Gynaecology Surgeries

1. Hysterectomy

A hysterectomy is the surgical removal of the uterus. It may also involve removing other reproductive organs like the ovaries, fallopian tubes, or cervix.

Types of Hysterectomy:

• Total Hysterectomy: Removal of the uterus and cervix.
• Subtotal (or Supracervical) Hysterectomy: Removal of the uterus, but leaving the cervix intact.
• Radical Hysterectomy: Removal of the uterus, cervix, upper part of the vagina, and surrounding tissues, often performed for cancer treatment.

Indications:

• Uterine fibroids (benign tumors).
• Endometriosis (abnormal tissue growth outside the uterus).
• Uterine cancer or other gynecological cancers.
• Chronic pelvic pain or abnormal bleeding that doesn’t respond to other treatments.
• Prolapsed uterus (falling or slipping of the uterus into the vaginal canal).

Approaches:

• Abdominal Hysterectomy: Incision made in the abdomen.
• Vaginal Hysterectomy: Uterus removed through the vagina.
• Laparoscopic (Minimally Invasive) Hysterectomy: Performed through small incisions with the help of a camera and special instruments.

2. Oophorectomy

An oophorectomy is the surgical removal of one or both ovaries. If only one ovary is removed, it’s called a unilateral oophorectomy; if both ovaries are removed, it’s a bilateral oophorectomy.

Indications:

• Ovarian cancer or tumors.
• Endometriosis or chronic pain from ovarian cysts.
• Genetic predisposition to ovarian cancer (e.g., BRCA1 or BRCA2 mutations).
• Pelvic infections or abscesses.

Types of Oophorectomy:

• Laparoscopic Oophorectomy: A minimally invasive procedure where small incisions are made to remove the ovaries.
• Abdominal Oophorectomy: Removal through an incision in the abdomen.

3. Myomectomy

A myomectomy is the surgical removal of uterine fibroids (benign growths in the uterus). This surgery aims to preserve the uterus for women who wish to retain their fertility.

Indications:

• Uterine fibroids causing symptoms like heavy bleeding, pain, or infertility.

Types of Myomectomy:

• Abdominal Myomectomy: A traditional open surgery for large fibroids.
• Laparoscopic Myomectomy: A minimally invasive procedure for smaller fibroids.
• Hysteroscopic Myomectomy: Fibroids are removed through the cervix using a camera and instruments.

4. D&C (Dilation and Curettage)

A D&C is a procedure used to remove tissue from the inside of the uterus. It’s often done after a miscarriage, to diagnose or treat abnormal bleeding, or to clear the uterine lining after a pregnancy.

Indications:

• Miscarriage or retained tissue after a miscarriage.
• Heavy or abnormal uterine bleeding.
• Endometrial hyperplasia (thickening of the uterine lining).
• Endometrial biopsy for cancer screening.

Procedure:

• The cervix is dilated, and a curette (a surgical instrument) is used to scrape the uterine lining.
• Hysteroscopy can sometimes be performed alongside the procedure to visually inspect the uterus.

5. Endometrial Ablation

Endometrial ablation is a procedure used to destroy the lining of the uterus (endometrium) to treat heavy menstrual bleeding (menorrhagia).

Indications:

• Heavy menstrual bleeding that doesn’t respond to other treatments.
• Fibroids or other uterine conditions causing excessive bleeding.

Types of Endometrial Ablation:

• Thermal Ablation: Uses heat to destroy the endometrial tissue.
• Cryoablation: Uses extreme cold to destroy the uterine lining.
• Laser Ablation: Uses a laser to burn away the endometrial tissue.
• Electrosurgical Ablation: Uses electrical currents to destroy the lining.

Procedure:

• Typically performed using hysteroscopy, where a camera is inserted through the cervix to visualize and treat the uterine lining.

6. Laparoscopy (Minimally Invasive Surgery)

Laparoscopy is a type of minimally invasive surgery that involves small incisions and the use of a camera (laparoscope) to perform surgeries on the reproductive organs. It is often used for diagnosis and treatment.

Indications:

• Endometriosis (tissue growing outside the uterus).
• Ectopic pregnancy.
• Ovarian cysts or tumors.
• Pelvic pain or unexplained infertility.

Procedure:

• Small incisions are made in the abdomen.
• A laparoscope (a small camera) is inserted to guide the surgery.
• Surgical tools are passed through the incisions to perform the procedure.

7. Colposcopy and Cervical Biopsy

Colposcopy is a diagnostic procedure that allows a doctor to examine the cervix, vagina, and vulva for abnormalities using a special microscope (colposcope). If abnormal areas are detected, a biopsy (tissue removal) may be performed for further testing.

Indications:

• Abnormal Pap smear results.
• HPV infection or suspicion of cervical cancer.

Procedure:

• A colposcope is used to magnify the cervix and examine it more closely.
• If necessary, a biopsy is taken for laboratory examination.

8. Pelvic Floor Surgery

Pelvic floor surgery is used to treat conditions that affect the pelvic muscles, ligaments, and organs (like the bladder, uterus, and rectum), such as pelvic organ prolapse or incontinence.

Indications:

• Pelvic organ prolapse (e.g., uterus or bladder dropping into the vaginal canal).
• Urinary incontinence or fecal incontinence.
• Pelvic floor muscle weakness after childbirth or due to aging.

Types:

• Sacral Colpopexy: A procedure to correct uterine or vaginal prolapse.
• Vaginal Pessary Insertion: A non-surgical option to support prolapsed organs.
• Perineal Repair: Repair of tears or injuries to the pelvic floor following childbirth.

9. Vaginal Rejuvenation and Cosmetic Gynecology

While not always considered a medical necessity, some women seek vaginal rejuvenation or cosmetic gynecology procedures to address issues related to childbirth, aging, or personal preference.

Examples:

• Vaginal Tightening: Surgical procedures to tighten the vaginal walls, often after childbirth or aging.
• Labial Reduction Surgery: Removal of excess tissue from the labia minora or labia majora.
• Vaginal Reconstruction: Surgery to restore vaginal function after injury or disease.

10. Fertility-Saving Surgeries

In cases where a woman has fertility issues, some gynecological surgeries are designed to correct conditions that impair fertility, such as endometriosis, fibroids, or blocked fallopian tubes.

Types:

• Tubal Ligation Reversal: Reversal of tubal ligation (a sterilization procedure) for women who wish to regain fertility.
• Ovary or Fallopian Tube Surgery: To treat conditions like cysts, adhesions, or endometriosis.
• Hysteroscopic Surgery: Used to remove polyps, fibroids, or adhesions within the uterine cavity that may affect fertility.

In Summary:

Gynecological surgeries address a wide variety of reproductive health issues. The specific surgery recommended depends on the condition being treated, the patient’s health, and fertility considerations. Modern advancements in minimally invasive techniques, such as laparoscopy and hysteroscopy, have made many gynecological surgeries less invasive, reducing recovery times and improving patient outcomes. Always consult with a qualified gynecologist to determine the best approach for your condition and personal health goals.