List of Services

Anorectal Ultrasonography

Anorectal ultrasonography may also be called transperineal ultrasound or pelvic floor ultrasound. A small ultrasound transducer is placed over the skin between the vagina and anus. The muscles of the anal canal can be comprehensively evaluated with the use of anorectal ultrasonography. This type of ultrasound evaluation is often used in the evaluation of women with fecal incontinence.

Sometimes the muscles of the anus (anal sphincters) become damaged due to child birth, trauma, and/or prior surgery. The nerves controlling these structures may also be damaged. A careful history, physical examination, and ultrasound often lead to a comprehensive understanding of the problem and development of an effective treatment program.


Defecography is a special X-Ray test used to evaluate bowel function. The test is routinely performed in the radiology department. Contrast material (barium) similar to the consistency of stool is placed into the rectum. Fluoroscopy is then performed during squeezing and relaxation of the pelvic floor and during evacuation of the contrast material.


Cystoscopy is a test that allows direct visualization of the bladder and urethra. A thin, lighted instrument called a cystoscope is slowly inserted into the urethra and advanced into the bladder. Tissue biopsies can be obtained by inserting tiny surgical instruments through the cystoscope. A cystoscopy is performed in situations where laboratory tests and/or imaging tests such as ultrasound and X-rays do not provide the necessary information to render a diagnosis.


Urodynamics comprise a series of tests of the lower urinary tract. They are commonly performed during the evaluation of urinary incontinence, but can be useful for evaluating other conditions as well. A small tube is placed into your urethra and advanced into your bladder. The tube allows the bladder to be filled with a sterile solution and pressures in the bladder and urethra to be recorded. An additional tube is placed in either the vagina or rectum for additional pressure measurements. The test takes about 15 minutes to complete.

Cosmetic Surgeries

Some women note excess labia minora (inner lips), labia majora (outer lips), and/or clitoral hood tissue. Others may wish that their labia majora had a more full appearance. As a fellowship-trained specialist in Female Pelvic Medicine and Reconstructive Surgery, Dr. Minaglia has performed thousands of labial and vaginal surgeries for over ten years. Most commonly, Dr. Minaglia performs the following four cosmetic procedures described below.

Labia Minora Reduction

Labia Minora Reduction is the most common procedure requested in my practice. There are many different ways to perform the procedure, and tailoring the procedure to each individual’s goals is important when achieving optimal results. An optimal procedure reduces the hyperpigmentation and bulk of the labia minora (inner lips) leaving behind barely visible, very small scars.

Labia Majora Augmentation

Some women desire a more full appearance of the labia majora (outer lips). Labia majora augmentation is accomplished by injecting adipose (fatty) tissue beneath the skin of the labia majora after it has been removed from other areas of the body. The procedure begins by making small incisions (a few millimeters) to allow access to subcutaneous adipose tissue in areas such as the butt or thigh. A tumescent solution is injected into the adipose tissue and the tissue is then easily aspirated. The natural contours of the body are easily preserved since only a small amount of adipose tissue is needed.

Libia Majora Reduction

Some women may also note excess labia majora (outer lips). The labia majora are commonly reduced by removing redundant skin and concealing the scar along the natural contour between the labia majora and minora.

Clitoral Hood Reduction

Excess skin of the clitoral hood, which lay across the top of the clitoris, can be present in some women. This excess skin may be removed to decrease the bulk of the area and allow greater exposure of the clitoris.

The above procedures are all performed in the outpatient setting. You can return to work in 5-7 days and return to exercising in about 2 weeks. You can resume sexual intercourse once complete healing occurs, which in general takes about 4 weeks.

We have arranged a special fee schedule with our local ambulatory surgery center and a local anesthesia group in order to deliver the highest quality care at the lowest available price. Our cost of labia minora reduction, for example, is a fraction of the cost other surgeons charge locally, on the neighbor islands, and on the mainland.

Minimally Invasive Gynecologic Surgery

The term, Minimally Invasive Surgery (MIS) is used more and more by gynecologists and can be somewhat confusing. In general MIS 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*

*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).

For a complete list of minimally invasive gynecologic and pelvic reconstructive surgical procedures please contact us.