Gynaecology

Gynaecological Surgery

Gynaecological Surgery

Abdominal Surgery

Abdominal surgery broadly refers to the many different types of surgery involving organs located in the abdominal and pelvic areas such as the appendix, gall bladder, small, large intestine, uterus and ovaries.
There are two main methods of performing abdominal surgery; open abdominal surgery and laparoscopic abdominal surgery.

Open abdominal surgery involves one large incision being made through the abdominal wall, so that the area being operated on can be directly viewed and accessed. The incision is closed with sutures or staples.

Laparoscopic abdominal surgery is a minimally invasive approach and involves several small incisions being made. Hollow tubes are inserted into the incisions, and the surgical instruments and a small camera are placed through these tubes. The camera allows the surgeon to view the area being operated on without the need to open up the area.

When comparing the two, laparoscopic surgery generally has a quicker recovery period than open surgery and provides a better cosmetic outcome; however, it is not possible for all conditions.

Common types of abdominal surgery

There are many different types of surgery that are performed on the organs in the abdominal area, some of the most common procedures include:

Appendectomy to remove the appendix

  • Caesarean section (C-section) to deliver a baby
  • Gallbladder removal due to gallstones or other gallbladder diseases
  • Inguinal hernia surgery to repair an inguinal hernia
  • Hysterectomy with or without removal of tubes and ovaries.
  • Laparotomy for removal of large uterine fibroids or a large ovarian cyst

Abdominal Hysterectomy

Refer to the surgical removal of the uterus via a laparotomy. This either involve removing the uterus and the cervix (total hysterectomy) or supra-cervical (subtotal hysterectomy).

Removal of the tubes and ovaries may be discussed and offered depending on the women’s age and the indication for the hysterectomy.

Indications for abdominal hysterectomy

  • Abnormal uterine bleeding: that not improve with conservative treatments.
  • Fibroids
  • Pelvic organ prolapse.
  • Cervical abnormalities
  • Endometrial hyperplasia
  • Cancer
  • Severe bleeding after childbirth
  • Chronic pelvic pain

Complications of abdominal hysterectomy

  • General risks such as anaesthetics, haemorrhage, blood transfusion and infections
  • Constipation
  • Urinary retention
  • Blood clots
  • Damage to adjacent organs (bladder, ureters and bowel) risk <1%
  • Early menopause

Vaginal Surgery

There are many different types of vaginal surgery that are performed and the procedure depends on the reason for the surgery. Surgery may be performed to remove the uterus and repair the pelvic floor prolapse (reconstructive purposes), or to treat urinary incontinence. Other times it is performed for cosmetic or functional reasons. Following is a look at some of the most common types of vaginal surgery that is performed for these reasons.

Vaginal Hysterectomy

Is a procedure in which the uterus is removed surgically through the vagina. This approach is performed if the uterus is not greatly enlarged, in conjunction with prolapse or incontinence surgery and if there is no cancer.

The vaginal approach has been shown in studies to have fewer complications, shorter hospital stay and faster recovery when compared to the abdominal hysterectomy.

Vaginal prolapse surgery

Vaginal prolapse also known as pelvic organ prolapse is when one or more of the pelvic organs moves out of its normal place due to the muscles and ligaments that support these organs weakening. There are various organs that may be involved with vaginal prolapse, and there are different types of surgery that can be performed to correct the problems caused by the weakened muscles or ligaments.

Labiaplasty

Labiaplasty involves surgery being performed on the labia, which are the lips surrounding the vagina. Unwanted tissue is removed to change the labia shape or size. This procedure is often completed for cosmetic reasons, however it is also used to correct congenital conditions or when physical discomfort is being experienced.

Vaginoplasty

Vaginoplasty can be performed for both cosmetic and reconstructive purposes. Also referred to as vaginal rejuvenation surgery, it is designed to tighten the vagina when the muscles and tissues have become loose or slack, normally due to giving birth or aging. It involves removing any excess vaginal lining and tightening the soft tissue and muscles. Vaginoplasty and labiaplasty are often performed together for cosmetic purposes.

Minimal invasive surgery

Minimal invasive surgery uses special instruments to perform surgery that, in comparison to traditional surgery, generally involves smaller incisions, a shorter recovery period, less adhesion formation and lesser side effects.

Laparoscopy and Hysteroscopy are both forms of minimal invasive surgery and in addition to the surgical treatment; they are also used for the diagnosis of certain conditions.

Both procedures involve a viewing tool (the hysteroscope or laparoscope) being inserted into the body. Images are transmitted to a computer screen giving the doctor a view inside the area.

Hysteroscopy

Hysteroscopy is used for diagnosis and surgical treatment in the uterus, particularly for conditions related to infertility and abnormal bleeding. The procedure is carried out by inserting the hysteroscope into the vagina, where it goes gently through the cervix and into the uterus.

A hysteroscopy is commonly used along with other instruments for the following procedures:

  • To diagnose and remove abnormal growths from the uterus such as fibroids, polyps and adhesions (Asherman’s syndrome).
  • Removal of a misplaced intrauterine device (IUD)
  • Endometrial ablation.

Laparoscopy

Laparoscopy is used to look inside and perform surgery in the organs in the abdomen and the pelvic area. A small cut is made in the navel, and the laparoscope is inserted through the incision. A separate small incision will also be made to insert surgical instruments when they are required.

Due to the number of different organs in the abdomen, laparoscopy is used for many different types of surgery. Some of the most common gynaecological procedures include:

  • Emergency conditions such as treating ectopic pregnancy
  • Permanent female sterilisation
  • Removal of ovarian cysts
  • Diagnosis and treatment of endometriosis
  • Removal of fibroids
  • To perform hysterectomy (removal of the uterus)
  • Investigations and treatment of infertility and tubal patency check

The possible complications of Laparoscopic surgery:

Any surgical procedure will have risks, despite the highest standard of practice.

Some of the risks are:

General risks of surgery:

  • Cardiovascular risks such as blood clots, stroke, heart attack which often depends on the medical History.
  • Infections of the skin incision, uterus, bladder, chest or bloodstream. This can be treated with antibiotics
  • A keloid or hypertrophic scar.

Specific risks of Laparoscopy:

  • Risk of injury to bowel, bladder, ureter or blood vessels. This type of injury occurs in about 1 in 1,000 procedures and it depends on presence of other risk factors like previous abdominal surgery.
  • Risk of converting to an open procedure Laparotomy
  • Very rare risk of a “gas embolism” when a bubble of carbon dioxide may get into the blood stream and can travel to the lungs or heart and may become life threatening.
  • Uncommon risk of hernia at the incision site.
  • Risk of infection inside the abdomen called peritonitis, which may occur after unrecognised small hole or burn to the bowel and may become obvious several days after the surgery. This requires further surgery.