Greenville Health System (GHS) surgeons offer a range of treatments to meet women’s health care needs.
Alternatives to Hysterectomy
“We lean toward conservative management of a patient’s condition when we are treating a woman of childbearing age or a woman who otherwise wants to keep her uterus, even when a problem exists that a hysterectomy would solve,” said Laura Wang, M.D., FACOG, a gynecologist with GHS’ Gynecology Specialists.
Beyond medicinal therapies, including birth control pills, some surgical procedures that can prevent or delay a hysterectomy include myomectomy, uterine artery embolization and endometrial ablation.
With this operation, the surgeon cuts away large uterine fibroids (myomas), common noncancerous tumors of the uterine musculature, without removing the uterus, so that a woman can maintain her ability to bear children. Removal of the fibroids tends to weaken and scar the uterine wall, so future deliveries may have to be performed by cesarean section. Myomectomy may not be recommended for women who do not desire future fertility or who are menopausal.
Traditionally a myomectomy is performed through a large incision in the abdominal wall, but some patients are candidates for laparoscopic fibroid tumor removal. A laparoscopic myomectomy is performed while the patient is under general anesthesia and her abdomen is inflated with carbon dioxide gas via a tiny incision. The surgeon inserts the laparoscope through the navel and examines the internal organs, then incises the outer coating of the uterus and muscular wall to remove the fibroid.
After the fibroid is removed from the uterus, it is cut into small pieces with a morcellator, and the pieces are removed through one of the ports or through an incision in the vagina. Following laparoscopic myomectomy, most women leave the hospital within 24 hours. Recovery takes about two weeks. In contrast, abdominal myomectomies require a hospital stay of three to four days and a recovery period of four to six weeks.
Uterine artery embolization
This minimally invasive hysterectomy alternative preserves the uterus but is not advised for women who want to become pregnant. Sometimes called uterine fibroid embolization, the operation blocks the arteries carrying blood to the uterus as well as the fibroids. Interventional radiologists perform the procedure. First, they place a catheter through a large artery in the groin and then they thread the catheter through the blood vessels until it reaches the uterine arteries. Next they inject plastic particles about the size of grains of sand through the catheter to block the uterine arteries and subsequently decrease the blood supply to the fibroid(s). Patients usually are hospitalized overnight for pain control. Over time, the size of the fibroids decreases because their blood supply is blocked. The procedure typically relieves heavy menstrual blood loss as well as pelvic pressure and pain caused by large fibroids.
This operation, which also is not recommended for women who want to bear children, can reduce or stop abnormal uterine bleeding by using electrical energy, heat or cold to destroy the endometrium (tissue lining the inside of the uterus). Following is one example of how the procedure can be performed: The surgeon inserts a narrow tube called a hysteroscope vaginally into the uterus and then uses the tube’s tiny camera to view the uterine cavity on a monitor while other instruments passed through the hysteroscope destroy the tissue. There are a number of other methods for accomplishing the operation. Complications can include recurrent symptoms that ultimately lead to hysterectomy to control dysfunctional bleeding.
For women who desire permanent sterilization but do not want to undergo an abdominal operation, GHS offers the Essure® Micro-Insert System. The first FDA-approved hysteroscopic approach to tubal sterilization, Essure requires no incision or general anesthesia and can be performed in approximately 30 minutes in an outpatient setting.
Hysteroscopic sterilization works by “plugging up” the fallopian tubes to prevent fertilization. Two small coil implants (the micro-inserts) are positioned through the body’s natural pathways (vagina, cervix and uterus) in each fallopian tube. Each one expands upon release, anchoring itself inside the tubes. Over time, the implants trigger scar tissue to grow around them, permanently blocking the tubes.