Open Surgeries ( Where we have to open the abdomen)
Abdominal Hysterectomy
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What is a Abdominal hysterectomy?

This is the most common type of hysterectomy. During a total abdominal hysterectomy, the doctor removes the uterus, including the cervix. The scar may be horizontal or vertical, depending on the reason the procedure is performed,and the size of the area being treated. Cancer of the ovary(s) and uterus, endometriosis, and large uterine fibroids are treated with total abdominal hysterectomy. Total abdominal hysterectomy may also be done in some unusual cases of very severe pelvic pain, after a very thorough evaluation to identify the cause of the pain, and only after several attempts at non-surgical treatments. Clearly a woman cannot bear children after this procedure, so it is not performed on women of childbearing age unless there is a serious condition, such as cancer. Total abdominal hysterectomy allows the whole abdomen and pelvis to be examined, which is an advantage in women with cancer or investigating growths of unclear cause..

Vaginal hysterectomy

During this procedure, the uterus is removed through the vagina. A vaginal hysterectomy is appropriate only for conditions such as uterine prolapse, endometrial hyperplasia, or cervical dysplasia. These are conditions in which the uterus is not too large, and in which the whole abdomen does not require examination using a more extensive surgical procedure. The woman will need to have her legs raised up in a stirrup device throughout the procedure. Women who have not had children may not have a large enough vaginal canal for this type of procedure. If a woman has too large a uterus, cannot have her legs raised in the stirrup device for prolonged periods, or has other reasons why the whole upper abdomen must be further examined, the doctor will usually recommend an abdominal hysterectomy (see above). In general, laparoscopic vaginal hysterectomy is more expensive and has higher complication rates than abdominal hysterectomy.

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What Is a Myomectomy?

Myomectomy means the surgical removal of just the fibroid, with reconstruction and repair of the uterus. There are now a number of techniques used to perform myomectomy: through an abdominal incision, vaginal incision, with a laparoscope, or with a hysteroscope. Myomectomy relieves symptoms in more than 75% of women. “The restoration and maintenance of physiologic (normal) function is, or should be, the ultimate goal of surgical treatment”, said Victor Bonney, an early advocate of abdominal myomectomy, in 1931. However, women are often told that myomectomy is not appropriate for them because hysterectomy is safer, is associated with less bleeding or that uterine muscle cancer (sarcoma) may be present. However, recent studies dispute all of those claims.

Studies show there may actually be less risk of complications during myomectomy than during hysterectomy. One study of women who had myomectomies and women who had hysterectomies for fibroids of the same sizes (about 4 months pregnancy size) found surgery took slightly longer in the myomectomy group (200 v. 175 min), but there was more blood loss in the hysterectomy group. The risks of bleeding, fever, life-threatening complications, need for another surgical procedure or re-admission to the hospital were not different. The authors of the study concluded that there was no difference in complications and with an experienced surgeon myomectomy is a safe alternative to hysterectomy.

Ovarian Cyst
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What Is an Ovarian Cyst?

An ovarian cyst is an accumulation of fluid within an ovary that is surrounded by a very thin wall. Any ovarian follicle that is larger than approximately 2cm is an ovarian cyst. Ovarian cysts can range widely in size; from being as small as a pea to larger than an orange - in rare cases ovarian cysts can become so large that the woman looks pregnant.

The majority of ovarian cysts are benign (harmless). According to the Centers for Disease Control and Prevention (CDC), USA, most premenopausal women and up to 14.8% of postmenopausal women are found to have ovarian cysts.

Ovarian cysts typically occur most frequently during a female's reproductive years (childbearing years). However, ovarian cysts may affect a woman of any age. In some cases, ovarian cysts cause pain and bleeding. If the cyst is over 5cm in diameter, it may need to be surgically removed.

There are two main types of ovarian cysts:

  • Functional ovarian cysts - the most common type. These harmless cysts form part of the female's normal menstrual cycle and are short-lived.
  • Pathological cysts - these are cysts than grow in the ovaries; they may be harmless (benign) or cancerous (malignant).
Ectopic Pregnancy
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What Is Ectopic Pregnancy?

Normal pregnancies develop inside a woman'suterus. "Ectopic" means out of place. In an ectopic pregnancy, a fertilized egg attaches to the wrong place in a woman's body. In most ectopic pregnancies, the egg attaches to the woman's fallopian tube. That is why ectopic pregnancies are often called "tubal pregnancies." Rarely, ectopic pregnancies can take place in other parts of a woman's body like on the cervix,ovary, or somewhere else in a woman's abdomen.

Ectopic pregnancies are serious. They can cause internal bleeding, infection, and death.

Ectopic pregnancies are not very common. They happen in about 2 out of every 100 pregnancies. However, they have become much more common in the past 30 years. Experts think the increase may be due to

  • an increase insexually transmitted infections that can scar the fallopian tubes
  • infertility treatments
Tubal Ligation
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What is Tubal ligation ?

Tubal ligation is surgery to block a woman's Fallopian tubes. Tubal ligation is a permanent form of birth control. After this procedure, eggs cannot move from the ovary through the tubes (a woman has two Fallopian tubes), and eventually to the uterus. Also, sperm cannot reach the egg in the Fallopian tube after it is released by the ovary. Thus, pregnancy is prevented.

This procedure is also called tubal ligation or having one's "tubes tied." More formally, it is known as bilateral tubal ligation (BTL).

Currently, about 700,000 of these procedures are performed each year in the United States. Half are performed right after a woman gives birth. The rest are elective procedures performed as a one-day operation in an outpatient clinic. Eleven million US women aged 15 to 44 years rely on sterilization as a means of birth control to prevent pregnancy. More than 190 million couples worldwide use surgical sterilization as a safe and reliable method of permanent birth control.

Prior to the 1960s, female sterilization in the United States was generally performed only for medical problems or when a woman was considered "too old" to have children or at risk to her health. The changing cultural climate in the 1960s resulted in safe, minimally invasive female sterilization procedures.

What is Tubal Ligation Procedure ?

While the patient is under anesthesia, one or two small incisions (cuts) are made in the abdomen (usually near the navel), and a device similar to a small telescope on a flexible tube (called a laparoscope) is inserted.

Using instruments that are inserted through the laparoscope, the tubes (Fallopian tubes) are coagulated (electrocoagulation), cauterized (burned), or a small clip is placed on the tube. The skin incision is then closed with a few stitches. Most patients feel well enough to go home after the procedure in the outpatient surgery center after a few hours.

The health care professional may prescribe to manage pain.

Most women return to normal activities, including work, in a few days, although some women may be advised not to exercise for several days. Most women resume sexual intercourse when they feel ready.

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What is a Tuboplasty?

Procedures involving the repair or reconstruction of the fallopian tubes are known as tuboplasty. This encompasses the most common technique of neosalpingostomy.

In a neosalpongostomy procedure to reverse tied tubes, a new opening is created in the end of a dilated and non-functional tube. This opening is then folded open and secured into place using very fine suture. This new opening takes the place of the normal fimbriated end of the fallopian tube.

There is a risk of reocclusion of the tube, though most all tubes will remain open. Because of a history of damage to the fallopian tube, there is thought to be an increased risk of ectopic pregnancy.

There is some evidence suggesting patients with hydrosalpinges, or dilated tubes filled with fluid, may have an improvement in their in vitro fertilization success rate following a neosalpingostomy. This comes from the possibility that the fluid may reflux into the uterine cavity and decrease implantation rates.

There is a significant amount of debate about this subject in the current medical literature. For more information or consideration for this procedure to reverse tied tubes, please schedule an appointment with one of our physicians at our Durham, NC office.

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