Currently about 65% of hysterectomies in the United States are performed through a large abdominal incision. Since the late 1980's and early 1990's, surgeons have been exploring minimally invasive techniques to decrease the complication rates and long recovery time of traditional open hysterectomy. This has lead to the development of conventional laparoscopic hysterectomy. Patients who benefit from a minimally invasive approach recover faster with less pain, return to normal activity sooner, and suffer fewer of the complications related to a more invasive procedure. For the last 10 -15 years, gynecologic surgeons have gotten better at laparoscopic hysterectomy, but the techniques have been relatively unchanged. Although still a great option, the current laparoscopic hysterectomy techniques require several - albeit small - incisions. The next logical step in the progression of medicine is to continue to make the procedure even less invasive by reducing the number of those small incisions. Recent technological advances and training have now made this possible.
In 2008, Dr. Stepp was one of the first four surgeons in the US to use single incision laparoscopy (SILS) to perform a hysterectomy with modern technology. In 2009, he performed the world's first single incision robotic assisted laparoscopic hysterectomy without the use of bedside assistants. Since that time he has been a leading investigator and teacher of innovative options to decrease recovery time from conventional laparoscopy. He currently offers:
- Single incision laparoscopy
- Conventional robotic assisted surgery
- Robotic assisted single incision laparoscopy Vaginal surgery (no abdominal incisions)
There are advantages and disadvantages to each of these techniques. Depending on specific needs and conditions of each individual patient, Dr. Stepp will discuss which minimally invasive approach might be best for her. In some situations, Dr. Stepp can offer techniques that are still considered investigational and will discuss these with the patient as well.
Of course this technique is not only limited to total hysterectomy. He has also performed laparoscopic supracervical hysterectomy, vaginal vault suspension for prolapse, excision of endometriosis, ovarian removal, and appendectomy using SILS surgery.