Microsurgery is a delicate surgery requiring the use of a magnifying lens or microscope.
Dr. Kontopoulos Vasilios has been a pioneer in the field of microsurgery in infertility and was one of the first to introduce it in Greece. He has performed a very large amount of microsurgical procedures.
Microsurgery in the past was the only solution for women with tubal obstruction, where re-anastomosis or neostomy could be performed. With the increasing success rates of IVF, most women prefer undergoing an IVF cycle to bypass tubal problems, leaving microsurgery only for specific cases.
Microsurgery is a lost art these days, but is still being practiced in cases where IVF is not an option, either for medical, economical or personal reasons. The principles governing microsurgery though can still be practiced in open surgeries in order to reduce the formation of adhesions and postoperative pain.
Laparoscopy is an operation performed in the abdomen through small incisions (0.5-1.2cm) with the aid of a camera and an insufflation system.
Also called keyhole surgery or Minimally Invasive Surgery, it has the advantage of smaller abdominal incisions leading to a shorter recovery time and less post-operative pain.
Laparoscopy can be diagnostic, where you inspect the abdominal organs and place a diagnosis or operative where you perform a surgical procedure.
How is laparoscopy performed?
Laparoscopy is performed under general anesthesia, a small incision is made at the umbilicus (belly button) and a special insufflation needle is inserted in order to inflate the abdomen. Inflating the abdomen helps the surgeon to visualize the organs in the abdomen with the laparoscope (a telescopic tube with a camera at the end) which is inserted via the umbilical entry point usually. The view is projected in a television monitor which guides the surgeon. Depending on the procedure performed 1 to 3 smaller (0.5cm) incisions are made in the lower part of the abdomen in order to insert the surgical instruments.
At the end of the procedure all the insufflating air is let out of the abdomen and the incisions are closed.
How is the recovery?
After laparoscopy the pain is diffuse and well tolerated. Occasionally there might be shoulder pain which results from radiation from the diaphragm irritation that dissipates over the following 24 hrs. The patient is released from the hospital on the same or the next day. Usually you can return to your everyday activities the following day.
It is a robotically assisted laparoscopy where the instruments are not directly mobilized by the surgeon. Instead they are mobilized by robotic arms that are controlled remotely by surgical console used by the surgeon.
Few of the advantages of robotic surgery is the greater range of motion of the robotic instruments, the 3D vision achieved with a special camera and the decreased surgeon fatigue in extensive operations.
The major disadvantage is the increased cost per case, which eventually will be minimized.
Robotic surgery in gynecology is limited only to more complicated procedures like oncologic procedures, difficult hysterectomies or extensive endometriosis because the benefits do not outweigh the extra cost yet.
Our doctors have been certified in the Da Vinci robotic surgery system and practice it in cases where it is needed.
The name is derived from the words “Hystero”, which in Greek means uterus and the word “scope” which in Greek means to look. So hysteroscopy is a procedure where you view the internal cavity of the uterus (the endometrium) and the cervical canal.
Hysteroscopy can be used for diagnostic purposes to confirm an intrauterine or cervical pathology or in order to treat certain conditions (operative hysteroscopy).
How is Hysteroscopy performed?
Diagnostic hysteroscopy can be performed in the office without anesthesia, especially if a flexible hysteroscope is available.
Operative hysteroscopy is performed under anesthesia, which is usually done in a hospital setting. The cervix is dilated to the appropriate diameter in order to accommodate the hysteroscope. The hysteroscope is a specialized telescopic camera that has 2 small canals. One canal is used to dilate the coaptating endometrial cavity with fluid (normal saline) in order to view the endometrium and the other canal is used in order to pass miniscule instruments. In more complicated hysteroscopic procedures electrosurgical instruments can be used. The procedures usually last a 10-30 minutes.
How is the recovery after the procedure?
After the procedure the patient feels minimal crampy pain (like menstrual cramps) that dissipates within 1 day and spotting for a few days. All hysteroscopic procedures leave on the same day. You can return to most of your usual activities including work within 1 day.
Vaginal surgery refers to any surgery performed via the vaginal approach. Gynecological surgeons can perform an excision or repair through the tight space of the vaginal canal.
The major advantage is that there are no visible incisions and the recovery is better. This has been one of the first minimally invasive procedures performed before the use of laparoscopy. It is still considered the best minimally invasive option when it comes to hysterectomy if that is feasible.
Vaginal surgery is used to repair several pelvic organ prolapse problems like cystocele, rectocele, enterocele or uterine prolapse or treat urinary incontinence.
Cryoablation is a process that uses extreme cold to destroy certain tissues.
Hollow instruments (cryoprobes) with an internal circulating system for liquid nitrogen cool the tip of the instruments to extremely cold temperatures. The cryoprobe is placed adjacent to the tissue to be destroyed superficially. Once the desired results are achieved the probe is warmed back to normal temperature and removed.
Anesthesia usually is not needed.
In gynecology cryoablation is used for lesions of the cervix, vagina and genital warts. In certain cases it has been used for the induced necrosis of symptomatic fibroids.
At Athens Reproduction we offer this procedure in our offices to all women requiring it.
Thermoablation is a process that uses extremely hot temperatures to destroy tissues.
The heat produced is achieved with electrical current or laser beams.
Thermoablation is used in surgeries for coagulation and in office procedures for superficial destruction of tissues like cervical lesions or genital warts.
Endometrial thermoablation can be used to ablate the endometrial lining in women that experience heavy menstrual bleeding and are adamant to medical treatment. These patients must have completed their child bearing, have a biopsy confirmed benign endometrium and a normally shaped cavity. It is a good alternative to patients that previously had no other choice than to undergo a hysterectomy.