Doctor, what are the newest advances in gynecologic surgery?

Technology is changing the way gynecologic surgery is performed. In this article I will discuss three new surgical procedures and how they are used to treat common medical conditions for women.   

Trans Obturator Tape (TOT)
It is estimated that 11 million women in the United States experience Stress Urinary Incontinence (SUI). This condition occurs as a result of pregnancy and childbirth, chronic heavy lifting, aging and obesity. SUI is defined as a loss or leaking of urine with increased intra-abdominal pressure such as coughing, sneezing, laughing and exercising. Because of this, women buy more sanitary pads for incontinence than for menstruation. SUI is not a part of aging, it is a medical condition. SUI can affect women at any age starting in their early 30s.

Normally the urethra is supported by the pelvic floor muscle and fibers to maintain a tight seal and prevent the involuntary loss of urine. When this support is weakened, SUI occurs. TOT is a ribbon-like mesh made from permanent material; it is inserted below the urethra through a 2-centimeter incision in the vagina. The mesh tape creates a supportive sling or hammock under the urethra, allowing it to maintain its seal to prevent involuntary urination. It is an outpatient procedure and highly successful with less than a week of inconvenience. 

Laparoscopic Supracervical Hysterectomy (LSH)
It is estimated that 600,000 hysterectomies are performed in the United States each year. Traditionally, a hysterectomy was done through an open abdominal incision, which typically means a long and painful recovery. The LSH procedure uses a thin, lighted telescope-like instrument called a laparoscope, which acts like a video camera, along with small surgical instruments that are all inserted through three to four tiny incisions (less than ¼ inch each) in the navel and the abdomen. Using the instruments, the surgeon carefully separates the uterus from the cervix and removes it through one of the openings. The cervix, the bottom part of the uterus, is left intact. Because this type of surgery does not require the surgeon to make a large abdominal incision, a woman will not have the same kind of visible scar typical with most traditional “open” surgeries. 

Some research suggests that preserving the cervix may help reduce the risk of pelvic floor prolapse, urinary incontinence and other complications associated with total hysterectomies. However, with the cervix in place, it means that following an LSH, a woman must be willing to continue getting annual Pap smears to screen for cervical cancer.

Our group has performed more than 200 LSHs, with very few converted to open hysterectomies. Most of the LSHs  that were converted were due mostly to unanticipated adhesions and sometimes due to the woman having a large uterus.

Endometrial Ablation
The endometrium is a mucus membrane that lines the inner surface of the uterus. Every month the ovarian hormones prepare this lining to receive the fertilized egg. If fertilization does not occur, most of the lining is shed and this process is repeated monthly. The average menstrual period for most women lasts five to seven days, changing one pad every two to three hours. Some women suffer either from heavier periods, soaking one to two pads every hour, or from longer, undesired periods lasting more than seven days with severe cramping.  Endometrial Ablation is an outpatient procedure that uses a variety of energy sources to destroy the endometrium and alleviate excessively heavy periods. This is done through the vagina and the cervix to the lining of the uterus without any incisions and with minimal discomfort afterward. Some of my patients have gone to work the next day.