Monday, July 7, 2014

Minimally Invasive Surgery – What Every Woman Needs to Know


Prescott W. Prillaman
OB/GYN Specialists of Richmond
Traditional abdominal surgery uses a single large incision to accomplish a goal. In obstetrics and gynecology, removing a large uterus or cancer treatments have historically been performed with these “open” surgery methods, as some procedures can only be accomplished with a larger incision. Modern technology has progressed and now allows for better visualization with cameras. Laparoscopy allows for the surgeon to use a small telescope and a camera to visualize the abdominal cavity through a 1 centimeter or less incision. Instruments that can better mimic the human hand have been developed, and newer methods allow many surgeries previously requiring a prolonged recovery and more post-operative pain to be accomplished through smaller incisions with less pain and a fraction of the recovery time. The most experienced surgeons are usually involved with programs that have a commitment to surgical innovation and forward thinking.

The development of laparoscopy in the 1980s led to innovations that allow surgeons to perform minor surgeries such as diagnostic laparoscopies and tubal ligations. The 1990s ushered in hysterectomies that were assisted with laparoscopy. The 2000s started robotic-assisted surgery and single-site surgeries that now allow for most gynecologic surgeries to be performed using minimally-invasive techniques. In 2011, the first single-site robotic-assisted total hysterectomies in the Mid-Atlantic were done in Richmond.

Most laparoscopic surgical procedures use one or more 8-12 millimeter incisions. Some surgeons feel that this method is the best for most procedures, but it usually requires more than one incision. The diverse instrumentation has been developed over many years, and most outpatient abdominal and gynecologic surgery can be accomplished with this method.

Single-site surgery elevates general laparoscopy to an approach that only uses one 20-25 mm incision. This method usually requires a specialized port that allows for the camera and several instruments to be inserted from the same site.  Benefits of this method include a single surgical site and less post-operative pain, with some patients able to return to their daily lives sooner, as well as a better cosmetic result.

Robotic surgical procedures help the surgeon to perform with greater precision due to advances in optical magnification and a development that enables the “robotic arm” to move with the same flexibility of the human wrist. Three to five incisions are usually required to perform the surgeries. Visibility using magnification is 10 times greater than regular laparoscopy. The improvements with robotics allow the surgeon to evaluate and work on areas that cannot be accessed with traditional surgery.

The combination of single-site surgery and robotics has provided the opportunity to perform standard laparoscopic surgeries with better visibility and dexterity through a 25-35 mm single incision, allowing the surgeon to have more precise movement and less tissue trauma. This method also allows for less post-operative pain and faster recovery.

All of the above methods require substantial education and experience to perform.

If you are in need of surgery, it is very important that you are aware of all available options. Most patients are not as concerned about the surgeon’s technique as they are for the concerns of going to sleep and waking up, worrying about what might be found during surgery, and how much the surgery will hurt.  Your doctor should explain the risks, benefits and alternatives of the surgeries.

To get prepared for surgery, there are several online resources that can help you better understand the methods.  Sites will discuss the particular methods and blogs can help you explore previous patient experiences. Unfortunately, it is difficult to determine if the information you receive on the web is accurate and reliable. Web rating sites for physicians can also be helpful but their information can sometimes be outdated or incorrect. Be informed. You and your physician are a team with the same goal working toward the best outcome.


For further inquiries about minimally invasive surgery, contact Prescott W. Prillaman, MD, of OB/GYN Specialists of Richmond at 804.673.8791, or visit their website at ob-gyn-specialists.com.

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