Q&A with Experts from the Duke Center for Minimally Invasive Gynecologic Surgery

Minimally invasive gynecology means providing care for women that focuses on making a positive impact on the condition without adversely affecting quality of life.

Sometimes that means prescribing innovative medical therapy. Sometimes it means offering procedures that were traditionally done in the operating room in a clinic or office setting. In our practice we seek to perform gynecological procedures using minimal access, thereby reducing the acute phase of treatment as much as we can.

Consider hysterectomy, for example. The majority of hysterectomies in the U.S. are performed through open abdominal surgery.

The minimally invasive approach would be to perform hysterectomy via small incisions, utilizing a lighted telescope (laparoscope), or no incisions, approaching through the vagina, instead of making a standard open abdominal incision. This is not your mother’s hysterectomy.

Answers provided by Alice P. Cooper, RNC, OGNP; Stanley J. Filip, MD; Craig J. Sobolewski, MD; and Jeffrey P. Wilkinson, MD.

Q. What are the benefits of the minimal approach?

Benefits include less pain and scarring and faster recovery time -- with an increased potential for sexual function sooner afterwards -- as well as a lower risk of complications related to surgery, such as lung complications, pneumonia, or blood clots.

The fact that we can do a variety of procedures in the office instead of the hospital has some very practical benefits. It’s often less time-consuming and requires fewer visits.

And though specifics depend on individual insurance coverage, even costs can be lower because the patient may have an office co-pay instead of an outpatient surgery co-pay, or perhaps she’s avoiding the cost of an overnight hospital stay.

Q. What are some minimally invasive gynecological services offered besides hysterectomy?

We provide consultation and potential treatment for the spectrum of benign gynecologic disorders, such as incontinence, pelvic pain, abnormal bleeding, fibroids, ovarian growths or masses, and more.

The procedures we commonly perform include hysteroscopy, which is viewing the inside of the uterus through a thin, telescopic tube.

We use the hysteroscope to perform endometrial ablation, a treatment for abnormal bleeding that is an alternative to hysterectomy for some. It’s completely outpatient and typically after a day and a half or so of some cramping, patients can get back to their normal activities relatively quickly.

We have recently begun offering a hysteroscopic sterilization procedure called Essure, which is done through the vagina and without incisions. For years, men have been able to have a vasectomy performed in a doctor’s office. Essure is much safer than a traditional tubal ligation done through the belly button, allowing us to offer women an in-office procedure also.

Dr. Wilkinson is a urogynecologist, so we offer bladder evaluations and some bladder procedures in the clinic as well. We address pelvic prolapse, a dropping of the uterus, bladder, or vagina -- sometimes the rectum -- and incontinence. We have minimally invasive treatments that can in most cases effect either a cure or considerable improvement without the weeks of surgical recovery that people may fear.

Even when we might need to go a more traditional surgical route, our promise is that we will try to keep the intervention as minimal as possible. The philosophy is always “more through less.”

Duke Center for Minimally Invasive Gynecologic Surgery is located on 3116 North Duke Street, Durham. For an appointment, call 919-660-2370.