D&C with Hysteroscopy

D&C with Hysteroscopy

D&C (Dilation and Curettage) with Hysteroscopy are procedures that are performed together, these procedures are used to: Diagnose or treat abnormal bleeding from the uterus, such as heavy or long menstrual periods or bleeding between periods Remove polyps or fibroid Find out whether a woman has cancer of the uterus.

Before the Procedure

Always tell your health care provider or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the days before the surgery:

  • • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
  • • Ask your health care provider which drugs you should still take on the day of your surgery.

On the day of your surgery:

  • • You very often will be asked not to drink or eat anything for 6 – 12 hours before the surgery.
  • • Take the drugs your health care provider told you to take with a small sip of water.

Your health care provider or nurse will tell you when to arrive at the hospital

D&C with Hysteroscopy Procedure

Dilation of the cervix will be the first step of the surgery. The doctor will grasp the cervix with a clamp and pass a thin, flexible piece of metal also known as a sound to determine the depth and angle of your uterus. The cervix will be dilated and a hysteroscope will be inserted into the uterus so the doctor can look inside the uterus.

The entire procedure should take 20 to 30 minutes.

After the D&C Hysteroscopy Procedure

  • The recovery time is generally short following a D&C Hysteroscopy Procedure. Cramps, similar to menstrual cramps, will probably be the patient’s strongest sensation immediately after a D&C Hysteroscopy. Although most women experience cramps for less than an hour, some women may have cramps for a day or more.
  • The patient may also have some light bleeding for several days.
  • The patient will most likely be placed in the recovery room immediately after the procedure. Most hospitals and outpatient clinics will keep the patient for an hour or until she is fully awake. The patient will need to arrange for a ride home.
  • It is suggested that the patient not drive for at least 24 hours after anesthesia. This is recommended even after a sedative/local anesthesia because side effects of these drugs can temporarily impair the coordination and response time.

Risks of the procedure

As with any surgical procedure, complications may occur. Some possible complications of D&C with Hysteroscopy may include, but are not limited to, the following:

  • • Infection
  • • Bleeding
  • • Pelvic inflammatory disease
  • • Perforation of the uterus (rare) or damage to the cervix
  • • Complications from fluid or gas used to expand the uterus

You may experience slight vaginal bleeding and cramps for a day or two after the procedure. There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Certain factors or conditions may interfere with a hysteroscopy. These factors include, but are not limited to, the following:

  • • Pelvic inflammatory disease
  • • Vaginal discharge
  • • Inflamed cervix
  • • Distended bladder

Cystoscopy

Cystoscopy

Cystoscopy is a test that allows your doctor to look at the inside of your bladder and urethra. It’s done using a thin, lighted tube called a Cystoscope. A Cystoscopy can reveal several conditions, including bladder tumors, stones, or cancer. Your doctor can also use this procedure to diagnose. Your doctor might order this test if you have urinary problems, such as a constant need to urinate or if you find urination painful. Your doctor might also order the procedure to investigate reasons for blood in your urine, frequent urinary tract infections (UTIs), an overactive bladder, or pelvic pain.

Before the Procedure

Always tell your health care provider or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the days before the surgery:

  • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
  • Ask your health care provider which drugs you should still take on the day of your surgery.

On the day of your surgery:

  • You very often will be asked not to drink or eat anything for 6 – 12 hours before the surgery.
  • Take the drugs your health care provider told you to take with a small sip of water.

Your health care provider or nurse will tell you when to arrive at the hospital

Cystoscopy Procedure

At this point, you’ll be given anesthesia. If you get general anesthesia, this will be all that you are conscious of until you wake up. If you’re getting a local or regional anesthetic, you may be given a sedative to relax you. Your urethra will be numbed with an anesthetic spray or gel. You’ll still feel some sensations, but the gel makes the procedure less painful. The doctor will lubricate the scope with gel and carefully insert it into the urethra. This may burn slightly, and it may feel like urinating. If the procedure is investigatory, your doctor will use a flexible scope. Biopsies or other surgical procedures require a slightly thicker rigid scope. The bigger scope allows surgical instruments to pass through it. Your doctor looks through a lens as the scope enters your bladder. A sterile solution will flow through to flood your bladder. This makes it easier for your doctor to see what’s going on. The fluid might give you an uncomfortable feeling of needing to urinate. With local anesthetic, your cystoscopy may take less than five minutes. If you’re sedated or given general anesthesia Cystoscopy is a test that allows your doctor to look at the inside of your bladder and urethra. It’s done using a thin, lighted tube called a cystoscopesia; the entire procedure may take 15 to 30 minutes.

After A Cystoscopy Procedure

The day after the test, you may feel tired and have a slight backache.

Most people report that this test is not nearly as uncomfortable as they thought it would be.

After the test, you may need to urinate often. You may have some burning during and after urination for a day or two. It may help to drink lots of fluids. This also helps prevent a urinary tract infection.

Slightly pink urine is common for several days after the test, especially if a biopsy was performed.

Risks

As with any surgery there are risks, however Cystoscopy carries the lowest risks of complications:

  • Bleeding
  • Infection
  • Swollen urethra (urethritis):urination difficult
  • puncture of the urethra or bladder
  • Rare risks include:

Blood clot in the legs or lungs

Complications from anesthesia

Talk with your doctor to understand possible risks and benefits of surgery.

 

Colpopexy (Vaginal Vault Suspension)

Colpopexy (Vaginal Vault Suspension)

Colpopexy is an excellent means to provide Vaginal Vault Suspension. This procedure entails suspension of the vaginal cuff to the sacrum with fascia or synthetic mesh. In addition, many patients require surgical procedures to correct stress urinary incontinence, which is either symptomatic or latent (occurs postoperatively after prolapse correction). This procedure is intended to correct pelvic prolapse that results from inadequate support of the vaginal apex. If the physician uses an abdominal approach and attaches the vault of the vagina to the sacrum the procedure is called a Colpopexy.

Before the Procedure

Always tell your health care provider or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the days before the surgery:

  • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
  • Ask your health care provider which drugs you should still take on the day of your surgery.

On the day of your surgery:

  • You very often will be asked not to drink or eat anything for 6 – 12 hours before the surgery.
  • Take the drugs your health care provider told you to take with a small sip of water.

Your health care provider or nurse will tell you when to arrive at the hospital

 

 

 

 

Colpopexy (Vaginal Vault Suspension) Procedure:

During surgery, the top of the vagina is attached to the lower abdominal (belly) wall, the lower back (lumbar) spine, or the ligaments of the pelvis. Vaginal vault prolapse is usually repaired through the vagina or an abdominal incision and may involve use of either your tissue or artificial material.

Recovery

General anesthesia is usually used for Colpopexy Vaginal Vault Suspension repair. You may stay in the hospital from 1 to 2 days. You will probably be able to return to your normal activities in about 6 weeks. Avoid strenuous activity for the first 6 weeks. And increase your activity level gradually

Risks

As with any surgery there are risks, however Colpopexy (Vaginal Vault Suspension) carries the lowest risks of complications than any other for prolapse.

What are possible risks from this surgery?

  • Bleeding
  • Infection
  • Damage to bowel
  • Difficulty with bowel movements
  • Failure of the surgery
  • Rare risks include:

Blood clot in the legs or lungs

Complications from anesthesia

Talk with your doctor to understand possible risks and benefits of surgery.

 

 

Colpoclesis (Le Fort Technique)-Treat Vaginal Vault Prolapse

Colpoclesis (Le Fort Technique)-Treat Vaginal Vault Prolapse

Colpocleisis (Le Fort Technique) is a surgery to correct Vaginal Vault Prolepses. This is when the pelvic organ has (“fallen womb, bladder”, etc.) for women who do not desire future vaginal intercourse and/or are in poor general health.

In older woman who are no longer sexually active a simple procedure for reducing prolapse is a partial colpocleisis. The procedure was described by ‘Le Fort’ Technique and involves the removal of strip of anterior and posterior vaginal wall, with closure of the margins of the anterior and posterior wall to each other. This procedure may be performed whether or not the uterus and cervix are present. When it is completed, a small vaginal canal exists on either side of the septum, produced by the suturing of the lateral margins of the excision.

 

Before the Procedure

If you have any medical problems, make sure that you are cleared for surgery (medicine or anesthesia). Make sure you have all the necessary lab work, EKG, or chest x-rays done at least 3 days before surgery.

Make sure your physician knows what medications, including herbal supplements, you are currently taking. Some Medications need to be stopped for some time before the procedure. Women seeking care for pelvic floor symptoms should undergo a thorough evaluation before having surgery. Those with pelvic organ prolapse may have coexisting pelvic floor disorders that may include defecatory dysfunction or urinary symptoms such as stress incontinence. Patients must therefore be questioned about any associated bothersome urinary or bowel symptoms because this may affect surgical planning.

In addition, a thorough physical examination should be conducted. Typically, a speculum and bimanual examination are performed.

 

Colpoclesis (Le Fort Technique) Surgical Procedure

The surgery is performed by making an opening in the vagina and the tissue layer under the vaginal skin is reinforced with strong sutures in order to “fix the bulging”. The vaginal opening is also narrowed. The stitches will dissolve over a period of a

Few months and will not need to be removed.

Recovery

Colpoclesis (Le Fort Technique) this procedure requires only an overnight stay in the hospital; Patients typically stay within the hospital for 23-hour observation and are discharged on postoperative day 1. Prior to discharge, a voiding trial is performed.

For patients with preoperative urinary retention, the authors use a suprapubic catheter. Those going home with a catheter are given antibiotics to prevent infection and are seen in the office within 5-6 days for catheter removal and subsequent bladder challenge. Pain control is usually accomplished with oral medications. Patients are discharged home with ibuprofen and acetaminophen with hydrocodone.

A follow-up postoperative visit is scheduled at 2 weeks. At this time, uterine pathology is reviewed if the patient had concomitant cervical dilation and curettage. A postvoid residual is also assessed to evaluate for urinary retention. Patients then have subsequent visits at 6 weeks, 3 months, and 1 year, and as needed thereafter.

Risks

As with any surgery there are risks, however this procedure carries the lowest risks of complications than any other for prolapse.

What are possible risks from this surgery:

  • Bleeding
  • Infection
  • Damage to bowel
  • Difficulty with bowel movements
  • Failure of the surgery
  • Rare risks include:

Blood clot in the legs or lungs

Complications from anesthesia

 

Anterior Colporrhaphy (Cystocele Repair) w/ Mesh

Anterior Colporrhaphy (Cystocele Repair) is the surgical repair of a defect in the vaginal wall, including a cystocele (when the bladder protrudes into the vagina) and a rectocele (when the rectum protrudes into the vagina).
The anterior is (front) and/or posterior (back) walls of the vagina.

Before the Procedure

Always tell your health care provider or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the days before the surgery:

  • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
  • Ask your health care provider which drugs you should still take on the day of your surgery.

On the day of your surgery:

  • You very often will be asked not to drink or eat anything for 6 – 12 hours before the surgery.
  • Take the drugs your health care provider told you to take with a small sip of water.
  • Your health care provider or nurse will tell you when to arrive at the hospital.

 

Surgical Repair

The Anterior Colporrhaphy (Cystocele Repair) the patient is first given general, regional, or local anesthesia. A speculum is inserted into the vagina to hold it open during the procedure. An incision is made into the vaginal skin and the defect in the underlying fascia is identified. The vaginal skin is separated from the fascia and the defect is folded over and sutured (stitched). Any excess vaginal skin is removed and the incision is closed with stitches.

After the Procedure

A Foley catheter may remain for one to two days after surgery. The patient will be given a liquid diet until normal bowel function returns. The patient will be instructed to avoid activities for several weeks that will cause strain on the surgical site, including lifting, coughing, long periods of standing, sneezing, straining with bowel movements, and sexual intercourse.

Risks of the procedure

Anterior Colporrhaphy (Cystocele Repair) is a relatively safe procedure. However; with all surgeries carry some risks. You will need to sign a consent form that explains the risks and benefits of the surgery.

  • Damage to the urethra, bladder, or vagina
  • Irritable bladder
  • Changes in the vagina (prolapsed vagina)
  • Urine leakage from the vagina or to the skin (fistula)
  • potential complications associated with anesthesia
  • infection
  • bleeding
  • A fistula is a rare complication of colporrhaphy in which an opening develops between the vagina and bladder or the vagina and rectum.

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your surgeon before the procedure.

Bladder Tumor Removal

Bladder Repair (for incontinence)

Bladder Repair (For Incontinence)

Bladder Repair for Incontinence is to repair a leakage of urine that happens when you are active or when there is pressure on your pelvic area. Walking or doing other exercise, lifting, coughing, sneezing, and laughing can all cause stress incontinence. Bladder Repair Surgery can correct this problem. Your Surgeon can operate on the ligaments and other body tissues that hold your bladder or urethra in place.

Preparation for Bladder Repair (For Incontinence)

Your health care provider will talk to you about how to prepare for surgery. He may tell you not to eat or drink anything after midnight on the day of your surgery. He will tell you what medications to take or not take on the day of your surgery before surgery; you will need to obtain clearance from your regular doctor if you have medical problems. You may be required to obtain some basic tests for screening before the surgery. Basic blood tests, a chest x-ray, and an EKG may be required depending on your health.

Surgery

General anesthesia usually is used during repair of the bladder and urethra. Unless another health problem is present that would require an abdominal incision, the bladder and urethra are usually repaired through an incision in the wall of the vagina. This surgery pulls together the loose or torn tissue in the area of prolapse in the bladder or urethra and strengthens the wall of the vagina. This prevents prolapse from recurring.

There are several types of surgery to correct stress urinary incontinence. These surgeries lift the urethra and/or bladder into their normal position.

Recovery

You may stay in the hospital from 1 to 2 days. You may go home with a catheter in place. You can most likely return to your normal activities in about 6 weeks. Avoid strenuous activity, such as heavy lifting or long periods of standing, for the first 3 months, and increase your activity level gradually. Straining or lifting after you have resumed normal activities may cause the problem to recur.

Most women are able to resume sexual intercourse in less than 6 weeks. Urinary function usually returns to normal in 2 to 6 weeks.

Risks

Like any surgical procedure, urinary incontinence surgery comes with risks. Although uncommon, potential complications may include:

  • Temporary difficulty urinating and incomplete bladder emptying (urinary retention)
  • Development of overactive bladder, which could include urge incontinence
  • Urinary tract infection
  • Difficult or painful intercourse

Talk with your doctor to understand possible risks and benefits of surgery.

Microdiscectomy

Microdiscectomy

pine-imgThe main goal of Microdiscectomy is to take pressure off your nerves to relieve your back pain. Microdiscectomy, also known as microdecompression, is one of the most common minimally invasive spine surgery procedures.

Before the procedure

In the days before your surgery, tell your surgeon about any medications you take at home including herbal supplements and over-the-counter medications. You may be asked to stop taking aspirin or other medications that thin your blood and may increase bleeding.

  • Tell your surgeon if you or someone in your family has any history of reaction to general anesthesia.
  • If you smoke, you may be asked to stop smoking well before surgery and avoid smoking for a period of time after surgery.
  • Before surgery you will probably be given instructions on when to stop eating and drinking. It’s common to have nothing to eat or drink after midnight on the night before the procedure.
  • Ask your surgeon if you should take your regular medications with a small sip of water on the day of the procedure

During the procedure

spinalFor the procedure, you’ll typically have general anesthesia, and during the surgery, you’ll be positioned lying on your stomach. Using one of the techniques above, your surgeon will remove the part of your disc that’s pressing on your nerve or spinal cord.

Your surgeon will pay careful attention to your nerve roots during surgery and will check the areas surrounding your disc to make sure there are no other additional disc fragments that need to be removed. Usually, only a small part of your disc is removed—surgeons rarely remove most or all of your disc.

Most microdiscectomies take about an hour to complete.

Microdiscectomy Recovery

The good news is that many patients have significant pain relief from a microdiscectomy and can quickly return to their normal lives, generally in less than 2 weeks. However, your doctor will advise you on how quickly you can return to exercise and your other daily activities.

A successful microdiscectomy should accomplish what a traditional open discectomy accomplishes—but with a faster, less painful recovery

Risks of the procedure

Microdiscectomy is a relatively safe procedure. However; with all surgeries carry some risks. You will need to sign a consent form that explains the risks and benefits of the surgery.

  • Your pain can come back.
  • Your disc can re-herniate.
  • Not all of your disc material may have been removed during your procedure.
  • Your spinal cord, nerves, and blood vessels can be injured.
  • Reactions to the anesthesia
  • Bleeding
  • Infection
  • Nerve injury Spinal fluid leak
  • Voice change
  • Loosened artificial disk Need for further surgery

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your surgeon before the procedure.

Lumbar Laminectomy – Open

Lumbar Laminectomy-Open

Lumbar Laminectomy-Open is a surgical procedure to remove a small portion of a vertebra, or back bone in the lower back (lumbar). Lumbar Laminectomy is usually done to take pressure off the spinal cord or a spinal nerve. It may also be done to access the spinal cord, bones and discs below the lamina, or the removed part of the bone. Spinal problems such as ruptured discs, bony spurs, or other problems can cause narrowing of the canals that the nerves and spinal cord run through. If it gets too narrow, it can irritate the nerve, causing:

  • Pain in the leg
  • Numbness or weakness

A Lumbar Laminectomy procedure is often performed along with a disc removal to help make the canal larger and take pressure off the irritated nerve.

laminectomy

Before the procedure

In the days before your surgery, tell your surgeon about any medications you take at home including herbal supplements and over-the-counter medications. You may be asked to stop taking aspirin or other medications that thin your blood and may increase bleeding.

  • Tell your surgeon if you or someone in your family has any history of reaction to general anesthesia.
  • If you smoke, you may be asked to stop smoking well before surgery and avoid smoking for a period of time after surgery.
  • Before surgery you will probably be given instructions on when to stop eating and drinking. It’s common to have nothing to eat or drink after midnight on the night before the procedure.
  • Ask your surgeon if you should take your regular medications with a small sip of water on the day of the procedure

During the procedure

  • The surgeon will make an incision in the skinof your back over the affected area. The muscles and soft tissues around the spine will be pulled to the side, exposing the spine.
  • The surgeon will then cut away bone, bone spurs, and ligaments that are compressing nerves. This is referred to as decompression. The surgeon may remove a small part or a large portion of several spinal bones, depending on your reason for the operation.
  • Some people may also undergo spinal fusion to stabilize the spine, receive a special implant that will help stabilize the bones in the lower back but not restrict motion in the same way a fusion does, have a disc removed, or have additional removal of bone to widen the passageway where nerves leave the spinal canal.

At the end of the surgery, the wound will be stitched

After the procedure

Post Lumbar Laminectomy patient’s mobilization (return to normal activity) is largely dependent on his/her pre-operative condition and age.

  • Patients are encouraged to walk directly following a Lumbar Laminectomy; however, it is recommended that patients avoid excessive bending, lifting, or twisting for six weeks after this surgery in order to avoid pulling on the suture line before it heals. You’ll need to limit your activities that include bending, stooping, or lifting for several weeks after your Lumbar Laminectomy.
  • You’ll also need to keep the incision site clean and dry. Ask your doctor for instructions on showering and bathing.
  • Your doctor will remove your stitches or staples after about two weeks

Risks of the procedure

Lumbar Laminectomy-Open is a relatively safe procedure. However; with all surgeries carry some risks. You will need to sign a consent form that explains the risks and benefits of the surgery.                                                                  Some potential risks of cervical spine surgery include:

  • Reactions to the anesthesia
  • Bleeding
  • Infection
  • Nerve injury Spinal fluid leak

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your surgeon before the procedure.