Gynaecological surgery
Your surgery
Surgery can be used to treat a number of gynaecological conditions. Surgery is not the right option for every person or for every problem, but for some people it can provide relief for their symptoms.
Whenever surgery is contemplated, a detailed assessment is required. That assessment will include a history of your symptoms and your general health, an examination, and some tests. Part of that assessment involves understanding your main concerns and what outcomes you are hoping to achieve. It is important that you have the opportunity to ask all of your questions when we are talking about having surgery.
Dr Holbeach operates at two Epworth Freemasons sites:
- Albert/Clarendon Street, and
- Victoria Parade
Surgical Procedures
I offer a range of surgical procedures to treat a number of gynaecological conditions.
Marsupialisation for a Bartholin’s gland abscess
A Bartholin’s gland cyst is a lump that can develop at the entry to the vagina. They can become large and bothersome and, in some cases, infected. If infected, they can become very painful. An infected cyst is called an abscess.
One possible treatment for a Bartholin’s gland abscess is called marsupialisation. This involves making an incision and draining the contents of the abscess and carefully washing the area out. Then the small incision is stitched open using dissolvable sutures to allow the now empty cyst to keep draining.
Large Loop Excision of the Transformation Zone (LLETZ)
A large loop excision of the transformation zone is a procedure that removes the area of the cervix that is affected by pre-cancerous changes from HPV (human papilloma virus) infection. The procedure involves a very thin wire loop that cuts through tissue of the cervix to remove the transformation zone.
IUD Removal & Insertion
An intrauterine device is a small device the sits inside the uterus and can be either hormonal or non-hormonal. These devices can be inserted and removed during a speculum examination either in the clinic rooms or in the operating theatre. The appropriate setting for you may depend on whether you require another procedure at the same time, whether you have had a pregnancy or a device before, and what your preference is.
Suction dilatation and curettage
A suction dilatation and curettage is performed for miscarriage, termination of pregnancy, and retained products of conception. It involves gently dilating the cervix and then using a catheter attached to suction to empty the uterus.
Hysteroscopic Surgery
A hysteroscopy is a procedure where a small thin camera is introduced to the uterus through the cervix. This allows a detailed assessment of the inside of the uterus to diagnose a thickened lining of the uterus, endometrial cancer, fibroids, and polyps as some examples. It is also possible to take a biopsy and even treat many of these conditions at the same time.
- Dilatation and curettageA dilatation and curettage involves gently dilating the cervix to access the uterus and then using a curette to take a small sample of the lining of the uterus for assessment by a pathologist.
- Resection of polyp/fibroid/retained products of conceptionA hysteroscopic resection can be done for polyps, fibroids, and retained products of conception as some examples. It involves using either a resectoscope (a device with a small electrified loop) or a device like a Myosure (a specialised device to shave tissue) to remove the pathology under direct vision.
- Endometrial ablationAn endometrial ablation is a procedure to treat heavy menstrual bleeding. Radiofrequency energy is used to permanently destroy the lining of the uterus. A curettage is normally performed at the same time to obtain a sample of the lining before it is treated. Some form of reliable contraception is required for this procedure because a pregnancy after ablation would be high risk. Commonly, this is a tubal ligation or salpingectomy.
Laparoscopic Surgery
Laparoscopic surgery involves a camera and a few small ports that are placed in the abdomen and through which your surgery can be performed. Many different types of surgery can be done this way. Compared to open surgery (through a large incision), these minimally invasive approaches mean that you have smaller scars, usually a shorter stay in hospital, and less pain after surgery.
- Ovarian cystectomyAn ovarian cystectomy is the removal of an ovarian cyst while preserving the ovary. Most functional cysts resolve over time and require only surveillance with ultrasound. Some other cysts, such as cystadenomas and dermoid cysts, are unlikely to spontaneously resolve. These cysts will require surgical removal if they are causing symptoms or are large.
- OophorectomyAn oopherectomy is the removal of the entire ovary on one side or both. The ovary is responsible for producing important hormones in the body and for releasing eggs during the menstrual cycle. An oophorectomy may be recommended to treat ovarian cancer, ovarian cysts (after the age of 50 or if the cyst is very large), endometriosis, ovarian torsion (if the ovary cannot be saved), and tubo-ovarian abscess. It can also be used for cancer risk reduction. An oophorectomy in young patients should always be carefully considered due to the fertility implications. Even if fertility is less important, the loss of both ovaries before the age of 50 may cause surgical menopause. This can result in severe menopausal symptoms and increase risk of cardiovascular disease, osteoporosis, and declining cognitive function.
- SalpingectomyA salpingectomy is the removal of one or both fallopian tubes. The fallopian tube is attached to the uterus and conducts the egg after ovulation towards the uterus. A salpingectomy may be recommended to treat ectopic pregnancy, to achieve permanent sterilisation, and to reduce ovarian cancer risk.
- Salpingo-oophorectomyA salpingo-oophorectomy is the removal of the ovary and fallopian tube on one or both sides. An oophorectomy may be recommended to treat ovarian cancer, ovarian cysts (after the age of 50 or if the cyst is very large), endometriosis, and tubo-ovarian abscess. It can also be used for cancer risk reduction. The decision to remove the tube and ovary together depends on the circumstances and the reason for the surgery.
- Tubal ligationA tubal ligation involves interrupting the fallopian tubes on both sides using clips that blocks the passage of the egg after ovulation. This is a form of permanent sterilisation. Tubal ligation, like salpingectomy, reduces ovarian cancer risk. However, salpingectomy reduces the risk of ovarian cancer more.
- Diagnosis and treatment of endometriosisA laparoscopy for endometriosis aims to confirm the diagnosis, to remove as much visible disease as possible and restore anatomy. It is important to know that moderate to severe endometriosis can often be diagnosed using a specialised ultrasound scan. Superficial endometriosis may not be detected using ultrasound. While some people get symptom relief from surgery, the limited evidence available indicates that surgery probably has little to no benefit on pain. Laparoscopy for endometriosis can be helpful when other treatment options have not yielded satisfactory improvement or to assist with fertility.
Hysterectomy
A hysterectomy is the surgical removal of the uterus, cervix and fallopian tubes. It may also include removal of the ovaries in some cases. The decision to remove ovaries in people under the age of 50 must be carefully considered and tailored to individual circumstances and risk profile given the long-term potential harms.
A hysterectomy can be used to treat many gynaecological problems including heavy menstrual bleeding, fibroids, adenomyosis, endometrial hyperplasia or cancer, cervical cancer, pelvic organ prolapse, endometriosis, and severe pelvic infection.
Hysterectomies can be done:
- Open (through a large incision on the abdomen)
- Vaginal (through the vagina, with no incisions on the abdomen)
- Laparoscopic or robotic (through small ports on the abdomen)
Myomectomy
A myomectomy is the surgical removal of fibroids. Myomectomies can be done to improve symptoms of pressure or pain, heavy menstrual bleeding, and fertility.
Myomectomies can be done:
- Open (through a large incision on the abdomen)
- Laparoscopic or robotic (through small ports on the abdomen)
- Hysteroscopic (through the vagina)
Ready to book an appointment?
Dr Holbeach is an experienced gynaecologist that has cared for patients with the conditions described here for over 10 years. She is a Fellow of RANZCOG and has a Masters of Reproductive Medicine and a PhD in Bioethics.
Surgical Procedure Fees
Cost of Surgery
The cost of your surgery will include the surgeon’s fees, the anaesthetist’s fees, and the surgical assistant’s fees (not all surgeries require a surgical assistant). Fees will depend on the type of surgery that you are having and this will be discussed with you in your appointment.
Health Insurance
If you have private health insurance, the cost of the hospital admission for included indications will be covered by your health fund. You should check what is covered in your policy and the waiting periods that apply. Depending on your insurance policy, there may be an excess or a co-payment when making a claim.
Frequently Asked Questions
What if I don’t have health insurance or haven’t served the waiting period?
If you do not have health insurance, then you have some options. You may choose to explore non-surgical options for the time being or while serving the waiting period. You may choose to pursue surgery in the public hospital system. Or you may choose to pay for your surgery. You can discuss these options in your appointment.
How long will I be in hospital?
This depends on the type of surgery you have, how complex it is, and how you recover. You can go home the same day for most minor operations. You will likely need to stay in hospital for at least one night and possibly two nights for major operations.
To be discharged home safely, your pain should be controlled sufficiently so that you can get out of bed and move around. You should also be able to eat and drink and pass urine. The amount of time that this takes can vary between people and for different operations.
What should I do to prepare for my surgery?
You will be given instructions that are specific to you, your other medical conditions, and your procedure.
If you have pre-existing medical conditions and you are taking medications, you should talk to Dr Holbeach about these in your appointment. Some important medications classes that may impact your surgery or anaesthetic are:
- Diabetes medications
- Blood thinners
- Weight loss medications