Procedures

A colposcopy is the use of a microscope to look at your cervix. It is indicated in women who have an abnormal pap smear. The pap smear involves collecting cells on the surface of the cervix. If these cells are abnormal, then additional testing is performed. During the colposcopy, your doctor will place vinegar on your cervix and then us a microscope to look at your cervix. The vinegar makes abnormal areas of the cervix stand out. If your doctor sees abnormal areas, a biopsy will be taken. This biopsy is then sent to a pathologist to detect cancer or precancerous cells.

How do I prepare for the test?

You should take 800mg of ibuprofen 30 min prior to your appointment. You will be asked to provide a urine specimen before the procedure. It is best to avoid tampon use or vaginal creams the day before and the day of the procedure.

What risks are there from the test?

Colposcopy and cervical biopsies are low-risk. There is a slight risk of infection and bleeding with this procedure.

Post-procedure Instructions

Call your doctor if you develop a fever greater than 100.4 degrees Fahrenheit or is you have vaginal bleeding that lasts longer than three days. Do you use tampons or have intercourse for 2 weeks following the procedure.When will I find out the results of the test?Test results are usually available 5-7 days after the biopsy is performed.

Please be able to give a urine specimen when you arrive at your appointment.

If you have any questions, please contact our office at (314) 432- 3669.

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Endometrial Biopsy

What is the test?

An endometrial biopsy involves taking a tissue sample from the lining of your uterus (the endometrium). It is sometimes indicated in women who have irregular bleeding to evaluate for problems including endometrial cancer.

How do I prepare for the test?

You should take 800mg of ibuprofen 30 min prior to your appointment to reduce the possible of uterine cramping during the procedure. You will be asked to provide a urine specimen before the procedure.

What happens when the test is performed?

This test is performed in the office. Your doctor will first clean your cervix with betadine. The doctor may place a clamp on your cervix to hold it steady during the procedure. A flexible, sterile plastic instrument called a Pipelle, will be inserted through the opening in your cervix into your uterus. The doctor will then pull a thin rod out of the Pipelle which creates suction. This draws some of the cells from the lining of your uterus into the Pipelle. To get a good sample, the doctor will then move the Pipelle forward and backward a few times before removing it. The sample will then be sent to a pathologist for review. The entire procedure takes about 10 minutes.

What risks are there from the test?

You might have pelvic cramps (sometimes intense) during the procedure and sometimes for a day or two afterward; you may also experience a small amount of vaginal bleeding. It is extremely rare to have heavy bleeding or to develop an infection that needs treatment.

Post-procedure Instructions

Call your doctor if you develop a fever of over 100.4 degrees Fahrenheit, or if you have vaginal bleeding that lasts longer than two to three days after any bleeding has stopped.

When will I find out the results of the test?

Test results are usually available 5-7 days after the biopsy is performed

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Intrauterine Device (IUD)

The IUD is usually inserted during your menstrual period. The doctor or nurse practitioner puts the IUD in a long, slender, plastic tube. He or she places it into the vagina, guides it through the cervix into the uterus. The IUD is then pushed down out of the plastic tube into the uterus. The IUD strings open into place, and the tube is withdrawn.

Once the IUD is inserted, the doctor or nurse practitioner may show you how to check that it’s in place. Each IUD comes with a string made of thin plastic thread. You will be able to tell the placement of the IUD by the location of the string. It is important to check the string regularly. If you don’t feel the string, call the office.

You will be scheduled for an ultrasound or an appointment with the physician or nurse practitioner about two-four weeks after the IUD insertion to confirm correct placement.

Preparation:

It is preferable to be on your menstrual cycle when the IUD is inserted
However, if the IUD is inserted other than the week you are on your menstrual cycle, you need to remain abstinent two weeks prior to your appointment
We will need a urine sample at the time of your appointment
Thirty minutes prior to your appointment, if no contraindications, take 600mg Ibuprofen

If you have questions, please don’t hesitate to call the office at 314-432-3669.

For more information please seewww.mirena-us.comwww.paraguard.com

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Nexplanon

What is NEXPLANON™?

NEXPLANON is an implant for subdermal (under your skin) use that offers women up to 3 years of contraception. The rod is easily implanted into the upper inside of the arm.

Who is a good candidate for receiving NEXPLANON?

Any woman who is not currently pregnant and has no history of blood clots or clotting disorders; liver tumors or active liver disease, breast cancer or abnormal vaginal bleeding. We will require you to have a pregnancy test prior to inserting NEXPLANON unless the NEXPLANON is inserted while you are menstruating.

What if I need birth control for more than three years?

You must have NEXPLANON removed after three years; however, you may choose to have another NEXPLANON inserted after taking out the old one.

What are the most common side effects of NEXPLANON?

The most common side effects are irregular and unpredictable bleeding. Other rare side effects are mood swings, weight gain, headache, acne and depression.

What if I should become pregnant while using NEXPLANON?

You should see your provider right away to remove NEXPLANON. Based on experience with birth control pills, NEXPLANON is not likely to cause birth defects.

Can I use NEXPLANON when I’m breastfeeding?

You may start Nexplanon if you are breastfeeding and if you delivered your baby six or more weeks ago.

Where can I find more information about NEXPLANON?

At www.NEXPLANON-USA.com.

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In Office Post Procedure Instructions

Colposcopy/biopsy and endometrial biopsy

There may be some light bleeding that can last for a few days, and you may experience heavy bleeding 5 to 10 days after the procedure. Do not use tampons, have sexual intercourse, or put anything into the vagina for two weeks following the procedure unless instructed otherwise by your doctor. Call our office if you experience fever, unusual pain, discharge, bad odor, severe cramping, fainting or dizziness. You may take Ibuprofen (3 or 4 tablets @ 200 mgs. ea) every 6-8 hours for pain/cramping. The biopsy results should be available in 1 week.

Cryosurgery

There may be some bleeding that can last for a few days, and you may experience heavy bleeding 5 to 10 days after the procedure. You may expect a profuse watery discharge for 2-4 weeks following this procedure. Call our office if you experience fever, unusual pain, severe cramping, fainting or dizziness. You may take Ibuprofen (3 or 4 tablets @ 200 mgs. ea) every 6-8 hours for pain/cramping. Do not use tampons, have sexual intercourse, or put anything into the vagina for at least two weeks following the procedure unless instructed otherwise by your doctor.

IUD insertion

Call our office if you experience fever, severe cramping or pain, bad odor, fainting or dizziness. You may take Ibuprofen (3 or 4 tablets @ 200 milligrams each) every 6-8 hours for pain/cramping. You may resume normal activity including using tampons and having sexual intercourse following this procedure. Be sure to discuss with your provider how long you need to remain on other forms of birth control before relying on your IUD.

Lesion removal

Please keep the lesion removal area dry and covered for 12-24 hours and call our office if you experience fever or redness at the lesion removal site. The lesion will be sent to pathology for evaluation. Results from this test should be available in 1 week.

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Surgical Procedures

Robot Assisted Hysterectomy (da Vinci)

A wide variety of conditions can affect a woman’s reproductive system, which consists of the uterus, the vagina, the ovaries and fallopian tubes. Most of these conditions affect the uterus, which is the hollow, muscular organ that holds a baby as it grows inside a pregnant woman.

Common types of gynecological conditions like fibroids (non-cancerous growths in the uterine wall), endometriosis (non-cancerous grows of the uterine lining) or prolapse (falling or slipping of the uterus) can cause chronic pain and abnormal bleeding, as well as other disabling symptoms.

Women who experience these symptoms are often treated with a hysterectomy-the surgical removal of the uterus. In fact, this procedure is the second most common surgical procedure for women in the United States, and an estimated one-third of all U.S. women will have a hysterectomy by age 60.

Your doctor might recommend a hysterectomy to treat your condition. A hysterectomy can sometimes be performed through the vagina. However, when the uterus is large or if you have internal scarring from prior surgery or other conditions, an abdominal hysterectomy is usually performed.Traditionally, abdominal hysterectomies are performed with open surgery, which requires a wide incision below the navel. This procedure can be painful, involving heavy pain medications, risk of infection and significant blood loss. After surgery, a long recovery (often 6 weeks) is necessary. In addition, many patients are not happy with the scar left by the incision. While a hysterectomy is a relatively safe procedure, it may not be appropriate or necessary for all individuals or conditions. Alternative treatments that preserve the uterus may be available. For example, da Vinci Myomectomy may be an option for women with fibroids who want to preserve their fertility and/or uterus. Always ask your doctor about all treatment options, as well as their risks and benefits.

If your doctor recommends a hysterectomy, you may be a candidate for an innovative, less invasive surgical procedure called da Vinci Hysterectomy. This procedure uses a state-of-the-art surgical system designed to help your doctor perform the most precise and least invasive hysterectomy available today.

For most women, da Vinci Hysterectomy offers numerous potential benefits over traditional surgical approaches, including:

Significantly less painLess blood loss and need for transfusionLess risk of infection
Shorter hospital stay
Quicker recovery and return to normal activities
Small incisions for minimal scarring
Better outcomes and patient satisfaction, in many cases
As with any surgery, these benefits cannot be guaranteed, as surgery is patient-and procedure-specific.

The da Vinci Surgical System is designed to provide surgeons with enhanced capabilities, including high-definition 3D vision and a magnified view. Your doctor controls the da Vinci System, which translates his or her movements of tiny instruments inside your body. Though it is often called a “robot,” da Vinci cannot act on its own: instead, the surgery is performed entirely by your doctor.

Together, da Vinci technology allows your doctor to perform complex procedures through just a few tiny openings. As a result, you may be able to get back to life faster without the usual recovery following major surgery.

The da Vinci System has been used successfully worldwide in hundreds of thousands of procedures to date.

For more information see www.davincihysterectomy.com

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Endometrial Ablation

Menorrhagia occurs in 1 out of every 5 women and is defined as unusually heavy and/or long-lasting menstrual periods. Many women do not seek treatment because they are embarrassed to discuss their periods; they think their bleeding is normal because it has always been that way; or they are afraid of the treatment options. If your period lasts a long time or is so heavy you need to change pads or tampons every 1 or 2 hours, then you may have menorrhagia.

There are several different ways to treat your heavy periods, including hormones or oral contraceptive pills, hormone-releasing IUDs; and for women who are finished having children, hysterectomy and endometrial ablation are also options.Endometrial ablation is a procedure that permanently removes the lining of the uterus. Your physician can perform endometrial ablation in the office or outpatient surgery center. Approximately 95% of patients experience little to no significant pain during the procedure which is done under IV sedation and it does not require incisions. Patients go home the same day and are typically back to work in 1 or 2 days. Most women see a great decrease in their level of menstrual bleeding with about 91% of women reporting normal bleeding or less and 40-50% reporting no bleeding at all. Many women also had a significant reduction in painful periods and PMS symptoms.

You and your doctor can decide which treatment option is best for your menorrhagia.

Please see the following sites for more information

www.novasure.comwww.bostonscientific.com/genesys-hta-treatment

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Hysterectomy

A Hysterectomy is the removal of the uterus. It is a way of treating problems that affect the uterus. Many conditions can be cured with a hysterectomy. Because it is major surgery, your doctor may suggest trying other treatments first. For conditions that have not responded to other treatments, a hysterectomy may be the best choice. You should be fully informed of all options before you decide.

About the Uterus

The uterus is a muscular organ in the pelvis. The opening of the uterus is the cervix. During pregnancy, the uterus holds and nourishes the fetus. In labor, it contracts to help deliver the baby. When a woman is not pregnant, the lining of the uterus (the endometrium) is shed each month in her menstrual period.

What is Hysterectomy?

Hysterectomy is the surgical removal of part of or all of the uterus. It is the second most common major surgery among women of child-bearing age.

Hysterectomy may be done to treat conditions that affect the uterus. Some reasons a hysterectomy may be needed include:

Uterine fibroids

Endometriosis

Pelvic support problems (such as uterine prolapse)

Abnormal uterine bleeding

Cancer

Chronic pelvic pain

A hysterectomy can be:

Subtotal (also called partial or supracervical), in which the upper part of the uterus is removed but the cervix is left in place
Total, in which the entire uterus, including the cervix, is removed.
Radical, in which the entire uterus and support structures around the uterus are removed (this is done if certain types of cancer are present)

A hysterectomy does not include removal of the ovaries and fallopian tubes. When these organs are removed at the same time as the uterus and cervix, it is called a salpingo-oophorectomy.

Types of Hysterectomy

The type of hysterectomy chosen depends on the reason for the surgery. It also depends on the findings of a pelvic exam. Your doctor may suggest abdominal, vaginal, laparoscopically assisted vaginal, or laparoscopic hysterectomy.

Abdominal Hysterectomy

In abdominal hysterectomy, the doctor makes an incision (cut) through the skin and tissue in the lower abdomen to reach the uterus. The incision may be vertical or horizontal. Abdominal hysterectomy requires a longer healing time than vaginal or laparoscopic surgery. But there can be advantages to having an abdominal hysterectomy. This type of hysterectomy gives the surgeon a good view of the uterus and other organs during the operation. The doctor may suggest this procedure if you have large tumors or if cancer may be present.

Vaginal Hysterectomy

In vaginal hysterectomy, the surgery is done through the vagina. With this type of surgery, you will not have any scarring on your abdomen. Because the incisions inside the vagina, the healing tie may be shorter than with abdominal surgery.

Laparoscopically Assisted Vaginal Hysterectomy

With laparoscopically assisted vaginal hysterectomy (LAVH), the doctor removes the uterus through the vagina. Your doctor may suggest LAVH if standard vaginal surgery cannot be done. LAVH involves the use of a small light-transmitting device called a laparoscope. The device is put into the abdomen through a small incision. It lets the doctor see the pelvic organs on a screen while doing the surgery.

Additional small cuts are made in the abdomen to assist the surgery. The uterus is removed through the vagina. Recovery from LAVH is similar to vaginal hysterectomy. However, the time it takes to perform an LAVH can be longer time than a standard vaginal hysterectomy.

Laparoscopic Hysterectomy

Laparoscopic hysterectomy is done through small incisions in the abdomen. The uterus is removed in small pieces through these incisions. Laparoscopic hysterectomy has a shorter recovery time than abdominal or vaginal hysterectomy.

What to Expect

It is helpful to know what to expect before any major surgery.

Before hysterectomy:

Your blood and urine may be tested.
Your abdominal and pelvic areas may be partially shaved.
Antibiotics will be given to prevent infection.
A needle may be placed in your arm or wrist. It is attached to a tube called an IV line that will supply your body with fluids, medication, or blood.
Monitors will be attached to your body before anesthesia (pain relief) is given. You will be given a general anesthesia, which blocks out feeling in the lower part of your body.
A thin tube called a catheter will be placed in your bladder. The catheter will drain urine from your bladder during the surgery.

Risks

The risk of problems related to hysterectomy is among the lowest for any major surgery. As with any surgery, though, problems can occur. These problems could include:
Blood clots in the veins or lungs
Infection
Bleeding during or after surgery
Bowel blockage
Injury to the urinary tract or nearby organs
Problems related to anesthesia
Early menopause (if ovaries are removed)
Death

Before having a hysterectomy, talk with your doctor about the benefits and risks.

Your Recovery

If you have a hysterectomy, you may need to stay in the hospital for a few days. The length of your hospital stay will depend on the type of hysterectomy you had.

You will be urged to walk around as soon as possible after your surgery. Walking will help keep your blood moving. It also will help prevent blood clots in your legs. You also may receive medicine or other care to help prevent blood clots.

You can expect to have some pain for the first few days after the surgery. You will be given medicines to relieve pain. You also will have bleeding and discharge from your vagina for several days. Sanitary pads can be used after the surgery.

During the recovery period, it is important to follow your doctor’s instructions. Be sure to get lots of rest, and do not left heavy objects until your doctor says you can. Also, do not put anything in vagina during the first 6 weeks. That includes douching, having sex, and using tampons.

If you had a vaginal or laparoscopic hysterectomy, you might feel better before 6 weeks. Even if you feel better, be sure to follow your doctor’s advice about what you can and cannot do. Work with your doctor to plan your return to increase activities such as driving, sports, and light physical work. If you can do an activity without pain and fatigue, it should be okay. If an activity causes pain, discuss it with your doctor.

Even after your recovery, you should continue to see your doctor for routine gynecologic exams. Pap tests may be needed if a total hysterectomy was done because of cancer or conditions that may lead to cancer. If you had a partial hysterectomy, pap tests will still be needed.

Effects of Hysterectomy

Hysterectomy can have both physical and emotional effects. Some last a short time. Others are long term. You should be aware of these effects before having the surgery.

Physical Effects

After hysterectomy, a woman’s periods will stop. If the ovaries are left in place, they continue to produce hormones. Although the ovaries still function, a woman can no longer get pregnant.If the ovaries are removed before menopause, hormone-related effects will occur. Your body may seem to go through menopause all at once, rather than over a few years as is normal. If you are younger than 45 years and your ovaries were removed, you may be at risk of early osteoporosis. Your doctor can suggest ways to handle menopausal symptoms and prevent osteoporosis.

Emotional Effects

Many women have an emotional response to the loss of their uterus. This response depends on a number of factors and differs for each woman.Some women feel depressed because they can no longer have children. Other women may feel relieved because the symptoms they were having have now stopped. If problems persist, further care may be needed.

Sexual Effects

Some women notice a change in their sexual response after a hysterectomy. Because the uterus has been removed, uterine contractions that may have been felt during orgasm will no longer occur.Some women feel more sexual pleasure after hysterectomy. This may be because they no longer have to worry about getting pregnant. It also may be because they no longer have the discomfort of heavy bleeding caused by the problem leading to hysterectomy.If the ovaries have not been removed, the outer genitals and the vagina are not affected. In this case, a woman’s sexual activity often is not impaired. If the ovaries are removed with the uterus, vaginal dryness may be a problem during sex. Estrogen or other vaginal lubricants can help relieve dryness.

Finally…

Hysterectomy is just one way to treat uterine problems. It is major surgery. Before you decide whether it is right for you, find out as much as you can about:

Your condition
Other treatment options
How hysterectomy may affect you

For some conditions, other treatment options are available for others, hysterectomy is the best choice. Your doctor can help you weigh the options and make a decision.

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Hysterosalpingogram

What is hysterosalpingogram?

Hysterosalpingogram is an x-ray procedure in which a special contrast (a dye like solution) is injected through the cervix into the uterine cavity to illustrate the inner shape of the uterus and degree of openness (patency) of the fallopian tubes.

Where do I have this performed?

This will be performed in the radiology department.

When do I need to have this test performed?

It is best for you to call to schedule your appointment the first day you start your next period. We will want you to have an HSG on Day 7-12 of your cycle (Day 1 is the first day of your period).

What will I experience during the procedure?

The procedure should cause minimal discomfort; however, we do recommend you take 2-3 ibuprofen one hour prior to this test and you may also wish to have a back-up ride available in case you don’t feel up to driving afterward. There may be slight discomfort when the catheter is placed and the contrast material is injected, but it should not last long. There may also be generalized lower abdominal pain, but this should also be minimal and not long lasting.

Who interprets the results and how do I get them?

A radiologist, a physician experienced in x-ray and other imaging examinations, will analyze the images and provide a report to us. We will contact you with the results.

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Laparoscopic Hysterectomy

Laparoscopic Hysterectomy is a minimally invasive choice

Innovative, minimally invasive procedure
Designed to reduce pain
Leaves only tiny scars
You can be home resting comfortably within 24 hours.
You can get back to most of your routine in one to two weeks

The decision to have a hysterectomy is rarely an easy one.

After all, a hysterectomy is major surgery, and that by itself can be scary. You probably have questions about how a hysterectomy will make you feel physically, emotionally and even sexually, long after the surgery is over.

Chances are you’ve talked about the issues that are most important to you with your doctor, family, and friends. You’ve explored the alternatives. But now that you and your doctor have concluded that a hysterectomy is the best option, where do you go from here?

Even after the decision to have a hysterectomy is made, you still have options to consider and choices to make. The days when every woman had the same kind of hysterectomy are long gone. Today there are several types of hysterectomies including minimally invasive procedures.

A quick guide to the female reproductive system.

Uterus

Also known as the womb. It is the muscular, pear-shaped female reproductive organ inside which a fertilized egg is implanted and a developing embryo and fetus grows.

Ovaries

The 2 female reproductive glands in which eggs are formed and which produce the essential female hormones estrogen and progesterone. They are located in the lower abdomen, to the left and right of the uterus.

Vagina

The organ through which blood and tissues pass out of the body during menstrual periods and through which a baby passes during birth.

Fallopian tubes

Two thin tubes through which the egg (fertilized or not) travels from the ovaries to the uterus.

Endometrium

The mucous membrane that lines the inner surface of the uterus, and which thickens during each menstrual cycle to prepare the uterus from implantation of a fertilized egg. Most of the endometrium is shed with each menstrual flow if fertilization does not occur.

Cervix

The lower, narrow part below the uterus- it connects the uterus to the vagina. The cervix dilates with labor to allow the baby to pass.

What is a hysterectomy?

A hysterectomy is the surgical removal of the uterus, or womb. It is the second most frequently performed surgery on women after Cesarean section (C-section). Depending on the type of hysterectomy performed and the reason it’s being done, removal of the cervix, ovaries and fallopian tubes is sometimes performed during the same surgery.

There are 2 basic types:

Supracervical (subtotal or partial) Hysterectomy

The uterus is removed but the cervix is left in place, which some research suggests may help to reduce the risk of pelvic floor prolapse. It may also help preserve sexual function. Moreover, recovery is easier. The ovaries and fallopian tubes may or may not be removed.

Total Hysterectomy (or “Traditional Hysterectomy”)

The uterus and cervix are removed. As an option the ovaries and fallopian tubes may or may not be removed.

Why are hysterectomies sometimes necessary?

Each year, 600,000 women in the United States undergo hysterectomies to treat a range of conditions.

These include:

Fibroids

Usually benign (non-cancerous) growths inside the uterus. A fibroid can be as small as a pea or grow larger than a grapefruit.

Menorrhagia

The medical term for excessive menstrual bleeding. Menorrhagia is usually caused by hormonal changes or by fibroids. It can also be caused by infection or disease.

Endometriosis

A condition where tissue that normally resides in the uterus appears in other parts of the abdomen. It can cause pelvic pain and infertility

Pelvic Support Problems

A condition such as uterine prolapse, when the uterus falls from its normal position and descends into the vagina.

Some Issues to Consider…

You should discuss your goals for treatment and recovery with your doctor. Some of the factors you’ll want to consider include whether the cervix, ovaries, or fallopian tubes will need to be surgically removed during the procedure and which procedure is the least invasive.

What are the benefits of keeping my cervix?

The cervix connects the upper portion of the vagina to the uterus. The ligament attached to the cervix provides support for both organs. For this reason, some gynecologists feel that leaving the cervix in place is important to reduce the chance of pelvic floor support problems. In addition, some research suggests the cervix may play a role in sexual arousal and the ability to achieve organism in some women.

On the other hand, retaining the cervix, means you may still experience some periodic bleeding. In addition, you – like women who have not had a hysterectomy- should continue to have pap smears to screen for cervical cancer.

What happens if my ovaries are removed?

If your ovaries are removed, you will enter menopause, if you have not done so already. Therefore, you may experience the symptoms associated with menopause (such as hot flashes, insomnia, vaginal dryness, irritability or depression). This may be helped with estrogen replacement therapy.

Exploring Your Options…

It used to be that total abdominal hysterectomy (removal of the uterus and cervix through a large abdominal incision) was often the only type of hysterectomy offered to women. If the uterus was small and dropping in the vaginal canal, a vaginal hysterectomy could also be performed. But today, the development of improved surgical devices and innovative techniques allows for less invasive procedures that can remove the uterus but can sometimes allow you to keep your cervix. Hospital stays and recovery times have also been reduced.

Although some medical conditions may require specific techniques, it is important to know what your options are and to discuss them with your doctor.

What are the different ways to perform a hysterectomy?

Laparoscopic supracervical hysterectomy (LSH)

Is an option that uses laparoscopy alone to remove the uterus, but leaves the cervix intact. During the procedure, a laparoscope and small surgical instruments are inserted through tiny incisions in the navel and abdomen. Using these instruments, the surgeon is able to carefully separate the uterus from its pelvic connections and from the cervix. The uterus is then removed through one of the incisions.

LSH is less invasive than traditional “open” hysterectomy and has many advantages. It was developed to reduce pain and trauma to the body, minimize scarring, and shorten recovery time. The procedure can be performed on an inpatient or outpatient basis, which means that you can be home resting comfortably within 24 hours, and back to your normal activities in one to two weeks.

In addition, LSH preserves the cervix, which some research suggests may help to reduce the risk of pelvic floor prolapse, and other complications associated with total hysterectomies, including sexuality concerns.

Total Laparoscopic Hysterectomy (TLH)

Is very similar to the LSH except the cervix is removed along with the uterus. Oftentimes the organs are removed through the vagina. Like LSH, TLH is less invasive than traditional “open” hysterectomy. You will usually be out of the hospital within 24 hours and recovery takes about 2 weeks. This is technically the most difficult type of the hysterectomy to perform, so it should be done by a highly skilled laparoscopic surgeon.

Total Abdominal, or open, hysterectomy (the “traditional” hysterectomy)

Involves removal of the uterus and cervix (with or without removal of the ovaries or fallopian tubes) through a large abdominal incision. This is the most invasive type of hysterectomy, and also the most common. Total abdominal hysterectomy may be recommended if you have large fibroids that have not responded to hormone therapy or would be difficult to remove vaginally. It also may be the preferred procedure if you have severe endometriosis (uterine lining tissue that has found its way out of the uterus), prior pelvic infections, scarring from prior pelvic surgeries, or some types of cancer.Total abdominal hysterectomy requires an average hospital stay of 2 days and a recovery period up to 6 weeks.

Vaginal Hysterectomy

Is a procedure that removes the uterus and cervix through an incision inside the vagina. Tubes and ovaries can often be removed at the time of vaginal hysterectomy. This is the method commonly chosen to treat uterine-vaginal prolapse and can also be used to help treat early cervical or uterine cancer.

A vaginal hysterectomy usually results in less postoperative discomfort than you would feel after a total abdominal hysterectomy. It has a hospital stay of 1-2 days and a recovery time of 2-4 weeks. There is no visible scarring. Vaginal hysterectomy may not be appropriate if very large fibroids are present.

Laparoscopically

Assisted vaginal hysterectomy (LAVH) is similar to a vaginal hysterectomy-the uterus and cervix are removed through an incision inside the vagina-but also includes the use of a laparoscope (a thin, lighted telescope) which is inserted through a tiny incision in the navel and abdomen.

Use of a laparoscope allows the upper abdomen to be carefully inspected during surgery and allows the surgeon to perform part of the surgery through incisions leaving small scars. Tubes and ovaries may be removed if needed by this technique. Hospital stay and recovery time are similar to simple vaginal hysterectomy. The combination of vaginal hysterectomy with laparoscopic technique requires more skill to perform and more time in the operating room than total abdominal or vaginal hysterectomy procedures along.

Some Final Thoughts…

The decision about which kind of hysterectomy to have is an important one. Remember, it’s usually an elective procedure, not an emergency. Give yourself some time to thoroughly understand your options. Talk with your doctor.

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LEEP

LEEP is done after abnormal Pap test results have been confirmed by colposcopy and cervical biopsy. This procedure (loop electrosurgical excision) uses a thin, low-voltage electrified wire loop to cut out abnormal tissue. LEEP may be used to treat persistent low-grade squamous intraepithelial lesions (LSIL) and may also be used to treat new high-grade squamous intraepithelial lesions (HSIL).

During LEEP, a small amount of normal cervical tissue is removed at the edge of the abnormal tissue area. The tissue that is removed can be examined for cancer that has grown deep into the cervical tissue. In this way, LEEP can help further diagnose as well as treat the abnormal cells. If all of the abnormal cervical tissue is removed, no further surgery is needed, though abnormal cells may recur in the future.

LEEP can be done at Women’s Care Consultants with local anesthesia. It may also be performed at Missouri Baptist Hospital as an outpatient procedure. Most women are able to return to normal activities within 1 to 2 days after LEEP is performed.

After LEEP you can expect 2 weeks of red brown to yellow discharge. You may also have a few days of cramping. Call the office if you experience severe pain, fever, or foul smelling vaginal discharge.

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In Patient (Hysterectomy) Post Operative Instructions

General

If you are having a Laparoscopic Hysterectomy or Vaginal Hysterectomy you can expect to spend one night in the hospital. Your doctor will routinely see you the morning after surgery. You will usually be discharged around noon if you are doing well.
If you are having an Abdominal Hysterectomy you can expect to spend 2 nights in the hospital.
Both of these projected hospital stays are dependent on your ability to urinate, have some bowel function (pass gas), and obtain pain relief with oral pain medicine.
The day of surgery you will have an I.V. line for fluid replacement and pain medicine, and a catheter in your bladder. The next day the I.V and catheter will be removed, and you will be ambulating, getting out of bed to the bathroom, and possibly showering.

Driving

We suggest that you do not plan on driving for 2 weeks following surgery and especially while taking narcotic pain relievers.

Activity

At home we encourage you to “listen to your body”. You may go up and down stairs (a rough guideline is to limit your “round-trips” to 2 a day for the first week), take a shower, and do what’s necessary to take care of yourself (though nobody else) for the first week or so. Gradually increase your activity daily, especially walking. Our guideline is to wait 4-6 weeks following surgery before “strenuous” activity, meaning straining that will cause your face to flush for an extended time.

Pain

You will be prescribed oral pain medicine, usually a narcotic/acetaminophen combination. Additionally you may take Ibuprofen over-the-counter 3 tablets every 6 hours. This can reduce the amount of narcotic pain medicine you need to take. Each prescription tablet will contain 325 or 500 mg of acetaminophen, and that number will be on the prescription label. You can also take acetaminophen alone. If you have pain unrelieved by these measures call the office.

Nausea

Occasionally people require medicine for nausea relief when they go home. If so, we will prescribe something.

Incisions

Most of the time your will have absorbable sutures under the skin which do not need to be removed. You may also have Dermabond , similar to “super glue” applied, which will gradually come off. Occasionally we use skin staples for wound closure, and these will need removal in approximately one week.

Bowels

Usually passing gas from below is a condition for discharge. After surgery it is extremely important that you do not get constipated. The single major thing that makes people feel well after surgery is resumption of bowel function. We encourage you to have adequate to extra fluid and fiber intake. Products such as Metamucil, Citrucel, Benefiber, etc. taken on a routine basis, 2-3 times a day until bowel movements become regular and normal, can help you recover more quickly. It is also safe to take Colace, Senna, and Miralax. Surgery and narcotics both contribute to constipation. It is important, however, to take adequate pain relief since pain can also inhibit your ability to relax and have bowel movements more easily. Early discharge from the hospital also facilitates return to normal bowel function since most people more easily relax in the familiarity of their own home.

Bladder

You should be emptying your bladder normally when discharged. In the rare instances when you are discharged with a catheter we will instruct you on how and when to remove it. If unable to void, call the office.

Bleeding

You will probably have some slight bloody discharge that will gradually become white/yellow vaginal discharge. Any bleeding should always be less than a “normal” menstrual period. You may have a “gush” of bloody discharge 2-3 weeks after surgery. If persistent or if you have questions please call the office. Many times at the post-op visit a small amount of raw slowly healing tissue at the top of the vagina called “granulation tissue” is seen and is usually dispensed with by an application of silver nitrate. This is quite common, can be a source of discharge, but can always be eliminated.

Questions?

Please call our nurse at 314-432-3669 with any questions or concerns. That is also the number to call to reach the doctor on-call for after hours emergencies.

Post-op appointment

You will be seen in 2 weeks. You will be made aware of this appointment date and time prior to your surgery, but we will also mail it to you. If for some reason you have not received this by one week following surgery, call the office 314-432-3669 to clarify.

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Out Patient Surgery Pre Op Instructions

PLEASE ARRIVE 1 HOUR 15 MIN BEFORE SURGERY

The Women’s Outpatient center is located in building D at Missouri Baptist. This is the same building as our office. Take the elevators to the 2nd floor. To your left is the “Women’s Outpatient Center.”

You will be contacted by a nurse from the Women’s Outpatient Center a few days before the procedure. She will go over all your information, medical history as well as your insurance information. This will help with the day of your surgery so it will be a simple and easy process.

Follow these guidelines prior to surgery

PLEASE BE ABSTINENT FROM SEXUAL INTERCOURSE FOR 2 WEEKS PRIOR TO SURGERY IF YOU ARE PRE MENOPAUSAL
STOP all ASPIRIN OR NSAID products one week before surgery (time permitting.) This includes Advil, Aleve, Motrin, Ibuprofen, etc. TYLENOL IS OK TO TAKE BEFORE SURGERY.
DO NOT eat or drink anything after midnight before surgery. This includes coffee, chewing gum, or mints. (Gatorade/Powerade/Water are allowed up to 3 hours prior to surgery.)
DO NOT smoke the morning of surgery.
PLEASE SHOWER with plain soap before your surgery. DO NOT USE lotions, oils or powder.

If you have questions or concerns please call Jamie at 314-432-3669. We want you to feel comfortable with all aspects of your upcoming surgery.

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Out Patient Surgery Post Op Instructions

Hysteroscopy, D&C, Endometrial Ablation

Anesthesia

You will receive I.V. sedation (MAC, Monitored Anesthesia Care), and local anesthesia injected into the cervix.

Activity

You should “take it easy” the day of surgery. In most cases you will feel pretty normal the day after surgery. If you have had an ablation, you may have cramping lasting for a few days post-operative. You may shower the day after surgery. Refrain from intercourse for two weeks after surgery.

Pain relief

Generally over-the-counter medicines such as ibuprofen, 3-4 tablets 3-4 times a day, and acetaminophen (Tylenol®) can help. If you have had an ablation, you may also be given a narcotic/acetaminophen combination prescription for pain relief. Your prescription will be labeled with the mg of acetaminophen contained in each tablet (either 325 or 500). If you have pain unrelieved by these measures, call the office.

Bleeding

You will probably have some vaginal bleeding but it should be less than a period. Following ablation you can expect some discharge of varying consistency lasting until your post-op exam, and often up to 4 weeks.

Questions?

Please call our nurse at 314-432-3669 for any questions or concerns. That is also the number to call to reach the doctor on-call for after hours emergencies.

Post-op appointment

You will normally be seen in 2 weeks. You will often be made aware of this appointment date and time prior to your surgery, but we will also mail it to you. If for some reason you have not received this by one week following surgery, call the office 314-432-3669 to clarify.

Laparoscopy

Discharge from hospital

Normally you will go home the same day of surgery.

Incisions

The number and size of incisions depend on the procedure, and may range from one to four. They will all be small and closed either with absorbable sutures (do not need removal), Dermabond® (an adhesive like “super glue”), or both. If your incision has a bandage on it you may remove it the day following surgery unless specifically instructed otherwise.

Shower and bath

Ordinarily you may do either, though “soaking” incisions is less advisable for the first week after surgery. It’s important to gently clean the umbilicus (belly button) and make sure it is gently and completely dried.

Pain

You can expect to have varying degrees of discomfort from your incisions, your pelvis, and from your shoulder(s). The incision and pelvis because these are the sites where incisions and tissue manipulation actually took place. The shoulder pain is due to the small amount of gas (CO2) used to create space during the operation left in the abdomen. This will usually disappear the first or second day. It is felt in the shoulder area because the gas “floats” up irritating the diaphragm which shares the nerve supply from the same area of the spinal cord as the shoulder.

Pain relief

You may use ice on the incisions. If you experience shoulder pain, when upright, lying down will usually relieve it. Over-the-counter medicines such as ibuprofen, 3-4 tablets 3-4 times a day, and acetaminophen (Tylenol®) can help. You will also be given a narcotic/acetaminophen combination prescription for pain relief. Your prescription will be labeled with the mg of acetaminophen contained in each tablet (either 325 or 500).

Bleeding

Depending on your procedure you may have a small amount of vaginal bleeding. If it is greater than a period call the office.

Post-op appointment

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Preparing for Your Surgery

Prior to Your Surgery

Smoking

If you smoke, you should stop before your operation. Any period of nonsmoking helps, but to get the most benefit you should quit for at least two weeks before surgery. Quitting or cutting down on smoking will allow you to tolerate an anesthetic more easily. It will also be easier for your lungs to resume normal function after surgery. You will not cough as much, and the risk of infection is decreased.

Medications

If you are taking aspirin, ibuprofen or any of the non-steroidal anti-inflammatory medications that can inhibit blood clotting, you should discontinue this two weeks prior to your surgery. Using Tylenol until the time of surgery is acceptable. Please notify your doctor of all other prescription and non-prescription medications that you may be taking.

Anemia

If you are anemic, please take an iron supplement prior to your surgery.

Pre-operative doctors visit

You may have a pre-operative visit scheduled with your doctor. This is the time for you to ask all your questions about your upcoming procedure and recovery. Your doctor may perform an examination at this visit. Bring a current list of your medications and drug allergies to this appointment.

Hospital preparation

If you are scheduled for in-patient surgery, you will be asked to pre-register at the hospital. You will also be asked to obtain special testing and meet with an anesthesiologist two to three days prior to surgery. For out-patient surgery, no pre-operative blood work is required. You may have your hemoglobin checked on the day of surgery.

Recovery in the Hospital

Pain

Your doctor will order pain medication for you. You are encouraged to ask for the medication on a regular basis before the pain becomes severe. Ibuprofen may be prescribed in addition to a narcotic to enhance the effect of the narcotic without increasing side effects.

Medications

You should continue to take most of your regular medications while in the hospital. In addition, your doctor may prescribe antibiotics. Medicine to help with nausea, sleeping or headaches is also available.

Activity

After the surgery, it is important to re-expand your lungs. You will be asked to breathe deeply, cough and change your position in bed often. As your strength returns, the nurses will have you move around as much as you can. Depending on the type of surgery you’ve had, you may be able to start walking soon after your operation. The sooner you resume activity, the sooner your body’s functions can get back to normal.

Length of stay

Your insurance company will have a standard length of stay for an uncomplicated surgery of your type. You should contact the company ahead of time to determine this.

Recovery at Home

Outpatient surgery

After outpatient surgery, you should be able to go home within one to two hours. You should not drive for 24 hours after outpatient surgery so you should arrange to have someone drive you home when you’re ready to check out.

Activity

Gradually resume normal activities as tolerated. No strenuous activities or heavy lifting are allowed until after your post-operative visit. Do not drive while you are still taking prescription pain medications. Walk several times a day. Expect to feel extremely fatigued during your recovery. This is a normal response and gradually passes with time. Limit lifting to 15 pounds or less during the first four weeks of recovery. Climbing stairs should cause no problems.

Medication

Take your pain medication as needed. Ibuprofen acts to enhance narcotics and may be recommended in addition to a narcotic. Tylenol may also be sufficient. Resume all of your usual medications as previously prescribed. A Dulcolax suppository or Fleets enema may be used if needed for a bowel movement. A stool softener (Colace, Citracel, Fibercon) may also be helpful during the first week or two of recovery.

Incision

Pain and bruising around the incision(s) are normal after surgery. Remove outer bandages (if any) one day after surgery. You may shower after the gauze dressings are off. Do not pull out or cut any sutures. Do not use ointments, topical antibiotics, or peroxide on the wound unless you are directed to do so. If your skin folds over the incision, you may use a hair dryer to keep the incision dry. The incision is usually healed by six weeks after surgery.

Additional instructions

Call the office for temperatures over 101 degrees, severe pain, nausea, vomiting, redness or drainage around the incisions, urinary burning, or if you have any other questions.

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