Gynaecological Surgery

Ovarian cysts are easily identified on ultrasound. A persistent or suspicious cyst should be removed. Cysts may be asymptomatic, but they can cause pain and irregular bleeding. Cysts thought to be cancerous are referred to a specialist gynaecological oncologist. Almost all ovarian cysts can be removed laparoscopically (by key hole surgery) as a day procedure.

An ultrasound scan can indicate potential causes of pelvic pain, but a laparoscopy is the only complete investigation which should confirm whether the cause is gynaecological in origin. Endometriosis is one of the most common causes of cyclical pain in women, and it can only be diagnosed by a visual assessment of the pelvic contents. Scarring or adhesions are less often the reason, but can result from old infection, or previous surgery. Tubal blockage and swelling often causes chronic discomfort. Uterine abnormalities may include fibroids, and endometriosis inside (adenomyosis). A chronically inflamed appendix can be easily identified.

A laparoscopy is keyhole surgery to fully assess the pelvic contents. Often any problems that are identified can be treated at the same time. This will be fully discussed with you before the operation. Most laparoscopies are performed as day cases, but if a lot of treatment is required the procedure takes longer than the usual 15 minutes (sometimes over an hour), and in these cases patients may prefer to stay overnight in hospital. A two to three week recovery leave period should be requested from your employer.

These extremely painful swellings of the vulva develop over a matter of days and can be associated with feeling generally sick, and sometimes a fever. They can burst and resolve themselves, or with a course of antibiotics, but often surgical treatment is required. This is quickly and easily performed under a general anaesthetic taking 10 minutes as a day case, and gives instant relief. Several dissolving stitches are usually placed in the skin of the labia to help prevent recurrence, and a course of antibiotics is mandatory.

There are times when continuation of a pregnancy just isn’t an option. A scan is always required to confirm the pregnancy, and in many cases if the decision is made in the early stages, some tablets may be all that is required, but after 2 months a quick surgical procedure is often the best option. I obviously discuss everything and must be sure that you are making the right decision for you beforehand, but can arrange a 5 minute operation at short notice. The surgery is simple and easy to recover from physically. Counselling can be arranged if you feel it would be of benefit. The operation should not affect your chances of having children in the future in any way. It can be combined with insertion of a coil (IUCD) to ensure future contraception.

Laparoscopic sterilisation is a permanent and should be regarded as an irreversible form of contraception suitable for those women who have completed their family, and should be considered for older women in particular for whom continued use of the contraceptive pill has increased health risks. The operation itself takes 10 minutes, but does require a general anaesthetic. The keyhole technique routinely used applies a clip to each fallopian tube to block it. The procedure has a low failure rate and no significant side effects, but if your natural period (not on the pill) is heavy this will continue to be a problem afterwards. A combined procedure will also effectively treat heavy periods (see thermal ablation of the endometrium) and can easily be arranged. Two weeks leave should be requested to recover from the procedure which is routinely performed as a day case.

An ectopic pregnancy is a pregnancy that implants outside the womb cavity. Typical symptoms include abdominal pain and bleeding in the early stages of pregnancy, but occasionally they are picked up incidentally at the time of an early pregnancy scan. You should contact us for an emergency appointment if you are worried about an ectopic pregnancy. Women who have previously had an ectopic, or have had pelvic surgery or pelvic infection in the past are particularly at risk. An early scan and hormone level measurements will usually confirm the diagnosis. The majority of ectopics are managed surgically by keyhole surgery. In most cases the pregnancy is in the fallopian tube, which may need to be removed if it is irreparably damaged (laparoscopic salpingectomy). In some instances the pregnancy itself can be removed, but the tube conserved (laparoscopic salpingostomy).

Heavy regular periods can be treated surgically by removing the layer of womb lining that normally comes away each month. The treatment is less successful for women who have fibroids but may be considered in some cases. Thermal ablation is a short operation taking 15 minutes, where a balloon filled with hot water is introduced into the womb cavity. The heat destroys the womb lining, significantly improving bleeding in up to 90% of cases. Trans-cervical resection of the endometrium (TCRE) involves surgical removal of the entire womb lining under direct vision using a telescope. It takes up to 30 minutes and in most cases can also be performed as a day case. These procedures are not suitable for women who have not completed their family.

Hysterectomy is suitable for women who want no more periods, and for whom other medical or surgical treatments for problematic periods have failed. The operation can be performed laparoscopically, vaginally or through an abdominal incision. The most suitable route will be discussed prior to the procedure. A hysterectomy may be combined with removal of the ovaries, but this is only recommended in older women or for those with ovarian problems or severe endometriosis. A subtotal hysterectomy is suitable for women who wish to retain their cervix, but have no more periods.

Labial reduction involves trimming the labial folds to correct any irregularities of shape, or in cases where they are uneven or too long. The surgery itself is relatively simple and can be performed as a day case, but will cause some discomfort for a week or so afterwards. Dissolving stitches are used, and in selected cases the procedure may be combined with vulval rejuvenation where simultaneous liposuction from the abdomen provides fat to use as a plumping agent for the vulval tissues.