Gynecologic surgeries are performed on many of the organs and supportive structures of the female pelvis (the vulva, vagina, cervix, uterus, fallopian tubes and ovaries). These procedures serve to correct, preserve or restore normal function and eradicate or prevent worsening disease states.
A hysterectomy is defined as removal of a woman’s uterus (womb). This surgical procedure is done for many reasons that include uterine fibroids or abnormal uterine bleeding, not responsive to medical treatment, cancer and chronic pelvic pain. This procedure can be done using an open abdominal incision, through the vagina or, in a minimally invasive fashion by laparoscopy. Types of hysterectomies include a: total abdominal hysterectomy, laparoscopically assisted vaginal hysterectomy, total laparoscopically hysterectomy (with and without robot assistance), supra-cervical hysterectomy (the cervix remains in place but the top of the uterus is removed) and total vaginal hysterectomy. In recent years, it is customary to remove both fallopian tubes when a hysterectomy is performed. A separate procedure that involves removing one or both of the ovaries may also be performed at the time of a hysterectomy depending on the circumstances.
Laparoscopy is a minimally invasive surgical procedure. It is characterized this way because the abdominal incisions in this procedure are much smaller than an open abdominal incision. A special camera and instruments are passed through these small opening in order to visualize the pelvic organs and perform the intended surgery. This approach to surgery, when possible, decreases hospital stay, post operative pain and decreases the time for recovery.
Myomectomy is a surgery that removes fibroids from the uterus, while leaving the uterus in place. This can be done through an open abdominal incision, by laparoscopy using the assistance of a robot and with hysteroscopy.
Hysteroscopy is done with a tool called a hysteroscope that allows the surgeon to look inside of the uterus through the vagina. The hysteroscope, contains a light, that enables visualization of the uterine cavity. This is often done to evaluate and treat abnormal uterine bleeding by removing fibroids, polyps, scar tissue and to perform endometrial ablations.
Ovarian Cystectomy (removal of cyst(s) on ovary)
This is a procedure done using laparoscopy and occasionally laparotomy (an open abdominal incision) depending on the size and type of cyst.
There are times when ovaries become diseased or need to be removed for other reasons and they typically may be removed using the laparoscopic approach.
Lysis of Adhesions
There are certain conditions that may cause a patient to develop adhesions or scar tissue within their pelvis. Adhesions cause pelvic surfaces to stick to each other and can cause pain and dysfunction. This may occur with previous surgeries, pelvic infections or endometriosis. Laparoscopy may be used to remove adhesions, restore function and minimize or relieve associated pain.
Pelvis Prolapse Surgery
It is estimated that up to 50% of women between the age of 50-79 have some degree of pelvic prolapse or pelvic relaxation on physical exam. Not all of these women are symptomatic but for those that are the options of pelvic floor physical therapy, pessary and surgery are available. Symptoms may include bowel or bladder function problems, discomfort with intercourse and pelvic pain.
Removal of the fallopian tubes or the sealing of them are surgical ways that a person who no longer wants to bear children can obtain permanent sterilization.
Loop Electrosurgical Excision Procedure (LEEP)
The loop electrosurgical excision procedure (LEEP) is an outpatient procedure used to remove cells and tissue from the cervix as a means of diagnosing or treating abnormal or cancerous cells.