Minimally Invasive Surgery
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Minimally Invasive Surgery refers to surgery performed through small incisions, usually ¼-inch to ½-inch in size. This procedure is in marked contrast to the traditional large incision, done through either a "bikini" cut or an up-and-down incision from the pubic bone to the belly button, or even up to the ribs. Request a consult with Dr. Cook. A "laparoscope" is a telescope-like instrument that is used to see through the small incision used in Minimally Invasive Surgery. The laparoscope was actually invented in the early 1900s, but it was not until the 1960s that the instruments needed to perform surgery were developed. The American Association of Gynecologic Laparoscopists (AAGL) was formed back in 1971, and gynecologists were some of the first to use laparoscopic surgery. Using a laparoscope in Minimally Invasive Surgery means that only a small area on your abdomen is affected – reducing the number of days needed for recovery. In 1981 the American Board of Obstetrics and Gynecology made laparoscopy training a required component of residency training, then video-laparoscopy was introduced in 1982. General surgeons were slower to adapt the laparoscopic approach, although the first laparoscopic appendectomy was performed in 1982 (by a German gynecologist, Dr. Kurt Semm), and the first laparoscopic cholecystectomy (removal of the gallbladder) was performed in 1985 (the first in the US was in 1988). In 1990 only 10 percent of cholecystectomies were being performed laparoscopically, but by 1992 approximately 90 percent were being performed in this manner. In contrast, Dr. Harry Reich performed the first laparoscopic hysterectomy in 1989. Twenty years later, only 11 percent of hysterectomies are being performed laparoscopically. Surgical treatment of endometriosis is the core of my practice. I have successfully treated women from across the globe, who have not previously been able to get relief from any other physician. These are often the most difficult type of cases that I perform. Virtually all of my surgeries are performed laparoscopically with Minimally Invasive Surgery. This includes difficult, Stage IV Endometriosis cases, extensive adhesion surgery, treatment of fibroids, appendectomies, laparoscopic hysterectomies and bowel resections. Compared to operating on these difficult cases, doing laparoscopic "belly-button" surgery to perform hysterectomies, treat ovarian cysts, remove fibroids, etc. is a piece of cake. In the United States, most hysterectomies currently are still being performed through large, bikini-type incisions. I do not understand, in this day and age, with the current technologies that are available, why the large, unsightly, bikini-type incision is still being used to perform hysterectomies. Quite frankly, laparoscopic hysterectomies are easy surgeries compared to endometriosis surgery, and patients do very well afterwards. Almost all patients go home the next day, and most are taking nothing more than Tylenol within a week. I would encourage all OB/GYNs to develop the surgical skills to perform most hysterectomies and basic ovarian cyst removal via laparoscopy. At the same time, treating patients with severe endometriosis symptoms as a result of Deeply Infiltrating Endometriosis (DIE) and/or adhesions requires advanced surgical skills that are not routinely taught in medical school or in a general OB/GYN residency. In these advanced cases, these diseases are like a tenacious covering that adheres to the normal delicate structures in the pelvis and abdomen. The disease can eat away at normal tissues and stick the normal structures together, similar to hardened glue. The appearance of the normal tissue and the disease blends together, and it becomes very difficult – but entirely possible with the necessary experience and surgical skills – to remove the hardened disease from the delicate normal structures safely. I do not think it is fair to expect the average OB/GYN, who is providing great routine medical care to their patients, to be expected to treat most cases of endometriosis and scar tissue. These diseases can be just as devastating as cancer, and just as we have official gynecologic cancer doctors, I feel we should also have official endometriosis surgeons/doctors who, as experts, can provide the best chance of successfully treating these complex diseases. Advantages of laparoscope surgery (Minimally Invasive Surgery) include:
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