Minimally Invasive Gynecologic Surgery: What to Know and How to Ask

Minimally Invasive Gynecologic Surgery:  What to Know and How to Ask

By: Cara King, DO • Posted on May 05, 2020

Hearing that you need surgery from your gynecologist can be a frightening experience. The good news is that you are not alone, and most benign gynecologic surgeries can be performed with minimally invasive surgical techniques. Smaller incisions mean less risk and shorter recovery, which gets you back to your life quickly. Surgical intervention is typically the last choice after less-invasive treatment options have been exhausted, but may be recommended for conditions such as:

Minimally Invasive Gynecologic Surgery (MIGS)

Minimally invasive gynecologic surgery (MIGS) includes routes of surgery that minimize the size and number of incisions, which reduces trauma to the body and allows the quickest recovery. The approach used is dependent on the type and size of gynecologic pathology, as well as surgeon preference.

Routes of MIGS include:

  1. Laparoscopic - through the abdomen
  2. Vaginal - through the vagina
  3. Hysteroscopic - through the opening of the cervix into the uterus

Laparoscopic surgery

Laparoscopic surgery requires very small incisions in the abdomen for the camera and small instruments to access the pelvis. These incisions typically range from 5 mm to 1 cm in size. The robot is a tool used by some surgeons to assist with laparoscopy, but is not always required.

Vaginal surgery

Vaginal surgery includes techniques that approach the pathology through the vagina and does not require any abdominal incisions.


Hysteroscopy is used for pathology that is located on the inside of the uterus, and uses a small camera placed in the vagina and advanced into the uterine cavity.

MIGS Benefits

There are many benefits of MIGS, including:

  1. Shorter hospital stay: Typically, you are discharged home the same day as your operation
  2. Quicker recovery
  3. Decreased risk of infection
  4. Decreased scarring
  5. Decreased pain

Can large pathology be removed with MIGS?

Even very large and complicated benign pathology can typically be removed utilizing minimally invasive surgery. The advancements in laparoscopic cameras and innovative surgical equipment allow surgeons to perform complex procedures using very small incisions.

Perimenopausal women may have an increase in abnormal bleeding from fibroids, endometrial polyps and other gynecologic problems. When large pathology is encountered, such as large fibroid tumors, small incisions can often still be utilized. If a mass is too large to fit out of the incisions, the tissue is cut into smaller pieces to fit through these small openings. Special equipment, including surgical bags, can be placed in the abdomen to contain the specimen and eliminate any spill of tissue into the abdomen.

Get to know your MIGS surgeon and ask questions

If you are told that you require surgical intervention, it is important that you get to know your surgeon and understand his or her experience. We encourage you to have the confidence and knowledge to advocate for yourself! If you are told that you require a large incision, please pause! Seek a second opinion with a Minimally Invasive Gynecologic Surgeon to see if your operation can be completed using small incisions instead. Many MIGS have additional training and expertise.

Questions to ask a MIGS surgeon

  • Why do I need this operation?
  • Are there are other treatment options?
  • How will this operation be performed?
  • How many cases like this do you perform per year?
  • How often do you have to convert from a laparoscopic to an open approach?
  • How often do your patients experience problems after surgery?
  • What are the risks, benefits, and possible complications of this procedure?

Perhaps you have been delaying surgery due to the COVID-19 epidemic. However, it is important to be in close contact with your surgeon’s office regarding the timing of the surgery and you should not delay needed medical care. Although committing to surgery can be a difficult choice for some women, educating yourself about the procedure and the surgeon will empower you to make the best decision. Furthermore, the advancements in MIGS paired with a high-volume surgeon will optimize your outcomes and get you back to your life quickly!

Be Strong, Be Healthy, Be in Charge!

- Cara King DO

Dr. Cara King is a member of the Cleveland Clinic Section of Minimally Invasive Gynecologic Surgery. She is the Director of Benign Gynecologic Surgery and Associate Program Director of the MIGS Fellowship. She completed her residency training at Tufts University, Baystate Medical Center in Obstetrics and Gynecology and a Fellowship in Minimally Invasive Gynecologic Surgery at Magee-Women's Hospital in Pittsburgh, PA. She obtained her Master's Degree in Medical Education from the University of Pittsburgh School of Medicine. Dr. King has served on the executive board of the AAGL Fellowship Board as well as the Society of Gynecologic Surgeons Board and is host of their collaborative podcast “Gynecologic Surgeons Unscrubbed.” She currently serves on the executive board of the International Academy of Pelvic Surgery. Dr. King also serves on the executive board of the Academy for Surgical Coaching and is a Surgeon Coach through the Academy. Clinical interests include minimally invasive surgical management of advanced endometriosis, uterine leiomyomas, Mullerian anomalies, and advanced operative hysteroscopy. To make an appointment with Dr. King, please call 216.444.2488.

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