Minimally Invasive Robotic Surgery
At CRM, we offer minimally-invasive surgeries such as hysteroscopy and laparoscopy, in addition to state-of-the-art robotic-assisted surgeries with the use of the da Vinci® robotic surgical system.
About Minimally Invasive Surgery
The physicians at CRM are dedicated to the latest advances in minimally invasive reproductive surgery, which, as opposed to open incision surgery, offers these benefits to patients:
- Faster recovery
- Less pain
- Smaller incisions
- Earlier return to normal activities
- Shorter hospital stay
Certain patients can even be treated in the office without the need for general anesthesia or a hospital admission. Because of minimal discomfort and enhanced convenience, many of our patients go home on the day of surgery; however others may stay in the hospital overnight.
Our approach is holistic. After a thorough consultation with an exam and ultrasound the entire clinical picture is evaluated. Treatment options are discussed in detail. Whenever possible, the first line of treatment is medical therapy. If medications are unsuccessful, surgery may be recommended. At CRM, we have developed expertise in minimally invasive procedures that permit the removal of abnormal ovarian cysts, irreparable fallopian tubes, as well as uterine polyps and fibroids. Frequently, endometriosis affecting the ovaries, bowel and many other sites inside the abdominal cavity can be surgically removed or destroyed with a minimally invasive procedure.
Hysteroscopy is utilized to diagnose and treat abnormalities within the uterus. Hysteroscopy can be used to remove uterine fibroids (myomas), polyps, scar tissue, and uterine malformations (such as septums) or to treat abnormal bleeding and other reproductive conditions.
Hysteroscopy is performed with a thin telescope that is inserted through the cervix into the uterus. This telescope is called a hysteroscope. The hysteroscope is attached to a video camera and a light source. Operative hysteroscopes are designed so that instruments can be placed inside the scope to remove tissue samples for biopsies or to remove fibroids, polyps or tumors.
How Hysteroscopy is Performed
At CRM, a hysteroscopy can be performed either in the office (diagnostic or minimally operative) or in the hospital operating room (for more extensive operative conditions). During hysteroscopy, the uterus is filled with a liquid such as saline or glycine to distend it so the doctor can see inside.
If hysteroscopy is performed to find the cause of a problem, the doctor will observe the inside of the uterus. The physician may take a sample of tissue (a biopsy) from the wall of the uterus. This sample is sent to the laboratory for analysis by a pathologist.
The procedure is only mildly uncomfortable. A woman can usually return to her normal activities as soon as the procedure is finished. More involved hysteroscopies are performed in an operating room and the patient can usually return to her normal activities within one to two days.
With hysteroscopy, surgery is performed through the vagina into the uterus. There is no abdominal incision. Therefore, there is less pain and no external scarring. Because the abdominal cavity is not exposed to the outside world as it is in traditional surgery, there is less risk of infection or other complications. Healing after a hysteroscopy is usually much faster and involves less pain than with traditional surgery.
At CRM, hysteroscopy is used to diagnose or treat conditions such as:
- Abnormal uterine bleeding
- Causes of repeated miscarriages
- Structural abnormalities of the uterus
- Uterine scarring
The goal of laparoscopy for reproductive surgery is to remove any pathology and restore normal anatomy. A laparoscope is a thin, fiber-optic telescope attached to a video camera. The laparoscope is inserted through a small incision, generally but not always, in the navel. After the incision is made and the laparoscope inserted, the surgeon looks at the pelvis and assesses the anatomy. The surgeon may place additional incisions with additional instruments (usually up to three additional) in order to remove an abnormal cyst, excise endometriosis, remove myomas or treat an abnormal fallopian tube.
The major benefit of laparoscopic surgery is that it only requires a few small incisions. This means less pain and external scarring and healing is faster than traditional, open surgery.
Laparoscopic surgery is used to treat conditions such as:
- Uterine fibroids
- Heavy menstrual bleeding (abnormal menstrual bleeding)
- Ovarian cysts/benign tumors
- Structural abnormalities of the uterus/vagina
- Pelvic pain
- Pelvic adhesions
- Ectopic pregnancy
About Robotic Surgery
At CRM, we are committed to utilizing the most advanced technology and medical procedures available today. Besides minimally-invasive surgeries such as hysteroscopy and laparoscopy, we also offer state-of-the-art robotic-assisted surgeries with the use of the da Vinci® robotic surgical system. The equipment provides unparalleled precision for even the most complex and delicate of gynecologic procedures.
During robot-assisted surgery, the surgeon's hands control the instruments in the robot's arms which can rotate in any direction. The surgeon sits at a console and performs the procedure using an enhanced, three-dimensional image. By contrast, laparoscopic surgery only allows the surgeon to see a two-dimensional image.
The robotic hands are 7 mm in greatest diameter and can translate the precise movements of the surgeon’s hands with 360 degrees of mobility and 7 different degrees of freedom. In addition, there is a level of magnification that can allow for microsurgery. The precision enables a surgeon to perform a minimally invasive procedure mimicking the same technique and with the same ease as an open procedure. This is beneficial to both the patient and the surgeon.
Robot-assisted surgery has all of the advantages of laparoscopic surgery — faster healing, less pain, fewer complications and less scarring — plus a three dimensional image.
Reproductive conditions that may be treated with robot-assisted surgery include tubal reversals and myomectomies (uterine fibroid removal).
Robotic Tubal Reversals
Worldwide, more than 153 million women have chosen sterilization as their contraceptive method. As many as 20 percent will subsequently express regret due to a change in family circumstances such as the death of a child, improved economic situation or change in marital partner. For couples that desire fertility after tubal ligation, only two options are available: surgical tubal reanastomosis (tubal reversal) and in vitro fertilization.
Tubal reversal allows for restoration of fertility after sterilization. The implementation of robotic technology allows for this once inpatient procedure to be converted to one that is outpatient.
The Procedure: While in the operating room, up to five incisions can be made. Initially an opening is created at the end of the fallopian tube connected to the uterus and then an opening is created on the other side of the tube near where the blood supply comes in. Sutures the size of a hair are placed to connect the tubal ends. At the end of the procedure, the tubes are tested to make sure they are patent.
The Results: Pregnancy rates are comparable to the open procedure and are dependent upon lengths and conditions of the fallopian tubes after reversal.
Uterine fibroids are present in 30 percent of patients and may cause pelvic pain, abnormal uterine bleeding or infertility. Uterine fibroids may affect fertility by altering uterine function, changing the vasculature or changing the shape of the uterine cavity, and ultimately can decrease pregnancy rates.
Uterine fibroids can be located in the cavity (submucosal), in the muscle (intramural), outside the muscle (subserosal) or attached by a stalk (pedunculated).
Treatment options include hysteroscopic myomectomy if the fibroid is in the cavity. If the fibroid is in the muscle or outside the muscle of the uterus, a myomectomy is indicated. This can be done through a small skin incision, laparoscopically or robotically.
Robotically, the procedure entails a patient going to the operating room where five to six incisions are placed in the abdominal skin and the fibroids are removed using dissection and cautery. The incisions are repaired in one to three layers as appropriate to reinforce the incision. This is to provide support to the uterus as it expands in pregnancy. Most patients go home the next day although some have gone home the same day.
Once pregnant after a myomectomy it is recommended a patient undergo a cesarean section to prevent complications during delivery.
We understand that facing surgery can be a trying time. Please contact the Center for Reproductive Medicine, serving the Orlando, Florida area, to request further information about our minimally invasive surgery program.