All Gynaecological Procedures/Surgeries

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It is understandable that you may have concerns about any procedure your gynecologist recommends. Sometimes further evaluation of a gynae issue is necessary, so your doctor may recommend that you have a procedure or surgery. Learning as much as you can is a good idea, but it's also important to have a good conversation with your doctor. Ask her any questions you may have and don't forget to tell her if you may be pregnant.

These procedures can be:

  • Diagnostic
  • Therapeutic
  • Combination (diagnostic as well as therapeutic)

The following are common Gynaecological procedures and surgeries that Dr. Shweta Mishra performs:

1. Diagnostic Procedures

The following are common Gynaecological procedures and surgeries that Dr. Shweta Mishra perform:

Cervical Biopsy : A cervical biopsy is performed to evaluate abnormal cervical tissue found during a Pap test or colposcopy.

Endocervical Curettage (ECC) : This procedure is frequently done in conjunction with a cervical biopsy. It involves taking a sample of the tissue just past the opening of the cervix as a precaution against missing any abnormal tissue.

Endometrial or Uterine Biopsy : This test, done to obtain a sample of the endometrial lining of the uterus, may be used to investigate abnormal menses (heavy bleeding, bleeding between periods, post-menopausal bleeding), infertility, and chronic infections. It is useful in detecting uterine polyps,uterine fibroids, uterine cancer, and adenomyosis.

2. Therapeutic Procedures

Adhesiolysis : This is also called lysis of adhesions. Cutting of adhesions (scar tissue).

Prolapse surgeries : If your symptoms are severe and nonsurgical treatments haven’t helped, you may want to consider surgery. There are two types of prolapse surgery: obliterative and reconstructive.

Obliterative surgery : narrows or closes off part or all of the vagina.

Reconstructive surgery : aims to repair the pelvic floor and return organs to their original position. There are a number of reconstructive surgeries your doctor can perform to restore the appearance and function of your pelvic organs. They include:

  • Sacrospinous ligament fixation and uterosacral ligament suspension. This procedure is designed to improve the support to the uterus or vaginal vault. Your own tissue (or vaginal mesh, discussed below) is used to fix or suspend the sagging pelvic organs. Your surgeon will make a cut in the vagina and use stitches to attach the vaginal vault to a ligament in the pelvis. The stitches may be permanent or dissolve over time.
  • Anterior and posterior colporrhaphy The goal here is to make the tissue that holds the pelvic organs in place tighter and stronger. Anterior repair is used when the bladder drops and presses against the front of the vagina. Posterior repair is used when the rectum drops and pushes into the back of the vagina. This procedure is also done through the vagina by using your own tissues or vaginal mesh to repair the prolapse.
  • Sacrocolpopexy and sacrohysteropexy These procedures use surgical mesh to fix and anchor organs that have dropped down. Sacrocolpopexy is used to repair prolapse of the vaginal vault. Sacrohysteropexy is used to fixed prolapse of the uterus. These operations are done with cuts in the abdomen. They can also be done laparoscopically.

Hysterectomy : This procedure is removal of the uterus. It can be:

  • A partial hysterectomy—removal of the upper portion of the uterus, leaving the cervix)
  • A total hysterectomy—removal of the entire uterus and cervix.
  • A radical hysterectomy—removal of the uterus, the tissue on both sides of the cervix, and the upper part of the vagina.

The Fallopian tubes and ovaries may also be removed at the time of hysterectomy. When the ovaries are also removed, a hysterectomy can relieve the pain of endometriosis. A hysterectomy may be done through open abdominal surgery, laparoscopic surgery, or hysteroscopic surgery.

Myomectomy : This procedure is done to remove uterine fibroids without hysterectomy for women who wish to become pregnant or do not want to lose their uterus. Myomectomies may be performed through conventional open abdominal surgery, with laparoscopic techniques or hysteroscopically, depending on the location of the fibroids.

Oophorectomy : Oophorectomy is the surgical removal of one ovary, both ovaries or a part of an ovary. It is performed to treat ovarian cancer, pelvic inflammatory disease and endometriosis or remove cysts or abscess. It may also be done to remove the main source of estrogens that stimulate the growth of some breast cancers. If one ovary is removed, a woman may continue to menstruate and have children. If both ovaries are removed, menstruation stops and a woman loses the ability to bear children.

Suspensions :

  • Uterine
  • Vaginal Vault

Tubal Surgeries :

  • Removal of Fallopian tubes
  • Tubal ligation
  • Correction of tubal pregnancy
  • Reanastomosis - reconnection of the Fallopian tubes
  • Wire guide cannulation to open a blocked tube

3. Combination

Dilation and Curettage (D&C)During a D&C procedure, the cervix is dilated (widened) to allow the insertion of an instrument called a curette into the uterus. The curette is used to scrape lining of the uterus (endometrium) and collect the tissue from inside the uterus. It may be performed to remove tissue for diagnostic examination, to remove small tumors or to treat abnormal uterine bleeding. A D&C may also be performed to remove remaining material after an incomplete miscarriage or abortion. This is called an aspiration or suction D&C and removes tissue from the uterus with a vacuum device.

HysteroscopyThis procedure is done to look for uterine abnormalities. A thin, telescope-like instrument (a fiberoptic endoscope called a hysteroscope) is inserted through the vagina and cervix into the uterus. If an abnormality is detected during a diagnostic procedure, a surgical procedure can often be performed immediately by substituting a surgical hysterosope (one that allows operating instruments to be inserted through it to the uterus). Surgical procedures may include:

  • Removal of polyps, fibroid tumors, scar tissue, or tissue overgrowth [hyperplasia]
  • Opening blocked fallopian tubes [recanalization]

LaparoscopyThis procedure is done to examine and treat abdominal and pelvic organs through a small surgical viewing instrument (laparoscope) inserted into the abdomen at the navel. Depending on your condition doctor may also take tissue samples, remove scar tissue, repair your uterus, or remove your ovaries.