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Laparoscopic Hysterectomy

A hysterectomy is a surgical procedure to remove a woman's uterus, which is the organ where a baby grows during pregnancy. In some cases, other reproductive organs like the fallopian tubes, ovaries, and cervix may also be removed. These organs are situated in the lower abdomen. The cervix is the lower part of the uterus, the ovaries produce eggs and hormones, and the fallopian tubes transport eggs from the ovaries to the uterus.

Undergoing a hysterectomy means you will no longer have menstrual periods and cannot become pregnant.

Hysterectomy

 

Types of Hysterectomy

  1. Partial/Subtotal Hysterectomy - Removes the upper part of the uterus but leaves the cervix intact.
  2. Total Hysterectomy - Removes both the uterus and cervix. This is the most common form.
  3. Radical Hysterectomy - Used mainly for certain cancer cases; removes the uterus, cervix, upper part of the vagina, and surrounding tissues.
  4. Bilateral Salpingo-oophorectomy - Often performed with a hysterectomy, this involves removing both ovaries and fallopian tubes.

Removing the ovaries before menopause can lead to sudden menopause, often with more severe symptoms than natural menopause.

Prevalence

Hysterectomy is the second most common major surgery among women in the United States, after caesarean section. Each year, over 600,000 hysterectomies are performed, and by age 60, about one-third of American women have had this surgery. This is approximately 21% among women of all ages.

In Europe the figure is lower at 11.4%

Procedure

Hysterectomies can be performed through abdominal surgery or vaginally, and sometimes with the assistance of a laparoscope, an instrument that helps see inside the abdomen. The choice of procedure depends on the reason for the surgery. Abdominal hysterectomies are more common and typically have a longer recovery period.

Reasons for Hysterectomy

  1. Uterine Fibroids - Noncancerous tumours in the uterus, often not requiring treatment unless they cause symptoms.
  2. Endometriosis - A condition where uterine lining tissue grows outside the uterus, causing pain and other issues.
  3. Uterine Prolapse - When the uterus descends into the vagina, usually treated with non-surgical options first.
  4. Cancers - Such as endometrial, cervical, and ovarian cancers, may necessitate a hysterectomy.
  5. Other Reasons - Chronic pelvic pain, heavy or abnormal bleeding, and chronic pelvic inflammatory disease.

Alternatives and Considerations: If you have non-cancerous conditions like fibroids, endometriosis, or uterine prolapse, it's often recommended to explore other treatments before considering a hysterectomy. For cancerous conditions, a hysterectomy may be essential.

It's important to understand your condition thoroughly and discuss all possible treatment options with your healthcare provider. While a hysterectomy can provide relief from severe symptoms and improve quality of life for many women, it also carries risks like any major surgery, including potential complications, urinary incontinence, early menopause, depression, and sexual dysfunction.

If you're advised to undergo a hysterectomy, it's crucial to weigh the benefits and risks and consider all available options.

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Types of Uterine Fibroids

Uterine fibroids

Fibroids Removal

Fibroids & Myomectomy

Fibroids

Description - Fibroids are non-cancerous growths that develop in or on the uterus. They vary greatly in size and number and are made of muscle and fibrous tissue.

Symptoms - Many women with fibroids experience no symptoms. When symptoms do occur, they can include heavy menstrual bleeding, prolonged periods, pelvic pain or pressure, frequent urination, difficulty emptying the bladder, constipation, and backache or leg pains.

Risk of Cancer - The risk of a fibroid being cancerous is very low.

Uterine Fibroids Treatment

Uterine fibroids treatment

 

Myomectomy (Surgical Treatment for Fibroids)

Description - A myomectomy is a surgical procedure to remove fibroids from the uterus. It is often recommended for women who wish to maintain fertility or who want to keep their uterus for other reasons.

Types of Myomectomy

Laparoscopic Myomectomy

A minimally invasive procedure. Small incisions are made in the abdomen, and a laparoscope (a thin, lighted telescope with a camera) is used to guide the surgery. Instruments are inserted through these incisions to remove the fibroids. The advantages of this method include less pain, faster recovery, and minimal scarring.

Abdominal Myomectomy (Open Myomectomy) 

A traditional surgical method where a larger incision is made in the lower abdomen to access the uterus and remove fibroids. This method is usually chosen if there are large or numerous fibroids. The recovery time is generally longer than for a laparoscopic myomectomy.

Recovery

Recovery times can vary based on the method used. Laparoscopic myomectomy usually has a quicker recovery time compared to an abdominal myomectomy. Patients may need to stay in the hospital for a short period following the surgery, and complete recovery may take a few weeks.

Effect on Fertility

Myomectomy can improve fertility in some women. However, the surgery can also cause scar tissue, which might affect fertility. It's important to discuss these risks with a healthcare provider.

In summary, fibroids are commonly occurring benign tumours that may require surgical intervention, especially in cases where they cause significant symptoms or affect fertility. Myomectomy offers a surgical solution with options that range from minimally invasive to more traditional open surgeries, depending on the individual case.

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Endometriosis

Endometriosis Treatment

Endometriosis is a condition where tissue similar to the lining inside the uterus grows outside it.

Symptoms - Pelvic pain, painful periods, pain during intercourse, infertility, heavy menstrual bleeding.

Treatment - Hormone therapy, such as birth control pills or GnRH agonists, reduces hormone levels, thereby reducing pain and slowing endometrial tissue growth. Pain medications are used for relief. Surgical treatment involves removing endometrial tissue via laparoscopy, a minimally invasive procedure with small incisions in the abdomen, using a camera and specialized instruments. In severe cases, a hysterectomy (removal of the uterus) may be recommended. 

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Ovarian surgery

Laparoscopic Tubal and Ovarian Surgery

Various surgical procedures performed on the fallopian tubes and ovaries.

Symptoms vary based on the condition being treated, such as pain or irregular menstruation for ovarian cysts.

Treatment - Laparoscopic surgery, involving small incisions, a camera, and instruments to remove or repair the affected ovaries or fallopian tubes.

This minimally invasive technique reduces recovery time and post-operative pain.

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Pelvic Prolapse Repair

Pelvic organ prolapse occurs when pelvic organs herniate into or out of the vaginal canal, often resulting from weakened support muscles and tissues. Common symptoms include a noticeable mass or protrusion from the vagina, pelvic pressure, backache, and can be accompanied by urinary incontinence, retention, sexual dysfunction, and bowel movement difficulties.

Types of Pelvic Prolapse

Complete Genital Prolaps

Entire female organ protrudes out of the vagina.

Uterine Prolapse

Uterus descends into or through the vagina.

Uterine Prolapse Stages

Vaginal Vault Prolapse

Occurs post-hysterectomy; the top of the vagina descends into the lower portion or inverts completely.

Cystocele 

Bladder protrudes into or through the vagina.

Rectocele

 

Rectocele

Rectum protrudes into or through the vagina.

Enterocele

Bowel protrudes into or through the vagina.

 

Urethrocele

Urethra protrudes into the vagina.

Vaginal Prolapse

Often coexists with other prolapse types.

Treatment Options

Non-Surgical

Lifestyle changes, pelvic floor exercises, vaginal pessaries, hormone replacement therapy.

Surgical

Various procedures to reduce prolapse and restore normal anatomy, performed under general anaesthesia with a brief hospital stay. These include laparoscopic uterine suspension, vaginal vault suspension, and specific repairs for cystocele, rectocele, and enterocele.

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Laparoscopic Lysis of Adhesions

Surgery to remove adhesions (scar tissue) in the abdomen or pelvic area.

Symptoms

Chronic abdominal or pelvic pain, bowel obstruction symptoms like nausea and vomiting.

Treatment

Laparoscopic surgery involves making small incisions in the abdomen and using a laparoscope (a thin tube with a camera and light) and instruments to cut and remove the scar tissue. This minimally invasive approach leads to less pain and quicker recovery.

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Urinary incontinence

Anterior Vaginal Wall Sling with Mesh Operation

Description

A surgical procedure to treat urinary stress incontinence.

Symptoms

Involuntary leakage of urine during physical activity, coughing, sneezing, or laughing.

Treatment

Surgery involves inserting a synthetic mesh through the vagina to support the bladder neck and urethra. 

This mesh acts like a hammock, providing support to prevent urine leakage under stress.

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Retropubic sling

Minimally Invasive Vaginal Surgery and Neurostimulation

Surgical approaches to treat different types of urinary incontinence.

Symptoms

Uncontrolled urine leakage, frequent and urgent need to urinate.

Treatment

Sling procedures involve placing a mesh or natural tissue under the urethra to support it.

Bladder neck suspension lifts and secures the bladder neck and urethra. 

Neurostimulation involves implanting a device that sends electrical pulses to nerves controlling the bladder to regulate its function. These surgeries aim to provide structural support or nerve stimulation to manage incontinence effectively.

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Vitro fertilization

Standard In Vitro Fertilization

Standard In Vitro Fertilization (IVF) is the most common and widely used fertility treatment. The process begins with ovarian stimulation, where fertility drugs are used to encourage the ovaries to produce multiple eggs. Once mature, the eggs are retrieved through a minor surgical procedure. In the laboratory, these eggs are then fertilized with sperm from the partner or a donor. 

After fertilization, one or more embryos are selected for transfer into the woman's uterus, with the hope that implantation will occur, leading to pregnancy. This procedure is often recommended for couples dealing with various infertility issues, including blocked fallopian tubes, severe male factor infertility, or unexplained infertility

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Icsi

Intracytoplasmic Sperm Injection (ICSI)

ICSI is a specialized technique used in conjunction with IVF to enhance fertilization rates, particularly in cases of severe male infertility. 

During ICSI, a single sperm is carefully injected directly into the cytoplasm of an egg using a fine glass needle. This method bypasses the natural fertilization process, which can be crucial when the sperm have difficulty penetrating the egg. 

ICSI has revolutionized treatment for male infertility, offering couples affected by low sperm count, poor sperm motility, or abnormal sperm shape an increased chance of achieving fertilization and pregnancy

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Egg donation

IVF with Donor Eggs or Sperm

IVF with donor eggs or sperm is an effective treatment for individuals or couples who cannot use their own eggs or sperm due to genetic concerns, age-related infertility, or absence of a male partner.

Egg donation involves using eggs from a young, healthy donor, which are then fertilized with the partner's or donor's sperm.

Sperm donation is used when the male partner has very low sperm count or poor sperm quality, or in single women or lesbian couples wishing to conceive. This approach opens up the possibility of parenthood to a broader spectrum of people, including older women, men with severe infertility, and those without a partner.

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Frozen Embryo Transfer (FET)

Frozen Embryo Transfer (FET) is a procedure in which embryos created during an IVF cycle are frozen and stored for future use. This allows couples to have additional attempts at pregnancy without going through the full IVF cycle again. FET has become increasingly popular due to its convenience and the improvement in freezing techniques, which ensure high survival rates of thawed embryos. FET is considered less physically demanding and more cost-effective than a fresh IVF cycle, and recent studies have shown that FET may lead to higher pregnancy rates and healthier outcomes for both the mother and the baby.

Preimplantation Genetic Testing (PGT)

Preimplantation Genetic Testing (PGT) is a powerful technique used to analyse the genetic makeup of embryos before they are transferred to the uterus. PGT aims to identify embryos with chromosomal abnormalities or specific genetic disorders, ensuring that only healthy embryos are selected for transfer.

This technology is particularly beneficial for couples with a known risk of passing on genetic diseases, women of advanced maternal age, and couples with a history of recurrent pregnancy loss. By improving the selection of embryos for transfer, PGT can increase the chances of a successful pregnancy and the birth of a healthy child.

Our mission is to deliver comprehensive and high-quality gynaecological care through advanced medical and surgical practices. Our commitment to excellence is reflected in the benefits of our laparoscopic and minimally invasive approaches, which encompass early recovery, minimized post-operative discomfort, swift return to normal activities, reduced blood loss, and the application of precise surgical techniques.

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FAQ – Gynaecology

Gynaecological surgery encompasses a wide range of procedures performed on the reproductive system by gynaecologists or specialized surgeons. Patients considering gynaecological surgery often have specific questions about the procedure, risks, recovery, and post-operative care. Here are some of the most common frequently asked questions.

What Are The Expected Recovery Times For Gynaecological Procedures?

Recovery varies by procedure:

  • Laparoscopic Hysterectomy  - Initial recovery is 7-10 days, with full recovery in 6-8 weeks.
  • Pelvic Organ Prolapse Repair - Up to 14-21 days for initial recovery, full activity after 2-3 months.
  • Fibroids Removal (Myomectomy) -  7-14 days, depending on the surgical method used.

Am I Suitable For Gynaecological Surgery?

Prior to booking we will require you to complete a detailed Medical History Questionnaire (MHQ).  This will give the consultant surgeon an indication as to whether you are a suitable candidate for surgery.   During your consultation with the Surgeon you will be able to ask questions and discuss any concerns.

How Long Is The Hospital Stay After Gynaecological Surgery?

Hospital stays lengths vary -

  • Laparoscopic Surgeries - Same-day discharge or 1-2 days
  • Open Surgeries - Typically requires a 2-5 day stay

When Can I Resume Normal Activities After Surgery?

Resumption of activities depends on the surgery:

  • Laparoscopic Hysterectomy - Light work in 2-4 weeks; avoid physical tasks for 6-8 weeks. Light walking is encouraged immediately; wait 6 weeks for strenuous exercise. Sexual activity is advised against for 6-8 weeks.
  • Pelvic Organ Prolapse Repair - Light activities in 4-6 weeks; avoid heavy work for 3 months. Start with light walking, avoid high-impact exercises for 3 months. Sexual activity can resume after 6-12 weeks, depending on healing.
  • Fibroids Removal (Myomectomy) - Return to work in 2-4 weeks for laparoscopic, 4-6 weeks for abdominal. Light walking recommended early on; heavy lifting and vigorous exercise should wait for at least 6 weeks. Sexual activity generally resumes after 6 weeks, following doctor's clearance.

What Symptoms Might I Experience After a Hysterectomy?

Post-hysterectomy, you may feel pressure or heaviness in the pelvic area, experience discomfort, bowel or urinary difficulties, and pain during sexual activity.

Is There A Risk Of Developing Prolapse After a Hysterectomy?

Yes, there's a risk of vaginal prolapse types like enterocele, cystocele, rectocele, and vaginal vault prolapse after a hysterectomy, depending on surgery type and individual recovery.

How Can I Prevent Prolapse After a Hysterectomy?

Preventing prolapse involves adequate rest, safe post-op movement, avoiding heavy lifting, and engaging in pelvic floor exercises once recovery permits, to improve symptoms and prevent organ descent.

What Are The Symptoms Of Endometriosis?

Symptoms include severe pelvic pain during periods, pain during intercourse, painful bowel movements or urination, excessive bleeding, fatigue, diarrhoea, bloating, and possibly infertility.

Is Endometriosis Hereditary?

Endometriosis can be hereditary. Having a first-degree relative with the condition increases your risk, suggesting a multifactorial, genetic component to its development.

How Is Endometriosis Diagnosed?

Diagnosing endometriosis involves a detailed gynaecological history, pelvic examination, and possibly ultrasound imaging. Laparoscopy is the definitive method for diagnosis, allowing direct observation and treatment of endometriotic tissue.

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