Hysterectomy alternatives/MIGS techniques

Understanding your options for pelvic pain surgery 

If you’re suffering from pelvic pain and medical treatments haven’t been effective, surgery may be recommended — but that doesn’t necessarily mean a hysterectomy.  

Today, there are more minimally invasive procedure options than ever before for the surgical treatment of gynecologic conditions — including endometriosis, fibroids and ovarian cysts — that cause pelvic pain.  

These proven procedures not only help alleviate women’s pelvic pain and suffering, they also allow patients to recover faster, need less pain medication and return to their normal activities much sooner than if they had a larger incision, says Dr. Tamisa Koythong, a minimally invasive gynecologic surgeon. 

Alternatives to hysterectomy  

How do you know if a hysterectomy or one of these minimally invasive alternatives is better for you? It depends on the patient and the extent of her disease, explains Dr. Koythong.  

“For example, if a woman has endometriosis, a hysterectomy may not address her disease or her pain,” she says. “This is because with endometriosis, for example, the abnormal tissue grows outside the womb and typically doesn’t involve the uterus.” For women who may want to become pregnant in the future, ideally the surgeon would use a laparoscopic approach to remove any endometrial tissue in the pelvis and/or on the ovaries. If there are cysts on the ovaries caused by endometriosis — a condition known as endometrioma — a hysterectomy wouldn’t address that disease either. 

“Another example would be if a woman has a large fibroid contributing to her pelvic pain,” Dr. Koythong says. “Depending on the size, location and number of other fibroids she has, a minimally invasive myomectomy — a procedure to remove fibroids — might be performed as an alternative to a hysterectomy. If she has a multitude of fibroids of different sizes all over her uterus, though, minimally invasive surgery might not be an option.”  

Unprecedented minimally invasive techniques and technologies 

“In the past when patients heard ‘minimally invasive surgery,’ they thought laparoscopy,” notes Dr. Koythong. “Today we have single-incision procedures, robotic surgeries and vaginal approaches that don’t require any incisions at all.” 

Highlights of these different techniques and technologies include:  

• Traditional laparoscopy: The surgeon uses tiny scopes (cameras) and surgical instruments, which are inserted through small incisions in the abdomen, to perform gynecologic procedures instead of making a large abdominal incision. 
• Robotic-assisted laparoscopy:  The surgeon operates through very small incisions, using robotic arms to perform complex tasks with precision and dexterity and with a 3-D view from an imaging console. 
• Single-incision laparoscopy: The surgeon performs a procedure performed through a single, slightly larger incision at the belly button, allowing for removal of large ovarian cysts, fibroids or other problems.  
• Vaginal natural orifice transluminal endoscopic surgery (vNOTES): The surgeon performs a gynecologic procedure that uses a vaginal approach, eliminating the need for any external incisions.  

Factors to consider 

With so many options, how do patients and their physicians decide which minimally invasive approach is right for them?  

“It really depends on what disease we’re treating and the extent of the disease,” says Dr. Koythong. “If there’s a need for additional surgical subspecialties — for example colorectal surgery or urology may be involved in some cases of endometriosis — that will factor into which approach we use. So, too, would the experience of the other surgical subspecialists in the techniques and technologies we’re using.”  

Another consideration is whether there are concurrent issues being treated at the same time. “For example, if there is a fibroid and an ovarian cyst, the approach we use would depend on their locations,” she explains.     

Get answers to your questions 

If surgery is recommended for your pelvic pain, talk with your doctor about your options. Ask questions, and make sure you understand what to expect from your procedure and your recovery.  

Common questions Dr. Koythong hears from her patients include:  

• Do I have to stay overnight at the hospital following my surgery?  
• How long is the recovery process and what restrictions will I have?  
• What kind of scarring will I have? 

For answers to these and any questions you may have about surgery for your pelvic pain, join us at our free Pelvic Pain patient seminar Thursday, July 21. Our team of experts will share the facts on pelvic pain that all women need to know. To reserve your spot, call 832-826-7376 or register online at https://bit.ly/PelvicPain7-21.  

Dr. Tamisa Koythong is an assistant professor and a minimally invasive gynecologic surgeon in the Department of Obstetrics and Gynecology at Baylor College of Medicine and Texas Children’s Pavilion for Women.