4 things every patient should consider

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Many women consider undergoing gynecologic surgery for a variety of conditions such as abnormal bleeding, pelvic pain, ovarian cysts, fibroids or endometriosis.  Historically, these surgeries were often done through large abdominal incisions requiring long hospitalizations and recovery time, increased scar tissue and increased risks of bleeding and infection.

In contrast, many women now have the option of having these procedures performed with minimally invasive surgery (MIS) techniques.  MIS techniques are usually associated with less pain, quicker recovery, and lower risks of infection and bleeding.  These surgical methods include vaginal surgery, laparoscopy and hysteroscopy.

• Laparoscopy is the performed with a small camera that is inserted into the abdomen with the use of several small instruments.  Traditionally, this involves 3-5 small incisions on the abdomen. Sometimes, a surgeon will use a robotic system to perform the laparoscopy.
• A single port device can be used where all of the instruments and camera are inserted through one small incision.
• Hysteroscopy is when a camera is inserted into the uterus through the cervical opening in the vaginal canal.

If a woman is considering gynecologic surgery, here are several things to think about:

1. Can the procedure be done with minimally invasive surgery? Although, some surgeries cannot be done with minimally invasive surgery because of existing scar tissue or extremely large size of the uterus or ovary, most patients are usually candidates for a minimally invasive approach.  A patient should speak to their doctor to discuss if they are a candidate for MIS.
2. If your doctor feels that your surgery cannot be done with MIS, consider a second opinion.  Not all surgeons are adequately trained to safely perform minimally invasive surgery, and some surgeons may not be comfortable with more complex procedures.  Consider seeking a second opinion with a surgeon with advanced training and experience before making a final choice regarding your health care options.
3. How much experience does your surgeon have with this particular procedure? Does he or she perform these procedures routinely?  Has your surgeon obtained advanced training for this type of procedure?  How often does your surgeon start a procedure with a minimally invasive technique, but then need to call for assistance or switch to a larger open incision to complete the procedure?  These are some of the most important issues to consider when choosing your surgeon.  The medical literature is quite clear that surgeons with higher surgical volume and/or greater surgical experience tend to have better outcomes for their patients.  For example, although you may have a long and positive relationship with your local OBGYN who performs your yearly exams, you may decide that this physician is not the best person to perform your gynecologic surgery.
4. Are you comfortable with your surgeon?  Every woman should feel at ease with her surgeon.  You should feel that all of your questions and concerns were heard and addressed prior to your procedure. Have you discussed options other than surgery, or are there other procedures that may be good options for your symptoms?  If surgery is the best option, what are the risks and what should you expect with your recovery?  Is the surgery likely to adequately treat your symptoms and what happens if your symptoms still persist?

The decision to proceed with surgery is not an easy one for most patients.  Feeling comfortable with your surgeon and type of surgery is important to achieve a result that maximizes your satisfaction.   Don’t be shy about asking questions.  It’s your health and your doctor should be happy to answer them!