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OBGYN Procedures

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Procedures

When a surgery or procedure is necessary, WHA physicians are qualified and experienced. We offer a full-range of procedures to provide the best outcome for our patients and strive to provide the least invasive, most convenient process to meet our patients’ needs.

Office Based

Sonograms

How You Benefit

Ultrasound tests are noninvasive, painless and cost effective. Because ultrasound images are captured in real time, they can illuminate complex bodily functions such as blood flow and heart valve operation. That means your doctor uses safe, high-quality images to guide your care and treatment.

What You Can Expect

During the ultrasound exam, our registered sonographer spreads a gel on the part of the body being examined and presses the transducer against the skin to capture the image. You can watch the ultrasound images on a specially positioned screen. The exam usually takes less than 30 minutes. Your doctor will review the results with you.

Colposcopy

Overview

Colposcopy (kol-POS-kuh-pee) is a procedure to closely examine your cervix, vagina and vulva for signs of disease. During colposcopy the doctor uses a special instrument called a colposcope.

Your doctor may recommend colposcopy if your Pap test result is abnormal. If your doctor finds an unusual area of cells during colposcopy, a sample of tissue can be collected for laboratory testing (biopsy).

Many women experience anxiety before their colposcopy exams. Knowing what to expect during your colposcopy may help you feel more comfortable.

 

Why Have A Colposcopy

Your doctor may recommend colposcopy if a Pap test or pelvic exam revealed abnormalities.

Colposcopy can be used to diagnose:

  • Genital warts
  • Inflammation of the cervix (cervicitis)
  • Precancerous changes in the tissue of the cervix
  • Precancerous changes in the tissue of the vagina
  • Precancerous changes of the vulva

 

Birth Control

Today, there are many options as it relates to birth control. To select the one that is best suited to your needs and those of your partner, you should consult with your doctor.

 

  • Sterilization
  • Intrauterine Devices (IUDs)
  • Transdermal Implant
  • The Shot
  • Hormonal Ring
  • Transdermal Patch
  • Birth Control Pills
  • Diaphragm
  • Condoms

Hysteroscopy

Overview

Hysteroscopy is a procedure that allows your doctor to look inside your uterus in order to diagnose and treat causes of abnormal bleeding. Hysteroscopy is done using a hysteroscope, a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus. Hysteroscopy can be either diagnostic or operative.

Diagnostic hysteroscopy is used to diagnose problems of the uterus. Diagnostic hysteroscopy is also used to confirm results of other tests, such as hysterosalpingography (HSG). HSG is an X-ray dye test used to check the uterus and fallopian tubes. Diagnostic hysteroscopy can often be done in an office setting.

Additionally, hysteroscopy can be used with other procedures, such as laparoscopy, or before procedures such as dilation and curettage (D&C). In laparoscopy, your doctor will insert an endoscope (a slender tube fitted with a fiber optic camera) into your abdomen to view the outside of your uterus, ovaries and fallopian tubes. The endoscope is inserted through an incision made through or below your navel.

What You Can Expect

Prior to the procedure, your doctor may prescribe a sedative to help you relax. You will then be prepared for anesthesia.

The procedure itself takes place in the following order:

  • The doctor will dilate (widen) your cervix to allow the hysteroscope to be inserted.
  • The hysteroscope is inserted through your vagina and cervix into the uterus.
  • Carbon dioxide gas or a liquid solution is then inserted into the uterus, through the hysteroscope, to expand it and to clear away any blood or mucus.
  • Next, a light shone through the hysteroscope allows your doctor to see your uterus and the openings of the fallopian tubes into the uterine cavity.
  • Finally, if surgery needs to be performed, small instruments are inserted into the uterus through the hysteroscope.

The time it takes to perform hysteroscopy can range from less than 5 minutes to more than an hour. The length of the procedure depends on whether it is diagnostic or operative and whether an additional procedure, such as laparoscopy, is done at the same time. In general, however, diagnostic hysteroscopy takes less time than operative.

Benefits

Compared with other, more invasive procedures, hysteroscopy may provide the following advantages:

Shorter hospital stay
Shorter recovery time
Less pain medication needed after surgery
Avoidance of hysterectomy
Possible avoidance of “open” abdominal surgery

Risks

Hysteroscopy is a relatively safe procedure. However, as with any type of surgery, complications are possible.

With hysteroscopy, complications occur in less than 1% of cases and can include:

  • Risks associated with anesthesia
  • Infection
  • Heavy bleeding
  • Injury to the cervix, uterus, bowel or bladder
  • Intrauterine scarring
  • Reaction to the substance used to expand the uterus

Recovery and Outlook

If regional or general anesthesia is used during your procedure, you may have to be observed for several hours before going home. After the procedure, you may have some cramping or slight vaginal bleeding for up to a week.

However, if you experience any of the following symptoms, be sure to contact your doctor:

  • Fever
  • Severe abdominal pain
  • Heavy vaginal bleeding or discharge

Hysteroscopy is considered minor surgery and usually does not require an overnight stay in the hospital. However, in certain circumstances, such as if your doctor is concerned about your reaction to anesthesia, an overnight stay may be required.

What Is Endometrial Ablation?

There are a lot of terms out there to familiarize yourself with before you make your appointment. If you do online searches to learn about this surgery, you may see several different topics and keywords, including:

  • Endometrial Ablation
  • Uterine Ablation
  • Cervical Ablation
  • Thermal Ablation
  • Hydothermal Ablation
  • Hysteroscopy Ablation
  • Tubal Ablation
  • Balloon Ablation
  • Womb Ablation
  • Female Ablation

An Overview Of Endometrial Ablation

For our purposes here, we will discuss Endometrial Ablation and its definition, details and an overview of the surgery experience and benefits. An endometrial ablation is a quick in-office procedure that is used to treat heavy bleeding in women who have not gone through menopause. It is a good option for women with heavy periods to normalize (or, in some cases, even stop) the blood flow. There are no hormones involved with the procedure. Overall, about 95% of women are satisfied with the results of the procedure. If you are still interested in having children, an endometrial ablation is not a good option for you. Pregnancies can be very high risk after an endometrial ablation. You should use some sort of birth control if you have this procedure.

Novasure Ablation Surgery, Miverva and Hydrothermal

There are different types of endometrial ablations, such as Novasure®, Minerva, and hydrothermal ablation. You can talk to your doctor about which is right for you.

What To Expect After Endometrial (Uterine) Ablation

The Novasure® and Minerva procedures work by placing a triangular shaped mesh inside the uterus. The mesh is heated and this treats the lining of the uterus (called the endometrium). The mesh is removed. The hydrothermal ablation system works by circulating very hot water inside the lining of the uterus with the same goal of treating the endometrium.

Ablation After Effects and Risks

There are risks with any procedure, including risk of bleeding, infection, pain, and damage to surrounding organs (like the vagina, cervix, and bladder). There is always a possibility that you may need other procedures in the future if the ablation does not fix your heavy bleeding. However, ablation surgery is a minimally invasive surgery with subsequently reduced risks. 90% of patients who have undergone ablation surgery express satisfaction.

Ablation Surgery Recovery

You can go back to work the next day after an endometrial ablation. You should expect some cramping and you may have irregular spotting or bleeding. Vaginal discharge is normal and expected, and may be clear, pink, red, brown, gray, or even black. This can last for several weeks after the procedure. You should call the office if you have a fever more than 100.4 degrees Fahrenheit, severe pain, or heavy bleeding.

Endometrial Ablation Cost

Surgery costs often depend upon your insurance. To find out what the procedure will cost you, contact our offices today.

Hours: Monday – Friday: 8:30 a.m. – 5 p.m.

Overview

“LEEP” is an abbreviation for loop electrosurgical excision procedure. It is a way to test and treat abnormal cell growth on the surface tissue of the cervix. LEEP may be recommended after abnormal changes in the cervix are confirmed by Pap tests and colposcopic biopsies. (Colposcopy is a non-invasive procedure in which a device similar to a microscope is used to view the cervix.) LEEP allows your physician to remove the abnormal tissue and test it for cancer.

Abnormal cell growth on the surface of the cervix is called cervical dysplasia. Though cervical dysplasia is not cancer, over time it can worsen and lead to cancer.

Why Have A LEEP

Your doctor may have recommended a LEEP if your Pap smear or a tissue sample from your cervix showed precancerous cells.

Risks

Complications are rare and the procedure can often be completed in the office or outpatient setting. However, there are some minor risks, such as infection and bleeding. Your doctor may check your cervix by ultrasound during any future pregnancies.

What You Can Expect

How Long?

A LEEP usually takes about 10 to 20 minutes.

Before the Procedure

  • Don’t take aspirin or any medications that contain aspirin for 7 days before your procedure.
  • Do not eat or drink anything 8 hours before the procedure.
  • Schedule your procedure for 1 week after your period. This will help us tell the difference between vaginal bleeding caused by your procedure and vaginal bleeding during your period.

After the Procedure

Before you leave, your nurse will explain how to care for yourself at home. Here are some guidelines to follow:

  • Rest for the remainder of the day after your procedure. Your doctor will let you know when you can return to work or school.
  • Take acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) if you have any discomfort.
  • You can shower as usual, but don’t take a bath until your doctor says it’s okay.
  • Don’t place anything inside your vagina (such as tampons or douches) or have vaginal intercourse for at least 4 weeks after your procedure. It usually takes about this long for you cervix to heal. During your follow-up appointment, your doctor will examine you and see if your cervix is healed.
  • You may notice a brown discharge for weeks after your procedure. This is from the solution put on your cervix after your procedure. Use a sanitary pad for vaginal discharge.
  • You may also have some vaginal bleeding. The amount of discharge and bleeding varies for every woman. Use sanitary pads for vaginal bleeding. Call your doctor if it is heavier than a typical period.
  • Don’t do any strenuous activity (such as running or aerobics) for 2 weeks after your procedure.
  • You may have a late or heavy period after your procedure. This is normal.

Hospital Based

Hysterectomy

Hysterectomy, Partial Hysterectomy, Laparoscopic Hysterectomy, Uterus Removal

Overview

Hysterectomy is the surgical removal of the uterus. It ends menstruation and the ability to become pregnant. Depending on the reason for the surgery, a hysterectomy may also involve the removal of other organs and tissues such as the ovaries and/or fallopian tubes.

  • A supracervical hysterectomy is the removal of the upper part of the uterus leaving the cervix behind.
  • A total hysterectomy is the removal of the uterus and cervix.
  • A total hysterectomy with bilateral salpingo oophorectomy is the removal of the uterus, cervix, fallopian tubes (salpingo) and ovaries (oophor). If you haven’t experienced menopause, removing the ovaries will usually initiate it since your body can no longer produce as much estrogen.

Why Have A Hysterectomy

  • Abnormal vaginal bleeding that is not controlled by other treatment methods
  • Severe endometriosis (uterine tissue that grows outside the uterus)
  • Leiomyomas or uterine fibroids (benign tumors) that have increased in size, are painful or are causing bleeding
  • Increased pelvic pain related to the uterus but not controlled by other treatment
  • Uterine prolapse (uterus that has “dropped” into the vaginal canal due to weakened support muscles) that can lead to urinary incontinence or difficulty with bowel movements
  • Cervical or uterine cancer or abnormalities that may lead to cancer for cancer prevention

What You Can Expect

Before the procedure

Your doctor will explain the procedure in detail, including possible complications and side effects. He or she will also answer your questions.

In addition:

  • Blood and urine tests are taken
  • An enema or bowel prep may be given to cleanse the bowel
  • Abdominal and pelvic areas may be shaved
  • An intravenous (IV) line is placed in a vein in your arm to deliver medications and fluids

During the procedure

An anesthesiologist will give you general anesthesia in which you will not be awake during the procedure.

Your surgeon removes the uterus through an incision in your abdomen or vagina.

Sometimes your doctor uses a laparoscope (small camera) or robotic system to help assist them with your surgery. Your doctor will decide what method is best for you.

How Long?

The procedure lasts 1 to 3 hours. The amount of time you spend in the hospital for recovery varies, depending on the type of surgery performed.

Cost?

To find out the cost of Hysterectomy and to check your insurance coverage, request an appointment or call our office and we will help guide you in selecting the best option for you. Call 214-824-3200. 

Recovery and Outlook

A responsible adult must drive you home the day you are discharged from the hospital.

Physically

After hysterectomy, your periods will stop. Occasionally, you may feel bloated and have symptoms similar to when you were menstruating. It is normal to have light vaginal bleeding or a dark brown discharge for about 4 to 6 weeks after surgery.

You may feel discomfort at the incision site for about 4 weeks, and any redness, bruising or swelling will disappear in 4 to 6 weeks. Feeling burning or itching around the incision is normal. You may also experience a numb feeling around the incision and down your leg. This is normal and, if present, usually lasts about 2 months.

If the ovaries remain, you should not experience hormone-related effects. If the ovaries were removed with the uterus before menopause, you may experience the symptoms that often occur with menopause, such as hot flashes. Your doctor may prescribe hormone replacement therapy to relieve menopausal symptoms.

Emotionally

Emotional reactions to hysterectomy vary, depending on how well you were prepared for the surgery, the reason for having it, and whether the problem has been treated.

Some women may feel a sense of loss or become depressed, but these emotional reactions are usually temporary. Other women may find that hysterectomy improves their health and well-being, and may even be a life-saving operation. Please discuss your emotional concerns with your doctor.

Sexual Function

A woman’s sexual function is usually not affected after hysterectomy, and her sexual desire should not change. Only if the ovaries were removed with the uterus prior to menopause, decreased sex drive may occur and vaginal dryness may be a problem during sex. However, estrogen therapy can relieve vaginal dryness and other hormone-related effects.

Ovarian Cyst Removal

Overview

Ovarian cysts are relatively common, but surgical treatment depends on whether or not you wish to maintain fertility, and also the condition of the cyst.

Why Have Ovarian Cyst Removal

Since the vast majority of ovarian cysts and masses in pre-menopausal patients are benign, laparoscopy is a great option for many patients. Minimally invasive procedures allow patients to avoid large, open incisions for the removal of their cysts, thereby decreasing hospital stays, recovery times, and pain. Laparoscopy is of significant benefit for these patients as well, since it will prevent an open surgery, and recovery from open surgery can be increasingly difficult for older women. Women who have laparoscopic cystectomy are discharged from the hospital the same day, with excellent pain control and rapid recovery. Most patients are back to work within seven days.

What You Can Expect

Masses of all sizes can be removed laparoscopically. Typically, one or two tiny (1/4 inch) incisions and one slightly larger (3/4 inch) incision are necessary for a cystectomy. The smaller incisions are located at the belly button and on the far right or left side in the bikini line. The larger incision is located just above the pubic bone. The larger incision is used to remove the cyst.

In order to remove the cyst from the body, the cyst is placed in a special bag. This allows for easy removal and prevents fluid from the mass from spilling into the pelvic cavity.

Ovarian Removal

Overview

An oophorectomy (oh-of-uh-REK-tuh-me) is a surgical procedure to remove one or both of your ovaries. Your ovaries are almond-shaped organs that sit on each side of the uterus in your pelvis. Your ovaries contain eggs and produce hormones that control your menstrual cycle.

When an oophorectomy involves removing both ovaries, it’s called bilateral oophorectomy. When the surgery involves removing only one ovary, it’s called unilateral oophorectomy.

Why Have An Ovary Removed

An oophorectomy may be performed for:

  • A tubo-ovarian abscess — a pus-filled pocket involving a fallopian tube and an ovary
  • Endometriosis
  • Noncancerous (benign) ovarian tumors or cysts
  • Reducing the risk of ovarian cancer or breast cancer in those at increased risk
  • Ovarian torsion — the twisting of an ovary

Oophorectomy combined with other procedures

An oophorectomy can be done alone, but it is often done as part of a more-complete surgery to remove the uterus (hysterectomy) in women who have undergone menopause.

What You Can Expect

During oophorectomy

During oophorectomy surgery you’ll receive anesthetics to put you in a sleep-like state. You won’t be awake during the procedure.

An oophorectomy can be performed two ways:

Laparotomy
In this surgical approach, the surgeon makes one long incision in your lower abdomen to access your ovaries. The surgeon separates each ovary from the blood supply and tissue that surrounds it and removes the ovary.

Minimally invasive laparoscopic surgery
In this surgical approach, the surgeon makes three or four very small incisions in your abdomen.

The surgeon inserts a tube with a tiny camera through one incision and special surgical tools through the others. The camera transmits video to a monitor in the operating room that the surgeon uses to guide the surgical tools.

Each ovary is separated from the blood supply and surrounding tissue and placed in a pouch. The pouch is pulled out of your abdomen through one of the small incisions.

Laparoscopic oophorectomy may also be robotically assisted in certain cases. During robotic surgery, the surgeon watches a 3-D monitor and uses hand controls that allow finer movement of the surgical tools.

Whether your oophorectomy is an open, laparoscopic or robotic procedure depends on your situation. Laparoscopic or robotic oophorectomy usually offers quicker recovery, less pain and a shorter hospital stay. But these procedures aren’t appropriate for everyone, and in some cases, surgery that begins as laparoscopic may need to be converted to an open procedure during the operation.

After oophorectomy

After an oophorectomy, you can expect to:

  • Spend time in a recovery room as your anesthesia wears off
  • Move to a hospital room where you may spend a few hours to a few days, depending on your procedure
  • Get up and about as soon as you’re able in order to help your recovery

Recovery and Outlook

How quickly you can go back to your normal activities after an oophorectomy depends on your situation, including the reason for your surgery and how it was performed.

Most people can return to full activity by six weeks after surgery. Those who undergo laparoscopic or robotic surgery may return to full activity sooner — as early as two weeks after surgery.

Discuss exercise, driving, sexual restrictions and overall activity level with your surgeon.

Tubal Ligation and Tubal Surgery

Overview

Tubal ligation prevents an egg from traveling from the ovaries through the fallopian tubes and blocks sperm from traveling up the fallopian tubes to the egg. The procedure doesn’t affect your menstrual cycle.

Tubal ligation can be done at any time, or in combination with another abdominal surgery, such as a C-section.

A salpingectomy is removing the tube in their entirety. Your doctor will determine what procedure is best for you.

Tubal Ligation is a non-invasive procedure that seals off a woman’s fallopian tubes that carry an egg from the ovaries to the uterus. By blocking these tubes, where fertilization usually occurs, sperm is unable to reach the egg to fertilize it. The procedure uses two small metal springs (micro-inserts) that are inserted into the fallopian tubes. This causes scar tissue to form and permanently blocks off the tubes. The procedure is performed in an outpatient environment.

It takes about 30 minutes, and requires minimal anesthesia. Patients should be aware that the procedure provides permanent birth control and is NOT reversible.

 

Why Do Tubal Ligation

It is one of the most commonly used surgical sterilization procedures for women. If you are seeking permanent birth control tubal ligation may be a good option for you. However, it does not protect against sexually transmitted infections.

Tubal ligation may also decrease your risk of ovarian cancer, especially if the entire fallopian tubes are removed.

What You Can Expect

Tubal ligation can be done:

  • During a C-section
  • Anytime as an outpatient procedure

Before The Procedure

You will be asked to take a pregnancy test to make sure you’re not pregnant.

During The Procedure

If you have an interval tubal ligation as an outpatient procedure, an incision is made through your belly button so your abdomen can be inflated with gas (carbon dioxide or nitrous oxide). Then a laparoscope is inserted into your abdomen.

In most cases, your doctor will make 1 or 2 additional small incisions to insert special instruments through the abdominal wall. Your doctor uses these instruments to seal off  or remove the fallopian tubes.

If you have a tubal ligation during a C-section, your doctor will use the same incision that was made to deliver the baby. This may all 5-10 minutes to your surgery time.

After The Procedure

If gas was used during tubal ligation, it will be removed when the procedure is done. You may be allowed to go home several hours after an interval tubal ligation. Having a tubal ligation immediately following childbirth doesn’t usually involve a longer hospital stay.

You’ll have some discomfort at the incision site. You might also have:

  • Abdominal pain or cramping
  • Fatigue
  • Dizziness
  • Gassiness or bloating
  • Shoulder pain

Your doctor will discuss management of any post-procedure pain with you, before you go home from the hospital.

Avoid the bath for 3 days after the procedure. Avoid straining or rubbing the incision as well. Carefully dry the incision after bathing.

Avoid heavy lifting and sex until your doctor informs you that it’s safe to do so. Resume your normal activities gradually as you begin to feel better. Your stitches will dissolve and won’t require removal. Check with your doctor to see if you need a follow-up appointment.

How You Prepare

Before you have a tubal ligation, your doctor will talk to you about your reasons for wanting sterilization. Together, you’ll discuss factors that could make you regret the decision, such as a young age or change in marital status.

Your doctor will also review the following with you:

  • Risks and benefits of reversible and permanent methods of contraception
  • Details of the procedure
  • Causes and probability of sterilization failure
  • The best time to do the procedure — for instance, shortly after childbirth or in combination with another abdominal surgery, such as a C-section

If you’re not having a tubal ligation during a C-section, continue using a reliable form of contraception until your doctor say you may stop.

Results

Tubal ligation is a safe and effective form of permanent birth control. But it doesn’t work for everyone. Fewer than 1 out of 100 women will get pregnant in the first year after the procedure. The younger you are at the time it’s done, the more likely it is to fail.

If you do conceive after having a tubal ligation, there’s a risk of having an ectopic pregnancy. This means the fertilized egg implants outside the uterus, usually in a fallopian tube. An ectopic pregnancy requires immediate medical treatment. The pregnancy cannot continue to birth. If you think you’re pregnant at any time after a tubal ligation, contact your health care provider immediately.

Keep in mind that although tubal ligation reversal is possible, the reversal procedure is complicated and may not work.

Fibroid Treatment

Overview

Uterine fibroids are non-cancerous tumors of the uterus. Uterine fibroids are also known as leiomyomata or myomas. Uterine fibroids grow within the muscles of the uterus, on the outside of the uterus, hang in the uterine cavity or very rarely form within the cervix. They can range in size from microscopic to several inches in diameter. Uterine fibroids form in the childbearing years of a woman’s life. There may be just one fibroid or many, with differing locations. Uterine fibroids are not usually a cause for concern, but when they become too large, cause heavy bleeding, or there are many present, they may become a problem.

Cause of Uterine Fibroids

Though a large percentage of women suffer from uterine fibroids, doctors are actually unsure of what causes them to occur. What we do know, however, is that hormones contribute to the growth of the fibroids.

Estrogen and progesterone are at their highest levels during a woman’s childbearing years, this is why uterine fibroids are thought to develop during this time. Normally, after a woman goes through menopause her body produces lower levels of estrogen and progesterone causing the fibroids to begin to shrink and any associated symptoms, such as pain and pressure to subside.

Medical Treatments

In many cases, the effects of uterine fibroids are so minor that often these women use a general over-the-counter pain medicine to treat any cramping or pain associated with the fibroid tumors. Since the tumors can also cause excessive menstrual bleeding, which can lead to anemia, an iron supplement is recommended if excessive bleeding is occurring. Bleeding may also be controlled with hormonal therapy. Discuss with your doctor to see if you qualify for medical treatments.

Surgical Treatments

There are four ways in which doctors aim to treat uterine fibroids:

Myomectomy
A myomectomy can help to remove the existing tumors that you have, but it will not prevent the tumors from growing back. However, this method of uterine fibroid removal is generally reserved for women that are still wanting to get pregnant in the future.

Hysterectomy
This surgical procedure removes the uterus completely. With a hysterectomy, you can guarantee that the tumors will not grow back. You will no longer be able to get pregnant after a hysterectomy.

Radiologic Procedures
There are some procedures performed by a radiologist to treat fibroids. Ask your doctor if you are a candidate.

Minimally Invasive Surgery

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Overview

In minimally invasive surgery, there are a variety of techniques to operate with less damage to the body than with open surgery. In general, minimally invasive surgery is associated with less pain, a shorter hospital stay and fewer complications.

Laparoscopy — surgery done through one or more small incisions, using small tubes and tiny cameras and surgical instruments.

Another type of minimally invasive surgery is robotic surgery. It provides a magnified, 3-D view of the surgical site and helps the surgeon operate with precision, flexibility and control.

Continual innovations in minimally invasive surgery make it beneficial for people with a wide range of conditions.

Why Do Minimally Invasive Surgery

Minimally invasive surgery is a potential surgical option for some patients.

Talk with your doctor about whether you would be a good candidate for this surgical approach.

Benefits

  • Less pain
  • Short hospital stay

Risks

Minimally invasive surgery, like all surgeries, has risks of complications including anesthesia, bleeding and infection. Your doctor will discuss these with you.

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