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.

She looked at options like uterine myomectomy and uterine fibroid embolization, but she wanted kids one day. She feared the potential impact on her future fertility. She searched for an effective medication to treat her fibroids and reduce her heavy menstrual bleeding. She wanted to get her life back. 

For many years, women with fibroids have sought out menstrual cycle control options beyond oral contraceptives, Depo-Provera injections, and Progesterone IUDs. In May 2020, the U.S. Food and Drug Administration approved Oriahnn™ for the management of heavy menstrual bleeding associated with uterine fibroids in premenopausal women.

What is Oriahnn™?

Oriahnn™ is the only FDA-approved oral medication designed to improve and lighten heavy periods caused by uterine fibroids. Fibroids, also called leiomyomas, are benign uterine tumors that grow in the uterus. Up to 80% of women will develop one or more uterine fibroids during their lifetime. 

Oriahnn™ is a combination product containing elagolix, estradiol, and a type of progesterone called norethindrone acetate. Elagolix is a gonadotropin-releasing hormone antagonist. This term means it suppresses the ovarian sex hormones estrogen and progesterone, both of which stimulate fibroid growth.

The addition of estradiol and norethindrone acetate adds back some of the female hormones to prevent side effects and help thin out the endometrial lining. 

Oriahnn™ is approved for use in premenopausal women to reduce the amount of bleeding caused by uterine fibroids.

Why would a woman want to try Oriahnn™?

Many women suffering from the effects of fibroids seek a non-surgical treatment to control heavy periods. Medial options allow her to reduce her symptoms without impacting her future fertility. An effective medication will enable her to keep her options open.

Older medications, such as Depo-Lupron (leuprolide acetate), are administered as an injection. This type of medication is costly, poorly covered by insurance companies, and often triggers menopausal symptoms such as hot flashes. 

Oriahnn™ comes packaged as a daily oral medication giving women the options to avoid surgery, procedure, or a birth control method. This pill is clinically proven to reduce heavy menstrual bleeding due to uterine fibroids within one month of taking it. 

Oriahnn™ is not birth control. Patients using this medication who do not want to get pregnant may want to consider a nonhormonal contraceptive option such as condoms, Phexxy, spermicide, copper IUDs, or a diaphragm. 

Does Oriahnn™ work? 

Oriahnn™ was studied in two 6-month clinical trials used for FDA approval. These studies included 591 premenopausal women aged 26–53 with heavy periods due to sonographically-confirmed uterine fibroids.

The participants measured menstrual blood loss (MBL) for two cycles before starting Oriahnn™ or a placebo. Only those with greater than 80 ml of MBL qualified for the study.

In the first study, 68.5% of patients who received Oriahnn showed a reduction in menstrual bleeding compared to 8.7% of patients who received a placebo. 

In the second study, 76.5% of patients who received Oriahnn showed an improvement in blood loss compared to 10.5% of patients who received a placebo.

Oriahnn™ was proven to lighten heavy periods in 70% of women with a 50% reduction in menstrual blood loss. During the 6-month clinical trials, only three women required surgery for their uterine fibroids.

What side effects for Oriahnn™?  

During the clinical trials, about 10% of patients stopped treatment because of any side effects. Of note,7% of women taking the placebo also stopped treatment due to side effects.

The most common reported side effects were hot flashes, headache, fatigue, and irregular uterine bleeding.

All products containing estrogen and progestin combinations increase the risk of thrombotic or thromboembolic disorders, including pulmonary embolism, deep vein thrombosis, stroke, and myocardial infarction. A doctor must evaluate a patient’s medical history to determine if these medications are an appropriate option. 

Oriahnn™ may increase the risk of bone loss so the FDA approval recommends limited its use to 24 months. 

A new medical option for fibroids

Gynecologists now have a new option to help women with fibroids. Women with fibroids who want to avoid surgery or birth control may want to consider Oriahnn™. 

This novel medication, back up by clinical evidence, gives women more choices to reduce menstrual bleeding caused by fibroids. 

The post Oriahnn; A Drug to Stop Heavy Periods for Women With Fibroids appeared first on Medika Life.

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

During a hysterectomy, the uterus is removed. Obgyns often recommend fallopian tube removal (bilateral salpingectomy) to reduce the risk of ovarian cancer. 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 
4. Laparoscopic-assisted vaginal hysterectomy 
5. Robotic hysterectomy robotic

What are the advantages of robotic hysterectomy?

Contrary to the name, robots do not perform the surgery. A human gynecologic surgeon attaches a surgical system to intraabdominal ports. While sitting at a surgical console, the surgeon controls the robotic arms while monitoring the surgical field in a 3D view..

Through 4–5 small incisions, the surgeon detaches the uterus from the surrounding tissues. Robotic surgery is a minimally invasive surgery that allows for faster recovery, reduced pain, and shorter hospital stay.

The American College of Obgyn acknowledges this type of hysterectomy’s growing popularity but recommends robotic hysterectomy be reserved for more complex cases that can not be safely completed through other minimally invasive techniques.

Experienced robotic surgeons prefer the precise control of the surgical arms allowing complex cases to be completed in a minimally invasive fashion. Patients benefit from small incisions, a short hospital stay, and a faster return to work, exercise, and everyday activities.

How long will I be in the hospital?

Surgeons perform robotic hysterectomies as an outpatient procedure or as an 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 robotic hysterectomy patients are able to leave the hospital much faster after a traditional abdominal hysterectomy. 

Can family visit me?

A trusted family member should drive you to and from the hospital or ambulatory surgery center for a robotic 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?

Laparoscopic robotic surgery requires general anesthesia meaning patients will be temporarily put to sleep. 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 robotic hysterectomies 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. An IV will be placed 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 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.” A surgical safety checklist is read 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. A small camera is inserted through an incision into the belly button. Air inflates and distends the abdomen to allow visualization of the pelvis. Three or four secondary ports are placed to allow the robotic arms to function. 

The robot is then positioned over the body and attached to the ports. The laparoscopic camera is positioned to show the pelvic anatomy. Small instruments are passed through the additional ports. Scissors are attached to one robotic arm and a grasping device in the other. This allows the surgeon to operate with both hands. 

The surgeon then moves away from the patient to the surgical consult to control the robot. 

As the surgeon takes her seat, she adjusts the camera and robotic arms’ position to begin the surgery.

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 tubes from the adjacent anatomy.

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

Towards to lower end of the uterus lies important anatomy. The surgeon will separate the bladder from the lower uterine segment to allow visualization of the cervix. 

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

Once the uterine arteries are controlled, the surgeon can safely separate the uterus from the vagina. 

The surgeon makes a circular incision just below the cervix freeing the uterus. The uterus is delivered through the vagina and sent to the pathologist to analyze the tissue. 

The surgeon then sews the edges of the vagina closed to form the vaginal cuff. 

The surgeon examines all of the surgical sites for bleeding. When safe, the Obgyn removes the operative ports and sews 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 robotic hysterectomy varies. The surgeon’s experience, surgical technique, patient body type, uterine size, and patient’s previous surgeries are all factors.

In general, 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. 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.

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 the vaginal cuff to heal.

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?

Robotic procedures require very little postoperative care. Keep the incisions clean and dry. Sexual activity should be avoided until cleared by your 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: Robotic Hysterectomy appeared first on Medika Life.

Every woman suffering from the effects of uterine fibroids deserves to know all of her options. Removing fibroids is not always the answer. While Obgyn physicians are comfortable discussing surgical treatment options, many doctors do not discuss all the alternatives.

Uterine fibroid embolization can be an excellent choice for the many women with fibroids who want to avoid surgery and keep their uterus. This minimally invasive alternative effectively treats fibroid with minimal downtime and recovery. 

Uterine fibroids are one of the most common gynecological conditions with many available treatment options. Educating yourself is a key step to allow you and your doctor to make a joint decision together on the best approach.

I want to keep my uterus. What are my options?

What are uterine fibroids?

Uterine fibroids are benign noncancerous tumors affecting women. Fibroids, also called leiomyomas, are groups of cells that form into a ball of muscle in the walls of the uterus. Up to 80% of women will develop one or more uterine fibroids during their lifetime.

Uterine fibroids behave in strange ways. They may grow slowly or quickly, or they may simply stay the same size throughout a woman’s life. Some women will develop more fibroids while others will not.

Many women are unaware they have fibroids, while others suffer unbearable symptoms. Heavy menstrual periods, pelvic pain, cramping, frequent urination, constipation, painful intercourse, and back pain are common complaints. 

Hysterectomy and myomectomy are not your only option to treat fibroids. 

Women with fibroids who want to avoid surgery and keep their uterus need to know about uterine fibroid embolization. UFE is an important option, but your Gynecologist may not mention it. 

What is a uterine fibroid embolization?

Uterine Fibroid Embolization (UFE) is a minimally invasive procedure to shrink or destroy uterine fibroids. Although fibroids are a common gynecologic condition, this procedure is not done by a gynecologist. 

Instead, this safe and highly effective non-surgical treatment is performed by an interventional radiologist.

To perform a UFE, the doctor inserts a small catheter into an artery in the arm or leg. The doctor injects a substance called IV contrast to project the blood supply onto a video screen via X-ray technology. 

The thin, flexible catheter is then advanced to the location of the fibroid. Small particles called polyvinyl alcohol are pushed through the catheter to block the blood flow to the fibroid. 

Starved of their blood supply, the fibroids shrink and die. 

UFE advantages

UFE has several advantages over hysterectomy and myomectomy.  

1. General anesthesia is not required.
2. No surgical incisions are needed. 
3. There is no blood loss. 
4. Treats adenomyosis. 
5. All fibroids may be treated at the same time. 
6. Minimal downtime and recovery. 
7. Can treat a fibroid of any size. 
8. A viable option for those with a medical condition prohibiting major surgery.

Disadvantages of UFE include:

1. Fertility effects. The long term effects on fertility are not completely understood. While some studies show an increase in fertility, others studies show negative effects. UFE is not typically recommended for women who would like to get pregnant in the future. 
2. Fibroids are not removed. While UFE shrinks and treats the tumors, it does not remove them from the body. 
3. Infection. The risk of infection is quite low but there is a possibility of delayed infection during the first postsurgical year. 
4. The potential need for retreatment. 
5. Not recommended for all types of fibroids. 

All procedures have risks

The risks of UFE is low but include:

1. Infection. The infection risk is low but is a serious, potentially life-threatening complication of UFE. In rare cases, hysterectomy is needed to treat an infected uterus. 
2. Premature menopause. 
3. Amenorrhea. Some women experience a loss of menstrual cycles after UFE. 
4. Pelvic pain. Pain and cramping are rare, but in some cases may persist for the first few months after the procedure. 

Why didn’t my Gynecologist mention UFE? 

Not all gynecologists discuss UFE as an option for uterine fibroids. Some doctors are not aware of UFE. Many have had little to no clinical experience with the procedure. Other Obgyns may have had a negative experience with interventional radiology referrals in the past. 

UFE is a highly specialized procedure and some geographic areas may not have access to a local Interventional radiologist. 

In my experience, I have found UFE to be a safe and effective option for women with fibroids. I am not trained to perform the procedure so I had to educate myself on the risks, benefits, and tremendous value UFE offers. 

Our practice refers patients to Dr. Suzanne Slonim at the Fibroid Institute of Dallas.

The post UFE: Treating Uterine Fibroids without Losing Your Uterus appeared first on Medika Life.

Uterine fibroids are benign noncancerous tumors affecting women. Fibroids, also called leiomyomas, are made of muscle cells forming into balls and bumps that grow in the uterus. Up to 80% of women will develop one or more uterine fibroid during their lifetime.¹ 

Many women are unaware they have fibroids. Doctors accidentally discover fibroids during a routine pelvic or pregnancy ultrasound.

Uterine fibroids behave in strange ways. They may grow slowly or quickly, or they may simply stay the same size throughout a woman’s life. Some women will develop more fibroids while other women will not. 

Why do we get uterine fibroids?

We do not know exactly why some women get fibroids, and others do not. Genetics and family history play a role. Having a family member with fibroid increases the risk. Fibroids are most common in African-American women affecting up to 50%. Two female hormones, Estrogen and Progesterone, affect fibroids. Fibroids tend to shrink when the production of these hormones stops after menopause. 

What are the symptoms of uterine fibroids?

Not all women will have symptoms. The size and location of the fibroids in the uterus impact the potential for life-disrupting symptoms as fibroids increase blood flow to the uterus. Fibroids can also impact fertility and the risk of miscarriage. Most fibroids do not cause problems in pregnancy but do increase the risk of preterm labor and fetal growth concerns. 

Size matters with fibroids. Large ones can lead to what we call bulk symptoms. These include:

1. Painful intercourse
2. Pressure or abdominal fullness
3. Increased abdominal size 
4. Frequent urination
5. Constipation
6. Low back pain

The location of the fibroid inside of the uterus plays a role as well. Fibroids increase blood flow to the uterus. These symptoms include:

1. Heavy periods (menorrhagia)
2. Painful periods and cramping (dysmenorrhea)
3. Bleeding after sex (postcoital bleeding)

Types of fibroids

1. Intramural These fibroids are located within the muscular walls of the uterus and typically can cause heavy bleeding, painful intercourse, or pressure symptoms.
2. Submucosal These dangle inside the uterine cavity, typically cause heavy bleeding, irregular bleeding, or bleeding after intercourse. 
3. Subserosal This type of fibroid grows on the outer wall of the uterus. Heavy periods, pelvic pain and bulk or pressure symptoms are common

How are fibroid’s diagnosed?

1. Pelvic exam: A healthcare provider can often diagnose uterine fibroids by feeling the size and shape of the uterus during a pelvic exam. Typically, a confirmation test will then be ordered
2. Ultrasound: Alos called a sonogram, this is a low-cost tool using sound waves to generate an image of the uterus to find, locate and measure the fibroids
3. Magnetic resonance imaging (MRI): MRI is the most accurate imaging tool to identify the size, number, and location of uterine fibroids. An MRI can often help distinguish between benign fibroids and a rare malignant tumor called a leiomyosarcoma.
4. Computerized tomography: CT scan is an alternative to MRI and ultrasound for the analysis of fibroids. 
5. Hysteroscopy: A simple procedure where a doctor uses a small camera to evaluate the inside of the uterine cavity. 
6. Saline infused sonogram: Also called a sonohysterogram, is a special type of ultrasound. A doctor fills the uterus with a small amount of fluid to separate the top of the uterus from the bottom. This technique allows better visualization of the inside of the uterus. 

How are fibroids treated?

1. Hysterectomy: The removal of the uterus. Approximately 40% of hysterectomies in the United States are performed because of fibroids.² While a hysterectomy is the most definitive treatment for fibroids, it also is the most invasive. 
2. Myomectomy: A surgical procedure to remove individual fibroids while preserving the uterus. The size and location of the fibroids in the uterus determine the type of myomectomy. Options include an abdominal, laparoscopic, robotic, and hysteroscopic myomectomy. Myomectomies provide highly effective relief for fibroid symptoms. The original fibroids do not grow back, but new fibroid may develop. 
3. Uterine fibroid embolization: A highly effective option for women who wish to preserve their uterus and avoid surgery. An interventional radiologist performs this procedure through an IV without surgery. Occluding agents are placed into the blood vessel supplying each fibroid. This process starves the fibroid of blood, causing it to shrink. 
4. Radiofrequency fibroid ablation: The Acessa procedure is a minimally invasive, outpatient treatment for fibroids of all types and sizes and in all locations within the uterine wall. This laparoscopic surgery is performed through small incisions using a camera, an ultrasound probe, and the Acessa electrode tip. Heat is used to destroy fibroid tissue causing the fibroid to shrink over time.
5. Endometrial ablation: A short, outpatient surgical procedure to treat abnormal uterine bleeding without the need for incisions. The process destroys the endometrial lining, the tissue responsible for menstrual bleeding. This low-risk option has a 95% patient satisfaction rate and requires minimal patient downtime. Endometrial ablation does not treat or shrink fibroid s but is an effective option to control the associated bleeding. 
6. MRI guided Focused ultrasound: This newer treatment treats fibroids through high-intensity ultrasound. Under MRI guidance, focused ultrasound waves pass through the skin to destroy the fibroids. 

Treatment with Medication

1. Gonadotropin-releasing hormone agonists: GnRH medications are often used preoperatively to temporarily reduce the size of fibroids before surgery. GnRH medications can help decrease blood loss, operative time, recovery time, and sometimes allow a minimally invasive type of hysterectomy. 
2. Progesterone IUD: These thin the endometrial lining. They do not directly treat uterine fibroids but effectively reduce menstrual bleeding.
3. Oral contraceptives: OCPS reduce menstrual bleeding. They do not treat fibroids but are often used to reduce symptoms in women who seek temporary relief.
4. Tranexamic acid: Antifibrinolytic therapy is an effective treatment to reduce the bleeding from uterine fibroids and menorrhagia. This treatment does not directly affect the size of uterine fibroids.
5. Pain medication: Nonsteroidal anti-inflammatory drugs reduce pain and blood loss from fibroids.
6. Selective progesterone receptor modulators: SPRMs such as Ulipristal acetate are newer medications that directly affect the Progesterone receptors. Progesterone is required for cellular proliferation and fibroid growth. This medication is currently FDA for endometriosis, but early clinical trials show promise in bleeding control and fibroid shrinkage. 
7. Oriahnn™ is a combination product containing elagolix, estradiol, and a type of progesterone called norethindrone acetate. Elagolix is a gonadotropin-releasing hormone antagonist. This term means it suppresses the ovarian sex hormones estrogen and progesterone, both of which stimulate fibroid growth

1. Wallach EE, Vlahos NF. Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol. 2004;104(2):393–406.
2. 3. Whiteman MK, Hillis SD, Jamieson DJ, et al. Inpatient hysterectomy surveillance in the United States, 2000–2004. Am J Obstet Gynecol. 2008;198(1):34.e1–34.e7.

The post Understanding Uterine Fibroids (leiomyomas) appeared first on Medika Life.

Our Preparing for series for Hysteroscopic Myomectomy for uterine fibroid removal allows a patient to prepare themselves for the procedure properly. Answers about how long the procedure will last, what’s involved, what to expect, and even advice on packing your bag, While your surgeon preps, we’ll make sure you’re ready.

What is a Hysteroscopic Myomectomy?

Hysteroscopy is a simple procedure where a doctor uses a small camera called a hysteroscope to evaluate the inside of the uterine cavity. During a hysteroscopy, a surgeon can remove uterine fibroids (myomectomy) and polyps (polypectomy) without having to cut or remove any part of the uterus.

A hysteroscopic myomectomy combines the visualization of hysteroscopy with a cutting device to remove the fibroids. The fibroids are removed without having to make any incisions on your body.

Your cervix will be slightly dilated to allow the introduction of the camera into the uterus. The gynecologist confirms proper placement and evaluates the fibroid to identify its attachment to the uterus. A resection instrument is chosen and placed down the operative channel to allow surgical removal.

What are uterine fibroids?

Uterine fibroids are benign noncancerous tumors affecting women. Fibroids, also called leiomyomas, are made of muscle cells forming into balls and bumps that grow in the uterus. Up to 80% of women will develop one or more uterine fibroids during their lifetime.

Uterine fibroids have multiple symptoms

1. Heavy periods (menorrhagia)
2. Painful periods and cramping (dysmenorrhea)
3. Bleeding after sex (postcoital bleeding)
4. Painful intercourse
5. Pressure or abdominal fullness
6. Increased abdominal size
7. Frequent urination
8. Constipation
9. Low back pain

Not all women with fibroids have symptoms. The size and location in the uterus impact the potential for life-disrupting symptoms. Fibroids can also affect fertility and the risk of miscarriage.

A Myomectomy is a surgery to remove individual fibroids while preserving the uterus. The size and location of the fibroids in the uterus determine the type of myomectomy. Options include an abdominal, laparoscopic, robotic, and hysteroscopic myomectomy. 

Hysteroscopic myomectomy is optimal for submucosal fibroids, the type of uterine fibroids contained inside the uterine cavity. 

How long will I be in hospital for?

Hysteroscopic myomectomies are outpatient procedures. You may go home after the surgery is complete.

Can family visit me?

Most hysteroscopic procedures are performed in a hospital or Ambulatory Surgery Center. A trusted family member should drive you to and from the appointment. Your family is welcome to stay with you before and after this outpatient procedure

Does my procedure require an anesthetic?

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

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

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.

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.
Most hysteroscopic myomectomies are performed 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. You will meet the nursing team who will provide care during your stay. An IV will be placed 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 question

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 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.

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

How does the procedure work?

Multiple medical device technologies can be used to perform hysteroscopic myomectomy. Gynecologic surgeons typically have a personal preference or comfort level with one or more of the various options. Each medical device works by combining the visualization of hysteroscopy with a cutting device to remove the fibroids. 

The most common technologies include loop resection, Myosure, Symphion, and True Clear. While each system functions differently, each subscribes to the same basic concept: fibroid resection under visual surveillance. 

Your cervix will be slightly dilated to allow the introduction of the camera into the uterus. The gynecologist confirms proper placement and evaluates the fibroid to identify its attachment to the uterus. A resection instrument is chosen and placed down the operative channel. A small cutting instrument slides down the operative channel to allow surgical removal.

The fibroid is cut into small pieces and removed. The procedure is complete once we have restored a normal-appearing uterine cavity. 

When the treatment is complete, the devices are safely removed. 

How long will I be in surgery?

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

The operative time for a hysteroscopic myomectomy varies. Small, soft fibroids may take only a few minutes. Large, dense, or hard to reach fibroids may take longer. 

In general, 30–60 minutes of operative time should be expected.  

When can I go home?

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.

hysteroscopic myomectomy 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

Most women should be able to return to normal daily activities the next day. You should speak with your physician about the resumption of sexual activity. You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection.

The short term effects on menstrual bleeding vary. Some may see immediate improvement. Others will continue to see menstrual cycle lightening for a few weeks as fibroid fragments and endometrial tissue are expelled. 

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 1–2 weeks after the procedure. The fibroid specimen pathology report will be reviewed during this visit.

Danger Signals to look out for after the procedure

After a hysteroscopic myomectomy 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:

• 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??

Hysteroscopic procedures require very little postoperative care. Vaginal discharge and spotting are expected. One should have a supply of sanitary pads available. Sexual activity should be avoided until cleared by your doctor. One may resume a normal diet and exercise the day after the procedure.

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.

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