Urogynecology

Bladder Repair (anterior colporrhaphy) is the vaginal repair of dropped or prolapsed bladder. The anterior “skin“of the vagina is opened vertically and dissected laterally to reinforce the weakened support under the bladder using either sutures or mesh graft. This is done under general anesthesia or regional (spinal block). There are no external cuts or stitches.

Vaginal rectal repair or rectocele/enterocele repair (posterior colporrhaphy) is the vaginal repair of the weakened support that causes bulging into the posterior lower and upper part of the vagina using the same technique as the bladder repair, performed with or without mesh graft augmentation. No external incision. Both the anterior bladder and the posterior rectocele repairs can be done to provide a tightening effect of the vagina as well as resolving the pressure and bulge they cause.

Vaginal prolapse repair or vaginal vault suspension is a vaginal procedure that uses minimally invasive techniques to reattach and anchor the upper vagina (vault) to firm ligaments deep in pelvis using mesh grafts or permanent sutures. This is usually done in conjunction with an anterior (cystocele) repair and posterior (rectocele) repair as part of pelvic reconstruction. A concomitant anti-incontinence procedure is often incorporated in the reconstruction.
Click here to view a video of the Elevate® Prolapse Repair System.

Perineoplasty is the external repair of the posterior vaginal outlet to restore normal form and function and is often done in conjunction with posterior vaginal repair when the anatomy has been distorted or damaged by childbirth trauma. The result is a more cosmetic and functional vaginal introitus.

Suspension of Prolapsed Uterus is a vaginal technique employing permanent vaginal mesh as part of a prolapse repair that attaches to the lower uterus and helps support and prevent further prolapse of the uterus. In cases of extreme prolapse, it may be best to remove the uterus vaginally (vaginal hysterectomy) and the support or suspend the upper part of the vagina with permanent sutures or mesh graft.

Urinary Incontinence Sling is a vaginal procedure that uses a thin permanent mesh under the urethra to control urine loss during coughing, sneezing, laughing or any other activity that increases abdominal pressure and causes bladder leaking. Several techniques exist to introduce the mesh, some using small incisions in the groin and more recently, by small intravaginal (invisible) incision with minimal pain or discomfort. It is usually done as outpatient.
Click here to view a video of the Miniarc® Single Incision Sling System.

Cosmetic Gynecology

Laser Vaginal Rejuvenation (LVR) is a cosmetic gynecologic procedure to restore normal anatomy and function to a relaxed or stretched vaginal canal and vulva. This condition may cause not only a bulge, pressure and an undesired appearance but also can result in sexual dysfunction with lack of or decreased sensation during vaginal intercourse. The procedure involves the use of a diode laser in a vaginal repair that tightens and restores the vagina. This can be done as part of complete prolapse repair that may require the use of mesh augmentation for better long term results.

Labioplasty is a surgical procedure done with laser assistance to reduce the size of the labia minora, usually for cosmetic reasons but occasionally the large labia may cause discomfort and irritation and impair certain physical activities. The clitoral hood usually requires reduction to be compatible with the reduced size of the labia.

Minimally Invasive Gynecology

Laparoscopic Hysterectomy, (total or partial) is a laparoscopic procedure for removing the uterus through small abdominal incisions. The entire uterus can be removed (TLH, total laparoscopic hysterectomy) or the cervix can be left in place (LSH, laparoscopic supracervical hysterectomy). With both procedures the ovaries can be removed if needed or desired without additional incisions. Laparoscopic hysterectomies are done under general anesthesia and many times as outpatient. The recovery is from 1-3 wks, with restriction on vaginal intercourse for 6 wks in TLH cases.

Laparoscopic Myomectomy is the removal of fibroid tumors from the uterus using laparoscopic techniques avoiding a large “open” incision. The use of special instrumentation allows this minimally invasive procedure to preserve the uterus. It is usually performed for abnormal menstrual bleeding, pain or infertility or in cases where hysterectomy is not desired. This procedure requires extensive advanced laparoscopic skills and can be done in an outpatient setting.

Endometrial Ablation is a minimally invasive procedure to treat heavy menstrual bleeding done with minimal anesthesia, occasionally in office setting. The procedure involves the use of energy to destroy the endometrium ( lining of uterus) which is responsible for menstrual bleeding. Several different devices using different energy modalities exist to accomplish reduction in menstrual flow or in many cases complete cessation of menses (amenorrhea). Novasure ablation uses a device inserted into the uterus through the cervix and applies heat energy for approximately 90 seconds to achieve the destruction of the endometrium leading to reduction of menstrual flow.

Hysteroscopic Myomectomy is the removal of fibroid tumors with the use of the hysteroscope allowing resection of fibroids that protrude into the cavity of the uterus. This approach does not involve abdominal incisions and is done through the vagina. Occasionally it is performed in conjunction with a laparoscopic myomectomy for removal of larger fibroids usually to treat abnormal menstrual bleeding or infertility. It can be done on an outpatient basis.

Hysteroscopic Sterilization ( Adiana, Essure) is a method of sterilization done in office with minimal sedation and local anesthesia. It is done with a hysteroscope to visualize the tubal openings and with a special device that deploys an insert into the tubes that will lead to scarring and occlusion of the tubes. Both procedures require some form of birth control for 3 months until tubal occlusion is confirmed by an X-Ray (hysterosalpingogram).

General Gynecologic Care