When surgery is advised, rest assured that Dr. Deborah Wilson and her excellent medical team have been handling the entire range of gynecologic and women’s health surgeries and procedures for decades, distinguishing themselves in the process. Our surgical services range from laparoscopic hysterectomy and pelvic reconstruction to surgical treatment for more aesthetic women’s health issues and needs.
Many women feel that the inner lips of their vulva are too large. Some women may be dissatisfied with the appearance, and others—especially athletes—experience discomfort when they run, bike, etc. As it happens, there is great variation in the size and shape of labia, and, frequently, one side is significantly larger than the other.
Although it isn’t discussed very often, labial reduction surgery is a common procedure, one that’s typically performed in the hospital under general anesthesia. A labial reduction involves trimming excess tissue from the labia and suturing the edges with fast-dissolving suture. We can remove as much or as little tissue as a patient prefers, and if the problem is asymmetry, we can very successfully even out the labia.
Recovery from this surgical procedure is approximately one week. Post-surgery, patients should plan to take it easy for the first few days. During this recovery period, it’s best to wear very loose clothing and to be mindful that you will need a pad. Most of the swelling subsides after a few days, but you will still be uncomfortable for approximately a week. The sutures dissolve in 10 days, and at two weeks post-op, patients will be nearly back to normal.
Importantly, many women have felt uncomfortable with the size or appearance of their labia for years, but were unaware that anything could be done to correct it. Feel free to discuss this matter with your practitioner if you are interested in labial reduction surgery.
The process of childbirth—especially if a woman has many children and they are more than 8 lbs at birth—causes weakness in the pelvic area. Many women won’t notice any difference immediately, but, over the years, and under the influence of gravity and aging, problems develop.
The most commonly occurring problem is called uterine prolapse. In this condition, the uterus actually slips from its supports and begins to move down in the vagina, until it actually protrudes out through the vulva. The protrusion will be worse after women sufferers from this condition are on their feet for long periods of time. Some women can relieve the symptoms temporarily by literally pushing the uterus back up. (Most women will notice the prolapse before the uterus actually protrudes. They typically experience pressure and heaviness in the pelvic area and they often describe the experience of “feeling something” when they insert a finger in their vagina.
The second most commonly occurring problem is vaginal cystocele or rectocele. During childbirth, as the baby moves through the vagina, the strong tissue surrounding the vagina is stretched and even split. The most common areas damaged are the wall between the vagina and the bladder, and the wall between the vagina and the rectum. The “splits” in the strong tissue—or fascia—are actually hernias, and can begin to bulge just like a typical hernia might.
A woman with a cystocele (a defect in the wall between the bladder and the vagina) will experience a bulging sensation in the top of her vagina when she inserts a finger in her vagina. Again, if the problem is not addressed, the bulge can actually begin to protrude through the vulva. Along with the discomfort of a cystocele, women frequently lose urine when they cough or sneeze.
A rectocele is best described as a hernia that occurs between the rectum and the vagina. Again, a woman will feel a bulge, this time in the back of the vagina. Sometimes the bulge actually protrudes to the outside.
Another common symptom associated with a rectocele is obstipation (similar to constipation). The symptoms of obstipation are an inability to move stool out of the rectum unless a finger is inserted into the vagina and the stool is actually pushed out. (The stool is being caught in the pocket formed by the hernia.)
Along with the above issues, women who have had vaginal deliveries often feel “loose” or “open” in the vaginal area, and complain that intercourse is not as satisfying to either partner.
Even women who have had hysterectomies can develop prolapse, known as vaginal vault prolapse, years after their hysterectomies. Again, these women experience pelvic pressure and heaviness and often feel something extruding from the vulva. Women who have had vaginal hysterectomies are especially susceptible to vaginal vault prolapse.
Thankfully, all of these problems can be remedied. If a woman with pelvic prolapse wants to avoid surgery, we can fit her with what’s called a “pessary,” which is a device that remains in the vagina and provides support to the organs. Although pessaries needs to be removed and cleaned regularly, some women are able to use them for years. For most, however, they’re only used temporarily.
Surgery is available for any of the above problems. For example, moderate uterine prolapse is treated by removing the uterus laparoscopically, and then using the uterosacral ligaments to support the vaginal cuff. This is a very successful procedure and recovery is swift. If the uterine prolapse is severe, however, a small bikini incision is made in the abdomen and a prolene mesh is sutured to the vaginal cuff after the uterus is removed. The other end of the prolene strip is sutured to the bone of the sacrum. With this surgery, the recovery time is longer than for a laparoscopic procedure, but it nevertheless is an effective procedure and a permanent solution to a severe problem.
In the case of vaginal vault prolapse following hysterectomy, the above two procedures are very successful. Again, if the prolapse is moderate, a laparoscopic procedure is performed, but if the prolapse is complete, a larger incision is necessary.
Rectocele repair is a vaginal procedure in which an incision is made in the posterior vagina, the vaginal mucosa are separated from the underlying tissue, and a piece of cadaveric dermis is sutured in place. This corrects the hernia, and enables the body to grow fibroblasts through the dermis, ultimately replacing the dermis and forming a strong wall between the rectum and the vagina. The dermis graft is a relatively new technique, and we have been impressed by how well women heal following this procedure. Post-operative pain is minimal, and the problem seems to be permanently corrected.
At the conclusion of a rectocele repair, we will “tighten” the vaginal opening if so desired. This reduces the feeling of looseness and openness in the vulvar area and usually increases sexual satisfaction.
Cystocele repair is generally handled by a urologist, and is similar to a rectocele repair. Surgery to correct stress urinary incontinence is also performed by a urologist. Currently, there are a few different procedures available, and the surgery will be tailored to a patient’s particular problem. We will refer patients to an excellent urologist if it is determined that these procedures are necessary. If a urologic procedure is necessary in addition to a gynecologic procedure, we will arrange to have both procedures accomplished under the same anesthetic.
Again, as with other women’s health problems, many women have been suffering for years with symptoms related to prolapse, cystocele and/or rectocele. They are often embarrassed to talk about it, and thus the problem goes untreated. We urge you to feel free and comfortable to discuss any of these symptoms with us.
Laparoscopic hysterectomy from master practitioners
The laparoscopic total hysterectomy removes the uterus and cervix intact, without morcellating unless the uterus is very large. If morcellation is necessary, it is done in a bag. This contains all of the cells and fluid and prevents spread of potentially dangerous cells into the body. The top of the vagina is closed with long lasting sutures and the supportive ligaments of the pelvis are incorporated into the top of the vagina to prevent prolapse.
Over the past 13 years, Dr. Wilson and her team have performed more than 8,000 laparoscopic hysterectomies with a complication rate of less than one percent. At least 20 physicians fly to Scottsdale from all over the country for the monthly course, which is held at Greenbaum Outpatient Surgery Center. The gynecologists are instructed in suturing and knot tying, instrument techniques, and avoidance of complications. These courses have been very popular and are booked months in advance.
A laparoscopic hysterectomy is a surgical procedure to remove the uterus. It differs from a total hysterectomy in that it does not remove the ovaries and fallopian tubes.
Dr. Wilson and Kurt Sanders, RN First Assist, produced the following video as a teaching tool for gynecologists to learn laparoscopic hysterectomy. In conjunction with Gyrus/ACMI, Dr. Wilson and Kurt Sanders teach a course on total laparoscopic hysterectomy to physicians nationally. The video is rather graphic, but you are welcome to view it by logging onto: http://www.herhealth.org/Testimonials/Wilson.aspx
What are the risks?
Whenever a patient has hysterectomy surgery, she must accept that there is a risk of injury from instruments used during the course of the procedure. Injuries that have been reported in association with this procedure include: puncture injuries of the bowel and bladder, burn injuries of the bowel and bladder, injuries to the ureters (the tube that runs from the kidney to the bladder), and blood vessel injuries. Generally, as long as these injuries are recognized right away, they can be treated and corrected at the time of surgery, but they may require another specialist to operate and may, as well, require a larger incision. In the event that an injury is not recognized, however, the consequences can be more severe, and may result in permanent injury and even death. We are very careful to warn our post-operative patients to contact us if they experience fever, severe pain, severe bleeding or any other symptoms that might seem unusual. As long as these symptoms are evaluated, negative consequences can typically be avoided.
Importantly to this point, however, the physicians in this office have performed a combined total of more than 8,000 laparoscopic hysterectomies. The complication rate is less than one percent. Approximately two percent of patients develop minor infections, which can be successfully treated with antibiotics. The complication rate owing to surgeons at this office is extremely low when compared with laparoscopic hysterectomy statistics on a national level.
For your reference, we’ve included below a summary explanation of many of the diseases and conditions we treat in our practice. While these are by no means comprehensive, we list them to offer you an introduction to many of the female health issues that might occur, and which you may be seeking treatment for at our practice.
Fibroids occur in 40 percent of women at some point in their lives. They tend to run in families, so if your mother and sister had fibroids, you have a good chance of developing them, too. They are almost always benign, but nevertheless can cause very heavy menstrual bleeding, bleeding between periods, or simply pain and pressure, due to the space they take up. A woman can have just one fibroid or many. Sometimes, one fibroid can grow quite large.
The most common reason for having a hysterectomy is because of fibroids. If the fibroid uterus is large, a vaginal hysterectomy can be difficult. A laparoscopic hysterectomy is generally possible in these cases, unless the uterus is enormous. But even if the uterus is very large, drugs such as Lupron can be used for a few months before the procedure to shrink the uterus and make a laparoscopic hysterectomy possible.
You might ask, “Why not just use Lupron to shrink my fibroid and not do surgery?” It’s because Lupron will only temporarily shrink a fibroid uterus. As soon as the Lupron is stopped, the uterus will go back to its previous size. Likewise, Lupron is not a drug that can be used over a long period of time due to its side effects. It creates a temporary state of menopause which causes hot flashes, night sweats, mood swings and bone loss. For a short period of time, Lupron is tolerable and safe, but not for more than a few months.
Women with fibroids are the largest group of females who undergo laparoscopic hysterectomies. Thankfully, most fibroid uteri can be removed laparoscopically, and the recovery is much shorter than a hysterectomy that involves a large incision.
Interested in knowing a little more about some of our medical and surgical procedures at Deborah Wilson & Associates? Following is a summary explanation—and a video—regarding laparoscopic hysterectomy surgery.
Adenomyosis is a disease in which the glands that normally line the muscle of the uterus, and bleed off monthly during periods, grow backwards into the muscle. Adenomyosis is a benign condition, but can cause cramping and bleeding that can become quite severe and debilitating. A uterus affected by adenomyosis might be only slightly enlarged or it can expand to become very large. Again, laparoscopic hysterectomy is a good solution for this problem.
Endometrial polyps are growths of uterine-lining tissue that do not shed off with the monthly period and can cause abnormal bleeding. They can be removed during a D&C, but tend to grow back. A laparoscopic hysterectomy removes the uterus so that this cannot occur again.
Hyperplasia is overgrowth of the uterine lining. Hyperplasia can cause heavy bleeding and bleeding between periods. If left untreated, it can develop into cancer. Simple hyperplasia is an early, benign form of the disease. As it progresses, the condition can develop into complex hyperplasia, complex hyperplasia with atypia, and, ultimately, cancer of the uterus.
A woman with simple hyperplasia is a candidate for a laparoscopic hysterectomy. It is generally recommended that a laparoscopic total hysterectomy be performed in this case. If any cancer cells do exist inside the uterus, they can be spread throughout the abdominal cavity during the morcellization process, unless the morcellation is performed “in a bag.” This procedure is called contained morcellation and it prevents the potential spread of cancer.
If the hyperplasia is noted on biopsy to be “atypical,” then the chance of cancer cells existing inside the uterus are significant, and the patient will be referred to a gynecologic oncologist.
Pelvic adhesions can make a vaginal hysterectomy difficult or impossible. Adhesions can result from prior surgery, endometriosis or infection. If the adhesions are not severe, a laparoscopic supracervical hysterectomy is possible. If the cervix needs to be removed, a laparoscopic total hysterectomy or a laparoscopic assisted vaginal hysterectomy can be performed.
Abnormal bleeding is a condition that describes either heavy menstrual bleeding and/or bleeding between periods. It can be due to fibroid tumors (benign muscle tumors of the uterus), adenomyosis (a process in which glands normally lining the uterus grow into the muscle of the uterus), or abnormalities of the uterine lining, such as hyperplasia (overgrowth of the uterine lining) or polyps (clusters of uterine lining tissue that grow inside the uterus).
The following videos are rather graphic, but you are welcome to view them.