Education

What is cryosurgery?

Cryosurgery is the use of extremely cold temperatures to freeze and destroy abnormal tissues. This procedure is used to treat pre-cancerous tumors, and to control bleeding. It often is used to remove abnormal tissue of the cervix, the lower part of the uterus (womb) that opens into the vagina (birth canal).

How is cryosurgery done?
The cold is introduced through a probe, which has liquid nitrogen circulating through it. To destroy diseased tissue, the tissue is cooled to below -20 degrees Celsius. Other procedures that control pain or bleeding are cooled to a lesser degree to prevent tissue damage.

What happens during cryosurgery?
Cryosurgery is an office procedure done while the patient is awake. During the procedure, the vaginal canal is held open with a speculum so that the cervix can be seen. The cryo probe is inserted into the vagina and placed firmly on the surface of the cervix, covering the abnormal tissue. Compressed gaseous nitrogen (temperature approximately -50 degrees Celsius) flows through the instrument, making the metal cold enough to freeze and destroy the tissue.

Although some slight cramping may occur, cryosurgery is relatively painless and produces very little scarring. An "ice ball" forms on the cervix, killing the superficial abnormal cells. For optimal treatment, the freezing is done for three minutes. The cervix is allowed to thaw, then the freezing is repeated for an additional three minutes.

What happens after cryosurgery?
A repeat Pap smear or biopsy should be done to ensure that the procedure was successful in killing abnormal tissue.

Almost all normal activities can be resumed immediately after surgery. Avoidance of sexual intercourse, as well as douching, may be recommended for several weeks. For two or three weeks after the surgery, there will be a lot of watery discharge caused by the shedding of the dead cervical tissue. Sometimes a woman will feel light-headed immediately following the procedure and may faint. If this happens, lying down flat on the examination table will prevent fainting and this sensation will go away within a few minutes.

What are the risks of cryosurgery?
Risks of surgery include:

• Bleeding
• Infection
• Cervical stenosis (scarring), which may make it more difficult to get pregnant, or cause increased cramping with menstrual periods

What is Uterine Fibroid Embolization (UFE)?

Uterine fibroid embolization (UFE) is a minimally invasive treatment for fibroid tumors in the uterus.

This procedure is performed by an interventional radiologist.

Fibroid tumors, also known as myomas, are masses of fiber and muscle tissue in the wall of the uterus. Although these tumors are not cancerous, they may cause heavy menstrual bleeding, pain in the pelvic region and pressure on the bladder or bowel.

In a uterine fibroid embolization procedure, physicians use image guidance to place a synthetic material called an embolic agent inside one or more of the blood vessels that supply the fibroid tumors with blood. As a result, these vessels become occluded, or closed off, and the fibroid tissue shrinks. In most cases, symptoms are relieved.

Benefits

• less invasive than open surgery done to remove uterine fibroids or surgically removing the uterus itself (a hysterectomy).
• Patients ordinarily can resume their usual activities weeks earlier than if they had a hysterectomy.
• Significant reduction or complete resolution of their fibroid-related symptoms.

Risks

• Risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection.
• allergic reaction to the x-ray contrast material
• Menopause can occurs shortly after uterine fibroid embolization. This appears to occur more commonly in women who are older than 45 years when they have the procedure.
• The question of whether uterine fibroid embolization reduces fertility has not yet been answered, though a number of healthy pregnancies have been documented in women who have had the procedure.

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Laparoscopy

Laparoscopy is a surgical technique in which a lighted viewing instrument (laparoscope) is inserted into the lower abdomen through a small incision, usually made below the navel. The abdomen is inflated with gas injected through a needle, which pushes the wall of the abdomen away from the organs so the doctor can see them more clearly.
Compared to open surgery, it leaves smaller scars, is often less risky, and usually requires a shorter recovery period.

Laparoscopy is often used to diagnose and treat problems in the female reproductive organs, such as:

• Endometriosis
• Infertility
• Tubal pregnancy.
• Tubal ligation (female sterilization)
• Remove abnormal growths
• Identify diseased organs
• Tissue samples for biopsy

Link to gynecosurgery

Hysterectomy

We perform this surgery using three different methods depending on the needs of the patient.

• Vaginal
• Laparoscopic
• Abdominal

Hysterectomy may be recommended for:

* Fibroids
* Endometriosis not cured by medicine or surgery
* Uterine prolapse - when the uterus drops into the vagina
* Cancer of the uterus, cervix, or ovaries
* Vaginal bleeding that persists despite treatment
* Chronic pelvic pain; surgery can be a last resort

Whether or not the ovaries are removed will depend on your age and risk for certain types of cancer. For example, removing the ovaries lowers the risk of ovarian cancer and some types of breast cancer. But, if you have your ovaries removed before the age of menopause, you will go into early menopause.
Before having a hysterectomy, it is important to discuss other possible treatments.

Diagnostic hysteroscopy is used to examine the uterus and cervical canal. Hysteroscopy provides patients with a viable alternative to hysterectomy, thus preserving the genital tract. Using a thin telescope (hysteroscope) to look inside the uterus and cervical canal, hysteroscopy can be used to locate polyps, cysts, fibroids and other pathology (diagnostic hysteroscopy) or to treat and/or remove pathology (operative hysteroscopy).

Link to Hysterectomy

Cryotherapy

Cervical cryotherapy (also called "cryosurgery" or "cryoablation") is a procedure that removes abnormal cells from the cervix. It’s most often done in the doctor’s office, and only takes a few minutes. During cryotherapy, tissue that includes the abnormal cells is frozen. This tissue is destroyed. The tissue that grows back is usually normal. In most cases, all abnormal cells are removed with only one treatment.

Reasons for the Procedure

Cervical cryotherapy may be done if a Pap test and colposcopy show abnormal cells on the cervix. Here are some of the problems cervical cryotherapy treats:

• Dysplasia occurs when cells in the cervix change in ways that aren’t normal. This is often caused by a sexually transmitted virus called HPV (human papillomavirus).
• Warts (condyloma) can grow on the cervix. These are also caused by HPV.
• Chronic cervicitis is a recurring inflammation of the cervix.

 Link to Cryotherapy

D&C

D and C — also known as dilatation and curettage— is a minor surgical procedure in which the physician first dilates or opens the woman's cervix and then inserts a thin, spoon-shaped instrument and uses it to scrape the lining of the uterus. Dilatation, therefore, stands for opening the cervix; curettage means the scraping of the uterine wall.

Why the Procedure is Performed  

• Diagnose conditions using the tissue samples collected (biopsies)
• Treat irregular or heavy bleeding
• Remove fetal or placental tissue -- used for some elective or therapeutic abortions and to remove any remaining tissue after a spontaneous abortion (miscarriage)

D and C may be recommended for:

• Bleeding between periods
• Heavy menstrual bleeding
• Investigation of infertility
• Endometrial polyps
• Uterine cancer (early diagnosis)
• Thickening of the uterus (endometrial hyperplasia)
• An embedded IUD (intrauterine device)
• Therapeutic or elective abortion
• Miscarriage
• Postmenopausal bleeding, or abnormal bleeding while taking hormone replacement therapy medications.

Link to dilatation_ and_curettage

Vulvar and Vaginal Repairs

Traumatic disruption of the female perineum is not uncommon. Women are at risk during parturition; additionally, their increasing participation in sports activities increases the incidence of injury to this area. Tragically, women continue to be the victims of sexual abuse; however, many of these injuries involve only superficial structures and heal spontaneously with local care.

When tissue disruption extends to deeper tissue planes or involves the vascular anatomy or structural integrity of the perineal support system, operative intervention is required.

Perineal trauma, in general terms, occurs by one of the following mechanisms:

• During parturition, as the fetal head passes through the birth canal and vaginal introitus
• As the result of impact caused by acute deceleration injury (eg, straddle injury associated with falling on the crossbar of a bicycle)
• Insertion injury (eg, from forceful coitus, insertion of foreign body during sexual assault, impaling injury secondary to a fall)
• Penetrating injury, such as knife or gunshot

LEEP

The loop electrosurgical excision procedure (LEEP) is used when your Pap smear indicates the presence of abnormal cells on the surface of the cervix. This does not mean you have cancer, but treatment of the abnormal area is important to prevent the cells from developing into cervical cancer.

LEEP uses a thin wire loop electrode which is attached to an electrosurgical generator. The generator transmits a painless electrical current that quickly cuts away the affected cervical tissue in the immediate area of the loop wire. This causes the abnormal cells to rapidly heat and burst, and separates the tissue as the loop wire moves through the cervix. The procedure itself is usually painless, although some mild cramping may occur afterward. The whole procedure typically takes about 10-20 minutes to perform.

This technique allows us to send the excised tissue to the lab for further evaluation which insures that the lesion was completely removed, as well as allowing for a more accurate assessment of the abnormal area.

Link to Loop Electrosurgical Excision Procedure

Cesarean Section

When necessary we are perform a surgical delivery of a baby through an incision (a cut) in the mother’s abdomen and the uterus called a Cesarean Section (C-section).

What are some reasons for a cesarean?

• Prolapsed cord (where the cord comes down before the baby)
• Placenta abruptio (where the placenta separates before the birth)
• Placenta previa (where the placenta partially or completely covers the cervix)
• Fetal malpresentation (transverse lie, breech (breech can sometimes be managed by External Version, exercises or a vaginal breech birth), or asynclitic position)
• Cephalopelvic disproportion (CPD, meaning that the head is too large to fit through the pelvis. This can also be over diagnosed, it can be caused by maternal positioning either from restraint to bed, lack of mobility or anesthetics.)
• Maternal medical conditions (active herpes lesion, severe hypertension, diabetes, etc. (please note that these conditions do not ALWAYS mean a cesarean.)
• Fetal distress (This is a hot topic with the recent studies indicating that continuous electronic fetal monitoring increases the cesarean rate and does not show a relative increase in better outcomes.
• Maternal exhaustion, and repeat cesarean, these are the main reasons for cesareans.

Tubal Sterilization

Surgical sterilization which permanently prevents the transport of the egg to the uterus by means of sealing the fallopian tubes is called tubal ligation, commonly called "having one's tubes tied". This operation can be performed laparoscopically or in conjunction with a Cesarean section, after the baby is delivered. It is considered permanent because reversal requires major surgery that is often unsuccessful.

Bipolar tubal coagulation

TubalClip

Surgery for Adhesions

Adhesions are abnormal tissue attachments between internal organs, which can develop due to previous surgeries or diseases. Because they prevent the normal movement of the organs, adhesions can affect the functioning of the organs, causing chronic abdominal pain.
When tissue that is normally not connected grows together, it is called an adhesion. It is also commonly referred to as scar tissue.

Adhesions may involve the female reproductive organs (ovaries, Fallopian tubes) can and do cause infertility, dyspareunia (painful intercourse) and debilitating pelvic pain.
The long-term success of many different surgical procedures can be improved by the use of barriers that act as “internal bandages” and prevent adhesions. During an operation a surgeon sprays SprayGel onto the internal surfaces most at risk for adhesions.

Because diagnosis of adhesions can be difficult using standard gynecologic examination, CT scans or ultrasound we use a long, thin telescope called a laparoscope, inserted into the abdomen through a single small incision, to view the abdominal cavity and determine if adhesions are present.