Minimally Invasive Gynecologic Surgery (MIGS)

The term Minimally Invasive Gynecologic Surgery (MIGS) is used more and more by gynecologists and can be somewhat confusing. In general MIGS involves one of two approaches. One approach involves entering a body cavity through a natural orifice. Just as a general surgeon may access the stomach through the mouth a gynecologic surgeon may enter the pelvis through the vagina. Most gynecologic surgeries can be performed through the vagina thus no abdominal incisions are required. Vaginal surgery therefore is often the least invasive of gynecologic surgery. The second approach used by gynecologists to access the abdominal or pelvic cavity is through the use of laparoscopy. Laparoscopy entails introducing small instruments, including a camera, through the abdomen. Dr. Minaglia can use laparoscopy to remove ovaries or cysts, endometriosis, uterine fibroids (laparoscopic myomectomy), the uterus and cervix (laparoscopic hysterectomy), and to perform many pelvic reconstructive procedures. All gynecologic procedures that are performed laparoscopically can alternatively be performed with robotic assistance.

Over the last several years, the rate of abdominal hysterectomy (hysterectomy performed through a large incision in your abdomen) in Hawaii has been decreasing. As of 2011, roughly half of all hysterectomies performed in Hawaii were still performed through a large abdominal incision. Consider a second opinion if your doctor is recommending an abdominal hysterectomy. There are many gynecologists available in Hawaii that can perform the surgery either vaginally, laparoscopically, and with robotic assistance. Mini-laparoscopic*gynecologic surgery is also now available in Hawaii.

Potential benefits of laparoscopic, mini-laparoscopic, and robotically assisted laparoscopic surgery:

• Less blood loss

• Shorter hospital stay

• Less postoperative pain

• Less risk of abdominal infection

• Quicker return to activity

• Small incisions

New trends in pelvic organ prolapse surgery:

Some pelvic organ prolapse surgeries were traditionally performed through large abdominal incisions. The abdominal sacrocolpopexy, for example, is one such procedure. A generous abdominal incision is made and the tissues of the pelvic floor are supported and suspended by attaching mesh to the tailbone (sacrum). Historically, this procedure has been regarded as the most effective procedure for providing a durable and effective cure to certain types of pelvic organ prolapse. Many surgeons however use the procedure as a last resort to other pelvic surgeries due to the invasive nature of the procedure. This results at times in patients receiving less effective procedures in order to improve overall recovery.

Application of laparoscopy, and more recently robotics, to pelvic organ prolapse surgery has changed the way we treat certain disorders. A sacrocolpopexy, performed either laparoscopically, mini-laparoscopically, or with robotic assistance, offers the success and durability of the open abdominal procedure but with significantly less burden on postoperative recovery. Mini-laparoscopic* sacrocolpopexy was introduced in Hawaii in 2014.

Dr. Minaglia was the first surgeon in Hawaii to perform the following procedures:

• Robotically-assisted laparoscopic sacrocolpopexy

• Robotically-assisted laparoscopic sacrocolpopexy combined with total laparoscopic hysterectomy

• Robotically-assisted laparoscopic sacrohysteropexy

• Mini-laparoscopic sacrocolpopexy*

• Mini-laparoscopic sacrocolpopexy combined with supracervical hysterectomy*

• McIndoe neovaginal reconstruction as part of gender affirming care

• Laparoscopic Vecchietti neovaginal repair as part of gender affirming care

*The term ‘mini-laparoscopy’ refers to the use of 3 mm laparoscopic instruments. 3 mm instruments are the smallest-sized laparoscopic instruments available worldwide and therefore result in the smallest skin incisions possible. There is much less tissue injury and scar tissue using 3 mm instruments compared to single-site laparoscopic surgery (28-36 mm incisions or more), traditional laparoscopic surgery (6-12 mm incisions), and robotically-assisted laparoscopic surgery (6-12 mm incisions).

Here is a near complete list of minimally invasive gynecologic and pelvic reconstructive surgical procedures I perform:

• Altemeier repair

• Anal sphincter repair

• Anterior repair

• Bladder botox injections

• Bulkamid urethral bulking for incontience

• Burch Urethropexy

• Cervical Cerclage

• Clitoral Hood Reduction/Repair

• Complex Pelvic Surgery

• Complex Vaginal Surgery

• Cystocele Repair

• Cystoscopy

• Cystotomy repair (bladder repair)

• Da Vinci Hysterectomy

• Da Vinci Sacral Colpopexy

• Da Vinci Minimally Invasive Gynecologic Surgery

• Da Vinci Proctopexy

• Dilation And Curettage

• Eclipse System Pessary Fitting

• Endometrial Ablation

• Enterocele repair

• Female Sexual Enhancement Surgery

• Fistula (Rectovaginal/Vesicovaginal) Repairs

• Gynecological Surgery

• Hysterectomy

• Hysteropexy

• Hysteroscopic Adhesiolysis

• Hysteroscopic Intrauterine Device (IUD) Removal

• Hysteroscopic Myomectomy

• Hysteroscopy

• Incontience surgery

• Interstim Sacral Neuromodulation

• Kelly Plication

• Labiaplasty

• Laparoscopic Adhesiolysis

• Laparoscopic Hysterectomy

• Laparoscopic Myomectomy

• Laparoscopic Oophorectomy

• Laparoscopic Ovarian Cystectomy

• Laparoscopic Salpingectomy

• Laparoscopic Salpingo Oophorectomy

• Laparoscopic Surgery For Endometriosis

• Laparoscopic Surgery For Ovarian Endometriosis

• Laparoscopic Tubal Ligation (LTL)

• Laparoscopy

• Laparoscopy Procedure Bladder

• Midurethral Sling

• Minilaparoscopy (3 mm instruments)

• Minilaparotomy

• Minimally Invasive Gynecologic Surgery

• Minimally Invasive Hysterectomy

• Minimally Invasive Surgery

• Minimally Invasive Surgery For Ovarian Endometriosis

• Myomectomy

• Oophorectomy

• Ovarian Cystectomy

• Partial Hysterectomy

• Pelvic Ultrasound

• Permanent Sterilization

• Pelvic Organ Prolapse Surgery

• Polypectomy

• Posterior Repair

• Prophylactic Oophorectomy

• Radical Trachelectomy

• Reconstructive Gynecological Surgery

• Rectal Prolapse Repair

• Rectocele Repair

• Robotic Bladder Surgery

• Robotic Gynecological Surgery

• Robotic Hysterectomy

• Robotic Myomectomy

• Robotic Surgery For Ovarian Endometriosis

• Sacral neuromodulation

• Salpingectomy

• Sexual Enhancement Surgery

• Suburethral Sling

• Surgical Excision Of Bladder Endometriosis

• Surgical Sterilization

• Transabdominal Pelvic Us

• Transvaginal Us

• Tubal Ligation

• Ureterolysis

• Uterine Surgery

• Uterosacral ligament suspension

• Vaginal Biopsy

• Vaginal Reconstructive Surgery