Overcoming challenges in minimally invasive gynecologic surgery

: Minimally invasive surgery (MIS) has gained widespread use over the past several decades and is now the prevailing surgical approach within gynecology through utilization of hysteroscopy, cystoscopy, laparoscopy, and vaginal surgery. A minimally invasive technique offers a number of benefits to patients, including improved postoperative recovery and superior cosmetic outcomes, and is becoming an increasingly recognized essential skill for all gynecologists. With appropriate precautions and preoperative planning, MIS has been shown to be a safe and effective option for gynecologic procedures. Certain patient populations may present specific challenges to the minimally invasive surgeon. In this article, we discuss commonly encountered challenges in gynecologic MIS. Given the effect that laparoscopy and positioning may have on organ physiology, we review preoperative planning and optimization for medically complex patients. Additionally, we discuss the approach to surgically complex patients, such as those with obesity, pregnancy, prior surgeries with associated scarring and adhesions, and other anatomic abnormalities. As MIS continues to be a growing and evolving field, we highlight novel surgical technologies and discuss the learning curve associated with adoption of new techniques. Through surgeon preparedness and experience, common pitfalls within the field of MIS may be avoided and patients may be provided with optimal care.