Minimally Invasive Gynecologic Surgeries We Perform

The University of Michigan Von Voigtlander Women’s Hospital Minimally Invasive Gynecologic Surgery Program offers a full spectrum of minimally invasive surgical options for treating fibroids, abnormal bleeding and endometriosis.

Thanks to our extensive training and leadership in research related to minimally invasive surgery, we offer unique specialization in myomectomy and hysterectomy using minimally invasive techniques for many women, even when they have been told by other physicians that a laparoscopic approach is not possible.

 

Procedures Offered by Our Clinic Include:

Diagnostic laparoscopy

Surgeons can use a laparoscope – a small, lighted viewing instrument, to look at and examine a woman’s reproductive organs.  The laparoscope is passed through a small incision in the abdomen (usually the belly button), allowing the doctor to see the outside of the uterus, ovaries, fallopian tubes, and nearby organs.  Additional incisions may be used to perform the appropriate surgery for each patient.  Each small incision is usually 5-10 millimeters wide (1/5 -2/5 inch) and can be covered by a small bandage,  which is why this technique is sometimes referred to as “band-aid surgery.”  Most types of laparoscopic surgery are “outpatient” surgeries, and patients generally go home on the same day.  Recovery for most of these surgeries is 7-10 days.

Laparoscopic removal of endometriosis

This procedure is performed by placing several small incisions in the abdomen and using a laparoscope (lighted viewing instrument) and other surgical instruments to remove or destroy endometriosis and scar tissue that may be causing pain or infertility.

Laparoscopic removal of ovarian cysts, ovaries, or fallopian tubes

Laparoscopy is very effective for removing masses involving the ovaries or fallopian tubes.  Most masses, even very large masses, can be removed with small laparoscopic incisions.  Benign (non-cancerous) cysts of the ovary can often be removed while preserving the ovary, but extremely large masses may require removal of the entire ovary and fallopian tube. The procedure is performed using three or four small incisions for the laparoscope (a small lighted viewing instrument) and other special tools to perform the procedure.  In order to remove the cyst or ovary from the body, a special bag is used to encapsulate the cyst or ovary. This allows for easy removal of the tissue and prevents fluid from the mass from spilling into the pelvic cavity.

Endometrial ablation

This procedure can be performed using various techniques, but each method involves applying some form of energy to destroy the lining of the uterus (the endometrium) in order to reduce the amount of menstrual flow for a woman who has regular, but heavy menstrual periods. All of the techniques can be performed as outpatient surgery, and a few can be done in a clinic setting without general anesthesia.

Hysteroscopic removal of uterine fibroids or endometrial polyps

Hysteroscopy is an outpatient procedure to remove uterine fibroids or polyps that may be the cause of abnormal bleeding.  The procedure is performed by placing a narrow instrument with a camera called a “hysteroscope” through the cervical opening into the uterus. The surgeon then passes special instruments through hysteroscope to remove the fibroid or polyp from the lining of the uterus.

Myomectomy

Myomectomy is the surgical removal of uterine fibroids without the removal of the uterus. There are several techniques that may be used, and the choice of technique depends on a number of issues including the location and size of fibroids, the number of fibroids as well as physical characteristics of the patient.  Surgical approaches to myomectomy include robot-assisted laparoscopic myomectomy, abdominal myomectomy, and hysteroscopic myomectomy.

Hysterectomy

Hysterectomy is the surgical removal of uterus.  Although ovaries can also be removed at the time of hysterectomy, this is not required or recommended for all women.  The decision to remove or keep the ovaries should be made on an individual basis. There are two categories of hysterectomy:

  • Total hysterectomy is removal of the entire uterus, including the cervix (the lower part of the uterus).  Surgical approaches to total hysterectomy include vaginal hysterectomy, laparoscopic hysterectomy, robot-assisted laparoscopic hysterectomy, and abdominal hysterectomy. 
  • Supra-cervical hysterectomy is removal of the upper part of the uterus, but not the cervix. This type of surgery is not recommended for women with a history of an abnormal Pap smear or certain types of pelvic pain. Up to 5-10% of women may continue to have chronic cyclic bleeding after surgery, similar to a period. It was previously thought that a supra-cervical hysterectomy would preserve sexual function better than a total hysterectomy, but research does not support this theory. Benefits to supra-cervical hysterectomy include slightly shorter recovery time.  U-M offers laparoscopic and robot-assisted laparoscopic approaches to supra-cervical hysterectomy.

An Office-based Procedure Clinic is also available to perform diagnostic hysteroscopy and/or saline sonography to identify uterine abnormalities such as endometrial polyps, submucosal fibroids, and endometrial scarring. Many in-office procedures can be offered without the need to undergo a major surgical procedure in the operating room. These in-office procedures include removal of small endometrial or cervical polyps, endometrial ablation, tubal sterilization, and retrieval of retained intrauterine devices (IUD).