Minimally Invasive Surgery

Thanks to high-tech surgical instruments, and miniature cameras, our doctors are able to treat many patients with minimally-invasive surgical procedures, instead of the more traditional techniques requiring large incisions. Advantages of this type of surgery include:Friendly Office Folk

  • Minimal pain with little or no scarring
  • Faster return to normal activity
  • Shorter or no hospital stay
  • Lower costs

Optimum success with these minimally-invasive and small-incision techniques depends, in large part, on the surgeon’s level of expertise. Our doctors have trained with world-renowned experts in this area, and are recognized by their medical colleagues as leaders in the performance of these surgical procedures. Several of these surgical procedures are described below.

Ectopic pregnancy is a potentially life-threatening condition in which an early pregnancy implants in the fallopian tube instead of the uterine wall. Severe internal bleeding can occur unless prompt diagnosis and surgical treatment are obtained. This condition can be successfully treated with minimally-invasive surgical techniques, usually with preservation of the fallopian tube.
Hysterectomy is the second most commonly performed surgery in the United States. The vast majority are performed for excessive and socially disabling menstrual periods, or for uterine fibroids. Endometrial ablation is designed as an alternative to hysterectomy for women with these conditions. As opposed to hysterectomy, endometrial ablation requires no surgical incision or organ removal. Instead, the uterine lining is burned away, or ablated. In doing so, monthly menstrual flow is successfully eliminated or reduced to several days of light flow. Hormonal status remains unchanged.
Endometriosis, ovarian cysts, adhesions, or complications of pelvic infection are often the cause of pelvic pain associated with sexual intercourse or with a woman’s monthly period. Such conditions may also be the cause of infertility. Minimally-invasive surgery, utilizing pelviscopic instruments and a laser, is used to diagnose and effectively treat these conditions.
When a hysterectomy is necessary, a minimally-invasive surgical technique utilizing laparoscopic instruments is available. This allows for removal of the uterus, tubes, and ovaries vaginally, rather than via the customary, large-incision abdominal approach. You should discuss with your doctor whether this is a viable choice for you.


Robotic Surgery

For many years, traditional gynecologic surgery has been performed through invasive procedures with large incisions and a relatively high rate of complications. As technology has advanced, new techniques in the medical world have become available to help reduce the complexity and invasive nature of many surgeries.

Laparoscopy offers access to the pelvis by using a thin telescope with a camera that lets surgeons see the treated area. However, laparoscopy is limited by rigid and restricted control over the instruments. While laparoscopy offers many advantages over traditional open surgery, robotic assisted surgery, performed with the da Vinci Surgical System, takes technology one step further. It combines the more effective control of open surgery with the less invasive approach of laparoscopy.


Surgery with the da Vinci Surgical System is performed through tiny incisions rather than one large incision. The robotic arms of the system’s console carry surgical instruments and a camera to the targeted area and perform the procedure under the complete control of the surgeon. The surgeon views a magnified, three dimensional view of the operative field. The robotic arms precisely mimic the movements

of the surgeon’s arms for natural dexterity and extreme control. In fact, many gynecologists believe that robotic surgery offers more control and accuracy than conventional techniques.

These features provide many advantages to patients, including:

  • Less pain
  • Less scarring/ less bleeding
  • Shorter recovery time
  • Less risk of infection

Our physicians are well-trained and remain on the leading edge of robotic procedures.


Uro-Gyne Surgical Procedures

A sling, composed of a synthetic mesh, is surgically inserted through a small vaginal incision and placed under the middle of the urethra. The sling supports the urethra and helps prevent leakage of urine with coughing, sneezing, or other daily activities. This surgery is performed as an outpatient, improves quality of life, and has a short recuperation time.
This procedure is performed when there is symptomatic descent of the vagina or uterus. The suspension utilizes the  sacrospinous ligaments in the pelvis in order to elevate the apex of the vagina and therefore preserve vaginal function.
This procedure corrects the descent of the front of the vaginal wall and the bulging bladder. The repair can be performed with absorbable stitches or with a minimal amount of mesh in order to support the bladder and the front of the vagina.
This procedure corrects the descent of the back of the vaginal wall and the bulging rectum. The repair can be performed with absorbable stitches or with a minimal amount of mesh in order to support the rectum and back of the vagina.


In-Office Procedures

A colposcopy is scheduled when the results of a Pap test show abnormal changes in the cells of the cervix. Colposcopy is a way of looking at the cervix through a special magnifying device called a colposcope, which shines a light into the vagina and onto the cervix. The magnified view provides more information about the abnormal cells and allows the doctor to investigate problems that cannot be seen by the naked eye. If an abnormal area is seen, a small biopsy may be taken.

Colposcopy can also be used to evaluate other problems such as inflammation or polyps on the cervix, as well as pain or bleeding with sexual intercourse.

The procedure is best done when a woman is not on her period. For at least 24 hours prior to the test, one should not:

  • Douche
  • Use tampons
  • Use vaginal medications
  • Have sex

During an endometrial biopsy, a soft, straw-like device (pipette) is used to suction a small sample of the lining of the uterus, or endometrium.  The sample is sent to a lab to be inspected under a microscope for abnormal cells that may result in difficulty becoming pregnant, precancerous or cancerous cells; or heavy, prolonged, or irregular bleeding.

This in-office procedure is quick and causes only minimal discomfort.  Before the procedure, we will take your vitals and collect a urine specimen to confirm that you are not pregnant.

Your doctor may suggest endometrial ablation to treat heavy or irregular uterine bleeding that has not stabilized with medication.  The procedure is quick, requires no incisions, and cause little to no discomfort.  Novasure uses radio-frequency energy to gently and safely remove a thin layer of the lining of the uterus.  This in-office procedure takes less than five minutes.

NOTE:   Endometrial ablation is not intended for women who wish to become pregnant in the  future or are undecided.  Highly-effective contraception or permanent sterilization is recommended for women who have had endometrial ablation.

Hysteroscopy is an in-office diagnostic procedure used to look inside the uterus. The most common indication for hysteroscopy is to find the cause of abnormal uterine bleeding. Abnormal bleeding can mean that a woman’s periods are heavier or longer than usual or that bleeding between periods is occurring. If bleeding or spotting is noted after menopause, hysteroscopy is also warranted. The most common findings include polyps or uterine fibroids.

It is performed utilizing a hysteroscope, which is a thin, lighted, telescope-like device. With local anesthesia, this instrument is inserted through the vagina and into the cavity of the uterus. The hysteroscope transmits the image of your uterus onto a screen, allowing the physician a better view for diagnosis.

Other uses for hysteroscopy include:

  • Diagnosing the cause of repeated miscarriages.
  • Locating an intrauterine device (IUD)
  • Performing sterilization as a permanent method of birth control

Cells on the cervix grow and shed all the time. Sometimes, usually due to HPV infection, these cells become abnormal. This is known as dysplasia. In its milder form, this may resolve on its own, but if it is severe or does not go away, it may lead to cancer of the cervix. Smoking and exposure to sexually transmitted disease (STDs) also increases one’s risk of developing cervical cancer.

LEEP is a simple and effective way to treat cervical dysplasia. LEEP uses a thin wire loop which acts as a scalpel. An electric current is passed through this loop and removes a very thin layer of the abnormal surface cells. New, healthy cells grow back and replace the dysplastic cells.

After the procedure, you may experience a watery, pink discharge, mild cramping, or a brownish-black discharge.

Contraception Options

Intrauterine devices and contraceptive implants are the most effective reversible contraceptives.  The major advantage of these compared with other reversible contraceptive methods is that they are highly effective and virtually maintenance-free.  Additionally, fertility returns rapidly after removal of the device.  Our patients have several highly effective devices or implants from which to choose, including:

Nexplanon:  a small, hormone-releasing device that is implanted in the inner upper arm and provides up to three years of pregnancy prevention.

Mirena:  a low-hormone, plastic intrauterine device that provides up to five years of pregnancy prevention.

Effective birth control is a major concern for many women. While there are many options, most come with side effects or worries about complete protection. When you decide that your family is complete and are considering permanent birth control, the Essure incision-free procedure offers benefits that no other permanent birth control method can.


Essure is the first non-invasive procedure to provide permanent and effective birth control. Essure is hormone free and requires no incision, no cutting or burning, and no anesthesia.


The Essure procedure takes less than 10 minutes to perform and can be done in the comfort of the offices of Carlos & Parnell, M.D.  During the procedure, your doctor will slide a soft, flexible silicone-free insert into each of your fallopian tubes. Over time, the body tissue in the fallopian tubes will grow into the inserts creating a natural barrier that prevents sperm from reaching the eggs.


Development of the barrier takes about 3 months so another method of birth control will need to be used during that time. After the 3 months, a special test, known as the Essure Confirmation Test, will need to be done to verify that the tubes are fully blocked. Once this is confirmed, you may start relying on Essure as your only form of birth control. Essure has been shown to be 99.8% effective, based on a 5 year study.


While Essure is reliable and simple, it is also permanent. The procedure is not reversible. You will need to be certain that you do not want any more children before considering the procedure.