Understanding your options in pelvic pain surgery

If you’re suffering from pelvic pain and medical treatments haven’t been effective, surgery may be recommended by a specialist. But that doesn’t necessarily mean a hysterectomy. There are now more minimally invasive options for the surgical treatment of gynecologic conditions that cause pelvic pain, including endometriosis, fibroids and ovarian cysts.

These proven procedures not only help alleviate women’s pelvic pain and suffering, but patients are recovering faster, requiring less pain medication and returning to their normal activities sooner than if they had a large incision during surgery, said Dr. Tamisa Koythong, a gynecologic surgeon.

Alternatives to Hysterectomy

How do you know if a hysterectomy or one of these minimally invasive alternatives is better for you? It depends on the patient and the extent of the disease, Koythong said.

“If a woman has endometriosis, a hysterectomy may not address her disease or her pain because endometriosis typically doesn’t involve the uterus – the abnormal tissue grows outside the womb,” Koythong said. “For women who may want to become pregnant in the future, ideally the surgeon would use a laparoscopic approach to remove any endometrial tissue in the pelvis and/or on the ovaries. If there are cysts on the ovaries caused by endometriosis – known as endometrioma – a hysterectomy wouldn’t address that disease either.”

If a woman has a large fibroid contributing to her pelvic pain, a minimally invasive myomectomy could be performed as an alternative to a hysterectomy, she said. A myomectomy removes fibroids; however, if the patient has several fibroids of different sizes all over her uterus, a minimally invasive surgery may not be the best option.

“In the past when patients heard ‘minimally invasive surgery,’ they thought laparoscopy,” Koythong said. “Today, we have single-incision procedures, robotic surgeries and vaginal approaches that don’t require any incisions at all.”

Different techniques and technologies:

• Traditional laparoscopy: Tiny scopes (cameras) and surgical instruments are inserted through small incisions in the abdomen to perform gynecologic procedures.
• Robotic-assisted laparoscopy: The surgeon operates through small incisions, using robotic arms to perform complex tasks with precision and dexterity while using a 3D view from an imaging console.
• Single-incision laparoscopy: Procedures performed through a single, slightly larger incision at the bellybutton, allowing for removal of large ovarian cysts, fibroids or other pathology.
• Vaginal natural orifice transluminal endoscopic surgery (vNOTES): A gynecologic procedure that uses a vaginal approach, avoiding the need for any external incisions.

Factors to Consider

With so many options, how do patients and their physicians decide which minimally invasive approach is right for them?

“It really depends on what disease we’re treating and the extent of the disease,” Koythong said. “If there’s a need for additional surgical subspecialties – colorectal surgery or urology may be involved in some cases of endometriosis – that will factor into which approach we use. The experience of the other surgical subspecialists in the techniques and technologies we’re using (could also factor into the decision).”

If there are concurrent diseases being treated at the same time, the approach used would depend on the location, she added.

If surgery is recommended for your pelvic pain, talk with your doctor about your options. Ask questions and make sure you understand what to expect from the procedure and recovery.

To learn more about surgical options for pelvic pain and other common pelvic pain topics, check out the videos from our “Pelvic Pain? Know the Facts” education event.

Learn more about our other obstetrics and gynecological services. 

Dr. Tamisa Koythong is an assistant professor and a minimally invasive gynecologic surgeon in the department of Obstetrics and Gynecology at Baylor College of Medicine and Texas Children’s Pavilion for Women.