Definition & Overview
A pelvic gynaecological surgery refers to surgical procedures performed on any of the organs in the pelvic region. Several of these procedures are now performed using minimally invasive techniques to reduce surgical risks and shorten recovery time. The procedures have relatively high success and safety ratings depending on the patient’s general condition. Some of them, however, may affect patients’ chances of becoming pregnant in the future.
Who Should Undergo and Expected Results
Pelvic gynaecological surgery can be carried out on patients who suffer from any problems that affect the organs in the pelvic region. These include but not limited to:
- Abnormal uterine bleeding
- Interstitial cystitis
- Ovarian cysts
- Pelvic congestion syndrome
- Pelvic floor muscle spasm
- Pelvic floor tension myalgia
- Pelvic organ prolapse
- Scar tissue adhesions
- Urinary prolapse
- Uterine polyps
Patients usually seek treatment and are diagnosed with the above conditions in the presence of the following symptoms:
- Chronic pelvic pain
- Abnormal bleeding
- Painful sexual intercourse
- Menstrual cramps
- Abnormal discharge
- Irregular menstruation or abnormally heavy menses
Some examples of pelvic gynaecological surgical procedures are the following:
- Pelvic radiotherapy – This is used to treat cancer that affects the pelvic region
- Hysterectomy – This procedure is used to remove the uterus usually to treat fibroid-related bleeding or to prevent future pregnancies.
- Presacral neurectomy – This is the primary surgical option for the treatment of endometriosis and pelvic inflammatory disease.
- Cystoscopy – This is a minimally invasive procedure used to examine the lining of the bladder and the urethra to check for abnormalities. It is widely used in urological diagnosis.
- Ovarian cystectomy – A cystectomy is a surgical procedure used to remove ovarian cysts or small fluid-filled sacs that form within the ovaries. These cysts are typically removed when they grow too big, are causing symptoms, or are recurrent.
- Myomectomy – This is a surgical procedure used to remove uterine fibroids. It can be performed through open abdominal surgery, laparoscopic or robotic-assisted surgery, or hysteroscopic surgery.
- Endometrial ablation – This is used to effectively reduce menstrual flow due to irregular bleeding.
While pelvic gynaecological surgery is often successful in relieving symptoms and treating the medical issue at hand, they do not rule out recurrences. For instance, a myomectomy does not guarantee against the development of new fibroids in the future.
How is the Procedure Performed?
There are now three main techniques used to perform pelvic gynaecological surgery. These include:
- Open abdominal surgery
- Robotic-assisted, such as the DaVinci Surgical System
An open pelvic surgery requires one large incision to give the surgeon access to the affected pelvic organ. These procedures are performed under general anaesthesia with patients completely asleep throughout the surgery. Although it is the primary surgical technique, the development of minimally invasive surgical techniques has reduced the need for an open pelvic surgery.
Laparoscopic procedures eliminate the need for a large incision. Instead, a number of small incisions are used to accommodate a thin hollow tube called a laparoscope. The laparoscope has a camera and a light scope attached to its end giving the surgeon visuals on the internal organs during surgery.
A robotic-assisted procedure, on the other hand, is in a way similar to a laparoscopy in that it also makes use of a laparoscope and requires around 4 to 5 small incisions instead of one large incision. However, instead of the surgeon directly controlling the special surgical tools during a laparoscopic procedure, a robotic system is used to translate the surgeon’s hand movements into the surgical instruments that have gained access to the surgical site. This type of surgery boasts improved accuracy and efficiency.
Possible Risks and Complications
Patients who undergo pelvic gynaecological surgery face a certain risk of the following complications:
- Scar tissue, which in some cases, may negatively affect the patient’s chances of conceiving
- Surgical site infection, which is the most common complication of gynaecologic surgical procedures
- Vaginal cuff cellulitis or pelvic cellulitis
- Pelvic abscess
- Injury to the blood vessels and nerves in the area
Most complications related to this type of surgery is caused by the migration of pathogenic microorganisms from the vagina to the endocervix and surgical site. Infections, for one, used to affect up to 33% of patients who undergo a vaginal hysterectomy. These can occur at the incision site, deep within it, or other nearby organs. Fortunately, the use of post-operative antibiotics has significantly reduced the rate of infection for such surgical procedures.
Meanwhile, female patients may need to undergo caesarian delivery in future childbirth as the pelvic scar may break open during the labour process.
To reduce the risk of complications, minimally invasive techniques are used when possible. These techniques are associated with much shorter hospital stay and significantly milder post-operative pain, with most patients able to return to their normal activities in just 2 weeks instead of 8 weeks. The risk of infections and scarring is also lower.
Lachiewicz MP., Moulton LJ., Jaiyeoba O. “Pelvic surgical site infections in gynecologic surgery.” Infect Dis Obstet Gynecol. 2015; 2015: 614950.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4348594/ Barber MD. “Surgical female pelvic anatomy.”
http://www.uptodate.com/contents/surgical-female-pelvic-anatomy Tizzano A., Paraiso MFR. “The evolution of pelvic surgery.” http://www.augs.org/p/cm/ld/fid=18