Gynecologic Surgery
Experience matters
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Our gynecologic surgeons have experience as laparoscopic and robotic surgeons, using the da Vinci surgery system. Common indications for robotic assisted surgery include: hysterectomy, myomectomy (removal of fibroids), surgery for endometriosis, tubal reversal surgery to restore fertility, and pelvic organ prolapse surgery. Our surgeons will discuss with you the optimal approach to minimize surgical risks and enhance your recovery.
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Hysterectomy
Hysterectomy is the surgical removal of the uterus. It is a commonly performed surgery to treat severe bleeding during your menstrual cycle, fibroids, pelvic prolapse and pelvic pain - if these conditions have not been able to be managed through more conservative therapies. Hysterectomy can be performed via minimally invasive surgery like laparoscopy, open surgery which leaves a larger scar, and through vaginal surgery which leaves no external scars. The choice of which type of surgery is best for you is a discussion that you will have with your gynecologist, and will depend on the reason for the surgery, your medical history and prior surgeries, and your anatomy. Hysterectomy does not have to involve the removal of your ovaries which are the source of female hormones, and if your ovaries are left intact you would not need to start hormone therapy after a hysterectomy. The decision on whether or not to remove ovaries during a hysterectomy is a personal decision that will be discussed with you prior to your procedure.
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Surgical Approaches
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Open Surgery
For generations, open surgery has been the standard approach to many gynecologic procedures and is still used today. With open surgery, a large incision is made in your abdomen - large enough for your surgeon to fit his/her hands and instruments inside your body. However, with open surgery there are certain drawbacks and trauma to the body due to the large incision. There are now less invasive surgical options for many women facing gynecologic surgery, although open surgery is still indicated at times.
Laparoscopic Surgery
One way of minimizing the recovery faced by women undergoing surgery is the minimally invasive surgical technique of laparoscopy. Instead of a large open incision, surgery is done through a few small incisions using a tiny camera and long, thin surgical instruments. The camera takes images inside your body and those images are sent to a video monitor in the operating room which guides surgeons as they operate.
Robotic Assisted Laparoscopic Surgery
Robotic assisted Surgery is the newest minimally invasive option for women facing gynecologic surgery. The da Vinci System features a magnified 3D high-definition vision system and special wristed instruments that bend and rotate far greater than the human wrist. The system translates the surgeon's hand movements into smaller, more precise movements of tiny instruments inside your body allowing for more control during surgery, and better visualization. Robotic surgery is beneficial for performing complex surgery that might be too challenging to perform with conventional laparoscopy.
Using FireFly for Endometriosis
The da Vinci robotic system offers some potential advantages to women having surgery for endometriosis. Using Firefly imaging, which is only available for the robotic system because of the specialized camera, blood flow to anatomic structures is illuminated. This allows even very small or atypical appearing lesions of endometriosis can be seen in real time, allowing for more complete removal or cauterization of the endometriosis. The endometriosis will appear indigo or bright green under the integrated fluorescence imaging.
Minimally Invasive Tubal Reversal Surgery ("Reanastimosis")
Tubal ligation is a surgical procedure in which a woman's fallopian tubes are blocked, to prevent her eggs from traveling from the ovaries into the fallopian tubes, where they could be fertilized by a sperm. Reversing a tubal ligation by reattaching the cut or sealed ends of the tubes can restore fertility. The success of surgery to reverse a tubal ligation depends on:
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The tubal ligation method that was originally used. Clips and rings are successfully reversed the most often. Electrocautery is less likely to be successfully reversed.
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Time. The less time that has passed since the tubal ligation was done, the more likely it is that the reversal surgery will be successful.
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Condition of the tubes. The more the tubes are damaged, the less likely the reversal is to be successful.
Success Rates
Depending on the method used for tubal ligation and how much of the fallopian tube is damaged after tubal ligation, success rates for open tubes following a reversal are about 70% to 80%. About half of the women who have the surgery will become pregnant. The success will be determined by the condition of the tubes after the reversal surgery, but also on the baseline fertility of the woman requesting the surgery. Women over 40 have baseline low fertility rates. You can meet with us for a consultation, but we may refuse to perform the surgery if we think there is little chance that it will be successful.
Other Considerations
The surgery takes several hours. It can sometimes be performed with small incisions (robotic surgery), but sometimes takes a larger incision. Our surgeons were the first to bring robotic assist tubal reversal surgery to Interior Alaska. Most insurance companies do not pay for the procedure. And it is not covered by U.S. government programs such as Medicaid. Women who have had a tubal ligation reversed have a higher-than-average risk of a fertilized egg implanting in the fallopian tube (ectopic pregnancy) rather than in the uterus. There is no guarantee that you will be able to become pregnant after having the reversal
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Example of the suturing technique used during a robotic assisted tubal reversal: