What Determines the Ability of a Gynecologic Surgeon to Perform Complex Laparoscopic...

As I discussed in my November 2011 blog, laparoscopic and/or robotic (minimally invasive) surgery has multiple and significant advantages as compared to laparotomy (open incision) surgery. Patients who need to have a hysterectomy (removal of uterus) or myomectomy (removal of fibroids) or sacrocolpopexy (suspension of sagging vagina) will definitely benefit avoiding laparotomy. Such a benefit can be achieved only if the surgeon starts and completes the operation in a minimally invasive way without converting to a laparotomy (open incision) and without causing organ injury.

Conversion happens when a surgeon (after the start of the operation) realizes that the surgical anatomy is to challenging for his/hers minimally invasive skills to accomplish the operation in an expedite and safe fashion. Challenging surgical anatomy could be the large size of the uterus and/or fibroids, significant amount of adhesions and scar tissue and inability to recognize the surgical plains.

Conversion happens also when an organ injury occurs and the surgeon is unable to repair it in a minimally invasive way. The most common complications are injury to the bowel, bladder and ureter (tube connecting the kidney and the bladder) or bleeding.

In order to choose the right minimally invasive gynecologic surgeon for the given patient, the following questions may be asked:

• How many hysterectomies, myomectomies or sacrocolpopexies he/she has done in total and on average every month?
• What size (pounds, grams, weeks) uteri and/or fibroids has he/she successfully removed?
• How he/she is comfortable with patients who had multiple prior pelvic/abdominal surgeries (C-sections, myomectomies, etc.)?
• What is his/her conversion rate?
• What is his/her complication rate (bowel, bladder, ureter and blood vessel injury)?

These questions may serve as a “check list” and help the patient to choose the appropriate surgeon.

Author

Dr. Nathan Mordel, MD Nathan Mordel, MD, is a board-certified gynecological surgeon at Atlanta Minimally Invasive Gynecologic Surgery Center in Atlanta, Georgia. He specializes in advanced robotic, laparoscopic, vaginal pelvic surgery, including for fibroids, endometriosis, heavy and/or painful menstrual periods, pelvic organ prolapse, and urinary incontinence.