There are many reasons why a person may choose to proceed with surgery, whether it be to no longer experience troublesome periods, to remove a uterine or ovarian mass, to reduce a risk of cancer, or to help confirm a transition one’s felt gender. We at Open Arms OB/GYN in Toronto offer the full spectrum of gynecologic / reproductive tract surgery. Drs. Ornstein, Raymond, and Frecker are each trained as gynecologic surgical specialists and Dr. Frecker and Raymond have each done fellowships in minimally-invasive gynecologic surgery.
Procedure types: hysteroscopic, laparoscopic, open (laparotomy), vaginal, and vulvar
If you and your doctor come to the decision that surgery is the next best step in your management, you will start with a counselling session about the surgery where the surgery details, any risks, benefits, logistics, and recovery plan will be discussed. You will be asked to sign a consent form for the surgery and fill out some additional paperwork. Your surgery date will then be booked.
You will also be asked to complete some blood work close to the surgery time and may also require consultations from internal medicine and/or anesthesia if you have certain medical conditions. You will be notified when and where to arrive at the hospital and when to stop eating and drinking before surgery. At the hospital, you will change into a gown, have an IV inserted, and be brought to a waiting area before surgery where your surgeon will come meet you.
After surgery, you will spend usually about 2 hours in a recovery room before either going home or going to the surgical ward. For day surgery, you must be accompanied home from the hospital.
Hysteroscopy means using a surgical telescope (a thin tube with a camera lens) to look inside the uterus. Hysteroscopy can be used to remove polyps or fibroids, remove scar tissue (Asherman’s), remove a uterine septum, or do an endometrial ablation. It is often, not always, paired with a dilatation and curettage (D&C), which is a sampling of the lining of the uterus. Hysteroscopy is typically a very quick (10-30min) procedure under a general anesthetic, which is minimally invasive. No cuts are made to the body as the natural passage of the cervix is gently dilated to allow the scope through.
After hysteroscopy, you will likely experience some mild to moderate cramping for one day, then light bleeding for 1-2 weeks. You will likely need 1-2 days off of work afterwards. We recommend no baths, intercourse, or tampons for 2 weeks after the procedure.
Laparoscopy means using a surgical telescope to look inside the abdomen. Under a general anesthetic, the abdomen is inflated with carbon dioxide gas and the telescope inserted through a small (5-10mm) incision, with the image displayed on monitors for the surgeons. Typically 2-3 other small (5mm) incisions are made in the abdomen and small instruments used to perform surgery inside. Many different types of surgery can be performed laparoscopically, such as hysterectomy, removal of fibroids, removal of ovarian cysts, treatment of endometriosis, and many others. Laparoscopy is typically a day surgery, meaning you will be able to go home the same day.
You will have some moderate abdominal pain afterwards and will be given a prescription for pain medication. You will feel very well by 1-2 weeks after, but not completely recovered for until about 4-6 weeks. Depending on the work you do, you may need anywhere from 2-6 weeks off from work. We recommend no vigorous physical activity or heavy lifting for about 4 weeks after surgery. If you have had a hysterectomy, we recommend no baths, intercourse, or tampons for 6 weeks after surgery.
Laparotomy means accessing your abdomen through a larger incision, typically about 10cm. This incision is often a low side-to-side incision just above the pubic hair line, similar to a C-section (Pfannenstiel), however some cases require this incision to be up-and-down below the belly button (midline). Laparotomy is usually necessary if there one or more very large masses (e.g. fibroid, ovarian cyst) that need to be removed, or if the patient has had many complicated surgeries in the past. Laparotomy requires an in-hospital stay, usually of about 48 hours. The recovery from laparotomy is about 4-6 weeks. We recommend no vigorous physical activity or heavy lifting for about 6 weeks after surgery. If you have had a hysterectomy, we recommend no baths, intercourse, or tampons for 6 weeks after surgery.
A vaginal hysterectomy is a procedure that is typically offered for treatment of pelvic organ prolapse. In a vaginal hysterectomy, the prolapsing cervix and uterus are removed through the vagina. This is typically paired with repairs of the front and back wall of the vagina if they are prolapsing as well. All cuts on the body are hidden inside the vagina. The recovery from a vaginal hysterectomy is about 4-6 weeks. We recommend no vigorous physical activity, heavy lifting, baths, intercourse, or tampons for about 6-8 weeks after surgery.