Gynaecological surgery

Scope of gynaecological surgery with an emphasis on mini invasive operational techniques and implementation of new methods.

Minor gynaecological interventions:

Induced abortion in the 1^st trimester

Operation is performed under general anaesthesia on the patient´s own request or for medical reasons. Access to the uterine cavity is through the vagina. The content of the uterine cavity is removed by suction or by a curette. Duration is approx. 10-15min. We recommend observing sexual abstinence and enhanced hygiene for at least 14 days after the intervention. First menstruation comes 4-6 weeks after the intervention.

Uterine cavity revision after spontaneous abortion, missed miscarriage or labour
The operation consists of removal of the content of the uterine cavity. The operation is performed under general anaesthesia. Access to the uterine cavity is through the vagina. The content of the uterine cavity is removed by a curette. Procedure duration is about 15 minutes. Hospitalization depends on patient´s health status and takes 1 day.

The operation allows histological examination of the removed tissue. We recommend observing sexual abstinence and enhanced hygiene for at least 14 days after the intervention. Mild bleeding (spotting) after the procedure will subside within a week. First menstruation comes 4-6 weeks after the intervention.

Curettage

The operation consists of removal of the cervical and uterine body lining. The operation is performed under general anaesthesia. Access to the uterine cavity is through the vagina. The lining lies on the internal surface of the uterine wall facing the uterine cavity and is gently removed by a curette during the intervention.

The operation allows histological examination of the removed tissue and assessment of its changes. Healing usually takes 10 days and is associated with bloody discharge. Hospitalization does not usually exceed 1 day. The operation does not endanger the further course of the menstrual cycle or your sexual life and also the chance to get pregnant is maintained in women of childbearing potential.

Diagnostic hysteroscopy

Hysteroscopy consists of inspection of the uterine cavity using special optics, potential tissue sampling or treatment of some lesions in the uterine cavity. In case of abrasion we remove cervical and uterine body lining by a curette.

The operation is performed under general anaesthesia after thorough disinfection of the genitals. Access to the uterine cavity is through the vagina and cervix that is enlarged by dilation for introduction of hysteroscope instruments.

The operation allows histological examination of the removed tissue and assessment of its changes. Growth of new uterine lining takes usually about 14 days and is associated with bloody discharge. The hospital stay usually lasts one day. We recommend abstaining from intercourse until bloody discharge stops and a new lining is built.

Cervical treatment using LEEP method

Operation consists of removal of the affected part of the cervix. The operation is performed under general anaesthesia. Access to the cervix is through the vagina. Areas of altered tissue are removed by an electrical loop. Coagulation is used to stop bleeding of the wound area. It is usually accompanied by sampling of the cervix lining. It is a diagnostic procedure that helps to find out the current status of the cervical disease – all tissue is sent for histological examination. Often, it is also a curative procedure because it removes the affected tissue of the cervix and further treatment is not necessary.

Vaginal or cervical biopsy or biopsy of the vulva

The intervention consists of tissue sampling from a specified site and subsequent histological examination of the samples. The intervention is performed under general anaesthesia, respectively under local anaesthesia – according to the extent of the intervention.

Ablation of anogenital warts

The operation consists of ablation of warts from the area of external genitals, respectively from the vagina or the surface of the cervix.

Condylomata accuminata are warty growths found mainly in the area of external genitals, the vagina or around the anus and they are caused by viral infection. It is transmitted by intercourse. The intervention is performed under general anaesthesia.

Major gynaecological interventions:

Laparoscopy

Laparoscopy allows direct control of organs in the lesser pelvis (ovaries, fallopian tubes, uterus and their ligaments, appendix, peritoneum etc.). It is performed using mini invasive techniques via few small punctures across the anterior abdominal wall (so called endoscopy). The surgery is performed under general anaesthesia when a laparoscope, i.e. a device allowing inspection of the pelvis and the abdominal cavity, is inserted. It consists of a thin tube with optics connected to a video circuit and aid tools that allow access to various organs. They are inserted via short incisions approximately 1.5 cm long. The abdominal cavity is filled with carbon dioxide during this procedure. All removed tissue is sent for histological examination.

In comparison with classical abdominal operations, patients better tolerate the postoperative period, convalescence is shorter and patients return faster to normal life.

Surgical removal of the uterus through the vagina with laparoscopic assistance (laparoscopically assisted vaginal hysterectomy – LAVH)

The laparoscope is inserted via an incision just below the navel. Another two devices used to perform the intervention in the abdominal cavity are inserted via two small punctures (approx. 0.5-1.5 cm) above the pubic hair line. The abdominal cavity is filled with carbon dioxide during this procedure.

Removal of the affected uterus can be accompanied by removal of the ovaries and the fallopian tubes.

Following the laparoscopic phase, the operation continues by removing the uterus through the vagina. Uterine removal that starts with laparoscopic and subsequent vaginal access, may sometimes, due to previously unforeseen complexity of the operation, continue with abdominal cavity opening through a skin incision and may be completed in this way.

Because temporary impaired bladder emptying may occur after the operation, a catheter is inserted to the urinary bladder for 24 hours that continuously evacuates the formed urine to avoid renal impairment.

Hysterectomia vaginalis – surgical removal of the uterus through the vagina

The operation is performed under general anaesthesia or conduction anaesthesia through the vagina. It can be accompanied by removal of the ovaries and the fallopian tubes. In case of associated descent of the vaginal walls, vaginoplasty may be performed.

Because temporary impaired bladder emptying may occur after the operation, a catheter is inserted to the urinary bladder for 24 hours that continuously evacuates the formed urine to avoid renal impairment.

Hysterectomia abdominalis – surgical removal of the uterus through the abdominal wall
The surgical procedure is performed under general anaesthesia via a skin incision, usually transversal, above the pubic hair line. The result is removal of the uterus from its original location in the lesser pelvis; fallopian tubes or ovaries or respectively other affected organs may be removed simultaneously. Because temporary impaired bladder emptying may occur after the operation, a catheter is inserted to the urinary bladder for 24 hours that continuously evacuates the formed urine to avoid renal impairment.

Surgical hysteroscopy

The aim of the surgical hysteroscopy is inspection of the uterine cavity using special optics and treatment of some lesions in the uterine cavity (congenital uterine septum, a fibroid in the cavity, polyps in the uterine cavity, ablation of the endometrium).

The operation is performed under general anaesthesia and the access to the uterine cavity is through the vagina and cervix that is enlarged by dilation for introduction of the hysteroscope. Patients with major interventions in the uterine cavity are discharged from hospital on the 2^nd day after the operation.