Contents


Preface

Now is an exciting time in minimally invasive gynecologic surgery. In May 2021, we have had the first group of OBGYN's to receive a focused practice designation for Minimally Invasive Gynecologic Surgery. Currently, there are more than sixty fellowship programs in the United States for MIGS, split between the Society of Laparoendoscopic Surgeons (SLS) and the American Association of Gynecologic Laparoscopists (AAGL). Many would say we are on our way to becoming a separately boarded specialty. Our mission of

Also, an unexpected ally has shown its face in this battle. Enhanced Recovery After Surgery (ERAS) continues to be an important element in our artform. For a practice that is barely 20 years old, the amount of literature is extremely vast and very useful. All aspects of the preoperative and postoperative periods have been dissected, and minimally invasive surgeons can benefit from this data in almost all procedures. Surgeons and anesthesiologists can manipulate local anesthesia, patient diet, ambulation, and thrombotic prophylaxis. Even gum chewing has been included in regimens to speed patient recovery and decrease the pain and suffering of the surgical process. Many ERAS protocols are so individualized as to apply to one specific surgery. This may be the friend

That is not to say that there are not challenges, the most serious of which has been the crisis of morcellation. Laparoscopic morcellation, when performed by skilled surgeons in appropriate circumstances, can be life-changing. I have seen it change a disabled invalid with a seven-pound uterus and serious comorbidities into a functional happy woman who walked out of a hospital she needed a wheelchair to get into just six hours earlier. Obviously, morcellation has been misused in situations where malignancy was likely, and even overused in scenarios where uteri have been morcellated even after creating a colpotomy large enough to simply pull it out. As a result, patients have been harmed. Clearly, combining morcellation with an occult malignancy is a terrible event, but I will wager that "conversion to laparotomy," because of the lack of the ability to perform morcellation, has cost many more lives than upstaged leiomyosarcoma ever has. No one knows how many patients have died or remained debilitated the rest of their lives because of the surgeon's decision to create a midline vertical rather than morcellate. I believe there is close to 100 percent consensus among gynecologic surgeons today that laparoscopic morcellation should be reserved for special cases where vaginal removal is simply not feasible and laparotomy would pose a serious threat to the patient's life or speedy recovery. In those cases, with all reasonable measures taken, the procedure is a very valuable tool. Much like chemotherapy, however, if used on the wrong patient it can be harmful or deadly. In my opinion, we need the patient population to understand the foolishness of banning morcellation and bring careful judicious use of

laparoscopic morcellation when indicated back into the mainstream of MIGS.

before long we were finishing up this first edition.

The inspiration for this book is the constant drive to provide patients with the most minimally invasive surgery possible. I was very blessed early on by several colleagues who share this drive. As a result, our discussions turned into an idea for a book, and

Writing the book was a difficult task, as some of us wanted more of a direct surgical and anatomical guide, whereas others preferred a text that would give more of an overview of the subject without actual operating room value. The former was initially thought to be more

providing the most minimally invasive care possible is well underway.

we've always wanted!
