Gynecologic Surgery: Minimally Invasive Approach Now an Option for More Procedures

**By Jil Johnson, DO**

female patient waiting in doctor exam roomAs an obstetrician and gynecologist, I have an appreciation for health care needs unique to my patients. I love that medical advances over the last five to 10 years have allowed me to help many women with an array of treatment choices, especially related to gynecologic surgery.

Many women consider gynecologic surgery for various conditions, such as abnormal bleeding, pelvic pain, ovarian cysts, fibroids or endometriosis. In the past, these surgeries were often done through large abdominal incisions requiring long hospitalizations and extended recovery time. In addition, they were sometimes accompanied by more scar tissue and increased risks of bleeding and infection.

Thankfully, as with much of modern medicine, an array of minimally invasive surgery techniques now exist to provide women with more choice, convenience and benefits, depending on individual needs. These approaches are usually associated with less pain, quicker recovery, and lower risks of infection and bleeding.

Using a minimally invasive surgical approach, many common procedures are now performed on an outpatient basis, including:

Endometrial ablation

This procedure ablates (destroys) the uterine lining or endometrium, which is shed each month during menstruation. It is typically used to treat abnormal uterine bleeding when medications have failed. It can also be used to treat small fibroids inside the uterus. The procedure does not require making an incision. Depending on the method chosen for the ablation, slender tools are inserted into the uterus through the vagina and cervix. Some methods of endometrial ablation use extreme cold, while others involve heated fluids, microwave energy, lasers or high-energy radiofrequencies to destroy the uterine lining. It can often be done using a local or spinal anesthetic.


Hysteroscopy is a procedure for looking inside the cervix and uterus. The hysteroscope is a thin, lighted tube inserted through the vagina that can diagnose and treat uterine conditions. Other instruments can be inserted through the tube to perform minimally invasive surgery procedures. Hysteroscopy can also be used with other procedures, such as laparoscopy, in which an endoscope (a medical device with a light attached used to look inside the body) is inserted in the abdomen to view the outside of the uterus, ovaries or fallopian tubes.

Laparoscopic surgery for endometriosis or pelvic pain

Laparoscopy is the most common procedure used to diagnose and remove mild to moderate endometriosis, a disorder where tissue that normally lines the uterus grows outside the reproductive organ. Instead of making a large abdominal incision, the surgeon inserts a lighted viewing instrument, called a laparoscope, through a small incision. If the surgeon needs better access, they make one or two more small incisions for inserting other slender surgical tools.

Laparoscopic removal of ovarian cysts or ovaries

While a woman’s health history, symptoms, examination and ultrasound images can provide a lot of information, sometimes the only way to know for sure if a cyst is benign is to remove it surgically. In general, an ovary can almost always be saved if the cyst is benign and not too large. In young women, the ovary can almost always be preserved. If a woman is peri-menopausal or menopausal, it usually makes more sense to remove the entire ovary, especially if there is a concern that the cyst might be cancerous. Even large ovarian cysts or ovaries can be removed laparoscopically, avoiding the recovery associated with major surgery.

Considering gynecologic surgery?

Here are a few things women considering any type of gynecologic surgery should ask and think about:

  • Can the procedure be done through a minimally invasive approach? While some surgeries cannot be done this way because of existing scar tissue or an extremely large uterus or ovary, most women are usually candidates. A patient should speak with her doctor to discuss whether it might be possible.
  •  If a woman’s doctor feels her procedure cannot be done through minimally invasive surgery, she should consider a second opinion. Not all physicians are adequately trained to safely perform minimally invasive surgery, and some surgeons may not be comfortable with more complex procedures. If this is the case, a woman should consider seeking a second opinion from a surgeon with advanced training and experience before making a final choice regarding her options.

Some of the most important questions to consider when choosing a surgeon include:

  • How much experience does the surgeon have with this particular procedure?
  • Does he or she regularly perform the procedure?
  • Has the surgeon received advanced training for this procedure?
  • How often does the surgeon start a procedure with a minimally invasive approach, but then need to call for assistance or switch to a larger, open incision to complete the surgery?

Research shows that surgeons with higher surgical volumes and/or greater surgical experience usually have better outcomes. For example, although a woman may have a long, positive relationship with her local OB/GYN, who performs her yearly exams, she may decide this physician is not the best person to perform her gynecologic surgery.

Are you comfortable with your surgeon? Every woman should feel at ease with her surgeon. A woman should feel that all her questions and concerns were heard and addressed before the procedure. Any nonsurgical options should always be discussed first. Women should ask whether there are other procedures that may be good options for their particular condition. If surgery is the best option, a woman should ask about risks and what she should expect with recovery. She should also ask whether the surgery is likely going to adequately treat her symptoms and what happens if they persist afterward?

The decision to undergo surgery is not easy for most patients. Feeling comfortable with your surgeon and type of surgery is important. Do not be shy about being inquisitive. After all, it’s your health and your doctor should be happy to answer all your questions.

Dr Jil Johnson_head shotJil Johnson, DO, is board certified in Obstetrics and Gynecology. She practices at Virginia Mason Federal Way Medical Center and Virginia Mason Hospital and Seattle Medical Center. She specializes in gynecology, minimally invasive surgery and robotic-assisted surgery.

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