Gynecological Surgery

Gynecological surgery covers the operations used to diagnose and treat conditions of the uterus, ovaries, fallopian tubes and pelvic floor. Most of them are now performed through small incisions or through the cervix with no incision at all, which is the change that has done more for recovery times than anything else in this field.

Dr. Adeeb Alshahrour, MD, FACOG, performs minimally invasive gynecologic surgery at the Women's Health Center of Chicago.

The starting position: surgery is not the first answer

For almost every benign condition that leads to a surgical consultation, there is a non-surgical option that deserves to be discussed first. Heavy bleeding often responds to a hormonal IUD, tranexamic acid or hormonal therapy. Fibroids can be managed medically or removed while keeping the uterus. Prolapse can be treated with a pessary and pelvic floor therapy.

Ask directly: what happens if I do nothing, and what are the alternatives to operating? A recommendation for surgery should survive that question. If it does, the operation is a good idea. If it does not, you have saved yourself an operation.

Second opinions are welcome here, including on advice you were given somewhere else.

Procedures we perform

**Hysteroscopy.** A thin camera passed through the cervix into the uterus. No incision. Used to diagnose the cause of abnormal bleeding and to remove polyps, submucosal fibroids, scar tissue or a lost IUD. Usually a same-day procedure with a return to normal activity within a day or two.

**Laparoscopy.** Keyhole surgery through several small abdominal incisions with a camera and narrow instruments. Used for endometriosis, ovarian cysts, adhesions, ectopic pregnancy, unexplained pelvic pain, and as the route for most other operations on this list.

**Myomectomy.** Removal of fibroids with the uterus left in place. The right choice if fibroids are the problem and you want to preserve fertility, or simply want to keep your uterus.

**Hysterectomy.** Removal of the uterus, performed vaginally or laparoscopically wherever anatomy allows, since those routes mean less pain and a faster recovery than an abdominal incision.

**Oophorectomy.** Removal of an ovary. Also the page to read on why keeping healthy ovaries before menopause usually matters more than women are told.

**Tubal ligation and salpingectomy.** Permanent contraception. Removing the tubes entirely, rather than tying them, also appears to lower the long-term risk of ovarian cancer.

**Surgery for pelvic organ prolapse** and for gynecologic cancers, including referral to gynecologic oncology where that is the appropriate level of care.

Endometrial ablation and endometrial biopsy for abnormal bleeding, and diagnostic dilation and curettage.

Before surgery

Diagnosis first. Imaging, and often a biopsy of the uterine lining, so the operation addresses a known problem rather than a suspected one.
A pre-operative assessment. Blood work, and clearance from your other physicians if you have heart, lung or clotting conditions.
A medication review. Blood thinners and some anti-inflammatories are stopped in advance. Do not stop anything without being told to.
Fasting from midnight before surgery.
A plan for home. Someone to drive you, and help for the first day or two.

Ask before the day: which approach, why that one, how long the operation takes, what the recovery timeline is, and what would make you change approach mid-operation.

Recovery, in general terms

Timelines vary by procedure and by person, but the pattern holds.

Hysteroscopy or diagnostic procedures. Cramping and light bleeding for a day or two. Most people return to work the next day.
Laparoscopic surgery. Sore incisions and shoulder-tip discomfort from the gas used, easing over several days. Light activity within a week, most normal activity by two to three weeks, no heavy lifting for about four.
Hysterectomy. Two to three weeks for light activity after a vaginal or laparoscopic approach, up to six weeks for full activity. Longer after an abdominal incision. Nothing in the vagina for about six weeks while the vaginal cuff heals.

Fatigue that lingers for several weeks after a major operation is normal and is not a sign that something has gone wrong.

Risks, stated plainly

Every operation carries risk of bleeding, infection, injury to the bladder, ureters or bowel, blood clots, adhesion formation, complications of anesthesia, and the possibility of converting to a larger incision. Serious complications are uncommon in minimally invasive gynecologic surgery, and uncommon is not the same as never.

Call urgently after any procedure for fever over 100.4°F, heavy vaginal bleeding, worsening rather than improving pain, redness or drainage from an incision, inability to pass urine, chest pain, breathlessness, or calf pain and swelling.

Talk to us

Medical disclaimer

This page is general health information, not medical advice for any individual. Whether surgery is appropriate, and which approach is right, depends on your diagnosis, anatomy, medical history and goals, and can only be advised by a physician who has evaluated you. Seek emergency care for heavy bleeding, severe or worsening pain, fever, chest pain or difficulty breathing after any procedure.