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Definitions

In Gynecology and Reproductive Surgery, there are two basic surgical approaches:  Minimally Invasive Surgery (Laproscopy) and traditional Open Surgery (Laparotomy).  

Laparoscopy is a technique that first started in the 1970’s and now includes robotic surgery and Microlaparoscopy.  Using small incisions, this technique allows patients to go home same day (outpatient surgery) and experience much quicker recovery times, usually just a few days.  Laparoscopy is much more technically difficult than traditional open surgery.  Nearly all traditional procedures are possible via Laparoscopy.  Surgeons possess different experience levels in laparoscopy and differ significantly in the procedures performed via laparoscopy.  At JCRM we offer all Laparoscopic procedures available in the U.S. for Reproductive Medicine and Gynecology, including Myomectomy, all stage Endometriosis Surgery, Tubal Repair, Tubal Reversal, and Total Laparoscopic Hysterectomy to name a few.  Robotic or Microlaparoscopy offers no significant advantages to traditional laparoscopy.  The main differences, at this time, involve incision size.  Robotics’ primary advantage is to convert what would be an open case to a laparoscopic case for those surgeons not comfortable with traditional laparoscopy.   Microlaparoscopy simply leaves smaller incisional scars.  Incision size is largest for robotics, followed by traditional laparoscopy and is smallest in microlaparoscopy.  

Laparotomy, a much older technique, is traditional open surgery.  In these surgeries, a large incision is utilized to gain access to the peritoneal cavity.  The larger incision requires a hospital stay and causes recovery to be extended and often on the order of weeks.  Six weeks is the most common recommendation for time off from work.  There are still a few procedures today that necessitate this approach.  Most notably Myomectomy in the setting of extreme fibroid number (>25).   Size is generally less problematic than numbers.  In laparoscopy, the surgeon is unable to feel the uterus, and therefore unable to appreciate small myomas that can not be evaluated with imaging studies such as ultrasound.  When the fibroid number gets to a certain limit, there are so many fibroids they can not be mapped for surgery.  Also when there are so many, there are bound to be multiple small myomas not seen on ultrasound that can be felt at open surgery.  For these reasons, there is an occasional patient that needs an open myomectomy.