Surgery

Surgery Scheduling

At Women Partners In Health, we believe in shared decision-making. If your condition requires surgical management, your physician will present all of the options available for your specific condition and assist you in making a decision. Your physician will explain your procedure in detail and discuss what you can expect during your post-operative recovery period. We understand that considering surgery can be intimidating or frightening, and we encourage you to ask questions if there is any information that you do not understand. Prior to your surgery, you will be asked to indicate that you understand the nature of the surgical procedure to be performed and that you give your permission for the operation. This is commonly referred to as the “informed consent” process. It is every patient’s right and responsibility to understand the risks and benefits of their surgical procedure.

Once you have made the decision with your physician to move forward with a surgical procedure, your chart will be sent to our surgery scheduler. The date of your surgery will depend on your schedule, your physician’s schedule, and the surgical facility. Our surgery scheduler will verify your insurance benefits and contact you to set up the pre-operative appointments in our office and the surgical facility. You will have a physical evaluation and will receive information regarding registration, lab work, and anesthesia at these appointments. When necessary, you may require additional medical clearance from your primary care provider or specialist for secondary health issues.

Our physicians utilize minimally-invasive surgical techniques when appropriate, which can help reduce your post-operative recovery time. As always, we individualize treatment recommendations to each patient. For general information on your specific procedure, please visit the “Types of Surgery” section on our website. We will work with you throughout the scheduling process to ensure that you are well-informed and comfortable in proceeding with your surgery.

Dilatation and Curettage (D&C)

Your physician may recommend a D&C to diagnose possible causes of abnormal bleeding, to take a sample of the uterine lining, or to surgically treat a miscarriage. This procedure is done in an outpatient setting; most patients are able to resume normal activity in 1-2 days.

During the procedure, a speculum is inserted into the vagina and your physician will dilate, or stretch the opening of the cervix. A thin tool called a curette is used to remove tissue from the uterine walls. Your physician may choose to use a suction tool rather than a curette, depending on your diagnosis. The uterine tissue sample is sent to pathology for analysis. You will have a scheduled post-operative appointment with your physician to discuss the results.

Hysteroscopy

A hysteroscopy can be used to diagnose abnormal bleeding, remove fibroids or polyps from the lining of the uterus, or to treat other specific conditions. The hysteroscope is a small, lighted instrument that is inserted through the cervix into the uterus that allows the physician to see an image of the uterine cavity. This procedure is done in an outpatient setting and in some situations, can be performed in our office. General or local anesthesia can be used for this procedure, depending on your health history and the severity of the problem.

During the procedure, the physician will insert a speculum into the vagina and gently insert the hysteroscope into the uterus. Then a saline solution, or salt water, is pushed through the hysteroscope into the uterus to expand it. This solution also allows the physician to see the uterus better. If a biopsy is necessary, small instruments are inserted into the uterus through the hysteroscope and a tissue sample is taken and sent to pathology. You may experience vaginal discharge and/or light bleeding for up to 2 or 3 weeks after the procedure. You will have a scheduled post-operative appointment with your physician to discuss the results.

Laparoscopy

A laparoscopy can be done to identify possible causes for infertility, pelvic or abdominal pain, for treatment of endometriosis, ovarian cysts, adhesions, or for permanent sterilization. The laparoscope is a telescope device that allows the physician to see the inside of the abdomen by using light and a camera. This procedure is usually done on an outpatient basis at the hospital or a surgical facility. The recovery period is fairly brief, usually lasting several days to a week.

During the procedure, a small incision is made in or slightly below the navel. Carbon dioxide gas (CO2) is put into the abdomen to allow the pelvic organs to be seen more clearly. Another small incision may be made in the pubic area, and an instrument called a manipulator may be used to adjust the position of the uterus. Different types of instruments such as clamps, scissors, cautery, or laser cautery tools can be inserted through the incision(s) to treat abnormalities that may be found in the pelvic space. If sterilization is being performed, your physician will use clips, bands, or cautery to seal the fallopian tubes in order to prevent pregnancy. If tissue or cysts are removed from the pelvis, they will be sent to pathology for analysis. When the procedure is complete, the tools and instruments are removed and the gas is released from the abdomen. You may have a few stitches to close the incisions. You may experience symptoms such as tenderness in your abdominal area, shoulder discomfort, vaginal discharge, and/or swelling after surgery. You will have a scheduled post-operative appointment with your physician to discuss the results.

Myomectomy

Uterine fibroids are growths associated with the uterine lining or muscle that can cause abnormal bleeding, painful periods, pelvic pain, or infertility. The surgical removal of fibroids from the uterus is called a myomectomy. This type of procedure leaves the uterus in place in order to preserve child-bearing potential. Depending on the size and location of the fibroids, they can be removed vaginally, laparoscopically, or through an abdominal incision. Your physician will discuss the most appropriate option(s) based on your health history and physical condition. The hospital stay for a myomectomy ranges from an outpatient to an inpatient stay, depending on the type of case your physician performs.

Hysterectomy A hysterectomy is the removal of the uterus for conditions that cannot be treated with non-surgical methods. The removal of the fallopian tubes and/or ovaries may be included with a hysterectomy. Conditions such as uterine fibroids, pelvic floor prolapse, abnormal uterine bleeding, or cancer may require this procedure as definitive treatment. There are different types of hysterectomies; your physician will discuss the most appropriate option(s) based on your health history, diagnosis, and physical condition. Your hospital stay may range from overnight to a few days, depending on the type of hysterectomy. The types of hysterectomies that we perform are listed below:

  • Abdominal Hysterectomy (TAH):
    • The uterus is removed through a large horizontal or vertical abdominal incision. If you have large fibroids, cancer, or other complications, your physician may recommend this type of hysterectomy as it provides a clearer view of the uterus and the surrounding pelvic organs. The removal of the fallopian tubes and/or ovaries may be included with this hysterectomy. This surgery usually requires a three-day inpatient stay, and has a longer recovery than other types of hysterectomy.
  • Vaginal Hysterectomy (VH):
    • In this type of hysterectomy, the uterus is removed completely through the vagina. There are no incisions made on the abdomen. The removal of the fallopian tubes and/or ovaries may be included with this hysterectomy. The hospital stay and recovery time for a vaginal hysterectomy is usually shorter than with an abdominal hysterectomy.
  • Laparoscopically-Assisted Vaginal Hysterectomy (LAVH):
    • The uterus is removed through the vagina with assistance from a laparoscope, which is inserted through a series of very small incisions in the abdomen. The removal of the fallopian tubes and/or ovaries may be included with this hysterectomy. You will have a few small incisions on your abdomen as well as in your vagina.
  • Total Laparoscopic Hysterectomy (TLH):
    • The uterus is removed wholly through a laparoscope. There will be a series of small incisions on the abdomen, through which instruments are used to remove the uterus in sections. The removal of the fallopian tubes and/or ovaries may be included with this hysterectomy. The recovery time for this procedure is usually much shorter than with an abdominal hysterectomy.

 

Cold Knife Cone

The purpose of a cold knife cone biopsy is to diagnose and treat precancerous changes in the cervix. Your physician may recommend this treatment if your pap test or colposcopy results come back showing severe dysplasia. This procedure is usually done under general anesthesia in an outpatient setting. During this procedure, a small cone-shaped sample of tissue is removed from the cervix and sent to the lab for analysis. If the surgical margins are free of disease, you may not require any additional treatment. Following the procedure, you may experience vaginal discharge and/or bleeding while the cervix heals.

Pelvic Floor Repair

A woman’s pelvic floor muscles can stretch and weaken following pregnancy and childbirth and with the aging process. When these muscles weaken, the bladder, uterus, or rectum’s position may lower, causing pressure on the vagina. Depending on the type and severity of pelvic support problem you have, your physician may recommend surgical correction. Pelvic support surgery is typically done when a woman is done with childbearing, as the uterus may have to be removed in order to correct the problem. These procedures can be done through the vagina or through an abdominal incision. There are different methods of pelvic floor repair; your physician will discuss the options that are available to you depending on your individual needs.

Bladder Suspension

Urinary incontinence, or loss of bladder control, is a common problem in many women. The urethra, which prevents the leakage of urine from the bladder, may change position as a result of pelvic floor relaxation. This can cause incontinence issues. Your physician may recommend a bladder suspension if you have urinary incontinence that has been unresponsive to lifestyle and/or behavioral changes, medication, physical therapy, or if your symptoms are severe enough to affect your quality of life. There are different methods of bladder suspension; your physician will discuss the options available, depending on your individual needs. This procedure is usually done under general anesthesia, and typically requires an overnight stay at the surgical facility. During the procedure, a sling, or mesh tape is placed underneath the urethra in order to support the bladder neck and urethra in a more natural position.