One of the most significant advances in gynecologic surgery in the past 25 years has been the ability to perform major surgeries that previously required large abdominal incisions through the three small punctures of operative laparoscopy.
I have been doing advanced laparoscopic surgical procedures since 1986 when I was originally introduced to the laparoscopic use of the CO2 laser. Within six months of beginning with this technology, I was using laparoscopy to achieve the same or better surgical success than when I previously performed the procedure through a laparotomy (abdominal wall) incision.
With the initial descriptions of laparoscopic assisted vaginal hysterectomies (LAVH) in the late 1980s, I have been doing the vast majority of hysterectomies laparoscopically. Initially, in the late 80’s and early 90’s these were LAVH’s. I have been doing total laparoscopic hysterectomies since the early to mid-90’s. I then began offering laparoscopic supracervical hysterectomies as indicated and desired by the patient since the year 2000. Ovaries are either left or removed based on the patient’s personal situation and her wishes.
Performing these surgeries has been an easy and natural extension of my laparoscopic surgical skills. I initially developed my advanced laparoscopic surgical skills to treat patients with extensive endometriosis and pelvic adhesions. These laparoscopic skills were based on the microsurgical principles and training I received as a fellow in reproductive endocrinology to treat these patients with severe pelvic pathology.
Currently, while I do receive referrals from family physicians and patients, the vast majority of my referrals for laparoscopic hysterectomies come from the best general OB/GYN’s in the tri-state area. Keeping their patient’s welfare as their foremost consideration, they recognize the quality of the medical and surgical care that their patients receive in my hands.
I offer laparoscopic hysterectomies routinely for uteruses enlarged with uterine fibroids, adenomyosis, abnormal uterine bleeding and pelvic pain. I routinely laparoscopically remove uteruses enlarged to the level of the umbilicus (belly button). While I will perform laparoscopic hysterectomies for uteruses above the umbilicus, this is done on a case-by-case basis with the final determination being a joint decision with the patient.
Finally, any gynecologic surgeon who is not skilled in performing hysterectomies laparoscopically for noncancerous diseases should probably not be performing hysterectomies. Similarly, surgeons who need to use the da Vinci Robot to perform laparoscopic hysterectomies also represent a less talented surgical group that exposes their patients to the higher risks and longer recovery times experienced by patients whose surgery is performed using the robot for gynecologic, laparoscopic surgery.