About Minimally Invasive Gynecologic Surgery (MIGS)

Minimally invasive gynecologic surgery (MIGS) are surgical procedures that limit the size of incisions compared to open surgery. Dr. Coiner, Dr. Whitley, Dr. Gay, and Dr. Haskins have received training and designations in these surgical procedures. They have several advantages over traditional surgeries. They are associated with less postoperative pain, less blood loss, smaller incisions, less scarring, and fewer postoperative infections.

Patients who undergo MIGS recover faster than traditional surgeries, resulting in an improved quality of life and allowing for a sooner return to normal life. The following common conditions can be treated with MIGS:

An ectopic pregnancy occurs when a fertilized egg implants and grows in the fallopian tube rather than making its way to the uterus. The egg grows into a fetus which eventually puts pressure on the tubes and causes pain and sometimes bleeding. The fallopian tube is not designed to support a pregnancy and the fetus will not be able to get the proper hormones and nutrients.

Therefore, the pregnancy must be terminated with methotrexate to destroy the pregnancy tissue in the tube. Minimally invasive laparoscopic surgery is sometimes needed to remove the pregnancy tissue from the tube.

Endometriosis affects the lining of the uterus, the endometrium. Endometriosis occurs when the blood and cells that build up during menstruation exit into the fallopian tubes, rather than where they normally should through the vagina.

The result is pelvic pain and irritation. Endometriosis can also cause infertility. A pelvic exam is used to diagnose endometriosis. A variety of MIGS treatments are available to manage endometriosis, reduce pelvic pain, and improve fertility.

Postmenopausal bleeding is defined as vaginal bleeding that occurs one year after your last period. It is not normal to have postmenopausal bleeding. It may be a sign of vaginal dryness, polyps (growths that are noncancerous), and in some rare cases, uterine cancer.

Treatment depends on the cause of bleeding. Minimally invasive surgical procedures are available, including hysteroscopy using a thin tube inserted into the vagina. Even a hysterectomy can sometimes be performed using minimal invasive procedures. Work with your gynecologist to identify the root cause and discuss your options.

While fluctuations in the amount of menstrual bleeding are totally normal, heavy or abnormal bleeding is not normal. Heavy bleeding is defined as soaking through a pad or tampon every hour for more than a few hours for more than 7 days.

Abnormal bleeding can usually be traced to hormonal issues and treated with hormonal birth control pills. Some cases of abnormal or heavy bleeding can be traced to the presence of fibroids, cysts, or polyps. Fortunately, these can be easily treated with minimally invasive surgery that does not disrupt your everyday life.

Painful periods, also known as dysmenorrhea, is often mild and common among women. However, some women will experience severe pain during menstruation that keeps them from doing normal everyday activities for several days per month.

When it comes to treating periods with severe pain, medications such as NSAIDs are often the first line of defense. Hormonal birth control methods may be used as well.

If painful periods are caused by issues like endometriosis or fibroids and non-surgical treatments don’t provide relief, your gynecologist may discuss minimally invasive surgical procedures with you as potential treatment options.

Ovarian cysts are a collection of excess fluid in one or both ovaries. The fluid around an egg collects in excess, causing the follicle to expand. This results in the ovary expanding, which may present as pain or pressure sensations in the abdominal cavity.

Sometimes cysts don’t cause physical symptoms and are only discovered during the pelvic exam. Most cysts are noncancerous and resolve on their own. However, sometimes they need to be removed. Cystectomies (the surgical removal of cysts) are performed using minimally invasive surgery with laparoscopy.

Uterine fibroids are benign growths that resemble tumors and are found in the muscular walls of the uterus. When present, they can cause heavy period bleeding, pelvic pain, and pelvic pressure. They may also be a cause of infertility in some women. They can also grow in an area that puts pressure on the bladder and causes frequent urination.

In most women, fibroids don’t cause symptoms and don’t need to be removed. However, in some women they need to be surgically removed. Fortunately, MIGS make it possible to remove fibroids with minimal interventions and complications. The surgical removal of fibroids is called myomectomy.

Pelvic inflammatory disease is an infection of the uterus, fallopian tubes and/or ovaries. Pelvic inflammatory disease is caused by the migration to the pelvis of bacteria that is most often acquired from sexually transmitted infections (gonorrhea and chlamydia). There are several complications associated with pelvic inflammatory disease if left untreated.

These include infertility, ectopic pregnancy, and chronic pelvic pain. Early intervention with antibiotics is the best defense against long-term complications. Minimally invasive laparoscopic surgery is used in some cases to remove scarring or when treatment with antibiotics was unsuccessful.

There are several fertility-sparing treatments available to you when dealing with these medical conditions requiring surgery. If you face surgical intervention to treat ovarian cancer or other medical conditions, and you desire to have children in the future, discuss the fertility-sparing options with your gynecologist and surgical team. They work with you to help you choose the safest option while keeping your fertility goals in mind.

• Smaller incisions
  • For minimally invasive surgeries, smaller incisions are typically used compared to traditional “open” surgeries. This is made possible by using specialized instruments such as hysteroscopes (like a telescope), laparoscopes (video-guided surgery) and robotics – which can perform the procedure without having to cut open the patient. 
• Less blood loss
  • Minimally invasive surgeries also result in less blood loss since the incisions are much smaller than in traditional “open” surgery. Reduced blood loss helps prevent complications or emergencies during surgery. 
• Less pain
  • Because the incisions are smaller in minimally invasive surgery, there is less pain associated with the surgical sites. There is also less overall pain post-surgery because there tends to be a lot less trauma associated with minimally invasive surgery – surgeons are not having to cut through large portions of tissue and muscle. 
• Shorter hospital stays
  • Shorter hospital stays are another benefit of minimally invasive gynecologic surgery. This also means that the surgery and associated costs are less expensive. 
• Faster recovery and return to daily activities
  • Minimally invasive surgeries can result in quicker healing and shorter recovery times for patients, due to the reduced trauma of the procedure. Additionally, advanced scopes and technology make more complex work possible, with increased accuracy that leads to better patient outcomes.
• Reduced scar tissue
  • Because of the smaller incisions in minimally invasive surgery, there is reduced scar tissue. This also means reduced risk of painful scarring. 
• Less risk of infection or other complications
  • Minimally invasive procedures that involve smaller incisions and less scar tissue can reduce the risk of infections or other complications after surgery.