Dr Blumenthal performs these clinical procedures

We have listed below some gynaecological procedures performed by Sydney Gynaecologist Dr Norman Blumenthal himself. As always, this information objective is to teach oneself more about these procedures, how they are diagnosed, performed and about recovery.

Please, send us an enquiry for any question that may arise following your reading.

Hysterectomy

Hysterectomy is the surgical removal of the uterus. It is the second most common form of major surgery in women. Dr Norman Blumenthal has specific experience in laparoscopic hysterectomy.

• Abnormal uterine bleeding.

This may be heavy or irregular bleeding, which may be due to various causes.

• Uterine fibroids.

These are non-cancerous growths in the uterus.

• Endometriosis.

This condition can cause pelvic pain and abnormal or heavy bleeding.

• Uterine prolapse.

This is where the uterus descends into the vagina. It is due to a weakness of the pelvic supports.

• Cancer.

Various forms of gynaecological cancer may need to be treated by a hysterectomy.

There are principally three different types of hysterectomy and there would be specific indications for each one of them.

• Abdominal Hysterectomy.

In this procedure there is an incision (cut) through the skin in the lower part of the abdomen.

This operation may be recommended if more extensive surgery is to be performed or where the uterus may be very large. Extensive endometriosis with adhesions and scar tissue may be another indication for this procedure.

An abdominal hysterectomy requires a longer healing time compared to the other forms of hysterectomy.

• Vaginal Hysterectomy.

In this procedure the surgery is done through the vagina. There will be no scarring on the abdomen. Dissolving sutures are used and therefore do not need to be removed. The healing time may be much shorter than with abdominal surgery.

• Laparoscopically Assisted Vaginal Hysterectomy (LAVH).

The primary purpose of a laparoscopically assisted vaginal hysterectomy is to convert an abdominal hysterectomy to a vaginal procedure.

Many of the contra-indications to a vaginal approach tend to be the indications for a LAVH. These include endometriosis, pelvic adhesions, no previous children and the desire for ovaries and/or tubes to be removed. Essentially, any condition that prevents a vaginal approach that can be resolved laparoscopically is an indication for LAVH.

The new laparoscopic techniques of reducing the size of the uterus (morcellation) can also save an abdominal hysterectomy. In addition, the ovaries can be removed if necessary.

It is an innovative approach to an otherwise standard operation. The risks and complications are expected to be similar to those of the traditional hysterectomy. However, the hospital stay, recovery pain, return to work and cosmetic results are far superior to that of a vaginal or abdominal hysterectomy. 

The Specialist surgeon enters the abdomen through the navel using an instrument called a trocar. Through this instrument, the laparoscope is inserted and a camera is connected so that the contents of the abdomen are clearly visualized. Two additional trocars are inserted and through these the actual operation is done. Cutting and diathermy is performed through these trocars and all blood vessels are adequately secured. Stitches can also be introduced and vessels tied through these trocars. When the uterus is mobilized, it can then be removed through the vagina and the vagina is then closed.

Only three small scars are left on the abdomen and these will be barely visible within a few months.
 
In Australia, almost 20 or 25% of hysterectomies are now done laparoscopically by surgeons who are experienced with the technique.

The risks of hysterectomy seem to be the lowest for any form of major surgery. However, some of the general problems include:

• Blood clots in the veins and /or lungs
• Infection
• Bleeding during or after surgery
• Damage to structures in the urinary tract
• Bowel involvement
• There are other more rare complications, which can be discussed

The stay in hospital will depend on the type of hysterectomy performed.

You will need to be mobile fairly quickly after the operation to reduce the risks and complications.

There will be some pain for the first few days and adequate pain relief will always be given. There may also be some bleeding or discharge from the vagina.

A woman will usually be happy to have her uterus removed but some emotional responses to the loss of that uterus may follow.

There may be some alteration to sexual response after a hysterectomy. This is uncommon but it is due to the fact that the uterus has been removed and some contractions during orgasm may be lost. On the other hand, many women will have much greater sexual satisfaction after a hysterectomy. This is because they do not have the concerns of a possible pregnancy and / or heavy bleeding.