Surgical Procedures

DaVinci surgery is one of the most effective, least invasive surgical treatment options available today. When medications and non-invasive procedures are unable to relieve symptoms, surgery remains the accepted and most effective treatment for a range of gynecologic conditions.

These include uterine fibroids, endometriosis, uterine prolapse, and abnormal or heavy bleeding. With the use of robotic surgery, Dr. Yamaki has been able to convert more complex gynecologic surgeries through large abdominal incisions into surgeries through small 1-2 cm incisions. This minimizes the risks and pain associated with large incisions while increasing the likelihood of a fast recovery and excellent clinical outcomes.

Laparoscopy is a minimally invasive surgical procedure that is used to diagnose and treat conditions in the abdominal and pelvic areas. During the laparoscopic procedure, a thin tube with a camera on the end, known as a laparoscope, is inserted through a tiny incision to allow the doctor to closely examine the organs of the area. Surgical instruments can be inserted through additional incisions to treat any identified problems or to retrieve tissue specimens.

Laparoscopy is much less stressful, both physically and psychologically, for the patient, and usually involves lower costs and fewer complications, than traditional open surgery. Laparoscopy is as an outpatient surgical procedure.

Endometrial ablation is a surgical procedure for those women suffering from excessive or prolonged menstrual bleeding who have not responded to other treatments and cannot or do not wish to undergo a hysterectomy.

Endometrial ablation removes or destroys the uterine lining, or endometrium, while leaving the ovaries and uterus intact. The endometrium heals by scarring, which reduces or stops future uterine bleeding.

Approximately 10-20% of patients require a second procedure or hysterectomy if symptoms reappear after a re-growth of the endometrium. Because endometrial ablation destroys the lining of the uterus, the procedure is not for women who still wish to become pregnant.

A hysterectomy is the surgical removal of the uterus.  Hysterectomy is the second most commonly performed surgery in the United States.  The vast majority are performed to treat cervical or ovarian cancer, endometriosis or tumors (fibroids) which may cause excessive and disabling menstrual periods.  A hysterectomy can oftentimes be done with the da Vinci robotic surgical system.  This allows greater precision, smaller incisions, less pain and scarring and a dramatically shorter recovery period. A hysterectomy involves removal of part or all of the uterus and may involve removal of the ovaries, cervix and fallopian tubes.  This results in sterility and menopause, if the ovaries are removed.  The surgery usually requires just an overnight hospital stay.
A sling, composed of a synthetic mesh, is surgically inserted through a small vaginal incision and placed under the middle of the urethra.  The sling supports the urethra and helps prevent leakage of urine with coughing, sneezing, or other daily activities.  This is an out-patient procedure which is often done in conjunction with other gynecologic surgery.

Non-surgical alternatives which also may be considered include the Femilift procedure, Genitone, Intone and Apex devices and kegal exercises.

Surgery is sometimes recommended to relieve the symptoms caused by pelvic support problems.  The symptoms depend on which organs are involved.  Symptoms include:

  • Feeling of pelvic heaviness or fullness, or as though something is falling out of the vagina
  • pulling or aching feeling in the lower abdomen or pelvis
  • Leakage of urine or problems having a bowel movement

A cystocele, sometimes called anterior wall prolapse, occurs when the bladder drops from its normal place into the vagina.  Some cystoceles cause urine to leak when you cough, sneeze, lift objects or walk.

When the rectum bulges into or out of the vagina, it is called a rectocele (or posterior wall prolapse).  A large rectocele may make it difficult to have a bowel movement.

Sometimes after hysterectomy, the top of the vagina loses its support and drops.  This is called vaginal vault prolapse.  Women with this condition may have problems with bladder and bowel function.

When the uterus drops down into the vagina, it is call uterine prolapse.  This sometimes causes discomfort or problems with sex.

The dilation and curettage procedure is done to scrape and collect endometrium, which is uterine tissue. Dilation is the widening of the cervix which allows instruments to pass into the uterus, while curettage is the scraping of the uterine walls. This procedure is performed to diagnose uterine cancer or other conditions, remove tissue after a miscarriage and treat heavy bleeding. It is an outpatient surgical procedure.

 

It is possible to remove some fibroids, polyps and other intrauterine tissue without having to remove the uterus.  The MyoSure tissue removal system is designed to allow the gynecologist to safely remove growths in the uterus, while preserving uterine function and form. A slender instrument is inserted into the uterus through the vagina which then gently cuts away at the unwanted tissue to be removed. This is especially important if the patient may want to have children in the future.