Gynecology Procedure Information

Lifestages offers the following surgical and non-surgical procedures for our patients. Please don’t hesitate to ask any of us for more information about any of the procedures listed below.

Non-Surgical Procedures

Bladder Retraining/Behavioral Modifications

Bladder retraining is a way of learning to manage urinary incontinence. It is generally used for stress incontinence, urge incontinence or a combination of the 2 types (mixed incontinence). Stress incontinence is when urine leaks because of sudden pressure on your lower stomach muscles, such as when you cough, laugh, lift something or exercise. Urge incontinence is when the need to urinate comes on so fast that you can’t get to a toilet in time.

Medication

Several medications are available to treat the symptoms of some types of incontinence. Low-dose topical estrogen may rejuvenate tissue in the vaginal and urethral area. Your physician may also prescribe anti-inflammatory drugs, antidepressants and antihistamines to relieve pain and other symptoms.

Nutrition Counseling

Diet plays an integral role in bladder health. For example, avoiding irritants such as coffee, tea, citrus and carbonation and drinking the optimal amount of fluids are two important considerations. Our staff will assess your diet and advise you on how to make healthy food choices to help with bladder health.

Pessary

A pessary is a silicone support device that is inserted into the vagina in the office to support pelvic organs. Pessaries come in various shapes and sizes and, with regular inspection and cleaning, can be used for many years. If your physician recommends a pessary, it will be professionally fit to your body. A pessary is an excellent alternative to surgical intervention in a properly selected patient.

Strengthening Pelvic Floor Muscles

Strengthening your pelvic floor muscles may be all you need to relieve your symptoms. If you have a surgical procedure, strengthening the pelvic floor muscles will be an important part of your rehabilitation and critical to the long-term success of your surgery. Lifestages offers a number of procedures to strengthen your pelvic floor muscles including:

• Biofeedback – Your physician may recommend biofeedback to help you identify your pelvic floor muscles. A small tampon-like sensor placed into the vagina or rectum will link you to a computer and screen. You will see an image showing the tightening and releasing of your pelvic muscles on the computer screen. By associating your action with the image, you will learn how to identify and control the proper muscles.
• E-stim – This is a mild, painless stimulus that is delivered to the pelvic floor muscles through a small tampon-like sensor placed in the vagina or rectum. This stimulus causes the pelvic floor muscles to contract and become stronger.

Ultrasound Imaging

Ultrasound imaging is a form of medical imaging which involves the use of high frequency sound waves. In ultrasonography, as ultrasound imaging is also known, sound waves are transmitted into the body from a small probe, and the probe reads the sound waves when they bounce back, generating a picture of the inside of the body. This technology is similar to that used in radar. Modern ultrasound machines are extremely sophisticated, and capable of producing very complex and detailed images, including three-dimensional ultrasound images which provide an even better visualization of the structures in the body. Ultrasound imaging is used for the physician to determine the composition of the patient’s pelvic floor.

Surgical Procedures

Anterior Repair

An Anterior Repair is a surgery performed through the vagina to support the bladder (the upper roof of the vagina) when it has fallen (cystocele). This procedure utilizes the patient’s own tissues and is done by making an incision in the vagina and plicating (pulling together) the vaginal support for the bladder with absorbable (dissolvable) sutures. This is a very commonly performed procedure and can have long-lasting success, but if done in isolation, often times fails. Success rates range from 60%-80%. Oftentimes it is performed in combination with other procedures to support the apex (top) of the vagina or a paravaginal repair, which can greatly improve success rates. Also called anterior colporrhaphy or cystocele repair.

Cervical and Endometrial Biopsy

A cervical biopsy is a procedure performed to remove tissue from the cervix to test for abnormal or precancerous conditions, or cervical cancer. An endometrial biopsy is a procedure performed to obtain a small tissue sample from the inner lining of the uterus, called the endometrium. Endometrial biopsy is typically performed with a plastic tube called a pilelle to rule out precancerous cancerous conditions of the uterus. After the biopsy, the tissue is examined in laboratory analysis.

Colposcopy

Colposcopy is a way of looking at the cervix through a special magnifying device called a colposcope. It shines a light into the vagina and onto the cervix. A colposcope can greatly enlarge the normal view. During the colposcopy, your provider may see abnormal areas. A biopsy may be done. During a biopsy, a small piece of tissue is removed from the cervix or from the canal of the cervix. This procedure is done in the office.

Dilation and Currettage (D&C)

D&C is a surgical procedure in which the cervix is opened (dilated) and a thin instrument is inserted into the uterus. This instrument is used to remove tissue from the inside of the uterus (curettage). D & C is used to diagnose and treat many conditions that affect the uterus, such as abnormal bleeding. It may also be done after a miscarriage. A sample of tissue from inside the uterus can be viewed under a microscope to tell whether any cells are abnormal. A D&C may be done with other procedures, such as hysteroscopy, in which a slender device is used to view the inside of the uterus. Lifestages physicians usually perform D&Cs as outpatient surgery in the hospital.

Endometrial (Uterine) Ablation

Endometrial (Uterine) Ablation can stop excessive bleeding from the uterine lining (endometrium) and reduce symptoms of menstrual pain. In one procedure, a flexible balloon made of non-allergenic material and filled with heated fluid is used to dissolve the uterine lining. In another option, a mesh is placed in the uterus. The uterine lining dissipates when electrical energy is applied to the mesh. The advantage of endometrial ablation is that in most cases, patients can return to normal activities the next day.

Hysterectomy

A hysterectomy is the removal of the uterus. By itself, it does not involve the ovaries, but at times the ovaries are removed at the same time (oophorectomy). This is a decision that is individualized to each patient and is discussed ahead of time in the office. A total hysterectomy refers to removal of the uterus and cervix (opening to the uterus and what dilates to allow delivery of a baby). A supracervical hysterectomy refers to removal of the uterus above the cervix (the cervix remains behind).

InterStim®

InterStim is a small, pacemaker-like device, surgically implanted in the upper buttocks, that sends mild, painless stimulation to the sacral nerve, which controls the bladder/anal sphincter and surrounding muscles. This is a minor procedure to help patients with overactive bladder symptoms and fecal incontinence. The procedure only requires “twilight sedation” and is staged with a trial first and the procedure later if the trial is successful. Over 80% of patients that go through the trial notice a significant improvement in their symptoms and desire the full procedure.

Laparoscopy

A laparoscopy is a surgery performed in the abdomen/pelvis through small incisions (oftentimes less than 1 cm) with special instruments. It is considered minimally invasive surgery and is an alternative to a large incision with less pain and quicker recovery time when performed laparoscopically. Sometime the da Vinci System is used to assist in laparoscopic surgery. It is fully operated by the surgeon and simply allows us to perform more complex laparoscopic procedures with finer precision.

LEEP Procedure

If you have an abnormal cervical cancer screening result, your provider may suggest you have a loop electrosurgical excision procedure (LEEP) as part of the evaluation or for treatment. LEEP is one way to remove abnormal cells from the cervix by using a thin wire loop that acts like a scalpel (surgical knife). An electric current is passed through the loop, which cuts away a thin layer of the cervix. LEEP is done in our Lifestages offices and usually only takes a few minutes. The patient receives local anesthesia.

LESS Procedure

The LESS procedure – laparo-endoscopic single-site surgery – allows surgeons to perform a variety of operations through only one small incision in the curve of the belly button. All instruments, including a flexible high-definition camera, are inserted through this incision. Because the incision is in the navel, there is minimal scarring. The small size of the incision also means faster recovery times for patients. LESS is used to perform hysterectomy as well as remove ovarian cysts, treat pelvic pain and endometriosis, and other gynecological surgeries.

Mesh Removal and Revision

Mesh removal and revision refers to removing part or all of a piece of pelvic mesh. Most often, this is mesh that has eroded into the vagina or is causing pain in the vagina. However, it may also be mesh that has eroded into other organs or tissues. At times we cannot remove all of mesh, but regularly can remove all that is coursing through the vagina. This procedure usually requires a native tissue repair at the same time as mesh removal to attempt to minimize the recurrence of the prolapse.

Paravaginal Repair

Most moderate to large cystoceles (weakness in the roof of the vagina) are due to a defect in the lateral aspects of the anterior vaginal support (paravaginal tissues). Performing an isolated anterior repair only addresses the midline aspect of the defect. A paravaginal repair is where the lateral tissues that connect the bladder support to the lateral aspects of the pelvic floor are reattached. These attachments are made using the patient’s own tissues and non-absorbable sutures to repair the defect. This used to be performed through a large abdominal incision, but can now be done laparoscopically sparing the patient a great deal of pain and a faster recovery. This is oftentimes performed in combination with an Anterior Repair and an apical procedure, producing success over 80% of the time.

Robotic-Assisted Surgery

Lifestages physicians use the da Vinci surgical system to perform complex gynecologic procedures through dime-sized abdominal incisions. The da Vinci system gives the surgeon better visualization, magnification and ability to perform complex surgery with added safety, minimizes pain and risk associated with large incisions, and increases the likelihood of a fast recovery and excellent outcomes. We perform a variety of procedures with da Vinci robot-assisted surgery due to the better outcomes this approach achieves for our patients. They include: Hysterectomy, Myomectomy, Sacrocolpopexy, Laparoscopy, LESS Procedure, Endometrial (Uterine) Ablation, Tension-Free Vaginal Tape (TVT), Pelvic Prolapse Repair, and Sacral Nerve Modulation (InterStim).

Posterior Repair

A Posterior Repair is a surgery performed through the vagina to support the posterior (floor) aspect of the vagina when it has pushed up and out (rectocele). This procedure utilizes the patient’s own tissues and is done by making an incision in the vagina and plicating (pulling together) the vaginal support for holding the rectum down with absorbable (dissolvable) sutures. This is a very commonly performed procedure and can have long-lasting success, but if done in isolation, many times fails. Success rates range from 60%-80%. Oftentimes it is performed in combination with other procedures to support the apex (top) of the vagina which can greatly improve success rates. Also called posterior colporrhaphy or rectocele repair.

Sacrocolpopexy

Sacrocolpopexy is a surgical procedure to support the vagina. It uses a permanent material that can support the bladder, rectum and apex (top) of the vagina. It is oftentimes used when other procedures for pelvic organ prolapse have failed or when a patient’s lifestyle would increase the failure rates of a native tissue repair. If a uterus is present, a supracervical hysterectomy is performed as the uterus is in the way of placing the material. The permanent material is in the shape of a “Y” which goes across the front, top and back of the vagina behind the skin and then is attached to the back of the pelvis. We are able to perform this procedure in a minimally invasive way with a laparoscopic approach through multiple small incisions (less than 1 cm each). This allows the patient to stay only one night in the hospital and leave the next morning. The night the patient is in the hospital she is able to eat, drink and walk around in her room.

Supracervical Hysterectomy

A supracervical hysterectomy refers to removal of the uterus above the cervix (the cervix remains behind). There are various reasons why this may be performed. With other pelvic floor repairs it is commonly done in order to maintain the integrity of the vagina to avoid any incisions into the vaginal mucosa (skin). By maintaining the vagina, it can decrease the incidence of erosions of materials into the vagina that are sometimes used in pelvic floor repairs.

Tension Free Vaginal Taping (TVT)

TVT is a support for the urethra that is placed through a small (1 cm) incision in the vagina to help stop stress urinary incontinence (SUI). It is a very effective procedure with long-term data supporting its use and involves the use of permanent material. There are two main versions, each with its own benefits. One version, called a TVT-Exact (Retropubic TVT), places the support behind the pubic symphysis with two small incisions above the pubic bone. The second version is called a TVT-O (Obturator) with two small incisions deep in the groin to the side of the vagina.

Uterosacral Ligament Suspension

The Uterosacral ligaments support the top (apex) of the vagina, whether the uterus is present or has been removed. These ligaments, along with others, become stretched out with apical prolapse of the vagina. The ligaments are able to be plicated (shortened) with sutures to better support the vaginal apex. Traditionally, this procedure has been performed vaginally, but with risk to other pelvic structures, notably the ureters (connect the kidneys down to the bladder to empty urine). We are able to do this laparoscopically with better visualization of the structures in close proximity, thereby greatly reducing the chance for damage to other organs and offering the ability to more clearly see the ligaments. This procedure is successful over 80% of the time. This procedure is oftentimes combined with anterior or posterior repairs and helps to improve the success rates of those procedures. Importantly, this procedure can be done without a hysterectomy (removal of the uterus) and thus is an excellent option for those who wish to retain their uterus or desire to avoid the additional surgery required during hysterectomy.