A hysteroscopy is a procedure that allows your specialist to look inside your womb (uterus). A narrow telescope with a light and camera at the end, called a hysteroscope, is passed into your womb through your vagina and cervix so no cuts are required.
A hysteroscopy is used to investigate gynaecological symptoms or problems including: heavy periods, unusual vaginal bleeding, postmenopausal bleeding, pelvic pain, repeated miscarriages or difficulty getting pregnant. It can diagnose conditions, such as fibroids and polyps and it can be used to treat women’s health conditions including: the removal of fibroids, polyps, displaced intrauterine devices (IUDs) and scar tissue that causes absent periods and reduced fertility.
Laparoscopy, also known as keyhole or minimally invasive surgery, allows your surgeon to see and access the inside of your abdomen and pelvis by making small incisions to your skin and inserting a laparoscope. This is a small tube with a camera and light source that sends images to a television monitor. Laparoscopy is typically performed under general anaesthetic.
Laparoscopy is used whenever possible as it has some advantages over traditional open surgery such as: a shorter hospital stay and a faster recovery time, less pain and bleeding after the operation and, reduced scarring.
Anterior vaginal wall repair
Anterior vaginal wall repair is used to restore a sinking vaginal wall, known as a prolapse. Bulging many also occur when the bladder or urethra sinks into the vagina.
If you’ve a vaginal wall prolapse you may experience a number of symptoms including: inability to empty your bladder fully, your bladder may feel full all the time, pressure in your vagina, bulging at the opening of your vagina, pain when having sex, leaking urine when you cough, sneeze, or lift something and bladder infections.
An anterior vaginal wall repair is performed under general or spinal anaesthetic and typically takes about half an hour. It involves moving your vagina back into its correct position, tightening the support tissues of your bladder and removing any bulge in your vagina.
Endometriosis is a common, chronic condition where the endometrial tissue inside your womb develops outside the womb often on organs in the abdomen and pelvis.
Common symptoms include: painful or heavy periods, bleeding between periods, pain in the lower abdomen, pelvis or lower back, pain during and after sex and difficulty getting pregnant.
Endometriosis is confirmed by a surgical examination called a laparoscopy, performed under general anaesthetic. Using a thin tube with a light and camera on the end, called a laparoscope, your specialist can see any endometriosis tissue. A sample (biopsy) can be taken for laboratory testing, or other surgical instruments can be inserted to treat the endometriosis.
A hysterectomy is a surgical procedure to remove the womb (uterus). After the operation you won’t be able to get pregnant so it’s normally only recommended if other treatment options have been unsuccessful.
A hysterectomy may be performed if: you have heavy periods, chronic pelvic pain, non-cancerous tumours called fibroids, prolapse of the uterus or cancer of the womb, ovaries or cervix.
There are a number of types of hysterectomy and the decision will be based on why you need the procedure and how much of your womb and reproductive system can be left in place. The main hysterectomies are: total hysterectomy (the womb and cervix are removed and is most commonly performed), subtotal hysterectomy (the main part of the womb is removed and the cervix is left in place), 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 under general, spinal or local anaesthetic.
laparoscopic hysterectomy – keyhole surgery is performed under general anaesthetic to remove the womb through several small cuts in the abdomen. This is often the preferred choice.
abdominal hysterectomy – the womb is removed through a cut in the lower abdomen under general anaesthetic
Your consultant gynaecologist will discuss and advise you on the best type of hysterectomy for your individual needs.
Ovarian cyst removal
Ovarian cysts are fluid-filled sacs that develop on a woman’s ovary. They are very common and often disappear after a few months without treatment. However, some large or persistent ovarian cysts, cysts that are causing symptoms and cysts that could be cancerous or become cancerous are usually surgically removed.
Ovarian cyst removal is performed under general anaesthetic by either laparoscopy or laparotomy. Most cysts are removed using laparoscopy. If the cyst is particularly large, or if it could be cancerous, a laparotomy may be recommended. A single larger cut is made in your tummy during laparotomy to allow your surgeon better access to the cyst. The whole cyst and ovary may be removed and then the incision is stitched or stapled. The cyst and ovary is then sent to a laboratory to check whether it is cancerous.
Removal of ovaries
An oophorectomy is the surgical removal of one or both of the ovaries (almond shaped organs that sit above the uterus and hold your eggs). It’s normally performed if the ovaries are damaged or to treat conditions such as ovarian cancer or endometriosis.
Ovary removal is a simple procedure. It’s carried out under general anaesthetic either laparoscopically or using open surgery. It can be performed on its own, but it is often done as part of a more complete surgery to remove the uterus (hysterectomy).
If just one ovary is removed a woman may continue to menstruate and have children. If both ovaries are removed menstruation stops and a woman can no longer have children.
Laparoscopic sterilisation is a form of female contraception. It involves blocking or sealing the fallopian tubes that link the ovaries to the womb (uterus) so that the eggs are prevented from reaching the sperm and becoming fertilised. The eggs are released from the ovaries as normal, but they are then absorbed naturally into the woman's body.
Usually sterilisation will be performed using laparoscopy. The fallopian tubes can be blocked using clips, rings or tying and cutting the tubes.
Hysteroscopic sterilisation involves using a hysteroscope to insert a tiny piece of titanium metal into your fallopian tubes which causes the fallopian tube to form scar tissue around it that will eventually block the tube.
Hormone replacement therapy (HRT) is used to relieve symptoms of the menopause (when a woman stops having periods as her menstrual cycle stops and her ovaries permanently stop releasing eggs).
As a woman moves into the menopause she may experience hot flushes, night sweats, mood swings, vaginal dryness and a reduced sex drive. HRT can relieve these symptoms. It works by replacing hormones that are at a lower level as you approach the menopause.
Treatment for miscarriage
A miscarriage is the loss of a pregnancy in the first 23 weeks. It's thought most miscarriages are caused by abnormal chromosomes in the baby and so the baby won't develop properly. Most women go on to have a successful pregnancy in the future after a miscarriage.
Sometimes there is pregnancy tissue left in your womb following a miscarriage and this can be removed by naturally waiting for it to pass out of your womb, taking medication that causes the tissue to pass or, having the tissue surgically removed. Your consultant gynaecologist will discuss the best options for your individual circumstances.
Stress incontinence treatment
Stress urinary incontinence (SUI) happens when you unintentionally leak urine due to increased pressure on your bladder. It may happen when you sneeze, cough or lift something heavy.
Conservative treatments are normally recommended at first such as: lifestyle changes, pelvic floor muscle exercises and bladder training. Surgery will be advised if these aren’t successful.
Surgical options for SUI include: tape procedures (only for women - plastic tape is used to hold up the urethra in the correct position), sling procedures (a sling supports your bladder neck and urethra), colposuspension (for women only – can be performed by laparoscopic or open surgery and lifts the tissues between your bladder and urethra) and artificial urinary sphincter (replacement of your urinary sphincter with an artificial one).