Sometimes in obstetric emergencies, a hysterectomy is needed after the baby is born. Usually that happens at the time of a cesarean, but this patient needed a hysterectomy following a vaginal delivery. This was the first time laparoscopy had ever been used to perform a hysterectomy right after delivery, and we published the case in the Journal of Minimally Invasive Gynecology.
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This is an example of a patient who had a hysterectomy and the ovaries removed for advanced endometriosis. The disease had invaded her rectum and a small portion of the intestine needed to be removed to get rid of all the endometriosis.
Sometimes fibroids can grow to be quite large and, in this case, the location caused it to prevent urine from passing from the kidney to the bladder and also obstructed her rectum, causing nausea, vomiting, and weight loss.
This was a unique situation where this young woman's pelvic organs didn't form normally and she needed to have her uterus removed and vagina reconstructed at an early age. Her ovaries were enlarged and scarred from endometriosis, making difficult to even find one of them.
In very rare cases, a pregnancy can implant in places it's not supposed to, known as an ectopic pregnancy. In this case, the pregnancy started growing in her cesarean scar. The condition was treated with medicine, but we needed to go in and remove the old pregnancy tissue and revise her cesarean scar to prevent this from happening again.
UNC is one of only a few centers around the world that does in utero surgeries for certain conditions. The surgery is performed similar to a cesarean--the baby is delivered from the uterus, the problem is corrected, and the baby is then put back into the uterus to continue growing until it's time for delivery. In this case, the incision that was used to deliver the baby was leaking amniotic fluid and had to be closed back together while the patient was still pregnant.
This patient had a large benign cyst diagnosed at the beginning of her third trimester. Laparoscopic surgery can be safely accomplished during pregnancy, but it becomes increasingly difficult the larger the baby and uterus grow. In this case, we were able to remove her cyst at her advanced gestation with laparoscopy and without rupturing (breaking) the cyst.
This is not a very common procedure, but occasionally when a woman has pain associated with the uterus and hysterectomy isn't appropriate, we perform an operation that interrupts the nerves that carry pain signals from the uterus to the spinal cord.
The patient presented here underwent laparoscopic myomectomy for fibroids that were contributing to her heavy bleeding. She also had a history of recurrent pregnancy loss due to cervical insufficiency and thus underwent concomitant cerclage placement.