Services
Minimally Invasive Surgery
Minimally invasive surgery is an intricate means of viewing and operating on internal organs that does not involve large incisions and results in shorter recovery times.
Minimally invasive surgery may be used to assist or correct fertility issues, endometriosis, incontinence, and abnormalities in the uterus and pelvis.
HEARTLAND physicians are expertly trained and highly skilled, offering a wide range of procedures:
Hysteroscopy
Hysteroscopy is a procedure which provides a direct look inside the uterus. It can be used for both diagnostic and operative purposes. If an abnormal condition is detected during the diagnostic procedure, the surgical procedure can often be performed at the same time, avoiding the need for a second surgery.
Diagnostic hysteroscopy involves the insertion of a long, thin, lighted telescope-like instrument, called a hysteroscope, through the cervix into the uterus in order to look for abnormalities such as fibroids, scarring, polyps, and congenital malformations. Carbon dioxide gas (CO2) or a special solution is injected into the uterus through the hysteroscope. This expands the uterine cavity and clears away secretions to enable the doctor to view the internal structure of the uterus. Diagnostic hysteroscopy is usually performed on an outpatient basis with either local or general anesthesia.
Operative hysteroscopy is a minimally invasive procedure which can be used to treat many of the abnormalities found during diagnostic hysteroscopy. The procedures are similar but operative hysteroscopy uses a wider hysteroscope to allow operating instruments to be inserted through it to the uterus. Fibroids, scar tissue, tumors and polyps can be removed in this way. Endometrial ablation via hysteroscopy can treat uterine bleeding, avoiding the need for a hysterectomy.
When operative hysteroscopy is planned, diagnostic laparoscopy may be performed at the same time to allow the doctor to see the outside as well as the inside of the uterus.
Postoperative Care
Advantages
Endometrial Ablation
Endometrial ablation is a surgical procedure in which the endometrial lining of the uterus is removed using electrosurgical techniques. This procedure is used to treat excessive uterine bleeding in women of reproductive age and may eliminate the need for a hysterectomy.
The operation involves day surgery performed under general anesthesia on an outpatient basis. A hysteroscope, used to examine the uterine cavity, is passed through the cervix into the uterus. Using a special electrode, the endometrial lining, which is the source of monthly bleeding, is destroyed or removed.
Most patients are able to return home the same day and control discomfort with common pain medication. Following a few days of rest and restricted activity, regular routines can be resumed.
Advantages
Candidates
Laparoscopy
Laparoscopy is a procedure which provides a direct look at the pelvic organs and is often part of a complete infertility evaluation. It can be used for both diagnostic and operative purposes. If an abnormal condition is found during the diagnostic procedure, the surgical procedure can often be performed at the same time, thus avoiding a second surgery.
Diagnostic laparoscopy is used to look at the outside of the uterus, the fallopian tubes, ovaries and internal pelvic area. It is used to diagnose many gynecological problems including endometriosis, uterine fibroids and other structural abnormalities, ovarian cysts, adhesions and ectopic pregnancy. It is usually performed on an outpatient basis, under general anesthesia, and with minimal discomfort. A needle is inserted through the navel and the abdomen is filled with carbon dioxide gas. The gas pushes the internal organs away from the abdominal wall so the laparoscope can be placed into the abdominal cavity without injuring the organs. The laparoscope, a long, thin, lighted telescope-like instrument, is inserted through an incision in the navel and allows the doctor to see the reproductive organs.
If an abnormality is discovered, it can often be treated immediately with laparoscopic surgery. This is a minimally invasive procedure in which the doctor inserts the required additional instruments through two or three small incisions in the lower abdomen. This procedure is used to remove minor fallopian tube blockage or scar tissue surrounding the tubes or ovaries, thereby improving fertility. It may also be used to remove ovarian cysts, treat ectopic pregnancy, and to remove fibroids and diseased ovaries.
Postoperative Care
Advantages
Endometriosis
The endometrium is the tissue lining the inside of the uterine cavity. Endometriosis is endometrial tissue found outside of the uterus in the pelvis & sometimes other areas of the body. It is often treated with laparoscopy utilizing laser or electrosurgical techniques.
A laser is a device that produces a very thin beam of light in which high energies are concentrated. In surgery, lasers can be used to operate on small areas of abnormality without damaging delicate surrounding tissue.
Lasers can be used to cut or destroy tissue. We typically use a CO2 laser for laparoscopic surgery for infertility and/or endometriosis. However, it is sometimes preferable to use other instruments such as electrocautery or scissors in these situations.
Hysterectomy LSH & TLH
Laparoscopic Supracervial Hysterectomy (LSH) is a partial hysterectomy procedure that preserves the cervix and often the ovaries. Only the diseased uterus is removed.
Unlike LSH, total laparoscopic hysterectomy (TLH) completely removes the uterus and cervix. By operating only through laparoscopy in the abdomen, the uterus is disconnected from its attachments and it, along with the cervix, is removed in pieces through one of the small incisions made in the abdomen. TLH can be done to remove small to medium uterine fibroids, when there is not a lot of scar tissue in the pelvic area or when there is no worry of cancer in the ovaries.
LSH and TLH are recommended to women who do not qualify for a vaginal hysterectomy. Because LSH and TLH are performed laparoscopically, the procedures can take longer than other hysterectomies but there is normally less pain and faster recovery times. Both LSH and TLH are relatively new advancements in medical procedures that require highly specialized training. As such, HEARTLAND is proud to be one of the clinics to offer these services.
Vaginal Hysterectomy
Vaginal hysterectomy is the most frequently used and preferred hysterectomy procedure. It is done entirely through the vagina through which the physician pulls the uterus down, disconnecting it from the cervix. To undergo this procedure, women usually have given birth vaginally as this widens the vagina and relaxes the connection of the uterus, making it easier to pull down into the vagina during the operation. It is almost impossible to be done on women who have never had children, have never delivered vaginally or who have an unusually large uterus.
TVT/TVTO
Trans-vaginal tape (TVT) treats female stress incontinence using a safe polypropylene mesh tape along with a traditional incontinence procedure called "the sling" to support the urethra. The mesh tape loosely supports the middle of the urethra, providing support only when needed and without tension like regular sling procedures.
Generally performed under sedation with local anesthesia, the tape is surgically inserted through a small incision in the vagina. Then it is woven through the pelvis tissue and positioned underneath the urethra. At this point the tape is pulled up through two tiny incisions just above the pubic area. As the tape passes through several layers of pelvic tissues, it creates friction that initially holds it in place. Over time, the mesh is secured as your body tissue grows into it.
TVT is a very successful incontinence procedure, with many women remaining completely dry and others experiencing significant improvement.
Congenital Uterine Anomalies
Surgical repair of congenital uterine anomalies is primarily directed toward women with uterine septae, bicorniate uteri and obstructed components of the genital tract. The most common indications for repair are pelvic pain and recurrent pregnancy loss.
Hysteroscopic metroplasty has become the method of choice for repair of most intrauterine septa. Benefits to the transcervical approach include less morbidity, no abdominal or uterine muscle incisions, faster recovery and high pregnancy rates.
Removal of an obstructed hemi uterus can be done laparoscopically. This procedure is done when there is pelvic pain or endometriosis caused by blood moving from the uterus into the pelvic cavity. This may also improve fertility in some women.
Adnexal Surgery
Ovarian and tubal pathology can occur at anytime throughout a women's life. Frequent causes of adnexal disease could include infection, benign cysts, malignant cysts and endometriosis.
Common surgical procedures for benign adnexal disease, that can be performed by minimally invasive surgery include, oophorectomy, salpingoophorectomy, ovarian cystectomy, fimbrioplasty and neosalpingostomy. The main advantages of a minimally invasive approach are reductions in recovery time, hospital stay and less adhesion formation, which is particularly important in women where fertility is an issue.
Tubal Ligation Reversal
Tubal ligation reversal (also known as "untying the tubes") is the rejoining of the fallopian tubes in women who have undergone voluntary sterilization. It is one of the most effective tubal reconstructive surgeries available, especially if the tubal ligation was performed with clips or rings.
Microsurgical tubal reanastamosis is the standard procedure for tubal ligation reversals. Using a laparotomy (incision in the abdomen), a horizontal incision is made above the pubic bone. Through this incision, the tubes are exposed and are reattached using microsurgical suture techniques. Dye is injected to confirm that the fallopian tube passageway is open. This procedure can be done safely and successfully on an outpatient basis, but most patients spend one night in hospital.
Advantages
This outpatient procedure offers the following benefits:
Note:
Approximately 55% to 70% of women will become pregnant following this procedure. The success rate is affected by the woman's age when she tries to conceive. The surgery is less successful if the tubes were cut (burned) using an elecrocautery instrument or if other pelvic disease such as scarring or endometriosis is present.
The main risks associated with tubal ligation reversal are a blockage rate of approximately 5% and an ectopic pregnancy rate of 8% to 12%. When a positive pregnancy test is detected following tubal ligation reversal, an early ultrasound and blood work should be done to identify a possible ectopic pregnancy.
