What is minimally invasive gynecologic surgery?

Minimally invasive gynecologic surgery (MIGS) is the incorporation of technology, skills and techniques that allows surgeons to perform internal procedures through small incisions measured in millimeters rather than centimeters or inches.

MIGS had its beginnings in the late 1960s with the development of laparoscopic approaches for diagnostic and very limited procedural approaches such as tubal sterilization. The appeal of less tissue injury and speedier recovery times were enticing but technical shortcomings still persisted. Now, women with conditions including uterine fibroids, abnormal uterine bleeding, pelvic pain, endometriosis, pelvic organ prolapse, cervical incompetence and ovarian cysts can opt for MIGS, resulting in a faster recovery, less pain, smaller incisions and a shorter hospital stay.

How have MIGS techniques evolved?

The last decades of the 20th century saw rapid advances in technology including digital video imaging, improved fiber optic light delivery, laser and ultrasonic power sources and more elegant instrumentation and manipulative devices. Rapid expansion of endoscopic, arthroscopic and laparoscopic procedures followed and doctors soon recognized that visualization and accessibility are often enhanced by minimally invasive approaches.

What is robotic surgery and how does it impact MIGS procedures?

The first decade of the new millennium saw enthusiastic interest in the possibility of robotic assistance for minimally invasive surgery. The development and subsequent adoption of the DaVinci robotic surgery system has further advanced the capabilities of minimally invasive surgery in many disciplines, perhaps most notably gynecology.

In robotic procedures, the lead surgeon sits at a console in the operating room with assistants who aid in manipulation, retraction and placement of the robotic instruments. The surgeon, who manipulates a “joystick,” allowing him/her to mimic the flexion and rotation of the human wrist, controls these instruments. This overcomes the limitation of the traditional “straight stick” instruments, which are more limited in their mobility. While not all surgeries demand the capabilities of the robot, its use allows some procedures that might otherwise demand open surgery to be completed by a minimally invasive approach.

Thanks to these pioneering developments in both technology and surgical skills the majority of hysterectomies in this country are performed via minimally invasive techniques. These disciplines also lend their adaptability to gynecologic procedures addressing fibroids, endometriosis, infertility, pelvic floor disorders (relaxation/prolapse/bladder issues), ovarian pathology, pelvic pain and even gynecologic cancers.

When is MIGS not  recommended?

Not all surgeries are amenable to the minimally invasive approach. Specimen size, the possibility of cancer, and history of prior surgeries are the most common reasons MIGS may not be the preferred route.

On the patients’ side the advantages of MIGS surgery are countless. Operative complications and surgical blood loss are generally reduced. Postoperative discomfort is diminished, requiring less potent drugs for pain control. Hospital stays are shorter and recovery time is quicker, leading to better return to daily activities and reduction of time off work with its related financial pressures. 

Board-certified in Obstetrics and Gynecology, Dr. Ostrum has been practicing in Wilmington and Newark, DE and Woodstown, N.J. since 1980. He is the first community-based OB/GYN to perform DaVinci Robotic surgery at Christiana Hospital and offers a wide array of minimally invasive therapeutic options in addition to traditional gynecologic care. Dr. Ostrum also serves as deputy chair of the OB/GYN Department at Christiana Hospital and has served as president of the Medical/Dental Staff. He is also a member of the teaching faculty of the minimally invasive teaching fellowship at Christiana Hospital.

First State Women’s Care
4745 Ogletown Stanton Road, Suite 106
Newark, Del., 19713
454-9800
www.firststatewomenscare.com

Dr. Gordon Ostrum