Surgical Procedures

Caesarean section also called C-section is a non-vaginal delivery of a baby. It is a surgical procedure of delivering a baby through incisions made in the abdomen and uterus of a pregnant woman. Your doctor may decide to perform a C-section if your condition is unsafe to go for a vaginal birth. Most of the times, it may be done when unexpected complications arise during labour however at times pregnant women may prefer C-section rather than normal vaginal delivery. Read more

Hysterectomy is a surgical method in which the uterus of a woman is removed. Sometimes, the ovaries and fallopian tubes are also removed.

The uterus, also referred to as the womb, is where a baby grows inside their mother.

Once a woman has had a hysterectomy, she will no longer menstruate and cannot become pregnant.

What are the indications for hysterectomy?

Your doctor may suggest you undergo a hysterectomy if you have the following conditions

• Uterine fibroids
• Endometriosis not cured by medicine or surgery
• Uterine prolapse - when the uterus descends into the vagina
• Cancer of the uterus, cervix, or ovaries
• Vaginal bleeding that continues despite treatment
• Chronic pelvic pain

What are the types of hysterectomy?

Types of Hysterectomies include Partial, Total or Radical Hysterectomy.

• Partial or supracervical hysterectomy is where the upper part of the uterus is removed, but the cervix is left in place.
• Total hysterectomy involves removal of both the uterus and cervix. Radical hysterectomy is usually done in cases of cancer and involves removal of the uterus, tissue on the sides of the uterus, upper part of the vagina, and the cervix.

Salpingo-oophorectomy may be performed along with hysterectomy in cases of cancer or infection. It is a procedure in which the fallopian tube and ovary on one side of the uterus are removed.

Bilateral oophorectomy is where the fallopian tubes and ovaries on both sides of the uterus are removed. This results in menopause right away from the sudden drop in hormone levels.

How is hysterectomy performed?

There are various ways to perform hysterectomy:

• Abdominal hysterectomy is where the incision is made through the skin and tissue in the lower abdomen to reach the uterus.
• Laparoscopic hysterectomy uses a laparoscope to guide the surgery. Laparoscope is a thin, lighted tube that is inserted into the abdomen through a tiny incision in or around the umbilicus (belly button) which allows the surgeon to view the internal pelvic organs on a monitor.
• Total laparoscopic hysterectomy is a method where the uterus is separated from inside the body and then removed in small pieces either through tiny incisions or through the vagina.
• Laparoscopic assisted vaginal hysterectomy uses a laparoscope to guide the surgery and the uterus is removed through the vagina.
• Robot-assisted laparoscopic hysterectomy uses a robot attached to instruments to help perform the surgery through tiny incisions with a laparoscope.
• Vaginal hysterectomy is a method where the uterus is removed through the vagina. As the incision is made inside the vagina, healing time may be less than with abdominal surgery.

What are the Post-operative measures to be taken?

Your recovery depends on the type of surgery performed and the progress of your healing. You will be prescribed pain medications to keep you comfortable and antibiotics to prevent infection.

You will be instructed to get adequate rest and avoid heavy lifting after your surgery. You can continue normal activities once the pain, bleeding, and abdominal pressure have resolved. Sexual activity can be resumed after about six weeks following surgery. Exercises should be avoided until 3 weeks after surgery.

Recovery and return to activities of daily living is earlier in cases of women who have undergone vaginal hysterectomy when compared to women who have undergone abdominal hysterectomy. Generally, it takes around 4-6 weeks for complete healing from an abdominal hysterectomy and about 3-4 weeks’ recovery from vaginal hysterectomy

What are the risks and complications?

Most women recover without any complications from the surgery. However, Risks and Complications associated with Hysterectomy surgery can include the following:

• Infection
• Bleeding
• Blood clots
• Urinary incontinence: loss of bladder control
• vaginal prolapse: a condition in which the vagina protrudes from the vaginal opening.
• Chronic pain
• Bladder or ureter injury
• Painful intercourse
• Early menopause if ovaries were removed

Call your doctor if you experience any of the following signs:

• heavy vaginal bleeding
• pain, redness, swelling, or discharge around the incisions
• fever over 101° F
• nausea and vomiting
• Shortness of breath

Dilatation and curettage, also referred as D and C is a common gynaecological procedure that is used in diagnosing and treating various conditions in women that cause abnormal or heavy vaginal bleeding, inability to conceive or maintain a pregnancy to its full term. The procedure involves scraping and collection of the tissue lining the walls of the uterus (endometrium) using the surgical tool, curette. To allow curettes to be introduced into the uterus, the cervix needs to be widened or dilated with special instruments.

Your gynaecologist may perform a D and C procedure if you have any of the following conditions:

• Heavy menstrual bleeding with painful abdominal cramps, leading to substantial blood loss from the body
• Abnormal bleeding which occurs as “spotting” in between menstrual periods, after menopause or after sexual intercourse
• Benign growth such as fibroid tumours or polyps in the uterus. These polyps can be removed during a D and C procedure
• Uterine cancer can be treated if detected early
• Adenomyosis, a condition in which the innermost layer of the uterus has grown into the muscular layer of the uterus. This causes painful cramps and abnormal bleeding
• Pelvic inflammatory disease, in which infection in the uterus and fallopian tubes spreads into the pelvic cavities
• Miscarriage or elective termination of pregnancy – In both these conditions, a D and C procedure will be required for the removal of remaining tissue which otherwise would cause infections in the future
• A contraceptive intrauterine device (IUD) that has to be removed

Dilatation and curettage procedure may be carried out either in a hospital or outpatient clinic under local anaesthesia, general anaesthesia or regional anaesthesia depending on you and your gynaecologist’s choice. On the previous day of your procedure, your gynaecologist will apply a softening agent that softens and dilates your cervix. This agent may cause minor discomfort or spasm in the abdomen. You may be advised to take pain medication if the pain becomes severe.

During the procedure, you will be made to rest on the operating table with your legs propped up. Then a speculum will be inserted gently to keep open the vagina. With special instruments dilatation of the cervix is done followed by which curettes are inserted into the uterus to scrape out the inner lining. The scraped tissue is sent to the pathological laboratory for further tests.

Dilatation and curettage is a very safe procedure however may pose certain risks and complications such as infection in the vagina, uterus or pelvis; bleeding during or after the procedure; damage to the uterine wall or other pelvic organs such as bladder, intestines, blood vessels and nerves may occur. You may see a bloody or brownish vaginal discharge after the procedure which is normal and not a serious concern. Avoiding intercourse, lifting heavy objects, and using tampons for 1–2 weeks after the procedure is recommended.

Labioplasty or Labiaplasty is a vaginal cosmetic surgery that reshapes or reduces the size of labia minora, the skin or inner lips of the vaginal opening. This procedure is also referred to as labia reduction or labia minora reduction.

Asymmetrical or abnormal labia are very common in women causing discomfort and deep embarrassment. Labioplasty re-contours or renews the labia without affecting adjacent tissues or sexual pleasure. After Labioplasty, you can feel comfortable wearing clothing, exercising, and having intercourse. Moreover, it improves the appearance of the labia and can boost a women’s self-confidence.

Indications

A typical woman who elects for labioplasty may have

• Elongated labia (vaginal lips) that cause rashes and irritation
• Discomfort or irritation from clothing
• Discomfort due to rubbing of the labia during sports and physical activities
• Physical discomfort or pain during sexual intercourse
• Embarrassment due to the enlarged labia

Procedure

The Labioplasty procedure will be performed after putting you to sleep by injecting anaesthetic (sleep inducing) medication. The total procedure takes about one to two hours. Your surgeon shortens the large or uneven vaginal lips using specific surgical equipment. Later, incisions will be closed with absorbable sutures so that suture removal is not required.

Post-surgical care

After the labioplasty, you may have swelling, tenderness, or slight bruising of the labia for a period of four weeks. Your physician may advise you to take medication to relieve pain, and prevent infection. Participating in exercise and intercourse and using tampons should be avoided at least for the initial four weeks after the surgery.

Risks

Every surgical procedure carries some amount of risk; therefore, it is necessary to be well informed about the associated risks before scheduling the surgery. The most common risks of labioplasty include bleeding, infection, and scarring.

What is Incontinence Surgery?

Incontinence surgery refers to surgical procedures aimed at treating urinary incontinence, a condition characterised by the involuntary leakage of urine. These surgeries are designed to support or enhance the function of the bladder and urethra, providing better control over urination.

What are the types of Incontinence Surgery?

Common types of incontinence surgeries include sling procedures, bladder neck suspension, and artificial urinary sphincter implantation.

Who is Suitable for Incontinence Surgery?

Incontinence surgery is typically considered for individuals who have not responded to conservative treatments such as lifestyle changes, pelvic floor exercises, or medication. It is often recommended for those with moderate to severe stress incontinence, where physical activities like coughing or lifting cause urine leakage, or for individuals with urge incontinence, where there is a sudden, intense need to urinate.

Why Consider Incontinence Surgery?

Surgery for incontinence can significantly improve the quality of life for those affected by this condition. It can reduce or eliminate the inconvenience and embarrassment associated with urinary leakage, enhance social interactions, and enable individuals to engage more freely in physical activities without fear of accidents.

Preparation for Incontinence Surgery

Preparation involves a thorough medical evaluation, including a review of medical history, physical examination, and diagnostic tests such as urodynamic studies or imaging. Patients may need to stop certain medications, avoid food and drink for a specific period before surgery, and arrange for postoperative care and support.

Incontinence Surgery Procedure

The surgical procedure varies based on the type of surgery being performed. Sling procedures involve placing a mesh tape under the urethra for support. Bladder neck suspension lifts and secures the bladder neck and urethra. An artificial urinary sphincter involves implanting a device that controls urine flow. These procedures are usually performed under general or regional anaesthesia.

Recovery after Incontinence Surgery

Recovery time varies but typically includes a brief hospital stay and several weeks of restricted activity. Patients may experience some discomfort, swelling, or bruising, and will need to follow postoperative care instructions, including avoiding heavy lifting and performing prescribed pelvic floor exercises.

Risks of Incontinence Surgery

As with any surgery, there are risks associated with incontinence procedures. These can include infection, bleeding, difficulty urinating, and pain. There may also be risks specific to the type of surgery, such as mesh erosion in sling procedures or device malfunction with an artificial urinary sphincter.

Outcomes of Incontinence Surgery

Incontinence surgery offers numerous benefits for individuals struggling with urinary incontinence. The primary advantage is the significant improvement in the control of urine leakage, which can dramatically enhance the quality of life. Patients often experience a marked reduction or complete cessation of incontinence episodes, leading to greater confidence and comfort in daily activities.