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Types of Surgery

Gynaecological Surgery - Dr Sheela Purkayastha

1. Laparoscopy

What is Laparoscopy?

Laparoscopy means to look inside the stomach with the help of a telescope.  The telescope is passed, under general anaesthetic (when you are asleep), through your belly button.  Initially the inside of the tummy is distended by introducing carbon dioxide gas to make the procedure safe.  A telescope is then passed through the belly button which reveals all of the organs, namely the uterus, ovaries and fallopian tubes to ensure that no abnormalities are present. 

Usual indications for laparoscopy are heavy periods, fibroids, suspected endometriosis, suspected pelvic inflammatory disease, undiagnosed pelvic pain and suspected ectopic pregnancy etc.  One can also ensure if the tubes are patent while performing a laparoscopy by injecting some dye through the cervix.  When the laparoscopy is performed to diagnose a gynaecological condition it is called a diagnostic laparoscopy.  One can also have a therapeutic laparoscopy which means treatment of the conditions like ovarian cyst, removal of ectopic pregnancy, treatment of endometriosis, separation of adhesions as a result of pelvic inflammatory disease.  At the end of the procedure the gas is taken out and absorbable sutures are inserted to appose the skin and the belly button.  One can also have two other small holes on either side of the abdomen.  These minor ports were to help the insertion of other instruments in order to perform the operation, also known as keyhole surgery.  The procedure is usually carried out as a day case.  However for operative laparoscopy one may be required to stay over night which will be at the discretion of your own doctor.

 

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2. Hysteroscopy

What is Hysteroscopy?

This is a procedure where a very thin telescope (hysteroscope) is introduced through the neck of the womb (cervix).  It is used to detect abnormalities inside the womb.  Usual indications are irregular bleeding, excessive bleeding or heavy periods.  A sample of tissue called a biopsy can be taken at the time of hysteroscopy.  A simple biopsy can be carried out or polyps can be removed.  Hysteroscopy can be performed as an outpatient procedure where a local anaesthetic is used.  It can also, depending on the patient’s requirements, be carried out under a short anaesthetic as a day case.  Hysteroscopy can also be performed to remove polyps or fibroids from inside the womb.  This is called operative hysteroscopy. 

How long does it take?

This depends predominantly on what has to be done during the procedure.  For a simple hysteroscopy where we just want to look inside the womb, it only takes a few minutes.  If however we are going to operate inside the womb using the telescope, it may take up to one hour. 

Where does the procedure take place?

Operative hysteroscopy usually requires general anaesthetic but diagnosic hysteroscopy can be carried out under local anaesthetic in the outpatient’s department procedure suite.  Depending upon whether the patient has a diagnostic hysteroscopy or an operative hysteroscopy, the stay in the hospital may vary within a few hours to one day.

 

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3. Hysterectomy

What is a Hysterectomy?

A hysterectomy is an operation to remove your womb.

Types of Hysterectomy.

 

  1. Vaginal hysterectomy – when the womb is removed vaginally.

  2. Subtotal hysterectomy – the womb is removed through the tummy but the cervix is left in place.

  3. Total hysterectomy – the womb and the cervix are removed.

  4. Radical hysterectomy – the womb, cervix, ovaries and the fallopian tubes are removed. Sometimes a part of the vagina is removed as well.

 

Symptoms Requiring Hysterectomy

 

  • Heavy or painful periods

  • Fibroids

  • Endometriosis

  • Chronic pelvic pain

  • Cancer of the womb, cervix or ovaries

  • Prolapse of the womb (womb drops into the vagina)

If you have not reached menopause, usually your ovaries are left in place as these produce oestrogen which is required.  Removal of the ovaries will lead to premature menopause.

 

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4. Operation for Prolapse of the Uterus and Vagina.

 

What is a Prolapse?

A prolapse is caused when there is damage or weakness to the pelvic floor muscles which support the uterus and other pelvic organs.  Weakness of these muscles can be as a result of childbirth, chronic coughing and straining.  Prolapse frequently occurs around the age of menopause as oestrogen levels fall which can cause the pelvic floor muscles and tissues to thicken. 

Types of Prolapse

There are a number of different types of prolapse.

  1. Cystocele where the bladder protrudes into the anterior wall of the vagina. 

  2. Ureterocele where the tube that carries urine from the bladder protrudes into the anterior vaginal wall.

  3. Rectocele where the rectum protrudes into the posterior wall of the vagina.

  4. Enterocele where the bowel protrudes into the posterior wall of the vagina.

  5. Uterine prolapse where the uterus drops into the vagina which could again be in various degrees.

  6. Vaginal wall prolapse where the top of the vagina falls on itself.  Sometimes associated with hysterectomy that is removal of the uterus.

Operation for Prolapse.

Vaginal repair operation is performed to rectify the pelvic prolapse.  In some cases a hysterectomy may be required.  In other cases, the uterus is kept in tact and just the prolapse is corrected.  A vaginal repair aims to tighten, strengthen and lift the weakened tissues so that the uterus, bladder and rectum return to their original position alleviating any associated symptoms.  The operation is performed vaginally and dissolvable stitches are used.

 

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5. Operation for Myomectomy

 

What is a Myomectomy?

This is a term for the surgical removal of fibroids, with the womb remaining intact.
Fibroids are benign, non cancerous tumours which grow in the muscle layers of the womb. 

How is a Myomectomy Performed?

A Myomectomy can be performed by three different methods.

  1. Abdominal Myomectomy

  2. Laparoscopic Myomectomy

  3. Hysteroscopic Myomectomy

 

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6. Ovarian Cystectomy

What is an Ovarian Cyst?

A cyst is a sac which contains fluid or some solid material.  It can grow from any tissue in the ovary.  There are many different types of ovarian cyst, most of them are benign (non cancerous), but some could be malignant (cancerous). 

Symptoms of Ovarian Cyst.

Pain, vaginal bleeding, pain during sexual intercourse, urinary frequency, constipation, intermenstrual bleeding or delayed periods, abdominal bloating or swelling. 

 

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