Types of Procedures/Surgeries

What is a myomectomy?

Myomectomy is the surgical removal of uterine fibroids without the removal of the uterus. There are several techniques that may be used, and the choice of surgical technique depends on the location and size of the fibroids as well as the characteristics of the woman.

It is sometimes impossible to remove all the fibroids, and new fibroids may grow after a myomectomy. Though myomectomy is the only accepted procedure for fibroids in a woman who wants to maintain fertility, a myomectomy may lead to scarring that can negatively affect future fertility. Following a myomectomy, cesarean delivery is frequently recommended to prevent the myomectomy scar from breaking open during labor. Types of myomectomies include:

• Laparoscopic Myomectomy
• Abdominal myomectomy
• Hysteroscopic myomectomy

What is a hysterectomy?

Hysterectomy is a surgery to remove the uterus. It prevents future pregnancy and eliminates fibroid-related bleeding and pressure symptoms.
There are two categories of hysterectomy:

• Total hysterectomy is removal of the entire uterus, including the cervix (the lower part of the uterus)

  Vaginal hysterectomy

  Laparoscopic total hysterectomy (removal of uterus and cervix)

  Robot-assisted laparoscopic hysterectomy

  Abdominal hysterectomy

• Supra-cervical hysterectomy is removal of the upper part of the uterus, but not the cervix. This type of surgery is not recommended for women with a history of an abnormal Pap smear or certain types of pelvic pain. Up to 5-10% of women may continue to have chronic cyclic bleeding after surgery, similar to a period. It was previously thought that a supra-cervical hysterectomy would preserve sexual function better than a total hysterectomy, but research does not support this theory. Benefits to supra-cervical hysterectomy include slightly faster surgery and shorter recovery time.

  Laparoscopic supracervical hysterectomy (removal of uterus, preservation of cervix)

What is a hysteroscopy?

When abnormalities such as polyps or small fibroids grow inside the uterus, irregular and heavy bleeding can result. In many cases, they can be removed by placing an instrument called a hysteroscope through the cervix to examine the inside of the uterus and then using various instruments to remove or vaporize the fibroid or polyp a little at a time. It takes between 30 and 90 minutes to accomplish, and usually the patient can go home the same day.

What is diagnostic laparoscopy?

In this surgical procedure, a person is in the operating room, under general anesthesia (totally asleep).  Through a small (half inch or less) incision in the belly button, carbon dioxide gas is placed inside the belly to create a space through which the surgeon can see the organs inside.  This is done by putting a small “telescope” (laparoscope) through this small incision and into the bubble of gas.

The surgeon can then look around inside and get a very good view of everything there, especially all the reproductive organs, especially the womb, ovaries, and tubes. With good technique, this surgery can be done safely in women who are significantly overweight or have had prior abdominal or gynecologic surgery.

When the diagnostic part is done, and something has been found that requires surgery, additional small instruments (a quarter of an inch in diameter) are then inserted through one or more small incisions at other locations in the belly wall between the belly button and the groin areas.

What is a laparoscopic excision of endometriosis?

Our clinical experience tells us that better results are obtained when endometriosis is excised (cut out), rather than cauterized or lasered, whenever there is the slightest hint that the disease goes deeper than the most superficial layers of pelvic tissue. We have extensive experience with this technique, including in cases of very advanced (stage IV) disease. We perform about 200 surgeries per year on endometriosis. 

What is a laparoscopic removal of ovarian cysts?

Ovarian cysts up to 10 cm (3.5 inches) in diameter are routinely removed laparoscopically in our division. In some cases in which careful preoperative testing has shown that the risk of a cancer is very low, even much larger cysts have been removed laparoscopically. Once separated from the healthy ovary tissue, the cyst is put in a plastic bag which is removed through a small incision at the navel.  

What is a laparoscopic removal of adhesions (scar tissue)?

When careful evaluation has shown that adhesions may play a role in a person’s abdominal or pelvic pain, we sometimes recommend laparoscopic surgery to try to reduce the amount of adhesions present. This type of procedure is most often helpful when adhesions are mild or moderate in degree.

When adhesions are very severe, long term results are often disappointing. We do find that even if relief is incomplete or temporary, the benefits of the surgery provide an opportunity to more effectively address other parts of the pain problem such as muscle disorders, bowel function problems, deconditioning, excess weight, and depression. 

What is a laparoscopic removal of a tube and ovary?

When an ovary is too involved with a disease process to salvage, it is almost always possible to remove it using laparoscopic techniques. In some cases, it is necessary to divide adhesions between the bowel and the ovary in order to remove the ovary.