Questions and Answers...
or FAQ's (Frequently asked Questions)
The questions listed below are frequently asked questions
of the center. If you have a more specific question that is not answered on this
page, please submit it to us for review by emailing Dr. Lyons at
What is a hysterectomy?
What are the different types of hysterectomies?
What is the recovery time for these procedures?
What is a laparoscopy?
What is a laparoscope?
How will I feel following a laparoscopy?
What is a laparoscopic bladder
What is endometriosis?
What causes endometriosis?
What are the symptoms of endometriosis?
How is endometriosis diagnosed?
What treatments are available?
What is a myomectomy?
What therapies are available?
Hysterectomy is the surgical removal of the
uterus. The procedure is indicated most often for abnormal uterine bleeding,
uterine fibroids, chronic pelvic inflammatory disease, endometriosis and uterine
or ovarian malignancies.
Four surgical options are currently available for a
woman who needs a hysterectomy:
- Abdominal Hysterectomy, which is performed by
making a large incision in the lower abdomen and surgically removing the
uterus. The tubes and ovaries can also be removed with this procedure, if
- Vaginal Hysterectomy, which is often indicated
when the uterus is low in the pelvis. The surgeon enters the abdominal cavity
through an incision in the vagina next to the cervix. The uterus is surgically
removed through this incision. It can be combined with a vaginal repair for
problems of urinary incontinence, cystocele or rectocele. Vaginal hysterectomy
is not possible if the patient's ovaries must be removed, if the patient has
had previous pelvic surgery or if the surgeon must treat related disorders
near the uterus.
Many patients are not considered for vaginal
hysterectomy due to a history of pelvic scar tissue (adhesions); a uterus that
is too large; or the condition of endometriosis, which makes vaginal removal of
the uterus more difficult.
- Laser Laparoscopic Assisted Vaginal Hysterectomy
is a procedure which can be used with any of the indications for hysterectomy
except when advanced disease is present. It is performed through the
laparoscope by detaching the uterus with the assistance of electrocautery,
lasers and other minimally invasive technologies. After the uterus is detached
it is removed through the vagina. Tubes and ovaries can also be removed with
the laser laparoscopic assisted vaginal hysterectomy, if necessary.
- Supracervical Laparoscopic Hysterectomy, a laser
surgery procedure developed by Dr. Lyons, leaves the woman's cervix intact.
The procedure causes less trauma to the patient and leaves the pelvic floor
intact as a further deterrent to pelvic prolapse or urinary stress
incontinence later on. In addition to less discomfort and an even quicker
recovery than the other alternatives, the patient can resume normal activity
within two days and intercourse within two weeks, compared to a six to eight
week resumption with abdominal hysterectomy.
A 30- year study conducted by Pent Killiku, M.D.,
in Finland, documents that sexual function is enhanced post-operatively because
of decreased scarring and trauma to the vagina. In the study, preoperatively 76%
of the patients were orgasmic, and six months after surgery 78% were orgasmic.
- Abdominal Hysterectomy: a three to five day
hospital stay with approximately six weeks recovery at home.
- Vaginal Hysterectomy: a three to five day
hospital stay with approximately four weeks recovery at home.
- Laser Laparoscopic Assisted Vaginal
Hysterectomy: a one to two day hospital stay with one to two weeks recovery at
- Supracervical Laparoscopic Hysterectomy: an outpatient
procedure which enables the patiant to leave the hospital or surgery center
the same day and be back to normal activity within two days to a week.
Laparoscopy is a surgical procedure in which the
surgeon makes a small incision in the patient's abdomen which allows the
insertion of an instrument called a laparoscope. Using this instrument allows
the surgeon to see the inside of the abdomen.
The laparoscope is a thin, long, rigid tube in
which light travels along glass fibers to light up internal organs. A
periscope-like attachment allows the surgeon to see into the abdomen and pelvis.
Other instruments used with the laparoscope allow the surgeon to take
photographs, obtain biopsies of tissue and now, with the addition of the laser,
to cut, coagulate or vaporize tissue.
Following any laparoscopic procedure, some
discomfort is normal and to be expected. Patients commonly report pain in the
shoulders, neck and abdomen. This may occur because gas used during the
procedure to expand the abdomen cannot be fully removed. These symptoms usually
resolve within 12-24 hours with bedrest.
Nausea may occur and can be related to abdominal
distention and/or manipulation of the bowel during the procedure. Some patients
develop post-surgical nausea from anesthesia.
The incision and stitches may be tender for a few
days. Most of these minor discomforts subside quickly. While each patient is
different, most will recover within a few hours or a day after the procedure.
Improvement is continuous.
This surgical procedure, developed by Dr. Lyons, is
used in the management of urinary stress incontinence, which is the involuntary
loss of urine-- usually during some physical activity such as lifting, sneezing,
laughing, jogging, bending or stooping. Childbirth and loss of estrogen
associated with menopause--conditions that can weaken muscles supporting the
bladder--are common causes for the condition.
Surgical therapy is indicated after conservative
therapies have been proven ineffective, or if the condition is interfering with
daily activities. The procedure takes one to two hours based on the patient's
anatomy, and has an eighty per cent success rate.
Initial management of the problem can include
weight reduction to help lessen intraabdominal pressure, behavior modification
(i.e. changing posture), estrogen replacement therapy in menopausal and
perimenopausal women, Kegel exercises, and electrostimulation to strengthen the
pelvic floor. Medication to help constrict the muscles in the bladder may also
In keeping with a total approach to pelvic floor
defects, including pelvic prolapse, Dr. Lyons has also developed procedures for
posterior pelvic floor relaxation. The procedure for rectocele (a defect in the
rectum, which causes severe constipation) is also performed laparoscopically in
a similar fashion to the laparoscopic bladder suspension. By performing these
procedures via laparoscope, the patient experiences a significant decrease in
post-operative pain. Once again, she is able to resume her normal activities,
including elimination of bodily wastes, more quickly than if the surgery had
been performed using a scalpel.
Endometriosis is a condition which occurs when
endometrial tissue, the tissue that lines the uterus and is shed during
menstruation, grows outside the uterus. When this growth occurs outside the
uterus, endometrial tissue can develop painful implants which are most common on
the ovaries, the fallopian tubes and the ligaments that support the uterus.
Other possible sites for endometrial growths are the bladder, bowel and vagina.
One of the most puzzling conditions affecting
women, the cause of endometriosis is not yet known. The most common theory,
however, is that "retrograde menstruation" causes some of the menstrual tissue
to back up through the fallopian tubes and implant in the abdomen. Endometrial
cells in the menstrual fluid may then attach themselves to various sites in the
pelvic cavity and cause growths.
Approximately 15% of all women during the
childbearing years develop some degree of endometriosis before reaching
menopause. The most common symptoms of the disease are pre-menstrual and
menstrual pain, heavy or irregular bleeding, pain during sexual intercourse and
urinary or bowel problems in conjunction with menstruation. In more serious
cases, scar tissue may form on the ovary or fallopian tube, thus causing
A physician can only definitively diagnose
endometriosis using a surgical procedure called laparoscopy. During this minor
outpatient surgical procedure, a slender light-transmitting microscope, the
laparoscope, is inserted through a tiny incision in the abdomen, often the navel
so the scar will be invisible. Before insertion of the laparoscope, the abdomen
is filled with carbon dioxide or nitrous oxide to help separate the intestines
from the pelvic organs. This way, organ surfaces are viewed easily and the
physician can check the size and extent of endometrial growths. This method also
allows the physician to rule out other conditions with similar symptoms, such as
Although endometriosis is not curable, the
condition does tend to disappear when the woman reaches menopause, due to
hormonal changes at that time. Treatment options may include surgery, drug
therapy or a combination of the two. The objective of surgical treatment is to
remove the endometrial implants and/or the organs that have been affected by the
disease. The objective of drug therapy is to suppress a woman's levels of
estrogen and progesterone, which stimulate the endometrial growths.
In most cases, the physician should be able to
treat endometrial implants during the laparoscopy. Using minimally invasive
procedures through small incisions, the surgeon can remove scar tissue, destroy
endometrial implants using a laser, and/or drain fluid. Less conservative
procedures such as hysterectomy may be considered for patients who have no
success with other treatments and who no longer want to have children.
In choosing a treatment for endometriosis, the best
approach is to review all treatment options with a physician, and pursue the
choice with confidence.
Myomectomy is the surgical procedure performed to
remove uterine fibroid tumors, which are the most common tumor in women with a
prevalence of between 20-50%. These benign fibroid tumors, or myomas, appear to
grow in relation to their exposure to estrogen. Symptoms can range from
excessive or dysfunctional uterine bleeding, severe pain, anemia of undetermined
origin, or pressure-related symptoms from enlarged fibroids. Infertility or
recurrent miscarriage have been associated with fibroids that significantly
distort the uterus.
Therapies can include progesterone therapy, oral
contraceptive therapy and/or other drug therapy to reduce the size of the
fibroid or multiple fibroids. The length of therapy with these drugs varies;
however, it is known that cessation of the drugs will usually result in
reoccurrence of the fibroid's growth.
Surgical therapy can be conservative or more
radical. For women who do not wish to have the uterus removed, myomectomy is an
option available for continued fertility. Women who have completed childbearing
may want to consider removal of the uterus because of the awareness that
multiple fibroids have a reoccurrence rate as high as 50%; however, solitary
fibroids return in only 10-20% of reported studies.
Myomectomy can be performed either via hysteroscopy
or via an abdominal approach. Patients who opt for myomectomy should be aware of
potential pregnancy-related complications if they do conceive, including
possibility of a necessary cesarean section.
Only a fraction of patients with fibroids are
candidates for surgical therapy, and for those who are candidates, minimally
invasive surgical techniques may be desirable. The physician's goal is always to
choose the most efficient and least problematic and painful alternative for
patients undergoing treatment for this extremely common gynecologic disorder.
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