Gynecological Procedures

Treatment options in gynecologic problems

Vulvo-Vaginal Cosmetic Surgery

Laser Vaginal Rejuvenation is a one-hour outpatient surgical procedure designed to enhance sexual gratification. According to Master and Johnson, sexual gratification is directly related to the amount of frictional forces generated. We can accomplish this with LVR. LVR is the modification of a gynecological surgical procedure used for the treatment of stress urinary incontinence. Our laser techniques result in gentle precision procedures with controlled accuracy that results in relatively bloodless surgery. Our pioneered techniques result in rapid healing and resumption of daily activities in a short period of time.

Click here to learn more.

Cervical Disease

The Pap test can detect changes in the cells of the cervix at an early stage. Some of the changes include infections, exposure to the wart virus, dysplasia (pre-cancerous changes of the cervix), cancer of the cervix.

Colposcopy:

Colposcopy is the next test performed if a Pap test is abnormal. This is an office procedure, and is minimally painful. The cervix is looked at through a magnifying instrument, which helps the doctor to see the abnormal cells better. If the areas of abnormality are of significance, small biopsies are performed. These small pieces of cervix are evaluated under the microscope by Doctors to detect any dysplasia and to be classified----mild, moderate, severe or precancerous growth. Sometimes colposcopic biopsies reveal a slight infection and inflammation as opposed to dysplasia.

Leep Procedure:

Loop electrocautery excision of the cervix is an office procedure. When the colposcopic biopsies come back consistent with dysplasia, a leep may be performed. After application of local anesthesia, with the help of a special instrument the superficial layers of the cervix will be removed and sent to pathology for further evaluation. The biopsied area of the cervix will be cauterized to avoid any bleeding. Evaluation by pathologists allow us to evaluate the extent of the growth of dysplasia and will assure us removal of all abnormal cells. The cure rate for dysplasia by the Leep procedure is 90-95%. Patients will be followed with Pap smears for some time after the procedure.

Cone Biopsy:

Cone Biopsy is an extensive removal of the abnormal cells of the cervix. This procedure is reserved for patients with severe dysplasia (pre-cancerous cells) and carcinoma insitu (one step below cancer). This procedure is either performed in the office or at an outpatient facility.

Abnormal Bleeding / Irregular Cycles

Menstrual cycles of 21-35 days are considered normal . Cycles longer or shorter than this are irregular and should be evaluated by your doctor. Irregular cycles may occur because of weight loss or gain, vigorous exercise, stress illness, or other changes that affect your body. For the first few years after menarche, menstrual periods are often irregular. A young woman may have only three or four periods a year. Menstrual cycles usually become lighter and less frequent as menopause approaches and hormone levels decrease. In some cases the cycles will become erratic and heavier around perimenopause.

Bleeding that is heavier than usual, or lasts longer than a week may also be abnormal. It can have a number of abnormal causes such as hormonal imbalance, coagulation disorders( problems with blood clotting) uterine polyps, uterine fibroids (benign tumors of the uterine muscle), uterine adenomyosis (sponginess), hyperplasia (pre-cancerous growth), cancer.

• Non-Surgical Treatments:

  Medical treatment with birth control pills, hormones, and other homeopathic and conventional medications is the first line of therapy for the treatment of irregular bleeding and heavy periods in our practice.

• Surgical Treatments:

  If medical options do not work or are not the appropriate treatment option for the disorder, the following surgical options can be recommended.

• Dilation and Curettage:

  D&C is a very common surgical operation . The procedure is performed under general anesthesia which is very safe. The cervix(opening to the uterus) is dilated with the help of instruments, and the lining of uterus is then removed. Sometimes doctors may perform hysteroscopy at the same time as the D&C. A thin telescope - like instrument is inserted through the cervix and allows the doctors to visualize the lining of the uterus directly. These procedures are performed to empty the uterus after a miscarriage

  • to remove polyps in the uterus which may cause irregular bleeding
  • to remove pre-cancerous or cancerous overgrowth of the lining of the uterus

• Uterine Lining Ablation

  This is a procedure which is performed at the time of a D&C. The lining of the uterus is burned with special equipment under general anesthesia. Patients do not feel any burning pain. The scar tissue which forms from the burning process will either stop any bleeding from the uterus, or minimize it during the menses. The success rate of this procedure in our practice is 60-65%. This procedure is performed as a treatment for the following problems:

  • Heavy menstrual cycles
  • Adenomyosis - which causes heavy bleeding
  • Uterine fibroids

• Cryotherapy of Uterus
• Freezing of the lining of the uterus
• The concept is the same as Balloon Ablation except instead of using heat the lining of the uterus is frozen.

• Myomectomy:

  Myomectomy is a surgical procedure that removes only the fibroid, leaving the uterus intact. Fibroids are overgrowths of the smooth muscle of the uterine wall. Fibroids can occur as one single growth or multiple growths. Myomectomy can be performed through an open abdominal incision or through laparoscopic techniques(small abdominal incisions through which instruments are introduced to the abdomen to perform the myomectomy). Myomectomy is performed in patients that are interested in future fertility or preservation of the uterus for other reasons.

• Radiologic Fibroid Embolization:

  Radiologic Fibroid Embolization is a procedure that blocks the blood supply to the fibroids, causing them to shrink. This procedure is performed in the hospital byInterventional Radiologists. This procedure is less invasive than conventional surgery and has a success rate 60-75%. Embolization is reserved for patients who are done with child bearing, and are perimenopausal or menopausal.

• Hysterectomy

  • vaginal, abdominal
  • Laporoscopic supracervical
  • Laporoscopic total

  The goal in our practice is to allow every patient to explore all options prior to definitive surgery. We feel it is your right to know that there are other methods of treatment besides hysterectomy, and we are willing to try all options.

Hysterectomy

Hysterectomy is the removal of the uterus and is one of the most common types of surgery performed in women. A hysterectomy is one way of treating problems affecting the uterus. In our practice we explore all options with our patients prior to recommending a hysterectomy. Some of the reasons women end up with a hysterectomy are: uterine fibroids, endometriosis, uterine prolapse, cancer, endometrial hyperplasia (heavy growth of uterine lining), menstrual and menopausal symptoms, cervical dysplasia (precancerous changes) and pain.

There are different kinds of hysterectomy:

1. partial or supracervical - cervix is left behind
2. total hysterectomy - uterus and cervix are removed completely
3. radical - for cases of cancerous growth
4. hysterectomy can be combined with the removal of the tubes and the ovaries - this is called salpingo-oopherectomy

There are different methods to perform a hysterectomy

1. Vaginal Hysterectomy

   The uterus, cervix and tubes and ovaries are removed through incisions through the vagina. All the blood vessels are sutured vaginally. Most patients can go home from the hospital the day after the surgery and they can return to work or normal activity within 2-4 weeks after surgery.

2. Abdominal Hysterectomy

   The uterus, cervix and tubes and ovaries are removed through an incision in the lower abdomen. Most patients can go home within24-48 hours after surgery. And they can return to work or normal activity within 4-6 weeks after surgery.

3. Laproscopic Supracervical Hysterectomy

   The uterus and tubes and ovaries are removed through very small abdominal incisions. Through these incisions small operative instruments are introduced, and the procedure is performed. Most patients can go home the day after surgery, and can return to normal activity within 1-2 weeks.
   Learn more about Laproscopic Supracervical Hysterectomy.

4. Laproscopic Assisted Vaginal Hysterectomy

   A combination of a vaginal hysterectomy and laporoscopy will allow the doctor to release adhesions and assist in removal of the uterus without an abdominal incesion.

*It is important to understand that your physicians will educate you about the best route of surgery for your particular case. Our goal is to have our patients have the safest, most comfortable surgery and to be able to return to normal activity as soon as possible.

Endometrial Ablation

Many women have long, heavy and painful periods. This is known as abnormal uterine bleeding. One treatment for this is uterine ablation. This procedure involves destroying cells in the endometrium or lining of the uterus.

Who should consider this treatment?

Women who have heavy, long and/or painful periods. Women who are finished with childbearing and no longer wanting pregnancy.

How Effective Is Ablation?

Ablation helps decrease the amount and length of your periods. Most women see a significant decrease. Some women may have very minimal to no period after ablation. Additionally, some women may require a repeat ablation or further treatment. Approximately 92% of women are satisfied with their ablation.

What Tests Will I Need Before Ablation?

Women considering ablation will need to have a sonohystogram and endometrial biopsy. These tests allow us to see the lining of the uterus to check for causes of abnormal uterine bleeding such as polyps, fibroids, etc. These tests are performed in out office.

Is Ablation Birth Control?

No, although ablation destroys endometrial cells in the lining of the uterus, it does not prevent ovulation. It may still be possible to become pregnant. After ablation, it will still be necessary to use some type of birth control.

How Is Ablation Performed?

Uterine ablation is performed vaginally. There are no incisions necessary.

What Are The Options For Ablation?

Dr. Simon offers two types of ablation: Her Option and Novasure. HerOption is cryoablation that involves freezing the endometrial cells with a wand. It may be necessary to freeze several zones of the uterus. This procedure is performed in our office. Novasure is ablation that involves heating and burning the endometrial cells. A gold mesh expands within the uterus, heats and is then retracted. This procedure is performed in an outpatient surgical center. The both Novasure and HerOption were approved by the in 2001.A comparison of these 2 procedures is provided below.

What Can I Expect After Ablation?

What Risks Are There With Ablation?

Risks include uterine perforation, bleeding infection and injury to other organs in the pelvis or abdomen. Safety precautions are followed to minimize these risks. Uterine ablation may also cause a delay in diagnosis of endometrial cancer since one of the warning signs of abnormal bleeding.

For more information on these ablation procedures you can visit their websites at www.heroption.com and www.novasure.com

Robotic Hysterectomy

Many women have a hysterectomy to treat cancer, chronic pain, irregular bleeding, uterine prolapse, fibroid or endometriosis. Previously, this surgery was traditionally performed with an abdominal incision. Today, women have additional options for hysterectomy including: vaginal, laparoscopic and computer assisted daVinci.

These types of hysterectomies are considered minimally invasive. These less invasive surgeries provide many benefits over the open abdominal surgery. They allow for a shorter hospital stays and faster recovery times. Additionally, these surgeries decrease risk of infection, reduce pain, blood loss and scarring.

www.davincihysterectomy.com

The vaginal approach to hysterectomy often includes a laparoscopic assist. Laparoscopy involves making small incision in the abdomen to allow instruments and cameras to aid in the surgery. The daVinci hysterectomy is similar to laparoscopy. However, the daVinci also provides increased precision of surgical instruments.

Although the daVinci is sometimes refer to as a robotic surgery, it is more correctly described as a computer aided surgery. The computer can not move or decisions on its own. It must have input or be directed by the surgeon. The computer takes this input and refines it to reduce tremors and provide highly precise movements.

During the operation, the surgeon sits at a computer console with a monitor screen. A computer cart, which has 3 or 4 arms, is placed next to the patient. The surgeon controls the arms of the cart from the console while observing real time images. An assistant stands with the patient to aid with the passing of instruments to the computer cart.

The daVinci was approved by the FDA for hysterectomy in 2005. However, it has been in use for studies since 1999. For more information you can visit www.daVinciSurgery.com

Pelvic Pain

There are many different causes of pelvic pain and painful menstruations. Some patients may also have pain with intercourse and other activities. Appropriate diagnosis of pelvic pain is the key to successful treatment of the symptoms.

Some of the reasons for Acute (sudden) and Chronic pelvic pain are as follows:

• Enlarged ovarian or tubal cysts
• Ovarian or tubal torsion or twisting
• Pelvic infections and pelvic inflammatory disease
• Fibroids - benign muscular growths of the uterus
• Endometriosis - implantion of the lining of uterus
  Outside the uterus
• Adenomyosis - implantation of the lining of the Uterus in the muscle of the uterus
• Pelvic adhesions and scar tissues
• Pregnancy,miscarriage or ectopic pregnancy
• Non-gynecological reasons including bowel and bladder problems

Steps towards diagnosis of the cause of the pelvic pain are multiple and include medical and surgical evaluations. The following list is some of the steps that we can take towards diagnosis and treatment of the patients:

• Physical and laboratory examination
• Cervical cultures to rule out infections
• Pelvic ultrasound for ruling out ovarian cysts, fibroids, tubal pregnancy
• Diagnostic laparoscopy - a surgical procedure in which a slender, Light-transmitting instrument is used to view the pelvic organs and look for abnormalities
• Laparoscopic release of adhesions, removal of endometriosis or removal of ovarian cysts. With the help of telescope - like cameras and instruments which are placed in patients abdomen through small incisions, the doctors are able to perform the procedures without having to open the abdomen.
• Myomectomy and fibroid treatments
• Hysterectomy - Click here for more information on this subject.

Uterine and Vaginal Relaxation

Sometimes the supportive tissues in the female genital track can be compromised and therefore the uterus, bladder and rectum can be prolapsed. Treatment options are vast and include non-surgical and surgical. Simons will work with every individual to find the best possible solution to their specific relaxation problems.

Female Urological Disorders

Urinary incontinence is defined as uncontrolled leakage of urine. There are different categories of incontinence. Our goal is to identify the different types and render the appropriate treatment options. Dr. Armity is trained in the treatment options - both state of the art surgical and non-surgical. Please contact the office for a consultation appointment.

© 2007 - 2009 Armity A. Simon, M.D. Obstetrics and Gynecology

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