Laparoscopy Basics and Benefits

Many surgical procedures that used to be performed through larger abdominal incisions are now performed laparoscopically. With quicker recovery time, very small scars, and excellent outcomes, laparoscopy can have you back to your normal activities within a few weeks compared to the months sometimes needed to recover from open surgery.

In laparoscopic surgery, an instrument called a laparoscope is inserted into the pelvic and abdominal cavities to diagnose and treat gynecologic disorders. Carbon dioxide gas is introduced to provide visualization of the internal organs. A camera is attached to guide the surgeon and to document the findings with photographs.

Laparoscopy has many uses, including the diagnosis and treatment of chronic pelvic pain, endometriosis, fibroid tumors, infertility, and ovarian cysts. 

Some laparoscopic procedures include: 

  • Gynecologic cancer staging
  • Hysterectomy (removal of the uterus with or without the cervix)
  • Myomectomy (removal of fibroids)
  • Sterilization (tubal ligation)
  • Tubal reanastomosis

Benefits of laparoscopy include: 

  • Less pain after laparoscopic surgery than with open abdominal surgery. Open abdominal surgeries require longer hospital stays, larger incisions, and a longer recovery period than laparoscopic surgery.
  • Faster recovery time
  • Less risk of infection
  • Less blood loss
  • Sometimes done in an outpatient setting, so you won’t have to spend the night in the hospital
  • Smaller incisions mean less scarring and faster healing time

Because laparoscopic surgery eliminates the need for large abdominal incisions, the recovery time is extremely fast. Even with hysterectomy procedures, most women are back to normal activities within a few weeks.

Not all gynecologic conditions can be treated with laparoscopy. Very large tumors or masses may need open surgery. Extensive endometriosis can also be very difficult to treat laparoscopically because of associated adhesions (scar tissue), which can involve the adjacent bowel, bladder, ureters, etc. Adhesions cannot be diagnosed with sonography or CT scans, so an operation may start with the laparoscope and end with an open procedure, if extensive adhesive disease is present.

It is important to choose a surgeon who has experience in advanced laparoscopy to properly evaluate you for this type of procedure. Doctors Strebel, Grolle, and Perez have the experience you can rely on when you need gynecological surgery in the Las Vegas area.

Hysterectomy Surgery Options and What's Best For You

Many benign (non-cancerous) conditions can affect a woman’s reproductive system. Common benign conditions including fibroids, endometriosis, adenomyosis, and pelvic prolapse, among others, can cause many different symptoms or no symptoms at all. Some of the more common symptoms may include: pelvic pain, heavy bleeding, irregular periods, fatigue, unusual bloating, pain during intercourse, and infertility. If your symptoms are severe, your doctor may suggest medicine, lifestyle changes, or surgery. Surgical options will depend on your exact condition, symptoms, and overall health.

If appropriate, your doctor may recommend a hysterectomy. There are different ways to perform a hysterectomy, and you should discuss all options with your doctor. 

Hysterectomy methods include: 

  • Vaginal Hysterectomy
    • A vaginal hysterectomy is done through a cut in your vagina. The surgeon operates through this incision and closes it with stitches.
  • Abdominal Hysterectomy
    • During an abdominal hysterectomy (open surgery), your uterus is removed through a large open incision. The incision must be large enough for your surgeon’s hands to fit inside your body and see your organs. 
  • Laparoscopy
    • aparoscopic surgery is minimally invasive. With traditional laparoscopy, your surgeon operates through a few small incisions using long instruments and a tiny camera to guide doctors during surgery. 

Doctors Strebel, Grolle, and Perez can also offer an even less invasive method of hysterectomy done with the da Vinci surgical robot.

  • Single-Site/Single Incision: Your uterus can also be removed through a small incision in your belly button using single-incision traditional laparoscopy or da Vinci® Single-Site® Surgery. 
    • With da Vinci Single-Site Surgery, doctors remove your uterus and possibly your ovaries and fallopian tubes through your belly button using state-of-the-art instruments.
    • Patients who choose da Vinci Single-Site Surgery experience virtually scar-free results.

Da Vinci Single-Site Hysterectomy offers the following potential benefits:

  • Low blood loss
  • Low rate of converting to traditional laparoscopy and open surgery
  • Low rate of complications
  • Short hospital stay
  • Small incision for virtually scar-free results

If hysterectomy has been suggested as a treatment for you, talk to Doctors Strebel, Grolle, or Perez about your options at your next appointment. They can help you choose the best type of surgery for you.

Tips for a Healthy Vagina this Summer

Summer brings with it many things we all enjoy — warmer weather, vacations, pool time. Unfortunately, it also is the season when more women see their doctors regarding yeast, urinary tract, and bacterial infections. Follow this advice for helping to avoid these common but uncomfortable problems and for what to do should you happen to get any type of vaginitis (vaginal inflammation):

  • Wear loose-fitting clothing and underwear that has a cotton crotch.
  • Don’t sit around in a wet bathing suit or clothing.
  • Urinate frequently (try not to “hold it”) and always after sexual intercourse.
  • Stay away from douches and vaginal sprays.
  • Don’t use scented tampons or other perfumed products on or in the vagina.
  • Keep your immune system up (this is as simple as taking daily vitamins or drinking a glass of orange juice every morning).

If you have symptoms of a vaginal infection such as pain, burning during urination, itching, and abnormal discharge:

  • Call your doctor, even if you think you may have a simple yeast infection
  • Drink plenty of fluids
  • Begin treatment as soon as possible

Many women often mistakenly think they have a yeast infection and treat themselves; when, in fact, they have a similar vaginal infection that will not respond to self-treatment with over-the-counter yeast medications. A study by the American Social Health Association found that 70% of women self-treated vaginal infections before calling a health care provider. Most often, they incorrectly thought they had a yeast infection when, in fact, it was bacterial vaginosis or another condition.

The important thing is not to guess, but to recognize the symptoms if you develop a vaginal infection. If you have any concerns, see Dr. Strebel or Dr. Grolle for precise testing and to get the most appropriate and effective treatment right away. Waiting too long to see a doctor or not properly treating an infection can result in even worse infections that can send you to the hospital and impact fertility, so it is absolutely necessary to treat your symptoms as soon as they appear. Keep in mind that the quicker you clear up any infections, the quicker you can get back in the pool and enjoy your summer.

Preeclampsia Explained and What to Expect

Preeclampsia is a condition that occurs only during pregnancy. Some symptoms of preeclampsia may include high blood pressure and protein in the urine, occurring after week 20 of pregnancy. Preeclampsia is often precluded by gestational hypertension. While high blood pressure during pregnancy does not necessarily indicate preeclampsia, it may be a sign of another problem. Preeclampsia affects at least 5-8% of pregnancies.

The following may increase the risk of developing preeclampsia:

  • A first-time mom
  • Previous experience with gestational hypertension or preeclampsia
  • Women whose sisters and mothers had preeclampsia
  • Women carrying multiple babies
  • Women younger than 20 years and older than age 40
  • Women who had high blood pressure or kidney disease prior to pregnancy
  • Women who are obese or have a BMI of 30 or greater
  • Mild preeclampsia: high blood pressure, water retention, and protein in the urine

Severe preeclampsia: 

  • headaches
  • blurred vision
  • inability to tolerate bright light
  • Fatigue
  • Nausea/vomiting
  • urinating small amounts
  • pain in the upper right abdomen
  • shortness of breath
  • a tendency to bruise easily

Contact your doctor immediately if you experience these symptoms.

At each prenatal checkup your healthcare provider will check your blood pressure, urine levels, and may order blood tests which may show if you have preeclampsia. Your physician may also perform other tests that include: checking kidney and blood-clotting functions, ultrasound scan to check your baby’s growth, and Doppler scan to measure the efficiency of blood flow to the placenta.

If you have any questions or concerns about preeclampsia, talk to Dr. Strebel or Dr. Grolle at your next appointment. We are here to help you with all of your health needs.


Know your Risks for Gestational Diabetes

A diagnosis of gestational diabetes (GDM) might feel overwhelming at first, but it turns out this pregnancy complication is much more common than you might think — and the number of cases is growing. With careful monitoring and treatment, GDM can be managed and you can have a safe and healthy pregnancy.

GDM usually starts between week 24 and week 28 of pregnancy when the body does not produce enough insulin (the hormone that helps convert sugar into energy) to deal with the increased glucose, or sugar, that’s circulating in your blood to help your baby grow. Gestational diabetes affects one in 10 expectant women, and because it occurs more often among obese women, rates of GDM in the United States have been rising along with obesity rates.

To understand what causes gestational diabetes, it helps to first understand what’s happening to your body during pregnancy. In some women, hormones from the placenta block insulin from doing its job, resulting in high glucose levels. This causes high levels of sugar in the blood (hyperglycemia), which can damage the nerves, blood vessels, and organs in your body. Researchers aren't sure why some women get gestational diabetes while others don’t.

Research shows you’re at an increased risk for GDM if you:

  • are overweight (having a BMI of 30 or more) going into pregnancy because the extra weight affects insulin's ability to properly keep blood sugar levels in check.
  • are older. Doctors have noted that women over the age of 35 have a significantly higher risk of developing GDM.
  • have a family history. If diabetes runs in the family, you may be more at risk of GDM. Women who are African-American, Hispanic, Asian, or Native American are also statistically more likely to receive a GDM diagnosis.
  • received a pre-diabetes diagnosis. If your blood sugar levels are elevated slightly before pregnancy, you may be at higher risk of GDM.

With proper treatment and regular monitoring by your practitioner, gestational diabetes can be managed and you can have a healthy pregnancy. However if gestational diabetes is left untreated, you and your baby are at risk for potentially serious complications.

If you have any questions about diabetes and pregnancy, ask Dr. Strebel or Dr. Grolle at your next appointment.  The can explain what you need to do to have a healthy pregnancy.

Breast Feeding Myths Debunked

Few topics arouse as much controversy as the topic of breastfeeding. Along with the multitude of stresses and pressures that come along with being a new mother, she must also decide if nursing her baby is right for her and the child. Unfortunately, the information that comes to us about the most natural of functions is heavily laden with myths and false notions. Here is some information; you can milk for all it's worth!

Myth: Breastfeeding will ruin the shape of your breasts.

Truth: Most women find that their breasts go back to their pre-pregnancy size and shape after they stop nursing. Age, the effects of gravity, and weight gain have more effect on breast size than nursing. Breasts will always change in consistency after pregnancy.\

Myth: Small breasts don’t produce as much milk as large ones.

Truth: Breast size has nothing to do with the amount of milk they produce.

Myth: You need to toughen your nipples before your baby is born.

Truth: Your body naturally prepares for breastfeeding. Tactics to toughen them may actually interfere with normal lactation.

Myth: Breastfeeding is painful.

Truth:  If the baby’s latching on properly, there shouldn’t be real pain or soreness. It’s important to talk to a lactation consultant who can help you and your baby make the process as comfortable as possible

Along with closeness and health benefits like hormones and antibodies in breast milk that protect babies from illness, other breastfeeding bonuses include:

  • Moms who breastfeed burn about 300 to 500 extra calories a day compared to those who feed their babies formula, and research shows that they do tend to slim down faster.
  • Breastfeeding releases hormones that trigger your uterus to return to its pre-baby size and weight faster.
  • A 2012 study in the International Journal of Psychiatry in Medicine found that women who breastfed were less likely to be diagnosed with postpartum depression over the first four months than those who bottle fed.

If you have questions about whether breastfeeding is right for you and your baby, talk to Dr. Strebel or Dr. Grolle at your next appointment. They can guide you toward the resources you need to make an educated decision. 

April is STD Awareness Month

April is Sexually Transmitted Disease (STD) Awareness Month, and recent data from the Centers for Disease Control (CDC) for three nationally-reported STDs—chlamydia, gonorrhea, and syphilis—show staggering numbers, with cases of all three diseases increasing for the first time since 2006. Those at greatest risk for infection include people ages 15–24, and gay, bisexual, and other men who have sex with men. There is some good news, though. STDs are preventable. There are steps individuals can take to minimize the negative, long-term consequences of these infections. The theme of the CDCs STD Awareness Month 2016 is Talk. Test. Treat.

Understanding what you can do to lower your risk of getting infected is the first step.


  • Talk with your partner BEFORE having sex. 
  • Talk about when you were last tested and suggest getting tested together.
  • If you have an STD (like herpes or HIV), tell your partner.
  • Agree to only have sex with each other.
  • Use latex condoms the right way every time you have sex.
  • Talk with your healthcare provider about your sex life, and ask what STD tests you should be getting and how often.


  • Get tested. It’s the only way to know for sure if you have an STD. Many STDs don’t cause any symptoms.
  • Find out which STD tests CDC recommends.


  • If you test positive for an STD, work with your doctor to get the correct treatment.
  • Some STDs can be cured with the right medicine from your doctor.
  • Other STDs aren’t curable, but they are treatable. Your doctor can talk with you about which medications are right for you.

Read more online and find more resources at:

Talk to Dr. Strebel or Dr. Grolle about what STDs you could be at risk for and what tests might be right for you. If you are concerned you might have an STD, call to schedule an appointment as soon as possible.

Breast Health Basics

Often when thinking about breast health and noticing breast changes, the only thing that comes to mind is breast cancer, but non-cancerous breast conditions are breast changes that are not cancer. They are very common and most women have them. In fact, most breast changes that are biopsied and tested turn out to be benign. Unlike breast cancers, benign breast conditions are not life-threatening, but sometimes they can cause symptoms that bother you. In addition certain benign conditions are linked with a higher risk of developing breast cancer in the future.

The main function of the breasts is to make milk for breastfeeding. 

  • Breasts have 2 main types of tissues: 
    • Glandular tissues
      • Lobules and ducts. In women who are breastfeeding, the cells of the lobules make milk. The milk then moves through the ducts – tiny tubes that carry milk to the nipple. Each breast has several ducts that lead out to the nipple. 
    • Supporting tissues
      • The support tissue of the breast includes fatty tissue and fibrous connective tissue that give the breast its size and shape

Any of these parts of the breast can undergo changes that cause symptoms. These breast changes can be either benign breast conditions or breast cancers. The most common symptoms are likely to be caused by benign conditions. Still, it’s important to let your doctor know about any changes you notice. Benign conditions have many of the same symptoms as breast cancer, so it can be hard to tell the difference between benign and cancerous conditions from symptoms alone. Your doctor can do other tests to find out exactly what is causing the breast change. Some breast changes may not cause any symptoms and may be found during a mammogram.

Read more online at:

Again, benign conditions are much more common than breast cancer, but it’s important to talk to Dr. Strebel or Dr. Grolle about any changes in your breasts so they can be checked out right away. Ask about what tests might be right for you at your next appointment