Women who come to our practice find a wonderful OB/GYN doctors that will make things easier for each and every patient. Excellence is our goal, and our patients can expect the best possible medical care. We provide a full range of women’s health services, including:
- Infertility and primary care
- Preconceptional counseling
- Prenatal care
- Urinary incontinence
- 3D Ultrasound
- Minimally Invasive Gynecologic Surgery
- Robotic Surgery
- Laparoscopic Hysterectomy
- Operative Hysteroscopy
- Endometrial Ablation
- Trans-Obturator Sub-Urethral Sling
- Essure® Hysteroscopic Sterilization
- Bio-Identical Hormone Replacement Theraphy for Women
Minimally Invasive Gynecologic Surgery
Over the past several years, hospitals and physicians have been using minimally invasive approaches to improve the lives of patients.
Using a high performance digital video camera connected to a small telescope, the surgeon places it through the naval (laparoscopy) into the abdomen or through the cervix into the uterine cavity (hysteroscopy). A variety of very small instruments, no larger than a quarter inch in diameter, are then employed to complete the procedure. All the while, the surgeon has a crystal clear view of the procedure as it is projected on high definition digital video screens set throughout the operating room.
Minimally invasive approaches accomplish the same goals of more traditional surgeries while reducing surgery time, anesthesia time, blood loss, and infection rate, resulting in less painful procedures with shorter hospitalizations, quicker recovery times, less tissue damage, as well as reduced health-care costs. Patients typically go home on the same day of their surgery or the next morning, and time off from work is usually one to two weeks.
The da Vinci® surgical system provides us with a state of the art robotic platform. Da Vinci® surgery enables gynecologists to perform the most precise, minimally invasive hysterectomy available today. With da Vinci® surgery, a hysterectomy requires only a few small incisions, so you can get back to life faster - within days rather than the usual weeks required with traditional surgery. The image produced by the da Vinci® surgical system is high definition and three-dimensional and the surgical instruments used are capable of more complex maneuvers than are possible with standard laparoscopic instruments.
For most women, da Vinci® Hysterectomy offers numerous potential benefits over traditional open surgery, including:
- Significantly less pain
- Minimal blood loss and need for transfusion
- Fewer complications
- Shorter hospital stay
- Quicker recovery and return to normal activities
- Small incisions for minimal scarring
- Better outcomes and patient satisfaction
Laparoscopic hysterectomy is a relatively new surgical procedure that allows the uterus to be detached from inside the body by laparoscopic instruments while the doctor is viewing the uterus, tubes, and ovaries through a camera attached to a telescope.
After the uterus is detached, it is removed through a small incision at the top of the vagina. One advantage of laparoscopic hysterectomy is that the incisions are smaller (l/2 inch) and much less uncomfortable than that of abdominal hysterectomy. Also, the hospital stay of l day and the ability to resume normal activity in about 2 weeks are substantially shorter than for abdominal hysterectomy.
This procedure is indicated for heavy and irregular menstruation unresponsive to medical management, symptomatic fibroids, pelvic pain from endometriosis/adenomyosis, pelvic adhesive disease, and certain gynecologic cancers or pre-cancers.
If the hysterectomy is performed for uterine fibroids, abnormal bleeding, or pelvic pain, you can have a choice as to whether the cervix should be removed or not. In the Laparoscopic Supracervical Hysterectomy, the uterus is excised laparoscopically and removed leaving a portion of the cervix behind. Some women feel that if the cervix is removed, they will have diminished sexual pleasure, while other women do not feel the cervix is part of their sexual enjoyment. Leaving the cervix may also serve as prevention for future pelvic floor or vaginal apex prolapse.
Hysteroscopy uses a hysteroscope, which is a thin telescope that is inserted through the cervix into the uterus. Diagnostic hysteroscopy and simple operative hysteroscopy can usually be done in an office setting. More complex operative hysteroscopy procedures are done in an operating room setting.
Hysteroscopy is commonly used to diagnose problems of the lining of the uterus including endometrial polyps, submucosal uterine fibroids, and uterine anomalies.
Heavy uterine bleeding is a very common gynecologic problem that affects millions of women in the United States. There are multiple possible causes for the bleeding such as hormonal disturbance, uterine fibroids, uterine polyps, endometrial hyperplasia, or cancer. Depending on the cause of the condition, the treatment options may vary.
Endometrial ablation is an alternative to hysterectomy for many women with heavy uterine bleeding who are unresponsive to hormonal control and wish to avoid major surgery. Endometrial ablation is the removal or destruction of the endometrium (lining of the uterus). It does not require hospitalization, and most women return to normal activities in a day or two.
After a successful endometrial ablation, most women will have little or no menstrual bleeding. The entire procedure takes about twenty minutes and can be done in the office under local anesthesia or as an outpatient surgery under general anesthesia.
Post operative pain is minimal and the patient is usually able to return to normal activity in one to two days.
Trans-Obturator Sub-Urethral Sling
Female bladder control problems and urinary incontinence (bladder leakage) is one of the most common problems affecting aging women. It is estimated that in the United States, close to 20 million women suffer from it with incontinence affecting half of all the women over the age of 60.
The most common cause of bladder control problems in women is relaxation and prolapse of the female pelvic genital organs. This pelvic prolapse, in turn, is caused by prior pregnancy, aging, menopause, and hereditary factors. The most common type of urinary incontinence in women is stress urinary incontinence. It is caused by the gradual weakening and "falling down" of the pelvic floor. This results in urine leakage every time the patient makes a strenuous activity like coughing, sneezing, laughing or even walking.
The Transobturator Sling is a minimally-invasive surgical procedure that is performed to help women with stress urinary incontinence. The Transobturator Sling surgery is performed by the doctor placing a narrow strip of tape or mesh in a position that provides support for the woman’s urethra. This tape functions as a "hammock" supporting the urethra in times of stress, such as coughing, sneezing, laughing, jumping, etc. When properly performed, the procedure results in an 86-95% success rate. The Transobturator Sling procedure eliminates some of the potential complications that come about from other traditional urinary incontinence procedures.
During the sling procedure, two very small incisions are placed in the groins (one on each side) and a small incision is made in the vagina under the urethra.
The procedure is performed under general or regional (spinal or epidural) anesthesia in about thirty minutes. There is minimal scarring and pain, and most patients go home the same day. Recovery is usually only a few days, and most patients are able to go back to light duty (office) work in a few days and resume all other activities in about 2 weeks.
Essure® Hysteroscopic Sterilization
Essure® is a permanent birth control procedure that works with your body to create a natural barrier against pregnancy. The Essure® procedure does not require any cutting into the body. Instead, small flexible micro-inserts are inserted through the vagina, cervix, and uterus and into your fallopian tubes using a hysteroscope.
The procedure can be performed in the office without general anesthesia, and most women resume their normal activities within one day. Three months after the Essure® procedure, a doctor will perform an Essure Confirmation Test, to confirm that the tubes are fully blocked and that the woman can rely on Essure® for permanent birth control.
The Essure® procedure is permanent and is not reversible. Therefore, you should be sure you do not want children in the future.
Bio-Identical Hormone Replacement Theraphy for Women
Today’s women prefer natural hormones. In a survey of a nationally representative sample of 1,009 women aged 40 and older, 83% said they would prefer to use hormones that are similar to their own body’s hormones. Bio-identical hormones include estrone (El), estradiol (E2), estriol (E3), progesterone, testosterone, dehydroepiandrosterone (DHEA), and pregnenolone.
What are Bio-Identical Hormones?
Bio-identical hormones have the same chemical structure as hormones that are made by the human body. The key to natural or bio-identical versus synthetic is the molecular structure of the hormone. In order for a replacement hormone to fully replicate the function of hormones which were originally naturally produced and present in the human body, the chemical structure must exactly match the original. Researchers have long held that there are significant differences between hormones that are natural to humans (bio-identical) and synthetic (including horse) preparations. Structural differences that exist between human, synthetic, and animal hormones can be responsible for side effects that are experienced when non-bio-identical hormones are used for replacement therapy. It is the structure of the hormone, not the source, that is key. The term “bio-identical” does not indicate the source of the hormone, but rather indicates that the chemical structure of the replacement hormone is identical to that of the hormone naturally found in the human body. These hormones are able to follow normal metabolic pathways so that essential active metabolites are formed in response to hormone replacement therapy. Synthetic – “patented,” “conventional,” “artificial,” or “horse”- hormones have been chemically altered, and arc not identical in structure or activity to the naturally-occurring hormones they are intended to replace.
Hormone Related Symptoms
- Dysmenorrhea (cramps)
- Premenstrual Syndrome (PMS)
- Irregular menstrual periods
- Fibrocystic breasts
- Poor concentration/memory lapses
- Weight gain
- Mood swings
- Reduced libido
- Vaginal thinning/dryness
- Painful intercourse
- Hot flashes
- Night sweats
- Premenopausal symptoms
- Insomnia/disturbed sleep
- Heart disease/Arteriosclerosis
Hormone Replacement Therapy (HRT) can effectively control symptoms of menopause. The risks of low-dose HRT may be much less -and the potential benefits much greater -than initial reports from the landmark study known as the Women’s Health Initiative (WHI), which showed that a synthetic hormone combination of conjugated equine estrogens (CEE) plus medroxyprogesterone acetate (MPA) increased the risk of developing invasive breast cancer, heart disease, stroke, and pulmonary embolism. A review of the Nurses Health Study found that using HRT to treat menopausal symptoms may actually lower a woman’s risk for heart disease by as much as 30% when HRT is started near the onset of menopause. Further analysis of the WHI revealed that the risk of heart problems among hormone users increased as more time passed since the women experienced menopause. However, researchers also concluded that synthetic CEE plus MPA does not improve mental functioning, and that CEE + MPA may increase the risk of stroke, a known risk factor for dementia in women over age 65.
For years, physicians have been prescribing Bio-identical Hormone Replacement Therapy (BHRT) for women who have experienced problems or have other concerns about the use of synthetic hormones.
The three types of hormones typically prescribed for BHRT are estrogens, progesterone, and androgens. The precise components of each woman’s therapy need to be determined after physical examination, medical history, and laboratory testing arc considered. Close monitoring is essential to ensure that appropriate dosage adjustments are made.