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Out-Patient Procedures

Endometrial Ablation

Ablation is a short procedure.  It is done as an outpatient surgery in most cases.  This means that you can go home the same day.  You most likely will be given some form of pain relief or sedative to help you relax before the procedure.  The type of pain relief used depends on the type of ablation procedure, where it is done and your wishes.  (Discuss this with your doctor)

There are no incisions (cuts) involved in an ablation.  Recovery takes about (2) hours, depending on the type of pain relief used.  Your doctor will use one of a number of types of energy to burn away the uterine lining.  These may include electrical, laser (light), or thermal (heat) ablation.  As new techniques emerge, your doctor can explain them.

Electrical

A loop or rollerball tool can be used to destroy the thin inner lining of the uterus.  For the procedure, the walls of the cervix are widened to allow passage of a device called a hysteroscope.  The doctor looks through it to see the inside of your uterus on a monitor.  Your uterus is filled with fluid to expand it.  Then, the ball or loop is pulled across the endometrial surface.  The rollerball or loop applies an electrical current to the surface as it is pulled across the lining.  This current destroys the lining.

Laser

A Laser device burns the lining using a high-intensity light beam.  Like the rollerball and loop, the laser reaches the lining of the uterus through the hysteroscope.  The laser then destroys the lining of the uterus.

Thermal

With thermal ablation, a device or fluid is inserted into your uterus.  Heat and energy are applied to increase the temperature and destroy the lining.

Risks

There is some risk involved with the many procedures.  Most problems result from pain medication, blood loss or infection.  The ablation procedure has certain risks.  The device used may pass through the uterine wall or bowel.  Rarely, the fluid used to expand your uterus may be absorbed into your bloodstream.  This may allow too much fluid in your body and can be serious.

After the Procedure

Some minor side effects are common after endometrial ablation:

  • Cramping, like menstrual cramps, for 1-2 days
  • Small amount of thin, watery discharge mixed with blood, which can last a few weeks
  • Frequent urination for 24 hours
  • Nausea

Ask your doctor about when you can exercise, have sex, or use tampons.  In most cases, you can expect to go back to activities within a day or two.  Your doctor will arrange follow-up visits to check your progress.  It may take a few months to achieve results.

Finally

Endometrial ablation works well for many women.  If other treatments have not worked, endometrial ablation may be an option for a woman who does not wish to become pregnant or have a hysterectomy.

Laparoscopy

What is a Laparoscopy?

It is an outpatient procedure that allows the physician to look directly into the abdomen and at the reproductive organs through a small telescope inserted through a small incision (cut) below the belly button. Dr. Anthony Carey at The Health Center for Women is the only Bahamian certified by the Council of Gynecologic Endoscopy (www.aagl.org/education-certification/cge/) and is capable to perform these surgeries and to treat these conditions with advance operative, laparoscopy and hysteroscopy. Laparoscopy is minimally invasive and can be used to:

  • Diagnose endometriosis
  • Assess pelvic pain
  • Assess ectopic pregnancy
  • Check ovarian cysts/masses

Minimally Invasive Hysterectomy

In the past, open surgical hysterectomies resulted in hospital stays of several days, pain, a lengthy recovery time and a large abdominal scar. Now, minimally invasive surgical techniques result in hysterectomies that eliminate many of the disadvantages of traditional open surgical procedures.

A minimally invasive hysterectomy performed in a hospital setting, can treat and correct conditions such as:

  • chronic pelvic pain
  • uterine fibroids
  • abnormal uterine bleeding
  • endometriosis
  • uterine prolapse
  • cervical abnormalities
  • cancer

Minimally invasive hysterectomies using laparoscopic techniques are unlike open surgeries because they are performed through one or more small incisions. These procedures may also allow more women, who may not be candidates for open surgery, have a hysterectomy.

Laparoscopic surgical procedures used in minimally invasive hysterectomies

  • use fiber optics (laparoscope) and a miniature television camera along with specialized instruments are inserted into very small incisions in the navel and abdomen or through the vagina
  • may be exploratory while others are used to remove appropriate reproductive organs
  • Minimizes incisions with less recovery time.

Approaches and treatments depend upon factors such as obesity, prior abdominal surgery, scar tissue and other medical considerations.

Types of minimally invasive laparoscopic hysterectomy procedures

Laparoscopically Assisted Vaginal Hysterectomy (LAVH). Surgeons use special laparoscopic instruments to remove the uterus and, if necessary, the fallopian tubes and ovaries. By operating through the vagina, the cervix is separated from the top of the vagina permitting the uterus and the cervix to be removed through the vaginal opening.

Laparoscopic Supracervical Hysterectomy (LSH). The LSH procedure is done to remove the upper two thirds of the uterus using laparoscopic instruments inserted through small incisions in the abdomen. By leaving the cervix intact and attached to the upper vagina, this procedure helps to provide better post-operative vaginal support and eliminates the need for the vagina to heal. Using specials instruments, the uterus is then removed through the small incisions in the abdomen.

Total Laparoscopic Hysterectomy (TLH). Using similar incisions to a Laparoscopic Supracervical Hysterectomy, a TLH involves removing both the cervix and the uterus. Unlike a Laparoscopic Assisted Vaginal Hysterectomy, a very limited portion of the TLH procedure is done through the vagina.

Vaginal hysterectomy

  • is a surgical procedure that is performed in a hospital
  • involves removing the uterus surgically through the vagina
  • is performed if the uterus is not greatly enlarged
  • is performed if the medical conditions are not related to cancer
  • has fewer complications, requires a shorter hospital stay, and allows a faster recovery when compared to the removal of the uterus through an abdominal incision (abdominal hysterectomy)
  • can be used to remove one or both ovaries as well as fallopian tubes. This procedure is called a bilateral salpingo-oophorectomy (BSO).

Some surgeons perform a laparoscopic assisted vaginal hysterectomy (LAVH) to assist with the vaginal hysterectomy procedure. This is done because the use of a laparoscope helps the surgeon to more easily see the uterus, ovaries, and tissues that surround these organs.

Heavy Menstrual Bleeding

What is Heavy Menstrual Bleeding?

1 in 5 women suffer from heavy menstrual bleeding. Many women begin to experience heavy and/or irregular bleeding in their 30s and 40s, as they begin to get closer to menopause. Heavy periods are more than just a hassle – they take a physical, social, and emotional toll as well.

Studies show heavy menstrual bleeding can affect women in a number of ways:

Physical

  • Many feel tired and nauseated
  • Many experience bad cramps
  • Many have headaches

Social

  • More than 60% have had to miss social or athletic events1
  • About 80% report avoiding sex1
  • 33% have been forced to miss work2

Emotional

  • 77% have depression or moodiness1
  • 75% feel anxious2
  • 57% report a lack of confidence during their period1

Heavy periods are not something with which you have to live. Today, there are a number of effective treatment options available. Click here to learn more about the NovaSure® procedure.

References

National Women’s Health Resource Center. Survey of women who experience heavy menstrual bleeding. Data on file; 2005.

Cooper J, et al. A randomized, multicenter trial of safety and efficacy of the NovaSure system in the treatment of menorrhagia. J Am Assoc Gynecol Laparosc. 2002; 9:418-428.