
MIGS PROCEDURES
Dr. Jon I. Einarsson, MD, PhD, MPH, offers a comprehensive range of minimally invasive gynecologic surgery (MIGS) procedures designed to address various women’s health issues effectively and with reduced recovery times. Utilizing advanced techniques and technologies, Dr. Einarsson aims to enhance patient comfort and outcomes by performing surgeries such as laparoscopic hysterectomy, endometriosis excision, and myomectomy. Each procedure is tailored to meet the specific needs of the patient, ensuring personalized care and a focus on restoring health and well-being with minimal disruption to daily life.
Pudendal Nerve Decompression Surgery and other Pelvic Nerve Procedures
Dr. Einarsson has specialized in Neuropelveology, which is a subspecialty in gynecologic surgery focused on abnormalities in the pelvic nerves. Conditions that fall within this field include endometriosis of the sciatic nerve and sacral nerve roots, pudendal nerve entrapment and sacral nerve root entrapment. While conservative management is often the first option, surgical management is sometimes required, and this is offered by Dr. Einarsson, who has developed a referral base for neuropelveologic procedures.
Patients with pudendal nerve compression have symptoms including pain in the genital area, pain that is aggravated by sitting and feeling of fullness in the rectum or vagina. The symptoms of this can vary though and the diagnosis requires a meticulous workup. The same goes for other neuropelveologic conditions.
The surgery is laparoscopic and during the procedure the affected nerve is dissected out and freed from entrapment or other ailments such as endometriosis.
Average recovery time is 3 weeks (range 1-6 weeks). However it is not uncommon for patients to initially have complete relief of symptoms, followed by resurgence of pain that can be worse than before and then gradual decline in symptoms over the next 6-12 months. Patients often need treatment with neuroleptic medications during this time as well as other ancillary treatments.
Success rates vary depending on the situation but are generally around 60-80%
Laparoscopic Excision of Endometriosis
Dr. Einarsson has performed thousands of surgeries for endometriosis and has been vetted by iCareBetter as an expert endometriosis surgeon. He as published extensively on surgical outcomes for endometriosis and has won awards for his presentations at international conferences.
Endometriosis causes severe pelvic pain and infertility. It can invade pelvic and abdominal organs as well as the diaphragm and lung. Common symptoms include painful menses, painful intercourse and painful bowel movements. Expert surgical skill is required for safe excision of this condition. The surgery is performed laparoscopically and during the surgery, the endometriosis lesions are excised from the body and removed for pathologic confirmation.
It is important to set appropriate expectations in patients having surgery for endometriosis and pelvic pain. Pelvic pain may be multifactorial, i.e. not just from endometriosis and therefore not all patients get better after surgery. Many get partially better and some are completely better. In a recent study by Dr. Einarsson, he found that patients that had surgery had on average pain at 9 out of 10 before surgery, but 4 out of 10 after surgery. This means most patients experienced significant symptom relief, but not all of them. Patients also on average missed 3.6 fewer days of work or school after surgery as compared to before surgery. Their quality of life was also significantly improved. In patients who do not fully improve, it is important to continue to seek other solutions. For example, many women with chronic pelvic pain have pelvic floor dysfunction and it is important to recognize and treat this. Sometimes collaboration with other specialties such as gastroenterology and urology is needed as well.
Average recovery time: 1-2 weeks (range 1-6 weeks)
Time in hospital after surgery: 0-1 nights
What is removed: endometriosis, sometimes uterus (in patients who have completed childbearing), rarely ovaries.
Laparoscopic Cerclage Placement for Cervical Incompetence
Dr. Einarsson has performed approximately 200 laparoscopic cerclage procedures, which is one of the largest series of this procedure in the United States. Cervical incompetence involves painless dilatation of the cervix in the second trimester (often around 16-18 weeks). In the laparoscopic cerclage procedure, a permanent suture is placed around the cervix and this prevents the cervix from opening prematurely during the pregnancy. Patients can go home the same day and recovery time is less than one week. In Dr. Einarsson’s most recent publication from his data, the efficacy of the laparoscopic cerclage was about 97%. Many of these patients had endured multiple losses prior to this procedure. The laparoscopic cerclage is generally placed prior to pregnancy, but can also be placed during the first trimester of pregnancy. It is recommended that patients wait 2 months to get pregnant after placement and the mode of delivery will have to be a cesarean section. If a miscarriage occurs, then evacuation can still be done with the cerclage in place. Patients do need frequent surveillance by an expert in high risk obstetrics during their pregnancy. If the cerclage looks good at the time of the cesarean section, it can be left in place to be utilized in future pregnancies. It is not necessary to remove it even if the patient is not planning to have more children.
Laparoscopic hysterectomy
Dr. Einarsson has performed over 2000 laparoscopic hysterectomy procedures and over 99% of his cases are done laparoscopically. He specializes in offering a laparoscopic hysterectomy in cases where patients were told that the procedure could only be done through a large incision (laparotomy). It is therefore important to seek a second opinion if your doctor has told you that “a laparoscopic hysterectomy cannot be done”. Average recovery time is 3 weeks (range 1-6 weeks) and patients are discharged the same day.
Laparoscopic myomectomy
Dr. Einarsson has performed over 1000 laparoscopic myomectomy procedures and over 99% of his cases are done laparoscopically. He specializes in offering a laparoscopic myomectomy in cases where patients were told that the procedure could only be done through a large incision (laparotomy). It is therefore important to seek a second opinion if your doctor has told you that “a laparoscopic myomectomy cannot be done”. Average recovery time is 3 weeks (range 1-6 weeks) and patients are discharged the same day. Even with this large number of cases, Dr. Einarsson has never needed to perform a hysterectomy when a myomectomy was planned. This is a common concern for patients who want to maintain their fertility options.
Laparoscopic Isthmocele Repair
Dr. Einarsson has performed hundreds of procedures to treat an isthmocele. Isthmoceles are defects of the lower uterine segment, usually following one or more cesarean sections. Patients may have intermenstrual bleeding and a very thin lower uterine segment on imaging and have a higher risk of uterine rupture should they attempt another pregnancy. The treatment involves laparoscopically excising the thinned area and meticulously reconstructing the lower uterine segment with at least two layers of suturing. The recovery time is approximately one week and the success rate is over 90%.
FAQs
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Chronic pelvic pain is a debilitating condition that affects millions of people worldwide, especially women. It is defined as pain in the pelvic region that lasts for more than six months and is not related to menstruation or pregnancy. The pain can be constant or intermittent, mild or severe, and can affect various areas of the pelvic region, such as the lower abdomen, back, and thighs.
Chronic pelvic pain can have a significant impact on a person’s quality of life. It can cause physical limitations, social isolation, and emotional distress. The pain can interfere with daily activities, such as work, exercise, and sexual intercourse. Many people with chronic pelvic pain also experience anxiety, depression, and other mental health issues.
The causes of chronic pelvic pain are diverse and complex. Some common causes include endometriosis, uterine fibroids, pelvic inflammatory disease, irritable bowel syndrome, and interstitial cystitis. In some cases, the cause of the pain may be unknown. Diagnosis often involves a thorough medical history, physical exam, and imaging tests, such as ultrasounds and MRIs.
Treatment for chronic pelvic pain varies depending on the underlying cause and severity of symptoms. It may include medications, such as pain relievers or hormonal therapies, physical therapy, nerve manipulation, or surgery. Lifestyle changes, such as stress management and dietary modifications, can also be helpful in managing symptoms.
It is important for those experiencing chronic pelvic pain to seek medical attention and receive proper diagnosis and treatment. With the right care, many people with chronic pelvic pain can improve their quality of life and manage their symptoms effectively. Additionally, raising awareness of this condition and reducing stigma can help those affected feel more supported and empowered to seek help.
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Endometriosis is a common and often painful condition that affects millions of women worldwide. It is a condition in which the tissue that is similar to the one that lines the inside of the uterus (endometrium) grows outside of it, typically on the ovaries, fallopian tubes, and tissue lining the pelvis. This tissue can cause inflammation, scarring, and adhesions, which can lead to pain and infertility.
Endometriosis is a chronic condition that can cause severe pain during menstruation, intercourse, and bowel movements. It can also cause fatigue, nausea, and other symptoms that can significantly impact a woman’s quality of life. The condition can also cause fertility problems, as the adhesions and scarring can interfere with the passage of eggs through the fallopian tubes or the implantation of a fertilized egg in the uterus.
The exact cause of endometriosis is unknown, but it is believed to be related to a combination of genetic and environmental factors. There is no known cure for endometriosis, but treatment options are available to manage symptoms and improve quality of life. Treatment may involve medications, such as pain relievers and hormonal therapies, or surgery to remove the endometrial tissue.
It is important for women to seek medical attention if they experience symptoms of endometriosis, as early diagnosis and treatment can help prevent complications and fertility problems. Additionally, raising awareness of the condition and reducing stigma can help women feel more supported and empowered to seek help.
Overall, endometriosis is a challenging condition that can significantly impact a woman’s physical and emotional wellbeing. However, with proper management and support, many women with endometriosis can lead fulfilling lives and achieve their reproductive goals.
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Cervical incompetence, also known as cervical insufficiency, is a condition in which the cervix (the narrow opening at the bottom of the uterus) is unable to support a pregnancy to full term. The cervix is responsible for keeping the fetus inside the uterus until it is ready to be born. In women with cervical incompetence, the cervix may begin to dilate (open up) too early in pregnancy, leading to premature labor and delivery.
Cervical incompetence is thought to be caused by a weakness in the cervix, often due to previous cervical trauma or surgery, or due to genetic factors. Women who have had multiple miscarriages or premature deliveries are at higher risk of cervical incompetence.
Symptoms of cervical incompetence may include vaginal discharge, pelvic pressure, and spotting or bleeding during the second trimester of pregnancy. In severe cases, the cervix may dilate and the amniotic sac may rupture, leading to premature labor and delivery.
Diagnosis of cervical incompetence typically involves a physical exam, ultrasound, and measurement of the length of the cervix. Treatment options may include cervical cerclage, a surgical procedure in which a stitch is placed around the cervix to keep it closed, and medication to prevent premature labor.
It is important for women who have had previous miscarriages or premature deliveries to discuss their risk of cervical incompetence with their healthcare provider. Early diagnosis and treatment can help reduce the risk of complications and improve the chances of a successful pregnancy.
Overall, cervical incompetence is a challenging condition that can lead to premature labor and delivery. However, with appropriate management and support, many women with cervical incompetence are able to carry a pregnancy to full term and deliver a healthy baby.
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Uterine fibroids, also known as leiomyomas or myomas, are non-cancerous growths that develop in the uterus. They are common, affecting up to 80% of women by the age of 50. While some women with uterine fibroids may not experience any symptoms, others may experience heavy menstrual bleeding, pelvic pain, and pressure on the bladder or rectum. This can use frequent urination and constipation.
The exact cause of uterine fibroids is unknown, but they are thought to be related to hormonal changes and genetics. Risk factors for uterine fibroids include age, family history, obesity, and African-American race.
Diagnosis of uterine fibroids typically involves a pelvic exam, ultrasound, or MRI. Treatment options depend on the severity of symptoms and may include medication to control bleeding or pain, hormone therapy to shrink the fibroids, or surgery to remove them.
In some cases, uterine fibroids may cause complications such as infertility, miscarriage, or preterm labor. Women with uterine fibroids who are trying to conceive or experiencing complications may need specialized care from a reproductive endocrinologist.
In summary, uterine fibroids are common non-cancerous growths that can cause a range of symptoms. While they may not always require treatment, women who experience symptoms or complications may benefit from medication or surgery. With proper management and care, many women with uterine fibroids are able to maintain their reproductive health and quality of life.
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Surgical management of uterine fibroids may be necessary for women who experience severe symptoms, such as pressure symptoms or heavy uterine bleeding or complications such as infertility, miscarriage, or preterm labor. There are several surgical options available, each with its own benefits and risks.
Myomectomy is a surgical procedure that involves removing the fibroids while leaving the uterus intact. This is an option for women who wish to preserve their fertility or who want to avoid a hysterectomy. Myomectomy can be performed through an abdominal incision or minimally invasive laparoscopic or robotic surgery. The minimally invasive approach is preferred due to faster recovery times and less risk of complications. The downsides of a myomectomy are the risk of recurrence of fibroids (approximately 50%) and about 20% of women who have a myomectomy end up needing another surgical intervention due to fibroids later in life.
Hysterectomy is the surgical removal of the uterus and is the only definitive cure for uterine fibroids. It may be recommended for women who have completed childbearing or who have severe symptoms that have not responded to other treatments. Hysterectomy can be performed through an abdominal incision or minimally invasive laparoscopic or robotic surgery. Here again, the minimally invasive approach is preferred.
Endometrial ablation is a minimally invasive procedure that destroys the lining of the uterus, which can reduce heavy menstrual bleeding caused by uterine fibroids. This option is only recommended for women who do not wish to have children in the future.
Uterine artery embolization (UAE) is a non-surgical procedure that blocks the blood supply to the fibroids, causing them to shrink. This option is not recommended for women who wish to preserve their fertility or who have fibroids that are too large or numerous.
Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a non-invasive procedure that uses focused ultrasound waves to destroy the fibroids. This option is only available at select medical centers and is not recommended for women who wish to preserve their fertility.
The choice of surgical management for uterine fibroids depends on several factors, including the size and location of the fibroids, severity of symptoms, and desire for future fertility.
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Neuropelveology is a relatively new medical specialty that focuses on the diagnosis and treatment of chronic pelvic pain (CPP) and other pelvic floor disorders (PFDs) caused by nerve dysfunction. This field combines the knowledge and expertise of multiple disciplines, including urology, gynecology, neurology, and pain management.
Neuropelveologists use a multidisciplinary approach to evaluate and treat patients with CPP and PFDs, with a particular focus on the relationship between the nervous system and the pelvic floor muscles. They may use a variety of diagnostic tools, including imaging studies, nerve conduction studies, and pelvic floor electromyography (EMG), to identify the underlying cause of a patient’s symptoms.
Treatment options for CPP and PFDs may include medications, nerve blocks, physical therapy, and surgical interventions, such as neuromodulation or nerve decompression surgery. Neuropelveologists work closely with other specialists, including pain management physicians, physical therapists, and psychologists, to provide comprehensive, individualized care to patients.
Overall, neuropelveology represents an important advance in the diagnosis and treatment of chronic pelvic pain and other pelvic floor disorders, offering new hope and improved outcomes for patients with these challenging conditions.