abdominal incisions, under local or regional anesthesia. In traditional sling procedures, the sling – a supporting strip of either natural or synthetic material – is placed under the urethra close to the bladder neck and secured to the abdominal wall or a pelvic bone with a permanent suture to maintain the urethra in its proper position.

Bladder Lift – This type of procedure is performed through an incision in the lower abdomen. To help maintain the bladder in its proper position, the surgeon will place sutures near the bladder neck and urethra and secure them to a pelvic bone or surrounding supporting structures.

Pelvic Support (Prolapse Repair)

Pelvic prolapse is the loss of pelvic support that occurs when the soft connective tissue that support the pelvic organs become stretched, weakened or torn. It is a very common disorder, particularly in older women.

Prolift (Ethicon Urology and Women’s Health Inc.) – Prolift is an innovative, standardized system used in minimally invasive surgical pelvic floor restorations.

Apogee (American Medical Systems, Inc.) – A simplified, tension-free system that allows surgeons to address vaginal vault repair. Using a minimally invasive, standardized approach, Apogee is designed to restore patient anatomy and normal function.

Parigee (American Medical Systems, Inc.) – Parigee is a comprehensive system to provide an innovative and time-saving procedure for surgical repair of all types of anterior defects including central, lateral, proximal and distal.

Endometrial Ablation

Endometrial ablation is a procedure that uses a lighted viewing instrument (hysteroscope) and other instruments to destroy the uterine lining, or endometrium. The endometrium heals by scarring, which usually reduces or prevents uterine bleeding.

ThermaChoice – The ThermaChoice Uterine Balloon Therapy System is a one-day treatment option designed to end heavy menstrual flows by removing the lining of the uterus. This medical device resolves heavy menstrual periods (clinically known as menorrhagia) due to benign causes in premenopausal women who have completed childbearing. Unlike hysterectomy, which takes out the entire uterus, the device only treats the lining of the uterus with heat through a process called endometrial ablation.

NovaSure – A new generation of endometrial ablation is the NovaSure procedure. Some devices remove the endometrium by using heated fluid. Others use freezing temperatures to remove the tissue. NovaSure uses a precisely controlled dose of electromagnetic energy to gently remove the lining of the uterus to lighten or stop periods in a one-time procedure. Because NovaSure is such a simple and safe procedure, recovery time is quick and many women can return to work the next day.

In-office Her Option – Her Option¨ Cryoablation Therapy is a treatment option for excessive menstrual bleeding (menorrhagia) that ablates endometrial tissue through sub-zero temperatures, using ultrasound guidance to monitor the safety and extent of treatment.

Endometriosis Treatment — Laparoscopic laser surgery restoration of pelvic anatomy

Laparoscopy is the most common procedure used to diagnose and remove mild to moderate endometriosis. Instead of using a large abdominal incision, the surgeon inserts a lighted viewing instrument called a laparoscope through a small incision. If the surgeon needs better access, he or she makes one or two more small incisions for inserting other surgical instruments.

Laparoscopic Endometriosis is generally performed to view the internal organs and look for signs of endometriosis and other possible problems. This is the only way that endometriosis can be diagnosed with certainty. But a “no endometriosis” diagnosis is never certain-growths can be tiny or hidden from the surgeon’s view. Laparoscopic Endometriosis is also performed to remove any visible endometriosis implants and scar tissue that may be causing pain or infertility. If an endometriosis cyst is found growing on an ovary, it is likely to be removed.

Advanced Hysteroscopy — Trans-cervical removal of myomas and polyps

Hysteroscopy is a diagnostic and surgical procedure that makes examining the inside of the uterus possible without making an abdominal incision. During hysteroscopy, a lighted viewing instrument called a hysteroscope is inserted through the vagina and cervix and into the uterus. Treatment can also be done through the hysteroscope during the same procedure. The uterus is filled with a fluid, such as normal saline or glycine. The hysteroscope is inserted through the cervix into the uterus so the inner surface of the uterus can be examined.

Hysteroscopy can locate the cause of bleeding for many women. Hysteroscopy is used both to diagnose and treat abnormal vaginal bleeding. If areas of bleeding are found during the procedure, the tissue may be destroyed by laser or electric current or surgically removed at the same time. Hysteroscopy are primarily performed to locate and evaluate the cause of uterine bleeding, such as uterine fibroids, when blood loss is severe and confirm a diagnosis before starting treatment with medicines that have significant side effects, such as danazol or a gonadotropin-releasing hormone analogue (GnRH-a).

Essure Tubal Ligation — Trans-cervical tubal ligation

Essure Tubal Ligation is a permanent birth control procedure that works with a woman’s body to create a natural barrier against pregnancy. This gentle procedure can be performed in a doctor’s office in less than an hour. The Essure procedure does not require any cutting into the body. Instead, an Essure trained doctor inserts small flexible micro-insertsª through the body’s natural pathways (vagina, cervix, and uterus) and into the fallopian tubes. The procedure can be performed in the comfort of a doctor’s office without general anesthesia, and most women resume their normal activities within one day.

During the 3 months following the procedure, the body and the micro-inserts work together to form a natural barrier that prevents sperm from reaching the egg. During this period, women must continue using another form of birth control (other than an IUD or IUS).

Three months after the Essure procedure, a doctor will perform an Essure Confirmation Test, to confirm that the tubes are fully blocked and that the women can rely on Essure for permanent birth control. Unlike birth control pills, patches, rings, and some forms of IUDs, Essure does not contain hormones to interfere with a woman’s natural menstrual cycle. Periods should more or less continue in their natural state.

Breast Care

Closed Breast Biopsy

A Closed Breast Biopsy, also known as an Image-Guided Needle Biopsy is performed using ultrasound or stereotactic guidance. Stereotactic refers to the use of stereo images — pictures of the breast taken from different angles — to determine the precise location of the abnormal tissue.

The area that needs to be tested is centered in the window of a specially designed compression paddle. Mammogram films are taken so the radiologist can examine the breast tissue to be biopsied. After giving a local anesthetic, the radiologist makes a small opening in the skin. A sterile biopsy needle is placed into the abnormal breast tissue. Computerized pictures help confirm the exact needle placement using digital imaging.

Tissue samples are taken through the needle. It is common to take multiple tissue samples (about three to five). This tissue is then examined under the microscope to look for cancer cells. This part of the biopsy takes approximately 15 minutes. Upon completion, sterile strips and a small adhesive bandage are applied to the skin. The entire procedure takes approximately 30 minutes to an hour. Results are usually available in three to five working days.

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