Bloodless Medicine and Minimally Invasive Gynecologic Surgery

An Interview with Suketu Mansuria, MD

What is minimally invasive gynecologic surgery?

Minimally invasive gynecologic surgery is a surgical approach that aims to eliminate large abdominal incisions during gynecologic surgery. Many surgical procedures that were performed through large incision in the abdomen can now be done laparoscopically or transvaginally.

The laparoscopic approach involves three to four tiny incisions, each about one-quarter inch long, in the abdomen. A camera is placed through one of the incisions and tiny instruments through the others to complete the entire procedure.

The transvaginal approach eliminates abdominal incisions entirely, and the entire procedure is performed through the vagina.

Common surgical procedures now performed with a minimally invasive approach include:

  • Hysterectomy: removal of the uterus due to heavy bleeding, pain, or fibroids
  • Endometrial ablation: treatment of the lining of the uterus to decrease bleeding during periods
  • Removal of ovarian cysts
  • Treatment of pelvic pain and endometriosis
  • Removal of fibroid tumors
  • Treatment of infertility

What are the benefits of minimally invasive gynecologic surgery?

There are many benefits to minimally invasive surgery. Due to very small incisions or no incisions, patients typically have considerably less pain and may recover much quicker.

Also, patients usually are able to return to work sooner, and cosmetically the results typically are superior. With new surgical techniques and equipment, we are now able to handle even difficult cases with a minimally invasive approach.

What are the benefits of minimally invasive gynecologic surgery to patients who refuse blood products?

Our surgical approach to patients who do not wish to receive blood products begins well before the day of surgery. A common indication for gynecologic surgery is heavy vaginal bleeding; thus, all patients are evaluated for anemia prior to their surgery.

If anemia is present, we then work with the patient to optimize her blood count. This is often done through hormonal manipulation of her menstrual cycles and other medical therapies.

Once in the operating room, meticulous surgical technique is employed, and due to the lack of large incisions, our blood loss is often minimal. Multiple research studies have shown that blood loss is considerably less with minimally invasive techniques when compared to traditional surgery.

What are your thoughts on patients who refuse blood products?

I have always felt that the patient is the most important decision maker in their health care team. I believe my role is to educate the patient about her treatment options and then allow her to make an informed decision. I am a firm believer in the rights of the patient to make decisions regarding their health care, from the type of surgery they desire to what types of treatments they would accept or refuse.

I have always honored the wishes of patients who refuse blood products and will work with them to achieve their health care goals while respecting their wishes.

I also believe that UPMC’s Center for Bloodless Medicine is a great resource for patients and their physicians. It allows for excellent communication of a patient’s wishes regarding blood products and helps coordinate their care not only with their surgeon, but also with other members of the health care team.

NOTE: UPMC policy officially respects “the right of a patient to refuse the administration of blood and/or blood products” and UPMC physicians respect such wishes.

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