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Overview

During a woman’s lifetime, it's possible to face a reproductive problem that requires evaluation and possible surgery from a gynecological specialist. Some conditions that may require surgery are endometriosis, ovarian cysts, fibroids, abnormal bleeding, intrauterine scarring, damaged fallopian tubes, pelvic pain, or abnormal development of the reproductive tract.

“Open” surgery, or surgery performed through traditional large incisions (similar to a cesarean section), is associated with longer hospitalizations, increased pain, increased surgical risk, and longer post-operative recovery times. Fortunately, minimally invasive surgery is oftentimes a reasonable surgical approach. Patients are often able to go home on the day of surgery or the next morning with less postoperative pain. Yale Medicine Reproductive Endocrinology & Infertility utilizes a minimally invasive surgical approach to treat reproductive conditions.

What is minimally invasive surgery?

Minimally invasive surgery is a surgical approach in which small skin incisions (less than an inch in size) and specialized tools are used to perform the surgery. This includes specialized procedures such as hysteroscopy, laparoscopy, and even robotic assisted surgery.

Hysteroscopy uses a small, narrow telescope (a hysteroscope) to allow for visualization of the inside of the uterine cavity without the need for any incisions. This is often performed when evaluating for abnormal uterine bleeding.

Laparoscopy uses a small telescope through small abdominal skin incisions to evaluate the pelvic anatomy (uterus, ovaries, fallopian tubes). The laparoscope (camera) sends live pictures to a video monitor, which allows the surgeon to visualize the anatomy and perform complex surgeries with minimal trauma to the patient. A subset of laparoscopic surgeries utilize the da Vinci Robot, a surgical tool that may be needed for certain types of surgeries.

What is robotic surgery?

Yale Medicine's surgeons are trained in the da Vinci Surgical System, a robotic tool used in cases that are too complex for traditional laparoscopy alone.

Robotic surgery was approved for gynecological conditions in 2005 and has since opened up the option of minimally invasive surgery for women who otherwise would not have been eligible for vaginal surgery or traditional laparoscopic surgery.

"Before the robotic system, we used to employ large heavy instruments as retractors or forceps or scissors in patient's abdomen," says Dan-Arin Silasi, MD, a Yale Medicine obstetrician-gynecologist. "The robotic system has enabled us to perform the most complex gynecologic cancer surgeries." 

What are some diseases that can be corrected with laparoscopy?

Laparoscopic surgery may be appropriate for the evaluation and treatment of endometriosis, pelvic pain, scar tissue, uterine fibroids, and ovarian cysts. Laparoscopy is also a commonly utilized approach for the safe removal of the uterus (hysterectomy) or ovaries (oophorectomy).

What are some diseases that can be corrected with hysteroscopy?

Hysteroscopy allows for visualization of the uterine cavity (the endometrium) without any incisions. This procedure is often performed to evaluate causes of abnormal bleeding, pain, fibroids, polyps, intrauterine scar tissue, or other structural abnormalities.

Specialized hysteroscopes even allow for the treatment of these conditions via removal of the fibroids, polyps, or scar tissue. A technique called endometrial ablation can also remove all of the above. Endometrial ablation is a possible treatment for heavy menstrual bleeding.

Can I opt for a minimally invasive procedure instead of hysterectomy?

There are some conditions that may be treated surgically without the need for a hysterectomy. Ask the minimally invasive gynecologist about what procedure and route of surgery is best.

Does Yale Medicine conduct clinical research?

Clinical research is a critical component of patient care; carefully controlled research studies help answer questions on the best way to treat patients. It's important for patients to find out if current studies are relevant to potential care. 

What is unique about Yale Medicine's approach to minimally invasive surgery for gynecologic issues?

Our team of world-class surgeons and specialists are dedicated to providing compassionate, comprehensive care to our patients. We offer the most advanced, minimally invasive surgical techniques for the most complex cases—and the most routine. 

Our goal is to help you understand your condition and recognize your symptoms, and to match you with the treatment that best suits your condition, comfort level, and lifestyle.

Meanwhile, our doctors are active researchers working to advance understanding of gynecologic issues that affect women. One of our focuses is developing minimally-invasive treatment options, and our patients are the first to benefit from these advances.