Jeanne Faulkner 6/2008
It's tough enough needing a minor surgical procedure but having to go to the hospital for one can be a hassle. It can also be expensive, time-consuming and nerve wracking. At Women's Health Today we've started performing many simple procedures in our office. In-office surgical procedures are safe and done in a familiar environment. You'll be in and out quickly, cared for by the medical team you already know. "We want to make things as easy, comfortable and uncomplicated for our patients as we can. New technology has simplified these procedures so that we can do them in the office," says Dr. Polo from WHT.
Not every patient is a candidate for an in-office procedure but many are. Women who are generally healthy and without major medical problems may want to consider having their "work" done in the more relaxed office atmosphere. For those women who aren't good candidates, or would rather have their procedure done at the hospital, don't worry – that's what the hospital is for. We'll perform the same procedures in the Outpatient Day Surgery Center where you'll receive excellent medical attention.
We understand many patients feel anxious before having a procedure and that pain management is important. We'll take care of both of these issues with oral medication, local anesthesia and tender loving care. Our staff will be right there to hold your hand. Before we proceed with any type of diagnostic or surgical procedure, we'll have a clear discussion about what to expect, risks, side effects and recovery.
LEEP – Loop Electrosurgical Excision Procedure
You've had a pap smear, maybe a colposcopy or biopsy and you know there are abnormal cells (dysplasia) on your cervix. The next step is getting rid of them. LEEP is one of the procedures we use for removing cervical tissue. It goes like this:
We'll decide together what type of medication we'll use for anxiety and pain before we start the procedure. Once you're "comfortable" (yeah, we know – no one's really comfortable) on the exam table, we'll use a speculum to view the cervix. We'll use colposcopy to magnify the cervix so we can see the abnormal tissue and a local anesthetic to numb the cervix. Then we'll proceed with the LEEP.
LEEP uses a thin wire loop that acts like a scalpel (surgical knife). An electric current passes through the loop and cuts away a thin layer of the surface cells. It only takes a few minutes. Whatever we remove, we'll send to a lab to be analyzed. You'll be able to leave the office within the hour but you might be a little sore and may have taken anxiety medicine. We'll want you to get a ride home and take the rest of the day off.
Endometrial ablation (EA) may be an effective treatment for abnormal uterine bleeding. EA goes directly to the source of the bleeding, the endometrium (uterine lining). EA destroys a thin layer of endometrium and stops all menstrual flow in most women. Some continue to have periods but they'll be much lighter. A few will have no improvement and we'll have to consider other options. We use the "NovaSure" ablator here at WHT. The NovaSure produces an electrical current to effectively destroy the endometrium.
Again – we'll get you "comfortable" with your legs up in stirrups. You'll probably have taken a mild medication to relieve anxiety and something for cramps (like ibuprofen). Then we insert a speculum, place the cervical numbing medicine and dilate the cervix just enough to be able to insert our narrow instruments. The first instrument is a hysteroscope that helps us see where we're working. If polyps are found, they can be removed before we proceed with ablation. The NovaSure Ablation takes 90 seconds or less to accomplish. You may feel some cramping but they're brief and most patients experience only minimal discomfort. You’ll rest comfortably for a while after the procedure.
You'll need a ride home and to take the rest of the day off. Most women are back in action the next day.
Dilation means we open the cervix up a bit. Curettage means we take out some of the endometrium (uterine lining) to examine it in the lab or to control bleeding. It's an effective treatment for a variety of conditions like abnormal bleeding, miscarriage and when we want to biopsy cells from inside the uterus.
Dilation: There are a few ways to go about this. We may insert Misoprostil tablets into the vagina, two to eight hours before your procedure then send you home to let it do its job. Misoprostil is a medication that softens the cervix, making it easier to dilate. Though it sometimes causes a little cramping and bleeding, that just means it's working. When you return for your D&C, we'll administer medication to make the procedure more comfortable. We help you back into the stirrups, insert the speculum and give local anesthesia to numb the cervix. Then we'll use our instruments to dilate the cervix further.
Curettage: Once we've opened the cervix we'll use either a suction device or an instrument called a curette to remove uterine contents. It's fast – just a couple minutes. You might feel cramps but they usually go away with ibuprofen. If you need something stronger, we'll work it out.
You'll go home within an hour or so of the procedure but be sure you have a driver. You'll take it easy the rest of the day and probably be up and around the next.
Sometimes we need a good look inside the uterus to know what's going on. A hysteroscope is a thin, telescope-like devise we insert through the vagina and cervix into the uterus. It's an excellent diagnostic tool for abnormal uterine bleeding, infertility, repeated miscarriages, adhesions, polyps, fibroids, or a displaced IUD. Once we're in there, we can remove tissue if needed.
Like the other procedures listed here, we may use a mild sedative, pain medication, local anesthesia and of course, stirrups and a speculum.
We'll dilate your cervix a little to make space for the hysteroscope. Once inserted into the uterus, we may use a liquid or gas to expand the uterus and give us a better view. If we need to take any samples, small instruments will be inserted through the hysteroscope so that the lesion can be removed under direct visualization.
Eventually, as new technology develops, we plan on bringing other diagnostic and surgical procedures into the office. We'll keep you posted as plans progress. If you think you'd be happier having your procedure in the hospital – no problem. Our goal is to make this as easy as possible on you. Oh, but just one thing - they have stirrups in the hospital too.