Surgical Procedures

Dr. Adler specializes in a range of minimally invasive surgical procedures that range from Hysterectomies to Robotic Surgery. Schedule a consultation to learn more about your options.

Hysterectomy

A hysterectomy is a surgical procedure to remove either a portion of or the entire uterus. Sometimes the ovaries are also removed in a procedure called an oophorectomy. They can be performed for different reasons, with the most common being:

  • uterine or cervical cancer
  • very large, symptomatic, recurrent fibroids
  • chronic and long-term pelvic pain that does not respond to other approaches
  • very heavy menstrual bleeding (menorrhagia) that cannot be adequately controlled using less invasive techniques
  • uterine prolapse, a painful condition that occurs when the strong bands of tissue or ligaments that support the uterus become weak or damaged, allowing the uterus to “drop” into the vagina, sometimes turning “inside out.”
  • chronic endometriosis, a painful condition that develops when tissue that normally grows inside the uterus begins to grow outside the uterus

What does the procedure entail?
Hysterectomies can be performed using different techniques depending on the patient’s health and anatomy and the reason for the procedure. Some hysterectomies can be performed through the vagina with no need for external incisions, while others are performed using small external incisions. These minimally-invasive hysterectomies are associated with faster recovery and less bleeding and tissue damage than traditional hysterectomies that use larger incisions. However, when a hysterectomy is performed due to cancer, a larger incision will usually be needed to ensure all the cancerous tissue has been removed.

What happens after the procedure?
Patients will typically need a 1-2 night hospital stay for initial healing to occur before being discharged. Discomfort can be managed with pain relievers, and sanitary napkins/pads (NOT tampons) can be used to control bleeding that can occur for about 7-10 days after the procedure. Patients will need to avoid sexual intercourse and strenuous activities for about 6 weeks to enable the area to heal more fully and to avoid straining the area. In some cases, hormone replacement therapy may be advised to maintain normal levels.

Laparoscopy

Laparoscopy is a minimally invasive procedure that uses special instruments and a tiny camera to perform procedures through very small incisions. Laparoscopy can be used to treat many gynecological issues, as well as perform other types of minimally-invasive surgeries. Using smaller incisions means patients are exposed to fewer risks and can experience less pain and a faster recovery.

The instrument used to perform a laparoscopy is a laparoscope, it’s thin and flexible with a small camera attached. When performing a laparoscopy the scope is inserted through a very small incision and transmits still pictures/video to a monitor which the doctor uses to guide the operation.

Laparoscopy has many applications in gynecology, with the most common including:

  • hysterectomy (removal of all or part of the uterus)
  • oophorectomy (removal of the ovaries)
  • removal of fibroids, adhesions (scars) or cysts
  • treatments for infertility
  • tubal ligation
  • treatment for the pelvic inflammatory disease (PID) or ectopic pregnancy
  • pelvic pain

What does the procedure entail?
In most cases, laparoscopy can be performed using sedation with local anesthesia, but sometimes general anesthesia may be needed. An incision will be made in the abdomen to enable the laparoscope to be inserted into the surgical site; then additional small incisions will be made to accommodate other instruments. Diagnostic procedures may use a single incision to admit the scope, which will be used to take still photographs as well as video. Some procedures can be performed on an outpatient basis so patients can go home the same day. Other procedures like laparoscopic hysterectomies require a very brief hospital stay, usually one night. Most take about 90 minutes or less to perform.

Robotic Surgery

Often referred to as robot-assisted surgery, robotic surgery uses special robots designed to provide surgeon-directed assistance during surgical procedures that require a high level of precision. In robotic surgery, the robot does not perform the surgery, but instead, it is guided by the surgeon to perform specific portions of the surgery. Robot-assisted procedures can be performed through extremely small incisions, resulting in less tissue damage, less bleeding and less postoperative pain, as well as a faster recovery.

One of the most commonly used tobot systems, especially for gynecological surgery, is the da Vinci system. The robot requires a few small incisions instead of a single large incision, and it also features a 3D magnifying camera designed to provide a detailed view of the surgical site. The instruments used by the robot have greater flexibility and control than traditional surgical instruments, enabling the surgeon to operate with far greater precision and dexterity.

When is robot-assisted surgery used?
Robot-assisted surgery has several applications in gynecology, with the more common instances being:

  • Treatment of certain types of cancer
  • Treatment of pelvic organ prolapse, a condition where one or more organs in the lower belly “drops” toward the vagina
  • Hysterectomy
  • Removal of fibroid tumors
  • Treatment of endometriosis, a condition that occurs when the tissue that normally lines the uterus begins growing outside the uterus
  • Treatment of heavy menstrual bleeding, including menorrhagia that occurs near menopause

Is robot-assisted surgery right for me?
Robotic surgery can be an excellent choice for some patients, but it can’t be used for all conditions or in all women. The decision to use a robot-assisted approach will be made following a thorough examination and a review of the patient’s medical history.

NovaSure

NovaSure® is a minimally-invasive procedure that is used to treat abnormally heavy periods. Periods occur when the uterine lining or endometrium sloughs off. Normal periods last about seven days and can be controlled with the normal use of pads or tampons. Heavy periods typically require the use of both pads and tampons which must be changed very frequently, even several times during the night, to control the flow and prevent leakage.

Sometimes, periods become so heavy, they can interfere with normal living and make even daily activities like going to work difficult to handle. NovaSure® uses radiofrequency energy to remove the lining of the uterus, preventing heavy periods from occurring. Dr. Adler at Comprehensive OB-GYN of the Palm Beaches in Palm Beach, Wellington, Royal Palm, and West Palm, Florida, has substantial experience in NovaSure® treatments, providing women with the care they need to enjoy a better quality of life.

What does the procedure entail?
NovaSure® uses a special mesh that’s inserted through the vagina and into the uterus using a special tube – as a result, no incisions are required. Once the mesh is in place it adheres to the contours of the uterus, then radiofrequency energy travels along the mesh for about 90 seconds, destroying the lining of the uterus and preventing heavy periods. Once the procedure is complete, the mesh and the tube are removed from the uterus.

How successful is this procedure?
NovaSure® is designed to dramatically reduce the occurrence of heavy periods or to stop them entirely in about 90 % of those who have the procedure. Women who are close to menopause are more likely to have their periods entirely stopped following the treatment. In a few cases, younger women may see a recurrence of heavy periods.

How long does the treatment last?
Most NovaSure® procedures take about 15 minutes or so to perform.

Sonata

The Sonata Treatment is an incision-free solution, and clinically proven to reduce fibroid symptoms. It can address a wide range of fibroid types, sizes, and uterine locations, and can treat multiple fibroids in one procedure. The fibroids are treated from inside the uterus, which means no scarring, no tissue needs to be cut or surgically removed – and the uterus is preserved.

How Sonata works
The Sonata Treatment uses a handpiece with a miniature high-resolution ultrasound tip that allows the doctor to see the fibroids from inside the uterus during the procedure, and then treat each fibroid with a process called an “ablation.”

  • Step 1: The doctor passes the Sonata Treatment handpiece through the vagina and into the uterus
  • Step 2: Ultrasound waves from the tip are used to locate the fibroid.
  • Step 3: The Sonata Treatment handpiece delivers radiofrequency energy to shrink the fibroid over time and reduce symptoms.

The Sonata procedure typically takes less than one hour, depending on the number and size of fibroids treated. On average, women return to normal activity in a couple of days. Some patients see improvements in heavy menstrual bleeding within their first cycle. In general, it may take 2-3 cycles, or in some cases, longer.

Possible Side Effects
The Sonata Treatment has been clinically proven to be safe and effective in women with symptomatic uterine fibroids. Most side effects are typically minor and temporary.
There are risks associated with any medical procedure. Your doctor should discuss all risks in detail.

PATIENT FEEDBACK

“This practice, Dr Adler, and entire staff is not only professional, but incredibly humane and compassionate. They reach out to the individual to offer genuine help to all the Baby Boomers, who want to look their personal best! I have coined Dr Adler and his team, the best at making “our world a much prettier place!” Thank you Staff of Dr Adler and Dr David Adler! Kudos”

Patricia M.
“I had the Sonata procedure done by Comprehensive OBGYN of the Palm Beaches’ Dr. David Adler and his team. They did an amazing job with making me feel calm before the procedure. Very professional group. After it was over they made sure I was ok to go home. Any ladies having issues with uterine fibroids I highly recommend you to go to his office and seek treatment. Staff is very friendly.”
Rebecca I.
“Hands down the best OB-GYN was office ever. Dr. Adler was professional and helpful when I told him what I was trying to accomplish. The staff was professional and it was nice to see a friendly face from the moment I walked in up until the moment I left.”
Nathalie Z.

“Dr. Adler and his staff are friendly and efficient! I am a returning patient of Dr.Adler and am extremely happy with his professional demeanor. He is understanding and listens to what you have to say. He explains procedures to you and answered any questions that you have. I’m so glad to be returning to his practice!”

Deborah K.

“I’ve been going to Dr. Adler for over a year now and I’m so happy I found his office. Everyone is super nice and helpful. I can’t say enough nice things.”

Thalia R.

“Very caring personnel. Would highly recommend visiting the office. Everyone is so helpful. Explains all procedures and concerned with your most utmost comfort.”

Terry W.

“I always enjoy visiting Dr. Adler’s office. Everyone is friendly and professional. He is very thorough in his assessment.”

Fabien D.

“From the moment I walked in I was pleased , nice clean office and such pleasant staff I was just blown away to say the least . The dr David alder is so kind and takes the time to listen as well as very detailed when telling me what I need to know !! More than satisfied I found a good gynecologist that I can put my trust in !!”

Mireya L.

“Apt was in time. Staff was very friendly and helpful. Dr took time with me, answering all my questions. Explained everything in advance
I would recommend to anyone.“

B. Russo

“I had a great experience from the start to the end. Staff was great and no long wait times. They are alway courteous in calling to remind me of appointments. I was provided all the details as to what my journey would look like. My first pregnancy I had a C section and wanted to do a Vbac this time and was successful despite everyone close to me telling me to have another C section. I would recommend Comprehensive OB-GYN to everyone”

Joel S.

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