Dr. Sarah Cohen, Division of Minimally Invasive Gynecologic Surgery

Today’s post is written by gynecologic surgery specialist Dr. Sarah Cohen, leader of our new Minimally Invasive Gynecologic Surgery  service in Foxborough.

For many patients, the thought of having gynecologic surgery can be worrisome. Thanks to minimally invasive surgery techniques, however, most women can now undergo surgery with minimal interruption to their lives. Benefits include a shorter hospital stay, minimal pain after surgery, less chance for surgical and post-operative complications, and less blood loss. My patient “Sue” is a good example. I recently performed minimally invasive gynecologic surgery to remove her fibroid tumors. After a short overnight stay in the hospital, she returned home and was back to work within a week.

What is minimally invasive gynecologic surgery?

Minimally invasive gynecologic surgery (MIGS) is a technique by which traditional pelvic surgery can be accomplished using small incisions or openings, as opposed to traditional “open” surgery (which includes a large abdominal incision). MIGS includes several surgical techniques. Laparoscopy is a procedure where a surgeon uses small incisions (5-10mm) to insert tiny instruments into a patient’s abdomen and perform the operation. Robot-assisted laparoscopy is similar to conventional laparoscopy, except the surgeon controls instruments and camera movement from a separate console in the operating room instead of by hand. Vaginal surgery and hysteroscopy (using a camera and instruments to perform intra-uterine surgery) are also used by physicians specializing in MIGS.

How does a physician become a specialist in minimally invasive gynecologic surgery?

After a four-year residency in Obstetrics and Gynecology, a physician may pursue further training as a minimally invasive surgical specialist during a two-year training fellowship. During these fellowships, physicians develop additional skills in advanced surgical techniques that incorporate laparoscopy, robotics, and hysteroscopy.

What types of conditions are commonly treated by a minimally invasive gynecologic surgeon?

In our practice, the most common operations we perform with minimally invasive techniques are myomectomy (removal of fibroids), hysterectomy (removal of the uterus), adnexal surgery for ovarian cysts or masses, removal of endometriosis or adhesions, and prolapse repair.

Although many gynecologic cancers also can be treated with minimally invasive surgery, these cases are typically handled by a gynecologic oncologist who has specific expertise in treatment of cancers.

How do I know if I should see a minimally invasive gynecologic surgeon?

Many women see their general OB/GYN for routine health care checkups. If you are experiencing significant gynecologic problems due to conditions such as fibroids, prolapse, endometriosis, or ovarian cysts, your doctor may suggest surgery as a treatment option. Since most conditions can be treated through minimally invasive techniques, which offers many benefits for patients, you should ask your doctor if this would be appropriate for you. There are some cases, however, where it is not appropriate to perform minimally invasive surgery, and a bigger incision may be needed (for example, certain types of cancer or in patients with severe heart or lung disease). A consultation with a surgical specialist also can help you weigh your options.

Learn more about the Division of Minimally Invasive Gynecologic Surgery at Brigham and Women’s Hospital.

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