Specialty Surgeries

The destruction of the lining of the uterus. For women who wish to preserve the uterus, who wish to avoid major surgery, or are at increased surgical risk (from other conditions), but who are finished with childbearing, endometrial ablation is a great alternative to a hysterectomy. This procedure is performed as an outpatient procedure. Most women have a rapid recovery with little discomfort and are able to return to normal activities in the following days. Women who wish to preserve fertility or who have significant menstrual pain are not candidates for endometrial ablation and should consider alternative treatments.

The vast majority of women (90%) are pleased with the results of their procedures, though only some (60%) will have a complete absence of uterine bleeding after an ablation. The remainder will have lighter, more manageable periods. A small percentage (~10%) have a failure of the operation and continue to have heavy cycles when adenomyosis or untreated fibroids are present.

Is the destruction of fibroid tissue using radiofrequency energy, under laparoscopic and ultrasound guidance, to heat up and ablate fibroids. The tissue is then reabsorbed by the body and surrounding tissue.

Is a procedure done during laparoscopy where a colored dye is passed through the fallopian tubes to confirm that they are patent and open.

Laparoscopic management of adnexal (Ovarian) mass –  Ovarian cysts are usually benign and very common in reproductive years. Occasionally they can grow to a bothersome size and cause pain. Many times, ovarian cysts will either dissolve on their own over time and the discomfort will resolve, or they may rupture, and the symptoms will resolve. If they are persistent or grow to a size that is concerning for risk of torsion (twisting), the recommendation may be to have the cyst removed. Oftentimes this can be safely done laparoscopically with small incisions in an outpatient procedure. Laparoscopic management of adnexal masses is usually necessary for endometriomas, dermoid (teratoma) cysts, and large benign ovarian cysts. 

Endometriosis is often a painful disorder in which tissue that lines the inside of the uterus, the endometrium, grows outside the uterus. It most commonly involves your ovaries, bowel, or the tissue lining your pelvis (peritoneum). Rarely endometriosis may spread beyond the pelvic region. Dr. Hawkins and Dr. Davis treat endometriosis surgically by excising the actual endometriosis implants.

Essure is an old tubal occlusion device that used to be used as permanent sterilization. Many women seek the removal of these devices due to side effects the nickel in the device can cause. Dr. Hawkins prefers to remove the Essure device inside of the tube in order to reduce the risk of leaving any particles behind. Depending on where the device is isolated; in the cavity, cornua (a muscular portion of the uterus where the fallopian tube attaches), or fallopian tube alone, a combination of procedures may be recommended. Options for removal that Dr. Hawkins offers and recommends include – Laparoscopic removal combined with Hysteroscopy, Tubal removal, and Hysterectomy. 

Is an outpatient surgical procedure performed to permit direct visualization of the uterine lining or cavity using a long thin, lighted telescope inserted through the vagina and cervix. Hysteroscopy is used as a diagnostic tool, and operative device, or both, depending on the specific condition.

Diagnostic hysteroscopy can be thought of as a way of “seeing” the inside of the uterine cavity. During diagnostic hysteroscopy, we will be examining the lining of the uterus, looking for polyps, fibroids, scar tissue, blockage of fallopian tubes, and abnormal partitions.

Operative hysteroscopy can be thought of as operating while “seeing” with the hysteroscopy. In many cases, with the use of operative hysteroscopy, the gynecologist will be able to surgically remove many of the abnormalities seen with diagnostic hysteroscopy such as polyps and fibroids. Hysteroscopy can also be used as a method of collecting samples of tissue similar to a dilation and curettage but under direct visualization. It can also be used to remove an object, such as an intrauterine device.

The surgical removal of the uterus and cervix is the most common non- pregnancy-related major surgery performed on women in the United States. Approximately 600,000 women undergo this procedure every year, 90% of the time the procedure is elective (non-emergent). The most common reason for hysterectomy are:

Fibroid tumors – non-cancerous tumors that can cause pelvic pain and pressure, heavy bleeding, painful intercourse, abdominal distortion, and other symptoms.

Endometriosis – a condition in which tissue that is normally found within the uterine lining grows in other parts of the abdomen or uterine muscle (adenomyosis) where it can cause pain.

Uterine prolapse – the sinking or downward movement of the uterus from its normal position into the vagina.

Cancer of the uterus or cervix – these conditions are usually best treated by a gynecologic oncologist specially trained to perform surgery for cancer.

Hysterectomy does not require the removal of the ovaries. Your doctor will discuss with you if the removal of your ovaries is recommended or not. The fallopian tubes however are removed standardly with the removal of the uterus. The fallopian tubes serve no function without the attached uterus and in recent studies, the tubes have been thought to be associated with ovarian and peritoneal cancer.

Hysterectomies can generally be accomplished through several different approaches:

Total Vaginal Hysterectomy (TVH) – operating entirely through the vagina to remove the uterus and the cervix. Removal of the tubes and ovaries can also be performed vaginally.

Total Laparoscopic Hysterectomy (TLH) or Laparoscopic Assisted Vaginal Hysterectomy (LAVH) – small instruments through small incisions to remove the uterus and cervix.

Robotic Hysterectomy – laparoscopy with the assistance of a robot to aid in visualization and instrument movement. The surgery is performed by the surgeon, not the robot. The robot cannot move without the command of a human. This allows your surgeon to many times remove the very large uterus (above the umbilicus) in a minimally invasive approach as supposed to through a large abdominal incision. This approach is one of Dr. Hawkins specialties.

Total Abdominal Hysterectomy (TAH) – traditional “open” abdominal surgery that allowed the surgeon to see and reach into the pelvis. This is rarely an approach used by minimally invasive surgeons however may be necessary for an extremely larger uterus or if other combined procedures are planned.

The approach to hysterectomy will depend on your symptoms, the size of your uterus, any previous surgeries you might have had, treatment goals, and the preference of your doctor. The pros and cons of each will be discussed with you during your consultation.

Involves performing surgery through a few very small holes in the abdomen. Through these holes, a camera and other instruments are placed, and the surgeon visualizes the procedure on a television screen. With advances in camera optics (quality of the picture), laparoscopic instruments, and laparoscopic techniques, many traditional operations can be performed entirely or partially in this fashion.

Loop Electrosurgical Excision Procedure is a treatment to prevent cervical cancer after abnormal cells are found during a PAP test, colposcopy, or biopsy. A small electrical wire loop is used to remove abnormal cells from a portion of the cervix.

Adhesions in the pelvis and abdomen can form after prior surgical procedures like cesarean sections, abdominal myomectomies, ruptured appendix, bowel surgery, and many others. They can also form from endometriosis or pelvic/abdominal infections. Significant adhesions have the potential to cause chronic abdominal pain. They are not easily visible on imaging such as CT scans, MRI, or ultrasounds.  Though many times it is difficult to treat abdominal adhesions, some patients are helped by surgery to remove adhesions and restore normal anatomy. Your doctor will discuss the pros and cons of this option during your consultation.

Surgical removal of one or more fibroids (leiomyoma) by making an incision in the muscle, skin, or lining of the uterus to dissect the fibroid from its uterine attachment. The uterus is then reconstructed to preserve its function and reproductive potential. This operation can be performed using three different methods:

The removal of one or both ovaries usually performed laparoscopically. The removal of the ovary may be necessary for a number of different reasons including but not limited to; persistent pain due to severe endometriosis, complex ovarian cysts, concern for malignancy, or even prevention of malignancy for women with increased risk of ovarian cancer. 

Is a procedure that corrects a cystocele (bulge of the anterior vaginal wall or bladder). The supporting layer of the ceiling of the vagina is known as the pubocervical fascia and supports the bladder.  When this breaks or weakens, the fascia detaches from the walls of the pelvis (paravaginal defect), and the bladder sags or falls down. Fixing these defects will fix a sagging bladder.

Hysteroscopic operation within the uterine cavity with telescope vision and small instruments to visualize and remove polyps.

This procedure involves making a 1-inch incision in the skin of the vagina directly beneath the urethra and then placing a sling (synthetic mesh tape) under and beside the urethra to act as a hammock to prevent leakage of urine with activity. Only patients who have stress urinary incontinence (leakage with cough, sneeze, or lifting) are candidates for a sling procedure. The cure rates of the mini sling approximate 90% after the first year. The mesh that is used is FDA approved and is a Type I, macroporous polypropylene mesh. Many studies have confirmed the mesh tapes safety and efficacy when used for treating stress incontinence.

Usually performed laparoscopic, this is the removal of the cervical stump after prior supracervical hysterectomy. It is typically performed to manage cervical symptoms or disease that develops postoperatively, such as abnormal bleeding,  abnormal cytology (precancerous cells) or pain.

Is a laparoscopic procedure to remove the fallopian tubes as a means of permanent sterilization. The current recommendation is not to remove a portion of the tube, but however remove the entire fallopian tube in order to simultaneously decrease the risk of ovarian cancer. Numerous studies have demonstrated that ovarian and peritoneal cancers begin in the fimbriated ends of the fallopian tubes. This is a common procedure performed simultaneously with hysterectomies due to this added benefit.

The surgical procedure utilized for the treatment of vaginal vault prolapse. Vaginal vault prolapse is best described as relaxation of the deepest point of the vagina. Your doctor will use the original ligaments known as uterosacral ligaments and attach the deepest point of the vagina (vaginal vault) to the original points of attachment thus pulling the vault to its original position.