The Center for Women’s Health offers a wide variety of diagnostic, surgical and contraceptive procedures. These may be performed at one of the local hospitals, Springfield Clinic's Ambulatory Surgery Center, or even in the office. 

     

Office Procedures

Helping our patients make their health a priority, The Center for Women’s Health offers several in-office procedures that will streamline the process for both diagnosis and treatment of many common gynecologic issues like abnormal pap smears, heavy periods, urinary incontinence and birth control. 

In-office procedures can help avoid a trip to the hospital, provide greater privacy, requires less time and lower costs. By performing these procedures in the comfort of our office, we're able to offer the warm, personalized care you deserve. 

Surgical Procedures

Our board-certified OB/GYN surgeons offer a variety of traditional and minimally invasive surgical procedures. Our experience and expertise is provided through out-patient as well as in-hospital settings to treat female health conditions.

These may be performed at one of the local hospitals, or our own Springfield Clinic's Ambulatory Surgery Center. The choice of location depends on the type of procedure, our patients’ health issues, and on their type of insurance.

Pre-operative Instructions for your gynecological surgery

The following guidelines will help prepare you for your surgery and avoid delays or possible cancellations: 

  1. Do not wear any makeup or fingernail polish.
  2. Do not bring jewelry, money or valuables.
  3. Do not drink any alcohol for 24 hours before your surgery.
  4. No solid food, liquid or gum after midnight the night before your surgery.
  5. Wear loose-fitting, comfortable clothing such as a jogging suit.
  6. Bring any medications you are taking (or a list of the medications you are taking) with you.
  7. Arrange for someone to drive you home and spend the first night after surgery with you.
  8. Do not bring a gown, robe or slippers for outpatient surgery, as these will be provided for you.
  9. Do not wear contact lenses. Wear glasses if needed.
  10. A consent form must be signed before the surgical procedure begins. For patients under 18 years of age, a parent or guardian must be present to sign the form.
  11. The patient is responsible for informing staff of any pertinent information, including change in medication.
  12. Do not take any aspirin, Advil, Motrin, ibuprofen or similar medication for one week prior to surgery unless directed by your physician.
  13. The following medications should not be taken the morning of surgery unless specified by your physician: oral diabetic medication, Coumadin or insulin. Usually 1/2 of the insulin dose is given.

Additional Information:

female anatomy diagram

Office Procedures List

Colposcopy

A screening Pap smear which returns an abnormal result may in some cases prompt the scheduling of a colposcopic exam of the cervix and / or vaginal tissues.

 During a colposcopy exam, a speculum will be inserted as it is for a regular gynecological exam. A diluted vinegar solution is placed on the cervix in order to allow a clear view of the cervix. This solution washes away mucus from the cervix and allows any abnormal cells to be more clearly visible during the exam. The cervix is visualized with the use of a colposcope, (a magnifying instrument) placed outside the vagina, allowing the physician a view of possible sources of abnormal cells.

If possible sources of abnormal cells are identified on the cervix or vaginal tissues, small biopsies of these areas may be performed. A small instrument may also be used to sample the tissue of the endocervical canal (the opening in the cervix) in order to ensure that abnormal cells are not found in an area not clearly visible with the colposcope. All samples obtained are then sent to a pathology laboratory and examined by a pathologist.

What should I expect during after a colposcopy?

You may have some vaginal bleeding. You also may have a dark discharge for a few days. This may occur from medication used to help stop bleeding at the biopsy site. While your cervix heals you will be instructed not to put anything into your vagina for a short time (no intercourse, no tampons, no douching). Depending on the results of a colposcopy your physician will recommend observation with a repeat Pap smear, medication or minor surgery called a LEEP or conization.

When to call your health care provider?

  • Heavy vaginal bleeding (using more than one maxi pad per hour)
  • Severe lower abdominal pain
  • Fever
  • Chills 

LEEP

A loop electrosurgical excision procedure, commonly referred to as a LEEP, is one possible course of treatment that may be suggested by a physician to quickly remove areas of abnormal tissue on the cervix.

During the LEEP procedure, a speculum is inserted into the vagina in order to clearly visualize the cervix. The cervix is numbed with a local anesthetic and a solution is placed on the cervix to highlight areas of abnormal cells. The physician will view the cervix through a colposcope (a magnifying instrument) placed outside the vagina.

A fine wire loop with a special high-frequency electrical current allows the physician to precisely remove the abnormal tissue from the cervix with very little damage to surrounding tissue. Different sizes and shapes of these loops can be used to remove one or more pieces of abnormal tissue. After completion of the tissue removal, a special device may be used to seal blood vessels and/or a medicated solution may be applied to the cervix to reduce bleeding.

The tissue samples taken are sent to a pathology laboratory and examined by a pathologist. The results are then returned to and reviewed by the physician.

After the procedure, you may have:

  • A watery, pinkish discharge
  • Mild cramping
  • A brownish-black discharge

It will take a few weeks for your cervix to heal. While your cervix heals, you should not place anything in the vagina, such as tampons or douches. You should not have intercourse. Your health care provider will tell you when it is safe to do so.

You should contact your health care provider if you have any of the following problems:

  • Heavy bleeding (more than your normal period)
  • Bleeding with clots
  • Severe abdominal pain

Additional Information:

Endometrial Biopsy

endometrial biopsy diagramEndometrial biopsy is a procedure in which a tissue sample is taken from the lining of the uterus (endometrium), and is checked under a microscope for any abnormal cells or signs of cancer.

An endometrial biopsy may be done to find the cause of abnormal menstrual periods (heavy, prolonged, or irregular bleeding), bleeding after menopause, bleeding from taking hormone therapy medications, thickened uterine lining seen on ultrasound, to check for overgrowth of the lining (endometrial hyperplasia) or to check for cancer. An endometrial biopsy is sometimes done if you are having difficulty becoming pregnant.

How to Prepare for the Test

There is no special preparation for the biopsy. You will want to take ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol) 1 hour before the procedure to reduce cramping.

How the Test Will Feel

The instruments may feel cold. You may feel some pain when the cervix is grasped. You may have some cramping as the instruments enter the uterus and the sample is collected.

How the Test Is Performed

You will lie on your back with your feet in stirrups. The health care provider will do a pelvic examination, and will insert an instrument (speculum) into the vagina to hold it open and see the cervix.

The cervix is cleaned with an antiseptic liquid and then grasped with an instrument (tenaculum) to hold the uterus steady. A device called a cervical dilator may be needed to stretch the cervical canal if there is tightness (stenosis). Then a small, hollow plastic tube is gently passed into the uterine cavity. 

Gentle suction removes a sample of the lining. The tissue sample and instruments are removed. A specialist called a pathologist examines the sample under a microscope. An endometrial biopsy takes 5 to 15 minutes.

After the procedure 

After the procedure, you may rest for a few minutes before going home. You may want to wear a sanitary pad for bleeding. It is normal to have some mild cramping and spotting or vaginal bleeding for a few days after the procedure. Take a pain reliever (Advil or Motrin) for soreness and cramping as recommended by your health care provider. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Do not have intercourse, use tampons, or douche until the spotting stops. You may also have other restrictions on your activity, including no strenuous activity or heavy lifting.

Notify your health care provider if you have any of the following:

  • Excessive bleeding, or bleeding longer than two days after the procedure
  • Foul-smelling drainage from your vagina
  • Fever and/or chills
  • Severe lower abdominal pain

Saline Hysterography

A saline infusion sonogram (SIS) is a special type of sonogram. During this procedure, your physician will place a thin catheter into the uterine cavity and insert a small amount of normal saline fluid into the uterine cavity. This allows the physician to see the inner cavity of the uterus in greater detail. Submucosal fibroids and endometrial polyps are better visualized using this technique. The endometrial thickness or endometrial lining is also seen in greater detail. This test is used to diagnose causes for abnormal vaginal bleeding in premenopausal and postmenopausal patients. It also can be used to diagnose some forms of abnormal uterine shapes such as bicornuate uterus.

The procedure causes some mild cramping but usually takes only 5-10 minutes to preform. 

IUD Insertion

IUD Insertion diagramAn intrauterine device (IUD) is a reversible form of contraception. It is a small T-shaped device that is placed through the cervix into the uterus during an office exam. The procedure only takes a few minutes. 

More detailed information on different types of IUDs and the benefits of this type of contraception is available on the birth control page of the sexual health section in this website.

Nexplanon

Nexplanon diagramNexplanon is a hormone releasing birth control implant placed under the skin in the inner, upper arm. Nexplanon is about the size of a matchstick and is made of a soft, flexible, medical polymer. It does not need to be taken daily, weekly or monthly. It is a long-term method that is 99% effective at preventing pregnancy for up to 3 years. It must be removed after this time (it will not dissolve), but you can choose to have it taken out at any time before the three years are over. You can also have a new Nexplanon inserted after having your old one removed.Your healthcare provider will help you determine if Nexplanon is right for you. He or she will review the patient labeling and consent form with you to be sure you understand all of the potential risks and benefits of using Nexplanon. 

Advantages of Nexplanon:

  • Discreet and private
  • Does not require ongoing maintenance or the need to remember to use birth control
  • One of the most effective, reversible contraceptives available
  • A good alternative option for women who can't use estrogen-based birth control
  • Can be used while breastfeeding (after 4 weeks)
  • Allows for sexual spontaneity (nothing needs to be inserted or put on prior to sexual intercourse)
  • Nexplanon is immediately effective if inserted between the first and fifth day of your menstrual period
  • Because of its low and steady hormone delivery, Nexplanon may have fewer hormonal ups and downs than daily or weekly birth control methods
  • Fertility quickly returns once you stop using Nexplanon; pregnancies have been reported to occur as early as 7 to 14 days after Nexplanon has been removed

There may be side effects from the Nexplanon. Nausea, stomach cramping/bloating, dizziness, headache, breast tenderness, acne, hair loss, weight gain, and vaginal irritation/discharge may occur. Pain, bruising, numbness, infection, and scarring may occur at the site where the Nexplanon is placed. If any of these effects persist or worsen, notify your doctor promptly.

The most common side effect of the Nexplanon is abnormal bleeding or spotting. Your periods may be early or late, shorter or longer, heavier or lighter than normal. You may also have some spotting between periods, especially during the first several months of use. If bleeding is prolonged (more than 8 days) or unusually heavy, contact your doctor. If you miss 2 periods in a row, contact your doctor for a pregnancy test.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Additional Information:

Endometrial Ablation

Heavy periods, or menorrhagia, affect about 20% of all women. If a woman is done with childbearing and having problems with heavy periods, she may be a candidate for an endometrial ablation.

An ablation is a treatment applied to the lining of the uterus to help improve heavy periods. There are several different choices available. Our physicians typically use Novasure or Thermachoice. Endometrial Ablation is a simple, one-time, 5 - 10 minute procedure. 

There are many advantages to having an endometrial ablation. If heaving bleeding is the only problem, an ablation can stop or decrease bleeding without the need for a hysterectomy. Keeping the uterus and ovaries intact means that the hormonal systems are intact as well. If bleeding has caused anemia, an ablation may improve this. Finally, the procedure can be done in a doctor's office or same-day surgery center, and the recovery is much quicker than a hysterectomy.

Although an endometrial ablation is a great alternative to a hysterectomy, there are some disadvantages that one should consider before proceeding. Complications are rare, but like any surgical procedure, they can occur. When you have the procedure, you will need permanent birth control, since it’s still possible to become pregnant and a pregnancy after any ablation procedure is unsafe for both mother and fetus. There also have been reports of the endometrial lining growing back and the bleeding continuing as heavily as before despite the procedure.

Minor side effects from the procedure can occur for a few days, include cramping (like menstrual cramps), nausea, and frequent urination that may last for 24 hours. A watery discharge mixed with blood may be present for a few weeks after the procedure and can be heavy for the first few days.

If you are absolutely sure that you never want to have any children in the future, and would like to stop your heavy period and restart your life, an endometrial ablation may be right for you.

Additional Information:

Vulvar Biopsy

What is the vulva?

The external female genital area is called the vulva. The outer folds of skin are called the labia majora and the inner folds are called the labia minora. If you see changes on the skin of the vulva, or if you have itching, burning, or pain, contact your health care provider.

What is a vulvar biopsy?

A biopsy is the removal of a small amount of tissue or skin. The biopsy can be looked at under a microscope and helps to determine if you have a specific skin condition. Knowing what is causing your symptoms is important for appropriate management and treatment to alleviate symptoms. The risks of the biopsy include bleeding, infection, scarring, inadequate sample possibly requiring another biopsy procedure, or allergic reaction. 

What you should do to prepare?

No preparation is needed; however, be sure and wear loose comfortable clothing. The biopsy can be performed anytime during the menstrual cycle, and you will not need to have anyone drive you to your appointment. No pre-biopsy medications are administered. If you want to take Advil, Aleve or Motrin ahead of time, you are welcomed to do so. The biopsy procedure will take only a few minutes.

What to expect during the procedure?

The area is cleansed with antiseptic solution and a small amount of local anesthetic or “numbing medicine” is injected around the biopsy site using a tiny needle. This portion of the procedure is slightly uncomfortable because the medication causes a burning sensation lasting about 3-5 seconds. During the remainder of the procedure you may feel pressure but should not feel any discomfort. Once a tiny sample has been removed some pressure may be applied to prevent bleeding. Sometimes a chemical substance is applied to the biopsy site to prevent bleeding. If the biopsy site is larger, it may be necessary to place a dissolvable stitch. The tiny sample of tissue will be sent to pathology for analysis. 

What to expect after the procedure?

After the local anesthesia wears off, you may be a little sore. Usually, 400 mg of ibuprofen will be enough to take care of any discomfort. It is important to keep area as clean and dry as possible.

When you urinate, either gently pat dry or rinse with a peri-bottle filled with warm water. Do not rub the area. If there is bleeding, apply firm pressure for a few minutes until the bleeding stops. If bleeding persists or if there are any signs of infection, such as redness, inflammation or pus, then call your health care provider.

Additional Information:

Cystoscopy Urodynamics

What is cystoscopy?

A flexible cystoscopy is an examination of the bladder using a flexible fibre-optic telescope. This enables the doctor to examine the urethra and bladder without a general anesthetic. It is simple, quick and fairly painless procedure.

What is urodynamic testing?

Urodynamic tests measure bladder function and efficiency. The testing is done if a woman has problems with leaking urine. The test may help decide if changing behavior, medicine, or surgery is the best way to treat bladder problems. Urodynamics refers to a group of tests that are performed to examine the bladder’s ability to empty steadily and completely. This testing can also evaluate abnormal bladder contractions, bladder storage, and the flow of urine. These tests focus on the lower urinary tract, which includes the bladder, the urethra, and the sphincter muscles. The provider will order the tests if he or she suspects a problem in these areas.

Why is it done?

Increasing age, chronic illnesses, injury, and pregnancy can cause problems in the urinary system. The bladder and urethral muscles may become weaker with age, increased abdominal pressure, or a decrease in estrogen. Weak muscles may cause problems in emptying the bladder completely or more commonly, may cause urinary incontinence or leaking of urine. Reasons for urodynamic testing may include: 

  • Frequent urination 
  • Involuntary release of urine, also called Incontinence (could be leaking urine with coughing, sneezing, laughing) 
  • Sudden, strong urges to urinate 
  • Problems starting a urine stream 
  • Painful urination 
  • Problems emptying the bladder completely 
  • Recurrent urinary tract infections 
  • Prior to surgery.

What is involved?

The patient will be instructed to arrive for testing with a full bladder. 

She will provide a “clean catch” urine sample, and then will be asked to empty her bladder completely. 

She will then be asked to undress from the waist down. She will then lie back on an exam table with her feet in stirrups, similar to the position for a pap test. A speculum will not be used. 

A catheter will be placed into the urethra and then into the bladder and several measurements of both urine amounts and bladder and several measurements of both urine amounts and bladder pressures will be obtained. The entire test takes about 20 minutes. 

Prophylactic Macrobid may be ordered after the procedure.

Cryocautery of the Cervix

Cryotherapy is a method of treatment used for cervical dysplasia, or abnormal cells on the cervix. If left untreated, these abnormal cells may develop into cervical cancer. Cryotherapy is a minor procedure that is performed in the doctor’s office. Cryotherapy is not performed if you are having a period or you are pregnant.

During cryotherapy, a speculum is inserted into the vagina. A small instrument is then inserted into the vagina and placed against the cervix. Liquid Nitrogen is used to freeze the cervix. Freezing lasts about three minutes. 

You may experience some mild cramping and cold sensation during and after the procedure. This should improve after 24 hours. You should take Ibuprofen or Aleve about an hour before the procedure and then after cryotherapy to decrease pain.

There are very few risks involved with cryotherapy. The risks include bleeding, infection, and cervical scarring, which rarely causes difficulty in getting pregnant.

After cryotherapy, a woman can expect a watery, blood tinged discharge. The cervix takes time to heal. It is important to remember to use sanitary pads until the discharge stops completely. Do not use tampons. You should also avoid sexual intercourse until the discharge has resolved. It is important to have follow-up monitoring after cryotherapy with repeat pap smears.

Essure

Essure® is a permanent birth control procedure that works with your body to create a natural barrier against pregnancy. This gentle procedure can be performed in a doctor's office in less than 10 minutes.

When you have completed your family and you want  to prevent unplanned pregnancy, it can lead to big decisions – and big surgeries. Springfield Clinic offers Essure, a gentle, minimally invasive procedure that gets patients back to their normal lives faster and with less risk than ever before.

Before you know it, you'll be right back to doing the things you love...

Essure offers women what no other permanent birth control solution ever has:

  • No cutting, surgery or general anesthesia
  • No hormones
  • No lengthy recovery period

During the procedure, small, flexible micro-inserts are placed into each fallopian tube through the vagina and cervix. Within three months, the body forms a natural barrier around the micro-inserts that prevents the sperm from reaching the egg. During this time, you will continue to use another form of birth control.

Three months after the Essure procedure, your doctor will perform a test to confirm the tubes are fully blocked. The confirmation of a successful procedure frees you from the fear of an unplanned pregnancy and the routine of temporary birth control.

Essure is 99.8% effective and is the most effective form of permanent birth control available. Essure is covered by most insurance providers. If performed in the office, payment may be as low as a simple co-pay.

Springfield Clinic doctors are specialists in Essure family planning. Contact us today to learn more.

Additional Information:

Essure Flyer

Essure Brochure

Video - Doctor Is In - Essure

 

* The Essure procedure may not be suitable for all women and there are risks. The procedure is not reversible, and you must use another form of birth control for at least three months following the procedure. Risks may include cramping/pain, nausea/vomiting, dizziness/lightheadedness, bleeding/spotting. Visit www.essure.com for a complete list of risks and considerations

MonaLisa Touch® Laser Therapy

The MonaLisa Touch® procedure is for patients who are experiencing vaginal and vulvar atrophy. This condition can sometimes occur after menopause, or for other reasons. 

The procedure takes less than ten minutes and can be done in your doctor’s office. So far there have been no reported adverse effects. The most is that some patients report slight discomfort for a day or two after the first treatment. 

Many patients report relief of symptoms after the first treatment, although most report feeling even greater improvement after the second treatment. If you are currently taking hormone treatment for vaginal or vulvar atrophy, this treatment will completely replace that medication.

Surgical Procedures List

Dilation & Curettage (D&C)

A dilation and curettage procedure, also called a D&C, is an out-patient surgical procedure in which the cervix is dilated (opened) so that the uterine lining (endometrium) can be scraped with a curette to sample endometrial tissue. A suction D&C uses suction to remove uterine contents. This is sometimes called a dilation and evacuation (D&E). This is generally done to treat a miscarriage.

A D&C may be used as a diagnostic or therapeutic procedure for abnormal bleeding. A D&C may be performed to determine the cause of abnormal or excessive uterine bleeding, to detect cancer, or as part of an infertility investigation. A D&C may be used following a miscarriage to remove the fetus and other tissues if they have not all been naturally passed. Infection or heavy bleeding can occur if these tissues are not completely removed. This type of D&C may also be called a surgical evacuation of the uterus or a D&E. Occasionally following childbirth, small pieces of the placenta remain adhered to the uterus and are not passed. This can cause bleeding or infection. A D&C may be used to remove these fragments so that the endometrium can heal properly.

As with any surgical procedure, complications may occur. Some possible complications of a D&C may include, but are not limited to, heavy bleeding, infection, perforation of the uterine wall or bowel, and adhesions (scar tissue) may develop inside the uterus.

Aftercare

Normal side effects of a D&C may last a few days and include mild cramping and spotting or light bleeding. For discomfort from cramping, your doctor may suggest taking ibuprofen (Advil, or Motrin) or another medication.

Wait to put anything in your vagina until your cervix returns to normal to prevent bacteria from entering your uterus, possibly causing an infection. Ask your doctor when you can use tampons and resume sexual activity. 

Your uterus must build a new lining after a D&C, so your next period may not come on time. If you had a D&C because of a miscarriage, and you want to become pregnant, talk with your doctor about when it's safe to start trying again.

Notify your doctor if you have any of the following:

  • Heavy bleeding
  • Foul-smelling drainage from your vagina
  • Fever and/or chills
  • Severe abdominal pain

Additional Information:

Hysteroscopy

Hysteroscopy enables a physician to look through the vagina and cervix to inspect the cavity of the uterus with an instrument called a hysteroscope. The hysteroscope is an extremely thin telescope-like instrument that looks like a lighted tube. The hysteroscope is so thin that it can fit through the cervix with only minimal or no dilation. Hysteroscopy may be either diagnostic or operative. 

Diagnostic hysteroscopy can be used to help determine the cause of infertility, dysfunctional uterine bleeding, adhesions, or repeated miscarriages. It can also help locate polyps and fibroids, as well as intrauterine devices (IUDs). Many times a hysteroscopy is done at the same time as a dilation and curettage (D&C).

An operative hysteroscopy may be used to both diagnose and treat certain conditions such as uterine adhesions, septums, or fibroids which can often be removed through the hysteroscope.

Hysteroscopy advantages are that a doctor can take tissue samples of specific areas and view any fibroids, polyps, or structural abnormalities in the uterus. In addition, small fibroids and polyps may be removed via the hysteroscope (in combination with other instruments that are inserted through canals in the hysteroscope), thus avoiding more invasive and complicated surgery. Any tissue removed through the hysteroscope is sent to pathology for examination.

When should hysteroscopy be performed?

The best time for hysteroscopy is during the first week or so after your period. During this time your physician is best able to view the inside of the uterus. 

Aftercare

You may experience cramping and vaginal bleeding for a day or two after the procedure. If you experience a fever, severe abdominal pain, or heavy vaginal bleeding or discharge, call your physician.

Endometrial Ablation

Heavy periods, or menorrhagia, affect about 20% of all women. If a woman is done with childbearing and having problems with heavy periods, she may be a candidate for an endometrial ablation.

An ablation is a treatment applied to the lining of the uterus to help improve heavy periods. There are several different choices available. Our physicians typically use Novasure or Thermachoice. Endometrial Ablation is a simple, one-time, 5 - 10 minute procedure. 

There are many advantages to having an endometrial ablation. If heaving bleeding is the only problem, an ablation can stop or decrease bleeding without the need for a hysterectomy. Keeping the uterus and ovaries intact means that the hormonal systems are intact as well. If bleeding has caused anemia, an ablation may improve this. Finally, the procedure can be done in a doctor's office or same-day surgery center, and the recovery is much quicker than a hysterectomy.

Although an endometrial ablation is a great alternative to a hysterectomy, there are some disadvantages that one should consider before proceeding. Complications are rare, but like any surgical procedure, they can occur. When you have the procedure, you will need permanent birth control, since it’s still possible to become pregnant and a pregnancy after any ablation procedure is unsafe for both mother and fetus. There also have been reports of the endometrial lining growing back and the bleeding continuing as heavily as before despite the procedure.

Minor side effects from the procedure can occur for a few days, include cramping (like menstrual cramps), nausea, and frequent urination that may last for 24 hours. A watery discharge mixed with blood may be present for a few weeks after the procedure and can be heavy for the first few days.

If you are absolutely sure that you never want to have any children in the future, and would like to stop your heavy period and restart your life, an endometrial ablation may be right for you.

Additional Links:

Laparoscopy

Laparoscopy is just a big word for a small procedure. It is a fairly noninvasive method used to examine the interior of the abdomen, pelvic cavity and other parts of the body. While laparoscopy can be used to aid in diagnoses, it is also frequently used to perform surgical procedures. A laparoscopy is an outpatient procedure and general anesthetic is usually used. More complex procedures, such as a laparoscopic hysterectomy, may require an overnight stay in the hospital.

A laparoscope is a thin scope (about the width of a pencil) which uses fiber optics to “light up” the abdomen. It is usually placed through a tiny incision near or in the belly button. By attaching a camera to the laparoscope, the doctor can examine your “insides” thorough a tiny incision. Sometimes additional incisions are placed in order to put other instruments into the abdomen.

As a diagnostic tool, laparoscopy is used to investigate the causes of gynecological pain such as endometriosis, ovarian cysts and tumors, or to discover and treat ectopic pregnancy. It is also performed to learn the reason for abdominal pain or tenderness, and to investigate scar tissue or other problems that may impede fertility. 

As a surgical tool, laparoscopy is most commonly used for removal of endometriosis, ovarian cysts, to perform sterilization in female patients, or to assist in hysterectomy. 

Performing laparoscopy usually only requires two to four tiny incisions. One incision is made just below the navel, and another is usually made near the bikini line. For organ removal, additional incisions may be required on either side of the abdomen. 

There is some risk of infection. There is a risk of puncturing an organ, which could cause the contents of the intestines to leak. There may also be bleeding into the abdominal cavity. Sometimes the surgery cannot be successfully completed by laparoscopy. Then the doctor may have to complete the operation using traditional "open" abdominal surgery, called laparotomy. This is called "converting" to laparotomy.

Complications after laparoscopic surgery are rare. Most people recover quickly and resume their normal activities without problems.

Contact the doctor immediately if:

  • an incision begins to bleed or leak fluid
  • an incision becomes red, swollen, or feels warm
  • a fever develops
  • there is increased pain in the abdomen or pelvic area
  • chest pain, shortness of breath, and/or leg pain develops
  • light-headedness or dizzy spells occur

Additional Information:

Tubal Ligation

Tubal ligation (or "tying the tubes") is surgery to close a woman's fallopian tubes to prevent pregnancy. A tubal ligation should only be done if a woman never wants to become pregnant again. These tubes are the path an egg takes from the ovary to the uterus. A woman who has this surgery can no longer get pregnant. 

Tubal ligation is done in a hospital or outpatient clinic. A patient may receive general anesthesia. She will be asleep and unable to feel pain. Or, she may be awake and given local or spinal anesthesia. She will likely also receive medicine to make her sleepy.

The procedure takes about 30 minutes. The surgeon will make one or two small surgical cuts in the belly, usually around the belly button. Carbon dioxide gas may be pumped into the belly to expand it. This helps the surgeon see the uterus and fallopian tubes. The surgeon will insert a narrow tube with a tiny camera on the end (laparoscope) into the belly. Instruments to block off the tubes will be inserted through the laparoscope or through a separate, very small cut. The tubes are either burned shut (cauterized) or clamped off with a small clip or ring (band).

Tubal ligation can also be done right after you have a baby through a small cut in the navel or during a cesarean section.

Tubal ligation has a low risk of complications. Risks include bleeding, infection, and damage to surrounding organs. While a tubal ligation is considered a permanent procedure, there is a one in three hundred risk of failure. Occasionally, a small channel reopens in the tube. If this does happen, there is a risk of an “ectopic” or tubal pregnancy occurring or of a pregnancy in the uterus.

What to Expect at Home

You will probably go home the same day you have the procedure. You may have many symptoms that last 2 to 4 days. As long as they are not severe, these symptoms are normal:

  • Shoulder pain - this is caused by the gas used in the abdomen to help the surgeon see better during the procedure. You can relieve the gas by lying down.
  • Scratchy or sore throat
  • Swollen belly (bloated) and cramping
  • Some discharge or bleeding from your vagina

You should be able to do most of your normal activities after 2 or 3 days. But, you should avoid heavy lifting for 3 weeks.

Follow these guidelines after your procedure:

Keep your incision areas clean, dry, and covered. Change your dressings (bandages) as your doctor or nurse tells you.

  • Do not take baths, soak in a hot tub, or go swimming until your skin has healed.
  • Avoid heavy exercise for several days after the procedure. Try not to lift anything heavier than 10 pounds (about a gallon jug of milk).
  • You can have sexual intercourse as soon as you feel ready. For most women, this is usually within a week. If a tubal ligation is done after the birth of the baby intercourse needs to be delayed until instructed by your physician.
  • You may eat your normal foods.

Call your doctor if you have:

  • Severe belly pain, or if the pain you're having is getting worse and does not get better with pain medicines
  • Heavy bleeding from your vagina on the first day, or your bleeding does not lessen after the first day
  • Fever higher than 100.5 °F or chills
  • Pain, shortness of breath, feeling faint
  • Nausea or vomiting

Also call your doctor if your incisions are red or swollen, become painful, or there is a discharge coming from them.

Additional Information:

Salpingectomy

Salpingectomy is the removal of a woman's fallopian tube, the tube through which an egg travels from the ovary to the uterus. A salpingectomy may be performed for several different reasons. Removal of one tube (unilateral salpingectomy) is usually performed if the tube has become infected (a condition known as salpingitis). Salpingectomy is also used to treat an ectopic pregnancy, a condition in which a fertilized egg has implanted in the tube instead of inside the uterus. A bilateral salpingectomy (removal of both the tubes) is usually done if the ovaries and uterus are also going to be removed. If the fallopian tubes and the ovaries are both removed at the same time, this is called a salpingo-oophorectomy. 

Salpingectomies also differ in terms of incision types. With a laparoscopic salpingectomy, the surgeon makes a tiny incision under the navel, using general anesthesia. If the surgeon needs to work with a larger area, she will make a bikini cut, which is a 4- to 6-inch incision just above the pubic hair line. This is generally done under general anesthesia.

Aftercare

The side effects of a salpingectomy depend somewhat on how it was performed. With the laparoscopic salpingectomy, recovery time is shorter because of the tiny incision. The bikini cut is major surgery and with it comes increased pain and risk of bleeding. With both types of incisions, there is risk for reaction to anesthesia, risk of infection and potential for scarring. Most women take about three days to recover after a salpingectomy. Because the bikini cut is major surgery, it will take longer to fully recover after the procedure.

When to call the doctor after going home?

  • If you experience fever above 100 degrees.
  • Excessive pain (not controlled by pain medication).
  • Swelling or discharge from the wound.
  • If you experience excessive bleeding.
  • If you develop severe chest pain, experience persistent nausea and vomiting or shortness of breath.

Conization

Cervical conization (cone biopsy) is a surgical procedure where a wedge or cone-shaped tissue sample is excised from the cervix for diagnostic and treatment purposes. As a diagnostic tool, the procedure is used to check cervical cells for cancer especially when magnified visual inspection (colposcopy) and cervical biopsy procedures have not provided adequate evidence to confirm or rule out a diagnosis. As a treatment tool, cervical conization is used to remove cells that are undergoing changes that could be precancerous (abnormal cells).

After the procedure, the biopsied tissue is examined by pathology for abnormal or precancerous cells (cervical dysplasia) and for cancerous cells. If the tissue tests positive for cervical dysplasia, further tests and treatment maybe scheduled. If the tissue tests negative for cancer, no other treatment is necessary. If the tissue tests positive for cancer, additional treatment such as further surgery or radiation are scheduled.

How the conization is performed

This procedure is done in the hospital. It is usually done under general anesthesia. The doctor will place an instrument (speculum) into your vagina to better see the cervix. A small cone-shaped sample of tissue is removed from the cervix. The procedure is done on the same day (outpatient) and a hospital stay is usually not needed.

Risks of cold knife cone biopsy include bleeding, infection, scarring or incompetent cervix

After a cone biopsy

  • Some vaginal bleeding is normal for up to 1 week.
  • Some vaginal spotting or discharge (bloody or dark brown) may occur for about 3 weeks.
  • Pads should be used instead of tampons for about 2 weeks.
  • Sexual intercourse should be avoided for about 2 weeks.
  • Douching should not be done.

When to call your doctor

Call your doctor for any of these symptoms:

  • A fever
  • Moderate to heavy bleeding (more than you would usually have during a menstrual period)
  • Increasing pelvic pain
  • Bad-smelling or yellowish vaginal discharge, which may point to an infection

Hysterectomy

types of hysterectomy diagramA hysterectomy is the surgical removal of a woman’s uterus. It may be done to treat fibroids, endometriosis, uterine prolapse, cancer, chronic pain, or heavy bleeding that has not been controlled by less invasive methods. 

A hysterectomy is typically necessary when all other options including medication, therapies and even other surgeries have not been successful and the patient’s life is at risk or her quality of life is being harmed. Hysterectomies are the most common surgery performed exclusively on women.

A hysterectomy can mean simply the removal of the uterus, or it can mean removal of the uterus, cervix and ovaries. Also, it can be performed in several ways. The types of hysterectomies:

Total or complete hysterectomy - The uterus and the cervix are removed. 

Supracervical (also called subtotal or partial) hysterectomy - The upper portion of the uterus is removed, leaving the cervix and ovaries intact. 

Radical hysterectomy – A hysterectomy occasionally used to treat cervical cancer. During a radical hysterectomy, extra tissue is removed from the area surrounding the uterus.

There are several ways the surgery can be performed -- some methods more invasive than others: 

Laparoscopic Assisted Hysterectomy - This is any hysterectomy using the vaginal approach with assistance from laparoscopic instruments inserted through tiny incisions in the abdomen. 

Vaginal Hysterectomy - This hysterectomy is performed entirely through an incision made in the vagina. 

Abdominal Hysterectomy - This hysterectomy is performed using an incision in the abdomen that can be either vertical from the area of the pubic bone up toward the belly button, or it may be horizontal along the bikini line. 

Robotic-assisted surgery – This hysterectomy uses a special machine (robot) to do the surgery through small cuts in your belly, much like a laparoscopic hysterectomy.

All types of hysterectomy end a woman's ability to become pregnant. Also, surgeries that include the removal of the ovaries cause menopause to set in after surgery, if you have not already entered menopause.

Risks

The risks for any surgery are:

Allergic reactions to medicines

Breathing problems

Blood clots in your leg or pelvic veins that may travel to your lungs. These can be fatal.

Bleeding

Infection

Risks that are possible from a hysterectomy are:

Injury to nearby organs, including the bladder, ureters, or blood vessels

Injury to bowels (intestines)

Pain during sexual intercourse

Early menopause, if the ovaries are removed also

Complete recovery may take 2 weeks to 2 months. Recovery from a vaginal or laparoscopic hysterectomy is faster than recovery from an abdominal hysterectomy. It may also be less painful. Average recovery times are: 

Abdominal hysterectomy -- 4-6 weeks.

Vaginal hysterectomy -- 3-4 weeks.

Laparoscopic or robotic hysterectomy – 2-4 weeks.

For the majority of women who have a hysterectomy each year, their quality of life is improved by the surgery as pain, bleeding, concerns about pregnancy and disease are alleviated. Those in the minority, who find a hysterectomy to be a very negative experience, usually attribute those feelings to the inability to have children after the procedure. 

One of the negative side effects of having a hysterectomy may be the onset of menopausal symptoms. Those who have the ovaries removed will begin those symptoms after surgery, but those who retain their ovaries frequently experience menopause earlier than is typical. 

After surgery hormone replacement may be necessary. There are risks associated with hormone treatment, but those risks need to be balanced against the risks for osteoporosis and other conditions and should be discussed with your health care provider.

You will still need regular Pap tests to screen for cervical cancer if you had a partial hysterectomy and did not have your cervix removed, or if your hysterectomy was for cancer. Ask your doctor what is best for you and how often you should have Pap tests. Even if you do not need Pap tests, all women who have had a hysterectomy should have regular pelvic exams and mammograms.

Vaginal Hysterectomy
This describes a surgical procedure in which the uterus is removed through the vagina. One or both ovaries and fallopian tubes may be removed during the procedure as well. This surgical approach avoids visible scarring and typically allows for a quicker recovery, as well as less postoperative pain and complications as compared with other types of hysterectomy. Risks associated with the vaginal approach include a slight risk of shortening or damaging the vagina.The post hysterectomy pain reported after a vaginal hysterectomy is much less than that experienced with an abdominal surgery, and this means fewer pain medications to control the pain. There is also typically a shorter hospital stay, sometimes only a day or two, and this can mean cost savings as well. 

With a vaginal hysterectomy an incision is made around the cervix and the removal of the uterus is done entirely through the vagina. If the uterus is very large or if cancer is suspected, a vaginal hysterectomy probably is not the best choice to remove the uterus.

​The symptoms after hysterectomy that you experience with a vaginal procedure can include bleeding from the vagina and pain which is mild to moderate. In some cases a vaginal procedure may turn into an abdominal incision if any complications or unexpected circumstances are present.

When to call your doctor following a vaginal hysterectomy:

  • Signs of infection, including fever and chills
  • Nausea and/or vomiting
  • Dizziness or fainting
  • Cough, shortness of breath, or chest pain
  • Heavy bleeding
  • Pain that you cannot control with the medications you have been given
  • Pain, burning, urgency or frequency of urination, or persistent bleeding in urine
  • Swelling, redness, or pain in your leg

Laparoscopic
One of the newest surgical methods used to perform a hysterectomy is the laparoscopic method, and this type of surgery has the shortest hysterectomy recovery time. Many women are able to return to work two to three weeks after surgery. With a laparoscopic hysterectomy two or three small incisions are made, and then a thin tube with a camera is inserted into one of the small incisions. Any surgical tools needed are inserted into the other incisions, and the uterus is usually freed up from the surrounding tissue and removed through the vagina. This method usually has the fewest symptoms after hysterectomy, and involves less pain and discomfort while you are recovering. This method also involves the smallest possible incisions, and any scarring is minimal. 

The risk of infection with this method of surgery is very small, because the incisions are smaller and heal faster. 

Benefits of laparoscopy include:

  • Excellent visualization of the pelvis
  • The procedure can often be done outpatient, or involves an overnight hospital stay
  • Less pain medication is required
  • Fewer complications
  • Smaller scars

What kind of recovery can be expected?

Patients should expect to take ibuprofen or narcotic pain pills for a few days post-operatively. It is encouraged for patients NOT to stay in bed. They should move around the house and resume normal activities as soon as they feel up to it. Some women are well enough to return to work one to two weeks after surgery. Women who have more physically demanding work should stay home for 3-6 weeks. Women can resume exercise and intercourse within six weeks of the surgery.

Laparoscopic patients can expect to suffer less post-operative pain than traditional hysterectomy or cesarean section patients.

After you leave the hospital, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, leakage, or any discharge from the incision site
  • Incision opens up
  • Nausea and/or vomiting
  • Dizziness or fainting
  • Cough, shortness of breath, or chest pain
  • Heavy bleeding
  • Pain that you cannot control with the medications you have been given
  • Pain, burning, urgency or frequency of urination, or persistent bleeding in urine
  • Swelling, redness, or pain in your leg

Robotic
Select Springfield Clinic OB/GYN physicians have received specialized training to perform surgical procedures with the da Vinci robotic system. Robotic surgery, with its 3-D optics, magnification and flexible or articulating wrists, enables surgeons to perform complex surgical procedures with greater precision in a minimally invasive technique that previously required a large, open incision.

Patients benefit from robotic surgery with:

  • reduced pain
  • shorter hospital stays
  • less blood loss
  • fewer infections
  • quicker recovery and return to normal activities

Additional Information:

Myomectomy

Myoma is another name for a fibroid. In women whose fibroids cause problems (generally bleeding or pain) and who still want to keep their uterus, a myomectomy (removal of myoma) may be recommended by their physician. Occasionally a myomectomy is suggested to treat infertility.

Some myomectomies can be done through a laparoscope or hysteroscope, some need to be done through a larger incision or cut on the abdomen.

Diagnosis/Preparation

Surgeons often recommend hormone treatment with a drug called leuprolide (Lupron) two to six months before surgery in order to shrink the fibroids and make them less vascular (prone to bleeding). This makes the fibroids easier to remove. In addition, Lupron stops menstruation, so women who are anemic have an opportunity to build up their blood count. While the drug treatment may reduce the risk of excess blood loss during surgery, there is a small risk that smaller fibroids might be missed during myomectomy, only to enlarge later after the surgery is completed.

Aftercare

Patients may need four to six weeks of recovery following a standard myomectomy before they can return to normal activities. Women who have had laparoscopic or hysteroscopic myomectomies, however, usually recover completely within one to three weeks.

Risks

Possible complications include: 

  • infection 
  • blood loss 
  • weakening of the uterine wall to the degree that future deliveries need to be performed via cesarean section 
  • adverse reactions to anesthesia 
  • internal scarring (and possible infertility) 
  • reappearance of new fibroids 

There is a risk that removal of the fibroids may lead to such severe bleeding that the uterus itself will have to be removed.

Normal results

Removal of uterine fibroids will usually improve any problems that the patient may have been having, including abnormal bleeding and pain. Under normal circumstances, a woman who has had a myomectomy will be able to become pregnant, although she may have to deliver via cesarean section if the uterine wall has been weakened by removal of the fibroid.

Alternatives

Hysterectomy (partial or full removal of the uterus) is a common alternative to myomectomy. The most frequent reason for hysterectomy in the United States is to remove fibroid tumors, accounting for 30% of all hysterectomies. 

Fibroid embolization is a less-invasive procedure in which blood vessels that feed the fibroids are blocked, causing the growths to shrink. The blood vessels are accessed via a catheter inserted into the femoral artery (in the upper thigh) and injected with tiny particles that block the flow of blood. The fibroids subsequently decrease in size and the patient's symptoms improve. 

This procedure is done by a specially-trained radiologist, not the gynecologist. The gynecologist will refer a woman to the appropriate radiologist.

Oophorectomy

Oophorectomy diagramOophorectomy is the surgical removal of an ovary. Sometimes just an ovary is removed, and sometimes it is removed at the same time as a hysterectomy.

An ovary may be removed due to pain, cysts or masses on the ovary, a family tendency toward breast or ovarian cancer, or if there is cancer of the ovary.

The surgery may be done through the laparoscope or through a larger incision in the abdomen.

If only one ovary is removed, there is minimal change in a woman’s hormones, but if both are removed her hormone level drops similar to the change during menopause. This may include hot flashes, night sweats, changes in sex drive or mood changes.

Risks

Oophorectomy is a relatively safe operation, although, like all major surgery, it does carry some risks. These include unanticipated reaction to anesthesia, internal bleeding, blood clots, accidental damage to other organs, and post-surgery infection.

Average Hospital Stay

  • Abdominal incision—2-5 days
  • Laparoscopic procedure—1 day

Aftercare

After surgery a woman will feel some discomfort. The degree of discomfort varies and is generally greatest with abdominal incisions, because the abdominal muscles may be stretched out of the way so that the surgeon can reach the ovaries. When both ovaries are removed, women who do not have cancer may be started on hormone replacement therapy to ease the symptoms of menopause that occur because estrogen produced by the ovaries is no longer present. If even part of one ovary remains, it will produce enough estrogen that a woman will continue to menstruate, unless her uterus was removed in a hysterectomy. Return to normal activities takes anywhere from two to six weeks, depending on the type of surgery.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Persistent or increased vaginal bleeding or discharge
  • Pain that you cannot control with the medications you have been given
  • Nausea and/or vomiting that you cannot control with the medications you were given after surgery, or which last for more than two days after discharge from the hospital
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision sites
  • Difficulty urinating
  • Swelling, redness, or pain in your leg
  • Cough, shortness of breath, or chest pain
  • Feeling depressed

Ovarian Cystectomy

An ovarian cyst is a very common condition for a woman to have. Women who are not using hormones for birth control (pills, patches, ring or IUD) make a small cyst almost every month. Most ovarian cysts disappear on their own in just a few weeks.

Some ovarian cysts need to be removed. A cyst that is large (more than 3 inches across), a cyst that appears solid (an endometrioma or dermoid cyst), a cyst that is possibly cancerous, or a cyst that persistently causes pain may need to be removed.

Ideally, a cyst can be removed without removing the ovary. This is called an ovarian cystectomy.

Many times, this can be done using a laparoscope, a thin scope that is placed into the abdomen near the belly button. If the cystectomy is done laparoscopically, recovery is fairly quick, just a few days.

Sometimes, a larger incision is made in the lower abdomen to remove the cyst. Recovery from this type of surgery is generally two to six weeks.

Complications are rare, but no procedure is completely free of risk. If you are having an ovarian cyst removed, your doctor will review a list of possible complications, which may include infection, bleeding, cyst returns after it is removed, the need for removal of one or both ovaries, infertility, blood clots, or damage to other organs.

There are also some side effects to be prepared for after a laparoscopic ovarian cystectomy, though they are generally mild. For instance, most women feel some tenderness near the incisions for the first few days after surgery, or nausea and bloating. Fatigue, vaginal bleeding, stomach pain, and cramping are also common side effects of this procedure.

Contact your doctor if any of the following occurs: 

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Pain that you cannot control with the medications you have been given
  • Increased vaginal bleeding or discharge
  • Cough , shortness of breath, chest pain 
  • Nausea and/or vomiting that you cannot control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
  • Headaches, muscle aches, lightheadedness, or general ill feeling
  • Constipation or abdominal swelling 
  • Vomiting
  • Urinary difficulties
  • Onset of pain or swelling in one or both legs
  • New, unexplained symptoms

Pelvic Support Surgery

Thirty million American women suffer from symptoms of pelvic relaxation and stress urinary incontinence. Many women have difficulty controlling their urine in certain situations or notice changes in their bowel habits. These two symptoms may be related to a common set of problems that may occur as a result of childbirth, aging or a combination of both. Grouped together these problems are referred to as pelvic relaxation.

The pelvic organs include the vagina, uterus, bladder, and rectum. Some, or all, of these organs may be affected by pelvic relaxation. When the uterus drops out of its normal position, this is called uterine prolapse. Relaxation of the front wall of the vagina and/or bladder is a cystocele, and relaxation of the back wall of the vagina in front of the rectum is called a rectocele.

Sometimes after a hysterectomy, the top of the vagina relaxes or “droops.” This is called vaginal vault prolapse. At times, a small amount of small bowel falls into this area (enterocele). The decision on how to treat pelvic relaxation depends on what part of the pelvis is affected.

The general symptoms associated with pelvic relaxation depend on which organs are affected. Often there is a feeling of heaviness or fullness. Woman often report pulling or aching feeling in the lower abdomen or pelvis. Difficulty urinating or having a bowel movement can occur. Small or moderate amounts of urine may be lost with normal physical activities such as laughing, coughing, walking, or running. In more advanced cases, a mass may actually protrude from the vaginal opening.

Treatment options include vaginal supportive pessaries, medication, and minimally invasive vaginal or abdominal surgeries to restore support of the vagina and pelvic organs. Treatment depends on the severity of symptoms. Surgery may be considered if symptoms are severe and disrupt one’s life, and if nonsurgical treatment options have not helped. 

Reconstructive surgery reconstructs the pelvic floor with the goal of restoring the organs to their original position. Some types of reconstructive surgery are done through an incision in the vagina. Others are done through an incision in the abdomen or with laparoscopy, including robot-assisted surgery.

The types of reconstructive surgery include the following:

  • Anterior and posterior colporrhaphy- With anterior colporrhaphy the anterior wall of the vagina is reinforced and strengthened with stitches so that it once again supports the bladder. During posterior coloporrhaphy, the posterior wall of the vagina is reinforced so that it once again supports the rectum. These procedures are performed through the vagina, so recovery time is shorter.
  • Sacrocolpopexy- Through an abdominal incision, surgical mesh is attached to the vaginal vault and secured to the sacrum. This abdominal procedure may result in less pain during intercourse than procedures performed through the vagina.
  • Surgery using vaginally placed mesh- Surgical mesh is placed through an incision in the vagina to help lift prolapsed organs into place or to reinforce repairs made to the vaginal walls. Mesh placed through the vagina has a risk of complications including mesh erosion, pain and infection. Because of these risks, vaginally placed mesh for pelvic organ prolapse usually is reserved for women in whom previous surgery has not worked, who have a medical condition that makes abdominal surgery risky, or whose own tissues are too weak to repair without mesh.

Recovery times vary depending on the type of surgery. For the first few weeks, you should avoid vigorous exercise, lifting, and straining. You also should avoid intercourse for several weeks after surgery until advised by your physician.

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