Using robotics to treat pelvic adhesions is safer than other laparoscopic surgical techniques

Robotic surgery requires a greater number and size of incisions without minimizing risks or increased improvement in the outcome

 What is resection of pelvic adhesions?

Pelvic adhesions are scar tissue. This scar tissue can grow between two organs in the pelvic area and cause significant pelvic pain. Resection of pelvic adhesions means the removal of this scar tissue.

 Why would a woman need to undergo resection of pelvic adhesions?

Pelvic adhesions are treated if they are causing aggravating symptoms, such as infertility, pain or gastrointestinal problems (bloating and constipation).

 What are the major risks associated with resection of pelvic adhesions?

Like any surgical procedure, resection of pelvic adhesions is associated with certain risks such as excessive blood loss and an infection requiring antibiotic treatment. Additionally, women should be proactive in selecting a surgeon who has had advanced training and experience in this type of procedure, as inexperienced surgeons may experience complications such as:

  • Higher risk of needing to convert to an open, more invasive procedure with larger incisions and longer recovery times
  • Increased risk of injury to bladder, bowel and ureter (part of the urinary tract)
  • Heightened risk of additional scarring (adhesions)

 What happens during the procedure?

Laparoscopic resection of pelvic adhesions is the preferred method due to less pain, faster recovery, and less risk of new adhesions compared to open surgery. 

Using two small incisions, the surgeon will remove the scar tissue that has developed between the pelvic organs.

DualPortGYN for pelvic adhesions is an innovative GYN surgical technique developed by surgeons at The Center for Innovative GYN Care that uses only two, 5 millimeter incisions. One incision is placed at the belly button and the other is at the bikini line. With these incisions, most GYN procedures can be performed safely in less than one hour.

 How does DualPortGYN work?

  • Clearer view and fewer complications – DualPortGYN uses a technique known as retroperitoneal dissection (RPD), originally developed to remove cancerous tissue. By going behind (retro) the lining (peritoneal), the surgeon completely visualizes all of the anatomy of the pelvis, and avoids complications such as excessive bleeding, bladder injury, injury to the ureter and bladder. RPD allows surgeons to map the organs and arteries in the pelvis, much like a GPS system, reducing the time of the procedure and avoiding injury to the pelvic structures. 
  • More convenience – In many situations, the surgery is performed on an outpatient basis allowing patients to go home the same day and return to most normal activity in approximately one week. 

 How long is recovery?

Recovery is dependent on the extent of the adhesions treated and the type of surgery – whether it is open abdominal or laparoscopic. 

 What should I ask my doctor or OB-GYN if he/she recommends resection of my pelvic adhesions?

Before undergoing surgery, you will likely have many questions for your doctor or OB-GYN. Below are some recommended questions to ask – and background information to help you weigh the answers. You can also download a printable version of these questions.

How do you perform resection of pelvic adhesions?

Laparoscopic removal of scar tissue (lysis of adhesions) is most effective in patients with extensive adhesions and adhesions involving the bowel. In cases of mild adhesions, cutting down of adhesions may not treat the pain and other causes of pain need to be considered. If scar tissue is caused by multiple cesarean deliveries, the removal of the uterus may be necessary to avoid adhesion reformation and repeat surgery.

Do you recommend open surgery?

Open resection is still the mostly commonly performed surgery to remove pelvic adhesions, but the major disadvantages with this type of approach are that it requires a much larger incision than new minimally invasive techniques, can result in longer hospital stays, can cause more pain during recovery and longer recovery times – patients often need six to eight weeks to recover.

A recent advancement in minimally invasive GYN surgery, DualPortGYN is a new way to perform resection of pelvic adhesions and has been used in thousands of surgeries.

How many times have you performed this procedure?

When it comes to any form of surgery, training, skill and practice matter, which is why GYN surgeons who specialize in minimally invasive surgery are the most qualified. The reality is that OB-GYNs are highly skilled obstetric practitioners, but very few perform GYN surgeries often enough to be surgical specialists. This is borne out by studies, which find that GYN surgery is commonly a secondary component of what an OB-GYN does.

What have your other patients experienced after this procedure?

Robotic, open and conventional laparoscopic GYN surgeries can lead to longer recovery times, increased blood loss and larger scars than newer procedures. Make sure your surgeon is trained in the latest minimally invasive techniques, such as The Center for Innovative GYN Care’s DualPortGYN, that prevent injury to the pelvic structures and minimize blood loss – resulting in reduced complication rates and improved recovery times.

Have you had fellowship training in minimally invasive GYN surgery?

While most OB-GYNs are highly trusted generalists, they spent most of their time focusing on obstetrics and basic GYN care and therefore, perform specialized GYN surgeries rarely. Be sure to choose a surgeon who has received comprehensive training and performs many pelvic adhesion resections or other minimally invasive minimally invasive GYN procedures each year.

Will you use robotics to assist with the surgery?

Although the American Medical Association and other leading medical societies have issued statements discouraging robotic techniques due to dramatically higher costs to patients without any medical advantages, robotics continue to be used in GYN surgeries. This is because robotic procedures “enable” an OB-GYN not well trained in laparoscopic GYN surgical techniques to complete a GYN surgeries through a “minimally invasive” approach. This is why women need to ask if robotics will be used during a GYN surgery and to seek a specially trained surgeon able to perform the latest minimally invasive surgical techniques, such as DualPortGYN and retroperitoneal dissection that do not use robotics.

What is my anticipated recovery time?

New minimally invasive techniques require, on average, only a week to recover. Other procedures such as open abdominal surgery can take up to 8 weeks.

What are my other surgical options?

Ask your physician if he or she is aware of new, minimally invasive procedures.

Women need to be their own best advocate, which is why getting a second opinion is always good practice. Since there are different surgical options for treating pelvic adhesions, getting a second opinion is a way you can ask questions about how the surgery will be performed, the recovery time, and possible complications.