Surgical Procedures

Colposcopy is a way of looking at the cervix through a special magnifying device called a colposcope. It shines a light into the vagina and onto the cervix. A colposcope can significantly enlarge the standard view. This exam allows an obstetrician-gynecologist (ob-gyn) to find problems that cannot be seen by the eye alone.

Why is colposcopy done?

Colposcopy is done when cervical cancer screening test results show abnormal changes in the cervix cells. Colposcopy provides more information about the abnormal cells. Colposcopy also may be used to assess other problems, including further

• genital warts on the cervix
• cervicitis (an inflamed cervix)
• benign (not cancer) growths, such as polyps
• pain
• bleeding

Sometimes colposcopy may need to be done more than once. It also can be used to check the result of treatment.

How is the procedure performed?

Colposcopy is typically done in your ob-gyn’s office.

The procedure is best done when a woman is not having her period. This gives the ob-gyn a better view of the cervix. For at least 24 hours before the test, you should not

• douche
• use tampons
• use vaginal medications
• have sex

As with a pelvic exam, you will lie on your back with your feet raised and placed on the footrests for support. A speculum will be used to hold apart the vaginal walls so that the inside of the vagina and the cervix can be seen. The colposcope is placed just outside the opening of your vagina.

A mild solution will be applied to your cervix and vagina with a cotton swab or cotton ball. This liquid makes abnormal areas on the cervix easier to see. You may feel a slight burning.

What should I expect during recovery?

If you have a colposcopy without a biopsy, you should feel fine right away. You can do the things you usually do. You may have a minor spotting for a couple of days.

If you have a colposcopy with a biopsy, you may have pain and discomfort for 1 or 2 days. Over-the-counter pain medications can be helpful. You may have some vaginal bleeding. You also may have a dark discharge for a few days. This may occur from medication used to help stop bleeding at the biopsy site. You may need to wear a sanitary pad until the discharge stops.

Your ob-gyn may suggest you limit your activity for a brief time. While the cervix heals, you will be told not to put anything into your vagina for a short time.

Cryotherapy is a freezing technique used to destroy diseased tissue.

Cryotherapy is a type of ablative treatment in which an instrument is used to freeze abnormal cervical tissue, which then sloughs off.

Loop electrosurgical excision procedure (LEEP) is a treatment to remove precancerous cells from the cervix. Removing precancerous cells helps stop them from developing into cervical cancer.

The procedure uses a small wire loop attached to an electrical current. When the loop is passed over cervical tissue, it cuts away a layer of abnormal cells. The removed tissue is sent to a lab for testing.

What happens during a LEEP?

You will lie on an exam table and place your legs in stirrups to start the procedure. Your ob-gyn will insert a speculum into your vagina in the same way as for a pelvic exam. Your ob-gyn may use a colposcope to see the cervix better.

Local anesthesia may be used to numb the cervix. Your ob-gyn also may apply a vinegar solution to the cervix to see the abnormal cells better. Application of this solution or the numbing medication may sting.

The loop is inserted through the speculum and passed over the cervix to cut away abnormal tissue. You may feel pressure, a dull ache, or a cramp. Some women feel faint during the procedure. If you feel faint, tell your ob-gyn. After the abnormal cells have been removed, a special paste may be applied to the cervix to stop bleeding.

The tissue that is removed will be sent to a lab. Your obstetrician-gynecologist (ob-gyn) should let you know the results when the testing is complete.

The procedure should be done when you do not have your menstrual period to better view the cervix. In most cases, LEEP is done in the office of an ob-gyn. The procedure takes a few minutes.

What should I expect during recovery from LEEP?

After the procedure, you may have

• a watery, pinkish discharge
• mild cramping
• a brownish-black discharge (from the paste used)

It will take a few weeks for your cervix to heal. While your cervix heals, you should not place anything in the vagina, such as tampons or douches. You should not have sexual intercourse. Your ob-gyn should tell you when it is safe to do so.

You should contact your ob-gyn if you have any of the following problems:

• Heavy bleeding (more than your normal period)
• Bleeding with clots
• Severe abdominal pain

A procedure in which a small amount of the tissue lining the uterus is removed and examined under a microscope.

Endometrial ablation destroys a thin layer of the lining of the uterus. Menstrual bleeding does not stop but is reduced to normal or lighter levels. If ablation does not control heavy bleeding, further treatment or surgery may be needed.

Why is endometrial ablation done?

The lining of the uterus—the endometrium—is shed by bleeding each month during menstruation. Some women have heavy bleeding or bleeding that lasts longer than usual.

Endometrial ablation is used to treat many causes of heavy bleeding. In most cases, women with heavy bleeding are treated first with medication. Endometrial ablation may be used if heavy bleeding cannot be controlled with medication.

Endometrial ablation does not involve the removal of the uterus, and it does not affect a woman’s hormone levels.

How is endometrial ablation done?

Ablation is a short procedure. Some techniques are done as outpatient surgery, meaning you can go home the same day. Others are done in the office of your ob-gyn. Your cervix may be dilated (opened) before the procedure. Dilation is done with medication or a series of rods that gradually increase in size.

There are no incisions (cuts) involved in ablation.

The following methods are those most commonly used to perform endometrial ablation:

• Radiofrequency—A probe is inserted into the uterus through the cervix. The probe’s tip expands into a mesh-like device that sends radiofrequency energy into the lining. The energy and heat destroy the endometrial tissue while suction is applied to remove it.
• Freezing—A thin probe is inserted into the uterus. The tip of the probe freezes the uterine lining. Ultrasound is used to help guide the procedure.
• Heated fluid—Fluid is inserted into the uterus through a hysteroscope. The fluid is heated and stays in the uterus for about 10 minutes. The heat destroys the lining.
• Heated balloon—A balloon is placed in the uterus with a hysteroscope. Heated fluid is put into the balloon. The balloon expands until its edges touch the uterine lining. The heat destroys the endometrium.
• Microwave energy—A special probe is inserted into the uterus through the cervix. The probe applies microwave energy to the uterine lining, which destroys it.
• Electrosurgery—Electrosurgery is done with a resectoscope. A resectoscope is a thin telescope that is inserted into the uterus. It has an electrical wire loop, roller-ball, or spiked-ball tip that destroys the uterine lining. This method usually is done in an operating room with general anesthesia. It is not as frequently used as the other methods.

What should I expect after the procedure?

Recovery takes about 2 hours, depending on the type of pain relief used. The type of pain relief used depends on the ablation procedure, where it is done, and your wishes.

Some minor side effects are common after endometrial ablation:

• Cramping, like menstrual cramps, for 1 to 2 days
• Thin, watery discharge mixed with blood can last a few weeks. The discharge may be heavy for 2 to 3 days after the procedure.
• Frequent urination for 24 hours
• Nausea

Ask your ob-gyn when you can exercise, have sex, or use tampons. In most cases, you can expect to return to work or your normal activities within a day or two.

It would help if you had follow-up visits to check your progress. It may take several months before you experience the full effects of ablation.

Hysterectomy is surgery to remove the uterus. It is a very common type of surgery for women in the United States. Removing your uterus means that you can no longer get pregnant.

Hysterectomy is used to treat many women’s health conditions. Some of these conditions include

• uterine fibroids (this is the most common reason for hysterectomy)
• endometriosis
• pelvic support problems (such as uterine prolapse)
• abnormal uterine bleeding
• chronic pelvic pain
• gynecologic cancer

There are different types of hysterectomy:

• Total hysterectomy—The uterus and cervix are removed.
• Supracervical hysterectomy—The upper part of the uterus is removed, but the cervix is left in place.
• Radical hysterectomy—The uterus and cervix are removed, and structures around the uterus. This surgery may be recommended if cancer is diagnosed or suspected.

If needed, the ovaries and fallopian tubes may be removed if abnormal (for example, they are affected by endometriosis). This procedure is called

• salpingo-oophorectomy if both tubes and ovaries are removed
• salpingectomy if just the fallopian tubes are removed
• oophorectomy if just the ovaries are removed

What should I expect after having a hysterectomy?

You can expect to have some pain for the first few days after the surgery. You will be given medication to relieve pain. You will have bleeding and discharge from your vagina for several weeks. Sanitary pads can be used after the surgery. Constipation is common after most hysterectomies. Some women have temporary problems with emptying the bladder after a hysterectomy. Other effects may be emotional. It is not uncommon to have an emotional response to a hysterectomy. You may feel sad that you can no longer bear children, or you may be relieved that your former symptoms are gone.

Follow your surgeon’s instructions. Be sure to get plenty of rest, but you also need to move around as often as possible. Take short walks and gradually increase the distance you walk every day. You should not lift heavy objects until your surgeon says you can. Do not put anything in your vagina during the first six weeks. That includes douching, having sex, and using tampons.

After you recover, you should continue to see your obstetrician-gynecologist (ob-gyn) for routine gynecologic exams and general health care. Depending on the reason for your hysterectomy, you may still need pelvic exams and cervical cancer screening.

Many surgeons perform robotic-assisted surgery using a da Vinci system because it extends the capabilities of their eyes and hands.

Your surgeon is with you in the operating room, seated at the da Vinci system console. The console gives your surgeon control of their instruments to perform your surgery.

The da Vinci vision system delivers 3D high-definition views, giving your surgeon a crystal-clear view of the surgical area that is magnified ten times what the human eye sees.

Your surgeon uses tiny instruments that move like a human hand but with a far greater range of motion. The system’s built-in tremor-filtration technology helps your surgeon move each instrument with smooth precision.

The pelvic organs include the vagina, uterus, bladder, urethra, and rectum. These organs are held in place by muscles of the pelvic floor. Layers of connective tissue also give support. Pelvic organ prolapse (POP) occurs when tissue and muscles can no longer support the pelvic organs and drop down.

How does reconstructive surgery treat pelvic organ prolapse?

The goal of reconstructive surgery is to restore organs to their original position. Some types of reconstructive surgery are done through an incision in the vagina. Others are done through an incision in the abdomen or with laparoscopy.

Sacrocolpopexy is used to treat vaginal vault prolapse and enterocele. It can be done with an abdominal incision or with laparoscopy. Surgical mesh is attached to the front and back walls of the vagina and then to the sacrum (tail bone). This lifts the vagina back into place.

What is involved in recovery after surgery to treat pelvic organ prolapse?

Recovery time varies depending on the type of surgery. It would help if you usually took a few weeks off from work. For the first few weeks, you should avoid vigorous exercise, lifting, and straining. You also should avoid sex for several weeks after surgery.

Laparoscopy is a way of doing surgery using small incisions (cuts). It is different from “open” surgery, where the incision on the skin can be several inches long. Laparoscopic surgery sometimes is called “minimally invasive surgery.”

Laparoscopic surgery uses a special instrument called a laparoscope. The laparoscope is a long, slender device inserted into the abdomen through a small incision. It has a camera that allows the obstetrician-gynecologist (ob-gyn) to view the abdominal and pelvic organs on a screen.

If a problem needs to be fixed, other instruments can be used. These instruments usually are inserted through additional small incisions in the abdomen. They sometimes can be inserted through the same single incision made for the laparoscope. This type of laparoscopy is called “single-site” laparoscopy.

Laparoscopy has many benefits. There is less pain after laparoscopic surgery than open abdominal surgery, which involves larger incisions, more extended hospital stays, and longer recovery times. Recovery from laparoscopic surgery generally is faster than recovery from open abdominal surgery. The smaller incisions that are used allow you to heal faster and have smaller scars. The risk of infection also is lower than with open surgery.

What problems can laparoscopy be used to diagnose and treat?

Laparoscopy may be used to look for the cause of chronic pelvic pain, infertility, or a pelvic mass. If a problem is found, it can often be treated during the same surgery. Laparoscopy also is used to diagnose and treat the following medical conditions:

• Endometriosis—A laparoscopy may be recommended if you have signs and symptoms of endometriosis and medications have not helped. The laparoscope is used to see inside your pelvis. If endometriosis tissue is found, it can often be removed during the same procedure.
• Fibroids—Fibroids are growths that form inside the uterus wall or outside the uterus. Most fibroids are benign (not cancer), but a minimal number are malignant (cancer). Fibroids can cause pain or heavy bleeding. Laparoscopy can sometimes be used to remove them.
• Ovarian cyst—Some women have cysts that develop on the ovaries. The cysts often go away without treatment. But if they do not, your ob-gyn may suggest that they be removed with laparoscopy.
• Ectopic pregnancy—Laparoscopy may be done to remove an ectopic pregnancy.
• Pelvic floor disorders—Laparoscopic surgery can treat urinary incontinence and pelvic organ prolapse (POP).
• Cancer—Some types of cancer can be removed using laparoscopy.