More than 13,000 US women are diagnosed with cervical cancer each year. In most cases, cervical cancer can be prevented through vaccination and proper cervical screening.

Despite screening programs, 4,000 US women die from HPV-related cervical cancer each year.

What is the point of a pap smear?

A pap (Papanicolaou) smear is a screening test for cervical cancer. The cervix is the opening of the uterus located at the back of the vagina. During a pap smear, doctors place a device called a speculum into the vagina.

The speculum opens the walls of the vagina allowing visualization of the cervix. Cervical cells are then collected using a small brush. These cells are sent to a lab for analysis.

The cells are processed under a microscope to evaluate for precancerous changes called cervical dysplasia. The goal of pap screening is to detect abnormal cervical changes so we can intervene long before cervical cancer develops.

Do I need an HPV test with my pap?

In addition to analyzing the cervical cells, doctors often perform an HPV test. HPV testing recommendations vary depending on your age. HPV testing is recommended for standard screening in women over 30.

HPV testing is also triggered when an abnormal pap smear is found in women under 30. Cervical dysplasia (precancerous cells of the cervix) are linked to the Human papillomavirus (HPV).

Statistically, 80% of Americans will contract HPV, making it the most common sexually transmitted infection. This means more of us will contract this STI than those who do not. HPV “co-testing” during pap smear helps guide the management steps when an abnormality occurs.

Around 40 of the known 130 known strains of HPV affect the genital tract. In men and women, HPV causes genital warts, and persistent strains can lead to cervical, penile, vaginal, anal, mouth, throat, and neck cancer. Approximately 20,000 women and 12,000 men develop cancer caused by HPV every year in the United States.

Who is at risk for HPV?

Anyone sexually active is at risk. The virus may stay dormant for years. Symptoms may not appear until long after you have sex with someone previously infected. It is rarely possible to know when you first became infected. You can not play the blame game with HPV.

Sexually transmitted HPV types fall into two groups, low risk and high risk.

• Low-risk HPVs mostly cause no disease. However, a few low-risk HPV types can cause warts on or around the genitals, anus, mouth, or throat.
• High-risk HPVs can cause several types of cancer. There are about 14 high-risk HPV types. Two of these, HPV16 and HPV18, are responsible for most HPV-related cancers.

Long-lasting infections with high-risk HPVs can cause cancer in parts of the body where HPV infects cells, such as in the cervix, mouth, throat, anus, rectum, penis, vagina, and vulva. 

The HPV vaccine and keeping your pap smears up to date are our best tools to impact cervical disease and HPV.

There is no cure or medication for HPV. The most effective way to protect yourself from HPV infection is to get vaccinated. The HPV vaccine is FDA approved for men and women age 9–45. The Center for Disease Control recommends that the vaccine be given as early as 11 or 12.

HPV vaccination is recommended by the Centers for Disease Control and Prevention (CDC)’s Advisory Committee on Immunizations Practices (ACIP) to prevent new HPV infections and HPV-associated diseases, including some cancers.

The vaccine is most effective when given before initiating sexual activity. It is still useful for those already sexually active as very few have already been exposed to the nine strains of HPV covered in the vaccine.

The most recent recommendations extended the age from 26 to 45, but insurance coverage for those in this age group is lagging.

Pap smears allow for early detection of disease

When a pap smear comes back abnormal, there is no reason to hit the panic button. The next step is a microscope exam called a colposcopy procedure. A colposcopy is an office procedure that allows your doctor to visualize the cervix more closely using a microscope. The colposcope identifies abnormal cervical tissue that cannot be seen with the naked eye.

This office procedure helps determine where on the cervix the abnormal cells are coming from and how severe the abnormality is.

If an area of the cervix appears concerning or precancerous, the doctor can sample the area with a biopsy during the exam.

If the biopsy shows a precancerous lesion, your healthcare provider may recommend a LEEP (loop electrosurgical excision procedure.)

A few minutes of discomfort can save your life

Pap smears save lives. Period. No one likes to get this test, but the benefits of early detection and prevention outweigh the risks of avoiding it.

If it is time for you to update you pap smear, it is well worth your time to do it. A pap smear could save your life.

The post Pap smears Aren’t Fun But Can Save Your Life by Preventing Cervical Cancer appeared first on Medika Life.

What is a hysterectomy?

A hysterectomy is a surgery to remove the uterus. Hysterectomies are performed for a variety of gynecologic conditions such as uterine fibroids, heavy periods, endometriosis, chronic pelvic pain, uterine prolapse, and gynecologic cancer.

A hysterectomy is a surgery to remove the uterus. When the entire uterus is removed, this is called a total hysterectomy. If the entire uterus, tubes, and ovaries are removed this is called a total hysterectomy with bilateral salpingo-oophorectomy. Sometimes the uterus is removed, but the cervix is left behind. This surgical technique is called a supracervical hysterectomy.

During hysterectomies, Obgyns often recommend fallopian tube removal (bilateral salpingectomy) to reduce ovarian cancer risk. Some women will also need the removal of the ovaries (oophorectomy). Hormonal changes only occur when the ovaries are removed.

Gynecologists perform hysterectomies through a variety of techniques. The size of the uterus, surgeon experience, the patient’s body type, and the prior surgical history help determine the proper surgical approach. Techniques include:

1. Vaginal hysterectomy
2. Abdominal hysterectomy
3. Laparoscopic hysterectomy (total or supracervical)
4. Laparoscopic-assisted vaginal hysterectomy
5. Robotic hysterectomy

What are the advantages of laparoscopic supracervical hysterectomy?

Many patients who need a hysterectomy are concerned about a long recovery and missing time off work. A laparoscopic supracervical hysterectomy is an excellent option for hysterectomy candidates who do not have any cervix problems.

The cervix is the opening of the uterus at the back of the vagina. Some women are not candidates for supracervical hysterectomy due to a history of cervical dysplasia, HPV, or abnormal pap smears.

This minimally invasive technique allows faster recovery, reduced pain, and shorter hospital stay. Patients benefit from small incisions, a short hospital stay, and a quicker return to work, exercise, and everyday activities.

During laparoscopic surgery, the surgeon places a camera through the umbilicus (belly button). This technique allows the surgeon to use small instruments to perform the surgery and monitor the surgical field through these tiny incisions.

How long will I be in the hospital?

Surgeons perform a laparoscopic supracervical hysterectomy as an outpatient procedure or inpatient surgery with an overnight stay. Various factors, such as the patient’s underlying health status, surgical complexity, and physician preference, help determine the surgical plan.

Most laparoscopic supracervical hysterectomy patients can leave the hospital much faster after a traditional abdominal hysterectomy.

Can my family visit me?

A trusted family member should drive you to and from the hospital or ambulatory surgery center for a laparoscopic supracervical hysterectomy. Families are welcome to stay with you before and after surgery. Hospital visitor policies for overnight stays vary from region to region due to the Covid-19 pandemic.

Does my procedure require an anesthetic?

A laparoscopic supracervical hysterectomy requires general anesthesia. An anesthesiologist will temporarily put the patient to sleep so they will feel no pain during surgery. The surgeon may also inject a local anesthetic into the incisions to decrease postoperative pain.

What’s the procedure when I check-in?

Most surgeries will involve a preoperative visit with your surgeon to go over the procedure’s risks and benefits in detail. Your surgeon answers questions regarding your upcoming surgery. The surgical consent form is reviewed, signed, or updated with any changes.

Because any hysterectomy will eliminate the possibility of child-bearing, your doctor will ask questions to make sure you are confident you will not want children in the future.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

After arrival at the hospital or Ambulatory Surgery Center, the staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. You will meet the nursing team who will provide care during your stay. Your nurse will place an IV at this time.

The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute questions.

What happens on the day of surgery?

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV to help you go to sleep.

The OR nursing team will cover your body with sterile drapes and prep the abdomen for surgical sterility. The team then performs a “surgical time-out.” The head nurse will read a surgical safety checklist aloud, requiring all surgical team members to be present and attentive.

The gynecologic surgeon will insert a speculum into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina.

Once the speculum is in place and the cervix visualized, the surgeon inserts a device called a uterine manipulator into the cavity of the uterus. This step facilitates the surgeon’s ability to safely operate and avoid injury to surrounding tissue such as the bladder, rectum, intestines, and ureter.

The surgeon will mark the surgical sites with a small marking pin and insert a small camera through an incision in the belly button. Air inflates and distends the abdomen to allow visualization of the pelvis. My preference is to insert a specialized instrument called Gel point mini by Applied Medical. This type of port will enable me to use one incision to perform the procedure.

The surgical team positions the laparoscopic camera to show the pelvic anatomy. We pass small instruments through the additional ports.

Many surgeons recommend complete removal of the fallopian tubes (bilateral salpingectomy) at the time of surgery as this technique reduces the risk of ovarian cancer.

The fallopian tubes are located and grasped with one instrument. Using the other hand, the surgeon clamps and cuts the fallopian tubes from the adjacent anatomy.

The surgeon travels down the sides of the uterus, freeing it from the connecting tissues. The round ligament and uterine/ovarian ligaments are clamped, cauterized, and then cut. At each step, the surgeon will take precautions to control and avoid bleeding.

Critical anatomy lies towards to lower end of the uterus. The surgeon will separate the bladder from the lower uterine segment to allow visualization of the cervix and avoid bladder injury.

The surgeon will focus careful attention on the uterine arteries, the main blood supply to the uterus. These two blood vessels travel over the ureters, which are the tubes connecting the kidney to the bladder.

At this point, we can separate the uterus from the cervix for removal. There are various techniques, but I prefer to use a product called the bipolar Lina Loop.

The surgeon lassos the loop over the uterus and positions it at the uterus and the cervical junction. We perform a safety check to make sure no other anatomy is in contact with the loop. Then the uterus is amputated from the cervix.

The uterus is now free but still needs to be removed. We place the uterus into a surgical bag for tissue retrieval.

The surgeon examines all of the surgical sites for bleeding. When safe, the Obgyn removes the uterus safely located inside the bag through the umbilical (belly button) incision. We removal the operative ports and sew the surgical incisions closed.

Once the procedure is complete, the surgical team completes a post-procedure review. All instruments and equipment are counted and verified. When finished, the anesthesiologist will begin to wake the patient up for transfer to the recovery room.

How long will I be in the operating room?

Once the patient enters the operating room, a series of safety steps must occur. This process takes about 20 minutes.

The operative time for laparoscopic supracervical hysterectomy varies. The surgeon’s experience, surgical technique, patient body type, uterine size, and previous surgeries are all factors. For example, a small uterus is a much easier surgery than a large, fibroid uterus.

In general, the patient should expect 1–2 hours of total operative time.

When can I go home?

Postoperative recovery time will vary from person to person. Some surgeons will recommend an outpatient procedure, while others prefer an overnight stay. The patients underlying health status, surgical complexity, and physician preference are all factors.

To be able to go home, each patient must meet specific discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. The recovery room team will control postoperative nausea, vomiting, and pain and monitor for postoperative bleeding.

The nursing team will go over discharge instructions, and confirm postoperative pain management plans.

AFTERCARE AND RECOVERY QUESTIONS

What is the usual recovery time?

Most women should be able to return to normal daily activities within a few weeks of surgery. The nursing team will help patients walk and move around a few hours after surgery to reduce blood clots’ risk, improve lung function, and expedite bowel function return.

Most patients will require pain medication like NSAIDs and narcotics for a time. Many experience discomfort in the right shoulder due to air irritating the nerves of the diaphragm.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are safe to use.

What aftercare is required?

You should speak with your physician regarding the resumption of exercise and sexual activity. Most can return to basic activities in one to two weeks. Sexual activity is typically restricted for 6–8 weeks to allow complete healing.

Your doctor will schedule a postoperative examination 1–2 weeks after the procedure to evaluate the incisions.

Danger Signals to look out for after the procedure

You should call your doctor if you experience heavy vaginal bleeding, fevers, severe nausea or vomiting, worsening abdominal pain, or the inability to pass gas.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over 24 hours, call your physician. After any surgery, contact your physician if you meet any of the following criteria:

• Pain not controlled with prescribed medication
• Fever > 101
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas

What preparations should I make for aftercare at home?

Laparoscopic procedures require very little postoperative care. Keep the incisions clean and dry. Patients should avoid sexual activity until cleared by their doctor. One may resume a normal diet the day of surgery and begin light exercise the day after the procedure or when you feel ready.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

Still have questions?

Read through any existing comments in the section below and if you still need information on this procedure please do leave your questions in the comments section.

The post Preparing for: Laparoscopic Supracervical Hysterectomy appeared first on Medika Life.

What is a Loop Electrosurgical Excision Procedure?

LEEP stands for Loop Electrosurgical Excision Procedure. It’s a treatment to prevent cancer after precancerous cells are identified during cervical cancer screening. Precancerous cells are caused by HPV, the human papillomavirus.

80% of Americans will contract HPV, making it the most common sexually transmitted infection. HPV causes genital warts, and persistent strains lead to cervical, vaginal, anal, throat, and neck cancer. Despite screening programs, 4,000 US women die from HPV related cervical cancer annually. A LEEP procedure saves lives. 

80% of Americans will contract HPV, making it the most common sexually transmitted infection. Persistent HPV strains lead to cervical, vaginal, anal, throat, and neck cancer. Despite screening programs, 4,000 US women die from HPV related cervical cancer annually. A LEEP procedure saves lives.

A small wire loop is used to remove abnormal cells from your cervix. The thin wire loop is attached to an electrical current to cut away the top layer of cervical cells and remove the effects of HPV. 

HPV effects are detected during a routine paps smears, the first step in cervical cancer prevention. When someone has an abnormal pap smear, the next step is a diagnostic procedure called a colposcopy.

A colposcopy is an office procedure that allows your doctor to visualize the cervix more closely using a microscope. The colposcope identifies abnormal cervical tissue that cannot be seen with the naked eye. Areas of the cervix concerning for pre-cancer or cancer can then be biopsied (sampled) during the exam.

If the biopsy shows a precancerous lesion then, your healthcare provider may recommend a LEEP (loop electrosurgical excision procedure.)

Where is a LEEP Procedure performed?

A Loop electro excision procedure can be performed in a variety of settings. Most commonly, Obgyns perform this procedure in the office setting. 

The office, surgery center, or hospital are all reasonable and appropriate surgical settings.

Can my family visit me?

Most LEEP procedures are performed in a medical office setting. A trusted family member should drive you to and from the appointment. If the procedure is done in an hospital or Ambulatory Surgery Center, your family is welcome to stay with you before and after the procedure.

Does my procedure require an anesthetic?

Anesthesia is required for a LEEP procedure. The type of anesthesia will vary depending on the surgical setting, the surgeon’s experience, and the availability of office equipment. 

Oral sedation, paracervical block, IV sedation, and general anesthesia are all potential anesthetic options. 

In the office setting, anesthesia is provided via a paracervical anesthetic. A paracervical block is an anesthetic technique done by a gynecologist to numb the uterus. Medication is injected into the cervical tissue to reduce pain during surgery. For a LEEP procedure, a medication called epinephrine is mixed with the anesthetic to reduce the risk of intraoperative bleeding.

Some gynecologists also recommend oral medication to reduce anxiety.

What’s the procedure when I check in?

Most surgeries will involve a preoperative visit with your surgeon. The risks and benefits of the procedure will be discussed in detail and questions regarding your procedure are discussed. The surgical consent form is reviewed, signed, or updated with any changes.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

When a LEEP procedure is performed in an office setting, the experience will feel like a normal office visit. After checking in, you will be taken to a procedure room. The medical assistant will prepare the room and provide a gown or leg coverings. When all is prepared, your surgeon will come and review any last-minute questions.

If a LEEP is scheduled in a hospital or Ambulatory Surgery Center, the staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. If an IV is required, it will be placed at this time. You will meet the nursing team who will provide care during your stay. The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute questions.

What happens in the operating room??

For an office-based procedure, your surgeon will help position your legs into the stirrups. A speculum is placed into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina. The cervix is cleaned to make the area sterile. 

A paracervical block anesthetic is then gently injected into the cervical tissue. The medication absorbs into the surrounding area to numb the nerves and make the procedure more comfortable. 

The surgeon selects the appropriate sized LEEP wire to match the size and appearance of your cervix. Because a low dose electrical current is used to do the cutting, a grounding pad is placed on the outside of your leg. The doctor will take extra precautions to ensure an adequate and safe view of the cervix. A grounding pad is placed on the outside of your leg.

Once all preoperative safety checks are confirmed, the surgeon will activate the electrical current to pass the wire across the top layer of the cervix. This action removes a small, pancake layer of cervical cells. This specimen is sent to a pathologist for analysis. 

The electrical current is then used to stop any bleeding through a process called cauterization. Often, a drying chemical called Monsel’s solution is painted onto the cervix to prevent bleeding later on. This chemical is messy and will cause a brown, coffee-ground vaginal discharge over the next few days. 

In the hospital setting, things function a little differently. 

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV if the procedure is being done outside of the office setting. 

The OR nursing team will cover your body with sterile drapes and prep the vagina for surgical sterility. The team then performs a “surgical time-out.” A surgical safety checklist is read out loud requiring all surgical team members to be present and attentive.

The surgeon then performs the surgical procedure as described above.

Once the procedure is complete. A post-procedure review is done together as a surgical team. All instruments and equipment are counted and verified. Once complete, the anesthesiologist will begin to assist the patient in waking up for transfer to the recovery room.

How long will I be in the operating room?

Once the patient enters the operating room a series of safety steps must occur. This process takes about 20 minutes. 

A LEEP procedure takes approximately 10–15 minutes of surgical time. This includes the surgical time as well as accounting for positioning, the speculum insertion, a paracervical block anesthetic, and removal of the instruments.

When can I go home?

After an office-based LEEP procedure, patients may go home after getting dressed as long as you are feeling normal. 

Hospital-based procedures under general anesthesia will follow a different process. 

Postoperative recovery time will vary from person to person. Each patient must meet certain discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. Postoperative nausea, vomiting, and pain must be controlled as well as confirmation of no postoperative bleeding.

The nursing team will go over discharge instructions, and the plan for postoperative pain management options will be confirmed.

LEEP procedures require a minimal amount of postoperative recovery. Patients are often discharged as early as 30–60 minutes after the procedure.

What is the usual recovery time

You should be able to resume all work and household activities the day after your procedure. You should expect to feel a little vaginal soreness for 2–3 days. Mild uterine cramping is also common. 

Some patients will require mild pain medication like NSAIDs or even low dose narcotics for a brief period of time. 

It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge. 

You will be instructed to abide by pelvic rest for approximately one week. This includes no douching, no sex, and no tampons. 

You should call your doctor if you experience heavy vaginal bleeding, fevers, or worsening abdominal pain.

What aftercare is required?

Most women should be able to return to normal daily activities the next day. You should speak with your physician regarding the resumption of sexual activity. Typically, the recommendation is no intercourse for 1–2 weeks. 

You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are advised. 

Your doctor will schedule a postoperative examination to evaluate your cervix 1–2 weeks after the procedure. The cervical specimen pathology report will be reviewed during this visit. 

A follow-up pap smear will be scheduled to confirm all of the abnormal cells have been successfully removed and do not come back. 

Danger Signals to look out for after the procedure

After a LEEP procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery contact your physician if you meet any of the following criteria:

What should I pack at home to take with?

Nothing special is required after a LEEP procedure. A supply of sanitary napkins will help keep your clothing clean.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

The post Preparing for: Loop Electrosurgical Excision Procedure (LEEP) appeared first on Medika Life.