ProceduresOur highly trained and experienced surgeons specialize in minimally invasive surgery for many gynecologic conditions. Minimally invasive techniques use smaller incisions (cuts to the body), and tiny cameras and instruments. In some cases, we don’t use any abdominal incisions if we can work through the body’s natural opening, such as the vagina. Minimally invasive surgery can be a safer approach, compared to traditional surgery, depending on the disease we’re treating and your medical condition and anatomy. With smaller incisions, there’s less pain, and faster healing and recovery.
Minimally invasive surgery is a general term used for any surgery that does not involve using a large incision on your abdomen. Many people now associate the term “minimally invasive” to mean robotic surgery, but hysteroscopy, laparoscopy, robotic, and vaginal surgery are all forms of minimally invasive surgery. Minimally invasive surgery is associated with lower complication rates and a shorter recovery time and is the trend in surgery right now.
Colposcopy is an office procedure most often used to evaluate abnormal pap smears. A device called a colposcope is used like a magnifying glass to look for abnormal cells on your cervix. Usually, a vinegar-like solution is applied to your cervix to highlight any abnormal cells that may be difficult to see with the naked eye. Sometimes your provider may use a different solution to look for the same things. If there are abnormal areas that your provider sees during this procedure, they may recommend doing a biopsy. With a biopsy, a very small piece of tissue is removed from the cervix, but don’t worry, most women feel minimal discomfort from this. Even though colposcopy is mostly done to evaluate the cervix, it can also be used to evaluate abnormal cells of the vagina and the vulva. Colposcopy is safe in pregnancy.
A loop electrosurgical excision procedure (LEEP) is sometimes done after a colposcopy and is used to remove severely abnormal cells from the cervix. Some providers do this procedure in the office while some perform this in the operating room of a hospital. Local anesthesia is injected into the cervix to numb the area and a wire loop with an electrical current is used to remove a thin layer of the cervix that will be sent to the pathologist to examine further. The electrical current or a special solution is used to prevent further bleeding from the cervix. You may have mild cramping, light bleeding, and a brown colored discharge. Avoid intercourse, tampons, or anything inserted in the vagina until your provider tells you it is safe. If you have heavy bleeding, clotting, severe pain, or fever please call your provider immediately.
A cold knife cone (CKC), like a LEEP, is also done to remove severely abnormal cells from the cervix. Unlike a LEEP, a cold knife cone is done in the operating room of a hospital and uses a scalpel instead of an electrical current to remove a cone shaped portion of the cervix. This procedure is not as common as a LEEP and is used for a special category of abnormal cells that are found.
An endometrial biopsy is an office procedure that is done to evaluate abnormal bleeding patterns. A small straw-like tool is used to take a sample of the cells that are on the inside of your uterus known as the endometrium. Most patients feel a strong cramp during the biopsy which usually improves quickly afterwards, so it may be beneficial to take ibuprofen prior to or after the procedure. You can resume normal activities afterwards. Not everyone needs an endometrial biopsy to evaluate bleeding; your provider will determine this based on your age, risk factors, and family history.
A hysteroscopy dilation and curettage (D and C) is a same day procedure that is done in the operating room of a hospital while you are asleep. First, your cervix is gently dilated or opened. Then, a small camera called a hysteroscope is placed through the opening of your cervix and used to look inside your uterus. Lastly, a rounded metal device called a curette is used to gently scrape the lining of the uterus, or endometrium, to obtain a sample. The endometrial lining is usually sent to pathology for more evaluation and testing. After the procedure you may feel crampy, have light vaginal bleeding, and have watery discharge which are normal. If you have heavy bleeding, clotting, severe pain, or fever please call your provider immediately.
Myosure is a special device used with a hysteroscope (a small camera that is used to look inside your uterus) that is used to remove polyps or fibroids from inside the uterus.
An endometrial ablation is usually done in the hospital operating room while you are asleep and is used to treat heavy or frequent periods. There are different endometrial ablation techniques and your provider will talk to you about which type they recommend for you. The goal of an ablation is to significantly decrease the amount of bleeding you have, it is not guaranteed to eliminate it completely. An ablation is not a form of birth control and pregnancy is still possible after an ablation, although rare. If you get pregnant after an ablation it can be extremely dangerous for you and your baby, so you must use some form of contraception. Many women get a tubal ligation at the same time as an endometrial ablation to avoid future pregnancy.
A tubal ligation is done in the hospital operating room for women who do not wish to have any more children. There are different techniques for tubal ligation, but more recently many providers are performing what we call a bilateral salpingectomy for this purpose. This is medical jargon for removing the entire fallopian tube. Why would we do this? Well, some research has shown that ovarian cancer may start from the end of the fallopian tube, so it may benefit you in the future to remove them if you are undergoing this procedure anyway.
Laparoscopy is done in the hospital operating room and is used for many different reasons. It is a minimally invasive technique that uses small incisions on your abdomen where a camera (called a laparoscope) and other surgical instruments can be passed through to perform the surgery. Many surgeries that used to be done with an open technique (using a larger incision several inches long) can now be done using laparoscopy. Compared to an open surgery, laparoscopic surgery results in shorter hospital stays, faster recovery times, lower complication rates, and less pain.
An ovarian cystectomy is a procedure that is done either laparoscopically (with small incisions on your abdomen) or open (using one larger incision on your abdomen) depending on the size of the cyst. Ovarian cysts occur very commonly and are actually a normal part of the female cycle, so not all cysts require surgery. Ovarian cysts may need surgery if they are growing, if they are exceptionally large, if they are causing pain, or if they appear abnormal. Surgeons usually try to save the ovary and remove only the cyst, but sometimes the ovary is too damaged by the cyst that the whole ovary needs to be removed. If the surgery is done laparoscopically usually you can go home the same day. If it is done using a larger incision on your abdomen, then you will likely be in the hospital from 1 – 3 days.
An ectopic pregnancy is a pregnancy that is growing in the wrong place. The most common place for an ectopic pregnancy to form is in the fallopian tube. This can be dangerous because it can cause the tube to burst, which can cause internal bleeding and is a life-threatening emergency. If you have had an ectopic pregnancy in the past you are at risk of having another one, so if you have a positive pregnancy test let your provider know as soon as possible.
A myomectomy is a procedure to remove fibroids from the uterus. This can be done through a large incision on your abdomen, laparoscopically, or robotically depending on the size of the fibroids and provider preference.
A hysterectomy is a surgical procedure to remove your uterus and your cervix. This is done for a variety of reasons such as abnormal or heavy bleeding, fibroids, pain, or uterine prolapse. A hysterectomy can be done a few different ways: vaginal, laparoscopic, robotic, or open. A vaginal hysterectomy does not require incisions on your abdomen and is a good route in patients who have prolapse. Laparoscopic and robotic hysterectomies use small incisions on your abdomen to remove the uterus. An open hysterectomy, or total abdominal hysterectomy, uses a larger incision on your abdomen either horizontally like a cesarean section scar or vertically below your belly button. Some people think a hysterectomy also removes your ovaries, but this procedure is called a salpingo-oophorectomy. Your provider will talk to you if they recommend removing your ovaries with the hysterectomy or not. In general, if you are pre- or peri-menopausal it is recommended to keep your ovaries because they can maintain your long-term health.
Depending on how your hysterectomy is done, any complications, and your overall health your provider may keep you overnight in the hospital or allow you to go home a few hours after your surgery. After you go home it usually takes about 6 weeks to fully heal. That usually means no heavy lifting over 10 lbs, no baths (only showers), no swimming, and nothing in the vagina (no tampons, sex).
A salpingo-oophorectomy is a procedure to remove your tube and your ovary. One or both sides can be removed. This can be done laparoscopically, robotically, or using a large incision depending on why you are having the procedure. This procedure can be done for an ovarian cyst or mass, an ectopic pregnancy, endometriosis, genetically high risk for ovarian cancer, electively at the same time as a hysterectomy, and many other reasons. If only one tube and ovary are removed the other side will still work to provide you with the hormones you need and will not decrease fertility if you desire to have kids.
Prolapse repair is performed in the hospital operating room while you are asleep. It is generally a same day procedure or overnight stay depending on what needs to be done and provider preference. This procedure uses dissolvable stiches to put together damaged connective tissue to give more support and trims the extra skin from the vagina. A cystocele repair is also known as an anterior repair. A rectocele repair is also known as a posterior repair and perineorrhaphy. This can feel like an episiotomy repair but is not a deep cut and is only involving the skin and not the muscle. If you have uterine prolapse your provider might recommend a hysterectomy as well as a vaginal vault suspension that uses stiches to create more support for the top of the vagina to prevent it from sagging. Vaginal vault prolapse is also repaired using vaginal vault suspension techniques.
Urodynamic testing is an office procedure that is done to evaluate urinary disorders such as urge urinary incontinence, stress urinary incontinence, or both. Small catheters are placed in the vagina and the bladder, then the bladder is filled with sterile water during which time you will be asked questions and asked to cough at different times. A computer will be monitoring your bladder function. Your provider will interpret the results for you and talk to you about an appropriate treatment.
Dr Fernando Mahmoud is trained to perform urodynamic testing.