Surgical Services Q&A

Q: What is a hysterectomy?
A: Hysterectomy means the removal of the uterus.  It does not involve removal of the ovaries.  Removal of the ovaries can be performed at the time of hysterectomy if indicated.  Removing the ovaries is called an oophorectomy.

Q: What is the difference between the different types of hysterectomies?
A:  The first thing to understand is the difference between a total hysterectomy and supracervical hysterectomy (also called sub-total hysterectomy).  A total hysterectomy involves removing both the uterus and cervix.   A supracervical hysterectomy involves taking the uterus without removing the cervix.

Q: Are there different ways a hysterectomy can be performed?
A: There are many ways a hysterectomy can be performed.  There are advantages and disadvantages to each type.  We encourage you to talk with your physician to understand the reasons a specific type of hysterectomy may have been recommended to you.

An abdominal hysterectomy (TAH) involves making an incision on the abdomen and performing the entire procedure through this incision.  The incision is usually similar in size and location to a C-Section incision. 

A vaginal hysterectomy (TVH) involves removing the uterus entirely through vagina.  Recovery is usually quicker as compared to an abdominal hysterectomy. 

A laparoscopically assisted vaginal hysterectomy (LAVH) is performed by making several small incisions on the abdomen through which a laparoscope is placed.  The uterus is removed through the vagina.  As compared to a vaginal hysterectomy, the laparoscope makes removal of the ovaries easier.

A laparoscopic supracervical hysterectomy (LSH) allows the uterus to be removed entirely through small (less than 1 inch) incisions on the abdomen.  Like the TVH and LAVH, recovery is much quicker than with a TAH.

A total laparoscopic hysterectomy (TLH) involves removing the uterus and cervix entirely through small (less than 1 inch) incisions on the abdomen.

A robotic hysterectomy is a specialized type of laparoscopic hysterectomy.  In this procedure, laparascopic instruments are place by the surgeon in the traditional way.  These instruments are then connected to the daVinci robot.  The robot allows the surgeon to control the precise movements of the instruments from a console adjacent to the patient’s operating room table.  Reported benefits include increase precision and less blood loss.

Q: How is incontinence treated?
A:The first step is to determine the cause for a woman’s incontinence.  Some cases of incontinence are best treated with medication or physical therapy.  Tests can be performed to determine the precise cause for incontinence.

Q: If my doctor determines that my incontinence is best treated with surgery, what are my options?
A:There are many different operations to help to restore a woman’s bladder control.  All of the procedures share the goals of improving support to the urethra (and/or the junction of the urethra and bladder).  Long-term success rates (and risk of complications) vary with the different procedures. 

Women with incontinence commonly also have prolapse of the bladder, uterus, rectum or upper vagina.  For this reason, the procedures for incontinence are commonly performed in conjunction with other procedures that correct pelvic organ prolapse.

Q: What is meant by prolapse and how is it treated?
A:  Prolapse involves loss of the normal support to the pelvic organs.  Prolapse can involve the bladder, uterus, top of the vagina or rectum.  It is common for more than one area to be involved.  Common symptoms include urinary incontinence, incomplete bladder emptying, lower back pain, discomfort with intercourse, pelvic/vaginal pressure, and difficulty evacuating stool.

Prolapse can only be treated with placement of a pessary or surgical correction.  A pessary is a temporary measure, used primarily in patients not considered to be good surgical candidates.

Surgical correction of prolapse can be accomplished either with suture or synthetic mesh.  There are advantages and disadvantages to each.  We encourage you to talk with your physician about the pros and cons of the different procedures/materials available to correct prolapse.  We also encourage you to read the FDA’s advisory as it relates to vaginal mesh products.

Q: Could you explain a hysteroscopy?  How is it different from a D & C?
A: These procedures are often performed at the same time.  A hysteroscopy involves using a camera attached to a very thin fiber optic light source to look at the inside of the uterus.  The fiber optic scope is passed through the cervix and into the uterus directly.  It is the best way to evaluate any problem of the uterine lining (called the endometrium).

D & C (dilation and curettage) involves dilating the cervix in order to place the hysteroscope or to biopsy the endometrium.

Q: What is a LEEP procedure?
A:  LEEP stands for Loop Electrical Excision Procedure.  The LEEP procedure is one of several procedures your doctor has available to help diagnose and treat abnormal cervical cells.   LEEP uses a thin wire loop electrode which is attached to an electrosurgical generator. The generator transmits an electrical current that quickly cuts away the affected cervical tissue in the immediate area of the loop wire.  It can usually be performed in the office with only a local anesthetic. 

Q: Are there surgical treatment options for heavy menstrual bleeding other than hysterectomy?
A: Yes.  Endometrial ablation is an outpatient procedure with high patient satisfaction.

Q: What exactly is an endometrial ablation?
A:  An endometrial ablation is an outpatient procedure that uses energy to remove the uterine lining.  It is associated with a quick recovery.  Women are able to return to work and regular activities quickly.  After the procedure, greater than 90% of women will report that their menses will returned to normal or lower than normal levels of flow.  Some women’s menses will completely stop.  It is not a contraceptive procedure.  It often will reduce menstrual associated symptoms, such as cramps, fatigue and PMS.  It is not recommended for women who desire to become pregnant in the future.

Q:  Are there different procedures for performing an endometrial ablation?
A: Yes.  There are several different medical devices to accomplish an endometrial ablation.  Novasure® and Thermachoice® are two of the more commonly used devices.  Each device has specific advantages and disadvantages.  If you are interested in learning more information about endometrial ablation, you should discuss your treatment options with your doctor.