A hysteroscopy allows your consultant to see inside your womb (uterus). It’s used to investigate gynaecological symptoms or problems including: heavy periods, unusual vaginal bleeding, postmenopausal bleeding, pelvic pain, repeated miscarriages and difficulty getting pregnant. It diagnoses conditions, such as polyps and fibroids. It can also be used as a gynaecological treatment to remove polyps, fibroids, displaced intrauterine devices (IUDs) and scar tissue that’s causing absent periods or reduced fertility.
A hysteroscope is a narrow telescope with a light and camera at the end. During a hysteroscopy, the hysteroscope is passed into the womb through your vagina and cervix and means no cuts are needed.
Laparoscopy is also called keyhole or minimally invasive surgery. It allows your surgeon to see and access the inside of your abdomen and pelvis. Small incisions are made to your skin to allow a laparoscope to be inserted under general anaesthetic. A laparoscope is a small tube with a camera and light source the end that sends images to a television monitor.
Nowadays, laparoscopy is often used instead of traditional open surgery as it offers a shorter hospital stay, a faster recovery, less pain and bleeding post-operation and, reduced scarring.
Anterior vaginal wall repair
An anterior vaginal wall repair is performed to restore a sinking vaginal wall, called a prolapse.
The symptoms of a vaginal wall prolapse include: not being able to fully empty your bladder, a full bladder feeling all the time, pressure in your vagina, bulging at your vagina opening, pain when having sex, leaking urine when you cough, sneeze, or lift something and bladder infections.
Your consultant gynaecologist will perform an anterior vaginal wall repair under general or spinal anaesthetic. It takes about half an hour and involves repositioning your vagina into its correct position, tightening support tissues in your bladder and removing any bulge in your vagina.
Endometriosis is a common condition. It’s caused when the endometrial tissue that’s normally inside your womb develops outside the womb often on organs in the abdomen and pelvis.
Symptoms of endometriosis include: heavy or painful periods, bleeding between periods, pain in the lower stomach, pelvis or lower back, pain during and after sex and difficulty conceiving.
A laparoscopy is used to confirm endometriosis. Your consultant gynaecologist inserts a laparoscope around your belly button and uses it to see any endometriosis tissue. A biopsy is often taken and sent off for laboratory testing. Surgical instruments can also be inserted at the same time to treat the endometriosis.
A hysterectomy is a surgical procedure to remove the womb and afterwards you can’t get pregnant. It’s normally only recommended if other treatment alternatives have been unsuccessful.
Heavy periods, chronic pelvic pain, non-cancerous tumours called fibroids, prolapse of the uterus or cancer of the womb, ovaries or cervix are reasons why a hysterectomy might be recommended.
The main hysterectomy options include: total hysterectomy (most commonly performed type of hysterectomy and involves the womb and cervix being removed), subtotal hysterectomy (the main part of the womb is removed, the cervix is left), total hysterectomy with bilateral salpingo-oophorectomy (the womb, cervix, fallopian tubes and the ovaries are removed) and radical hysterectomy (the womb and surrounding tissues are removed, including the fallopian tubes, part of the vagina, ovaries and lymph glands).
A hysterectomy can be performed in three ways:
vaginal hysterectomy – the womb is removed through a cut in the top of the vagina. General, spinal or local anaesthetic may be used.
laparoscopic hysterectomy – also known as keyhole surgery. The womb is removed through several small cuts in the abdomen, under general anaesthetic to remove. This is often favoured.
abdominal hysterectomy – the womb is removed through a cut in the lower abdomen under general anaesthetic.
The decision regarding the type of hysterectomy is based on why you’re having the procedure and how much of your womb and reproductive system can safely be left.
Ovarian cyst removal
Ovarian cysts are sacs filled with fluid on a woman’s ovary and are very common. They often disappear after a few months but some are large and chronic and some may be cancerous or could become cancerous and these are usually surgically removed.
Ovarian cyst removal is performed under general anaesthetic and most often by laparoscopy.
If the ovarian cyst is particularly large, or if it could be cancerous, a laparotomy may be advised. During a laparotomy, your gynaecology surgeon will make a single larger cut in your stomach so they have better access to the cyst. They will then remove the whole cyst and often the ovary too and stitch or staple the incision. They will then send the cyst and ovary to a laboratory to check if they are cancerous.
Removal of ovaries
One or both of your ovaries may be surgically removed during an oophorectomy. Ovaries are almond shaped organs positioned above the uterus that hold your eggs. If just one ovary is removed, you may continue to menstruate and have children but if both ovaries are removed menstruation stops and you will no longer be able to have children.
If your ovaries are damaged or you’ve a gynaecological condition such as ovarian cancer or endometriosis, your ovaries may be removed.
Ovary removal can be performed laparoscopically or using open surgery, under general anaesthetic. It can be carried out on its own or as part of a hysterectomy.
Laparoscopic sterilisation is a type of female contraception. It blocks or seals your fallopian tubes that link the ovaries to the womb. The eggs are then stopped from reaching sperm and cannot become fertilised. After laparoscopic sterilisation the eggs continue to be released from the ovaries but they are absorbed naturally into the woman's body.
Usually female sterilisation is performed laparoscopically. Clips, rings or tying and cutting the fallopian tubes are methods to block them.
Hysteroscopic sterilisation involves using a hysteroscope to block the fallopian tubes. A tiny piece of titanium metal is placed into your fallopian tubes and scar tissue will form around it and block the tube over time.
Hormone replacement therapy (HRT) is used as a treatment for menopausal symptoms. The menopause is when a woman stops having periods, her menstrual cycle stops and her ovaries permanently stop releasing eggs.
As a woman moves into the menopause she may experience symptoms such as hot flushes, night sweats, mood swings, vaginal dryness and a reduced sex drive and HRT can relieve these. It replaces hormones that are at a reduced level when a woman is approaching the menopause.
Treatment for miscarriage
A miscarriage is the loss of a pregnancy in the first 23 weeks of gestation. Miscarriages are often caused by abnormal chromosomes in the baby that would result in the baby not developing properly. Following a miscarriage, most women go on to have a successful pregnancy.
Sometimes after a miscarriage pregnancy tissue is left in your womb. It can be removed naturally by waiting for it to pass out of your womb, by taking medication that causes the tissue to pass or, surgically. Your gynaecology surgeon will discuss these options with you based on your own individual circumstances.
Stress incontinence treatment
Stress urinary incontinence (SUI) is when you unintentionally leak urine because of increased pressure on your bladder. This often happens when you cough, sneeze or lift something heavy.
Initially conservative treatments will be recommended including lifestyle changes, pelvic floor muscle exercises and training of your bladder. If these aren’t successful, then surgery may be advised.
There are a number of surgical options for SUI. Women only treatments include tape procedures (plastic tape is used to hold up the urethra in the correct position) and colposuspension (laparoscopic or open surgery to lift the tissues between your bladder and urethra). Surgeries for men and women are sling procedures (use of a sling to support your bladder neck and urethra) and an artificial urinary sphincter (replacement of your urinary sphincter with an artificial one).