Our clinic has facilities for performing small ambulatory gynaecological performances, such as:
- Artificial pregnancy interruptions
- Curettages, hysteroscopy
- Cerclages (precautionary)
- Excises from cervixes and conisations
- Vulva operations (Bartholin´s glands, excises and the like)
- Subtle vaginal performances
- Plastic operations on outer genitals and in the vagina
For routine performances (curettages, pregnancy interruptions) on the younger women, less than 40 years old, who have not been affected by a serious illness and/or are not treated for any illness we do not ask for a pre-operational internal examination. In such cases the internal examination will be carried out by our anaestesiologist. As far as the laboratory examinations concerned the chemical urine examination will be enough and it will be carried out by us from the delivered urine just before the performance. If the performance is to be bigger (e.g. cervix conisation) or the woman is older than 40 years, maybe even younger when treated for any disease or having undergone a serious illness before, it is necessary to have the pre-operational examination in this extent:
- Internal examination (can be made by a general practitioner)
- Laboratory examination in this extent: blood count, urine chemically and urine sediment, liver tests
- When the patient takes chronical medicaments it is necessary in advance to agree with the anestesiologist on which medicaments can be omitted. At the same she will get advice on the exact time and the way of usage
Diagnostical hysteroscopy, curettage of the cervix
The hysteroscopy means that the uterus is irrigated with a special solution. The intervention is done under the general anaesthesia (etherizing the patient), 6 hours before the intervention please do not eat and drink anything, do not smoke. Sometimes it is possible to make the intervention in the local anaesthesyia. The hysteroscopy in one intervention is supplemented with sampling from the uterus cavity and from the cervic channel, the so called biopsy, for the histological examination (a tissue examination). Its advantage is in the aimed taking of the material from the suspicious niduses.
In case of a strong bleeding the hysteroscopy cannot be performed because of the unclearness of the uterus cavity. In such cases, only an individual fractionized curettage, i.e. taking of the mucous membrane of the cervix and subsequently taking of the bleeding mucous membrane of the uterus (terapeutical curettage) will be performed. The both samples are always sent for the histological examination which will make clear the reason of the bleeding (hormonal inbalance, “overgrown mucous membrane”, pre-cancer or tumor origin). Then, in accordace with the result, the further medical strategy or the examination algoritm are determined.
Taking of the samples = biopsy of the cervix
The most frequent and frequently the only indication of the beginning of the pre-cancer canges of the cervix is vaginal spotting out of the menstrual cycle or a slight bleeding after the intercourse. Sometimes such change can be connected with a repeated discharge. Often it is however the development of the cervix changes without any indications and an important role in its recognition play prophylactic medical examinations including cytological smearing (smearing for the examination of the cells of the cervix) and a colposcopic examination (overlooking of the cervic surface by enlargement and using stains by means of the optic enlargement instrument – colposkope.) The smearings of the cervic cells have an informative character only, i.e. they warn that there is something wrong on the cervix but they do not give any exact picture of the seriousness of the changes. Taking of the biopsy from the cervix is actually sampling of the cervix tissue. The reason for this intervention is an attempt to obtain the material out of which the pathologist can under a microscope better evaluate how grave the changes are which are taking place on the cervix. Such changes are registered in several categories. The microscopic examination of the tissue sample is necessary for assessing the gravity of the changes on the cervix. Taking of biopsy has been recommended to you by your gynaecologist on the basis of the results of the oncologic cytology or of the presence of the above mentioned symptoms and of the colposkopic examination (overview of the cervix area by enlargement and using coloring by means of an optical instrument). Taking of biopsy from the cervix is usually done by a physician without anaesthesia mostly directly in the surgery. After the disinfection of the external genitals tissue samples will be splitted of from the various spots of the cervix by means of the forceps, mainly from the spots with the greatest suspicion for pathological changes under the colposcopic control. As an advantage it will be manipulated with the special colouring of the cervix surface in order to make the suspicious niduses more distinct. The material will be sent for the histological examination (a tissue examination which will precise for us the character and the gravity of the changes on the cervix). After the performance there will be sometimes a short tamponade (a gauze strip) introduced into the vagina to minimize the bleeding. The gauze will be taken out by the patient herself after 4 to 6 hours after the intervention. The further procedure (frequency of controls) will be then fixed or removing the ill cervix parts – conisation - will be recommended.
Conisation, amputation, plastic surgery of the cervix
The purpose of this performance is the treatment of your cervix and through it the removal of the changes which have the origin in the imperfect healing of the after-birth wounds or changes which are counted among the precancerous ones. During the cervix conisation the superficial part of the cervix, the so-called conus, is taken out of the cervix. The possibilities of the conisation performance can be principally divided into the conisation by an electric handle (the so called LEEP) or by a needle (the so called SWETZ) or by the classic conisation. When the electric high frequency methods are used the conus is removed by means of a handle or a needle and at the same time the bleeding from the newly-emerged wound is stopped thanks to the influence of the current. By the application of the classic conisation the conus is removed by the scalpel and the wound is stitched together with absorbable stitches. The conus will be then sent for the histological examination (examination of the tissue which will precise to us the character and gravity of the changes on the cervix). By the conus removal a sufficient quantity of the tissue is obtained for the exact determination of the grade of the changes on the cervix and at the same time the most damageable part of the cervix from the oncological point of view is removed (the spot from which a potential malignant tumor can arise). At the end of the performance a tamponade (a strip of the sterile gauze) will be sometimes put into the vagina to minimize the immediate bleeding after the intervention. According to the situation, the tamponade will be left in the vagina for 12 – 24 hours then it will be removed. The intervention is performed under the general (the total patient´s etherizing) or the local anaesthesia. If the intervention is to be performed under the general anaesthesia, please, at least 6 hours before the perfomance do not eat, drink nor smoke!
Vulva surgery – excision, operation of the Bartholin´s gland
The most frequent and often the only indication of the precancerous changes of the external genitals is itching, burning or light bleeding, sometimes a whitish or a dark stain and/or a small pustule can occure. There can be even some quantity of small non-invasive tumors on the external genitals which may be unpleasant in the everyday life (warts, fat tumors, skin irritations …). Pathological changes in the vagina can be proved through an irregular bleeding, discharge or unpleasant feeling e.g. during the intercourse. Sometimes the development of the changes on the external genitals and in the vagina is without any symptoms, they will be first observed during the prophylactic examation by the attending gynaecologist.
Taking of the biopsy (excision) from the area of the external genitals is actually the sampling of the skin tissue of the external genitals or from the mucous membrane of the vaginal wall. The reason for this intervention is an attempt to obtain the material from which the pathologist can, under the microscope, better evaluate how grave the changes on the external genitals or in the vagina are going on (precancerous changes). A further reason is the removal of a bothering wart, a lentigo, a cyst or of another nonpathological formation, both in the vagina or on the external genitals.
Taking of the biopsy from the area of the external genitals or vagina is done under the general or the local anaesthesia in the intervention room, exceptionally in the surgery theatre. The choice of the anaesthesia depends on the extent of the pathological process. After the disinfection of the genitals and the vagina samples of the tissue will be taken of by special small forceps or by a scalpel or according to the local extent the whole nidus will be removed. All the taken samples will be sent for a histological examination.
If the intervention is to be performed in the general anaesthesia, please come with an empty stomach, .i.e. at least 6 hours before the intervention do not eat, do not drink nor smoke.
Cutting off the condylomata
Condylomata accuminata (pointed kondylomata) are small skin warts on the external genitals (or even in the vagina or on the cervix). If left on the spot, they can get larger or spread to the till now not affected spots. The most probable is also the sexual transfer to the partner. According to the extent the condylomata can be cut off under the local (if they are individual) or the general anaesthesia in the intervention room (in case of a larger extent or of occurrence in bunches).
Operation of the Bartholini´s gland
The Bartolini´s gland is a bivalent organ placed in the depth of the back part of the labia. Its function is to moisten the vaginal entrance. When the gland duct is stuck together (as a rule due to the inflammation) the congestion of the gland secretion occurs and a cystic formation arises from the duct. When this process is accompanied with an infection it will lead to an abscess – a cavity filled in with pus. The process is mostly one sided, it results in the swelling of the external genitals at the vaginal orifice which arches into the vagina, too. This swelling is mostly very painful and it can be as big as a hen egg.
The solution is surgical – from the simple cutting off through the stuck duct, through various types of drainages to the complete gland removal. Owing to the fact that this disease of the once attacked gland is often repeated, it is appropriate to remove the gland. We usually speak about the gland exstirpation which is done in 2 phases. At the beginning the gland sleeve will be cut into under the general anaesthesia of the patient and its volume, whether mucous or suppurative, will be discharged. After irrigating a small alum stick will be introduced into the inside of the gland and the before created opening will be stitched together again. Alum will be left to work for 24 – 48 hours. After that, under the general anaesthesia, the stitches and the complete gland bed will be made free and the complete gland bed loosened by means of alum from the base will be taken out. The opening after the cutting into the sleeve will be left without stitching now, it will get skinned over later on.