Dr Alice Huang

About

Fertility Medicine

Early Pregnancy

Gynaecology

Treatment and Procedures

Clinic Info

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Phone

(03) 9417 1088

Hours

9am ~ 4pm Mon to Friday

Contact
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Operative Procedures

Pelvic Procedures

Uterine Procedures

Cervical Procedures

Other Procedures

Laparoscopy

Laparoscopy is a minimally invasive technique of performing a surgery through small incisions on the abdomen.

A long thin telescopic instrument (camera) called a laparoscope is inserted into the abdomen through a small incision. It allows visualisation of the pelvic organs and through additional small incisions elsewhere on the abdomen pelvic pathology can be treated.

The procedure is performed under general anaesthesia in the operating theatre. Between 2 – 4 small incisions are made on the abdomen where a long thin camera and other surgical instruments are inserted. The abdomen is filled with a gas to allow for a clear view of the pelvic organs. Once the treatment is complete, the incisions are closed.

You may need to have a bowel preparation which will empty the lower half of your bowel before the surgery. You will be given instructions for this beforehand if you need this.
If you develop signs of illness prior to your surgery, please contact my rooms immediately.

You will be in the recovery room when you wake up from anaesthesia. You may feel sleepy for the next few hours. You may have pain in the shoulder or back which is caused from the gas used in the procedure inside your abdomen. It will resolve within a few days. You may have some discomfort or feel tired for a few days after the procedure. Pain is usually worst in the first 2 days and strong pain medication is usually not needed after the third day. Please attend the emergency department at your nearest hospital or contact me if pain is becoming worse.

You should avoid heavy activities or exercise until your post-operative review.

You may return to half intensity activities after 2 weeks and back to normal intensity activities after 4 weeks.

As with any surgical procedure, laparoscopic surgery is also associated with certain risks and complications and they include:

  • Problems with anaesthesia
  • Injury to internal or surrounding organs
  • Bleeding and infection

Any specific risks and complications will be discussed with you prior to the procedure.

You should seek immediate medical attention by going to the emergency department of your closest hospital or contacting me if you experience any of the below mentioned conditions:

  • Fever
  • Offensive vaginal discharge or heavy bleeding
  • Severe nausea or vomiting
  • Inability to empty your bladder or bowels
  • Severe pain
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Laparotomy

Laparotomy in the setting of gynaecogy, is an open operation on the abdomen, typically involving a 10-15cm incision across the bikini line. Sometime the incision can also be vertical, midline and higher up in the abdomen. The surgery allows access to pelvic organs for larger pathology that needs removal, or for pelvices that are difficult to access through minimally invasive laparoscopy. It is also appropriate for surgeries where the pathology for removal is suspicious for cancer. This can be done to operate on organs in the pelvis including uterus, ovaries or in the area around the lower parts of the bowel.
The procedure is performed under general anaesthesia in the operating theatre. Typically, after laparotomy, you should stay in hospital for one to two nights before going home.
You may need to have a bowel preparation which will empty the lower half of your bowel before the surgery. You will be given instructions for this beforehand if you need this. If you develop signs of illness prior to your surgery, please contact my rooms immediately.
You will be in the recovery room when you wake up from anaesthesia. You may feel sleepy for the next few hours. In many cases, there will be a catheter left in the bladder. The catheter can be removed after breakfast the following day, if you are able to mobilise to the toilet by yourself by then. If you need a longer time to recover at that stage, the catheter can be removed on the second morning after your operation. Pain is usually worst in the first 2-5 days and strong pain medication will be provided to you while you are in hospital and also given to you to take home at discharge. Please attend the emergency department at your nearest hospital or contact my rooms if pain is becoming worse after discharge. You should avoid heavy lifting and strenuous activities or exercise until 6 weeks after operation.

As with any surgical procedure, laparotomy surgery is also associated with certain risks and complications and they include:

  • Problems with anaesthesia
  • Injury to internal or surrounding organs
  • Bleeding and infection

Any specific risks and complications will be discussed with you prior to the procedure.

You should seek immediate medical attention by going to the emergency department of your closest hospital or contacting me if you experience any of the below mentioned conditions:

  • Fever
  • Offensive vaginal discharge or heavy bleeding
  • Severe nausea or vomiting
  • Inability to empty your bladder or bowels
  • Severe pain

Myomectomy

A Myomectomy is a surgical procedure to remove uterine fibroids, benign or non-cancerous growths on the uterus. Many women with uterine fibroids do not experience any symptoms.

However some women may experience symptoms including heavy and prolonged menstrual bleeding, bleeding between periods, pelvic pain, infertility, lower back pain, pain during intercourse and urinary or bowel problems. Rarely you may have difficulty emptying your bladder, difficulty moving your bowels, or anaemia due to heavy menstrual bleeding.

Myomectomy is the treatment of choice for women with fibroids who desire fertility. Myomectomy removes only the fibroids and leaves the uterus intact.

The surgical modality depends on the size and site of the fibroid. If the fibroid is mainly in the uterine cavity, it can be removed hysteroscopically by inserting a long thin camera through the cervix into the uterus. The fibroid is then cut away and removed through the cervix and vagina. If the fibroid is in the uterine body or outside the muscle layer, then it will need to be removed through the abdomen, either laparoscopically with a long thin camera through small incisions on the abdomen or an open operation (laparotomy) through a long incision on the abdomen.

Potential risks of the operation include infection, bleeding, blood transfusion, small risk of needing to perform hysterectomy (removal of uterus) due to uncontrolled bleeding, nearby organ injury and anaesthesia risks.

After a myomectomy through the abdomen, if fertility is desired, you should wait for at least 4 months for the uterus to heal before starting to try to fall pregnant. In some cases, labour may carry a significantly higher risk of uterine rupture and an elective caesarean section is advised for future pregnancies. After myomectomy through hysteroscopy, you can start trying for pregnancy after 4 weeks.

Endometrial ablation

Endometrial ablation is the removal of endometrium, a thin layer of the tissue lining the uterus. It is done to treat heavy menstrual bleeding.

Endometrial ablation is not recommended in women who are planning for a pregnancy in future, were pregnant recently, in post-menopausal women and in those with disorders of the uterus such as cancer, recent infection, and endometrial hyperplasia.

This procedure is performed as a day procedure under general anaesthetic. The procedure is minimally invasive and associated with fast recovery. There is a high level of patient satisfaction after endometrial ablation where 1 in 2 women have completely stopped bleeding 2-5 years after the operation. However, 1 in 4 women will choose to have a repeat operation (either repeat ablation or hysterectomy) within 2-5 years after ablation.

Hysteroscopy

A Hysteroscopy is a minor and fairly safe surgical procedure used for diagnosis and/or treatment of various conditions in the uterus cavity.

In this procedure, a thin long telescopic instrument (camera) called a hysteroscope is inserted into the uterus through the vagina and the cervix to view the cavity of the uterus.
You will go home the same day after you have recovered from the general anaesthetic. There can be mild vaginal bleeding for few days after the procedure which is not a cause for concern, and also you may experience mild period-pain-like cramps. Heat-packs, paracetamol and ibuprofen can all be helpful to relieve the short-term discomfort after the procedure.
A Hysteroscopy is generally safe. Occasionally, injury may occur to the uterus or cervix during the procedure (uterine perforation), which does not usually require any treatment and will heal by itself. Rarely, there can be injury beyond the perforation to internal organs such as bladder, bowel or blood vessels. These injuries may require a further operation through the abdomen to repair (either at the time of operation or later down the track). Infection, bleeding and reactions to the anaesthesia are some of the adverse effects observed in few individuals.

You should seek immediate medical attention by going to the emergency department of your closest hospital or by contacting me if you experience any of the below mentioned conditions:

  • Fever
  • Heavy vaginal bleeding
  • Severe abdominal pain
  • Offensive vaginal discharge
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Suction D&C

A Suction D&C (dilatation and curettage) is a minor procedure to empty the uterus of pregnancy tissue after a miscarriage. In this procedure, mechanical cervical dilator may be used to dilate the cervix first, to allow a thin long cannula (around 7-10mm diameter) to be inserted into the uterus.
You will go home the same day after you have recovered from the general anaesthetic. There can be mild vaginal bleeding for up to 10 days after the procedure which is not a cause for concern. You may also experience mild period-pain-like cramps. Heat-packs, paracetamol and ibuprofen can all be helpful to relieve the short-term discomfort after the procedure.
A Suction D&C is generally safe. Occasionally, injury may occur to the uterus or cervix during the procedure (uterine perforation), which does not usually require any treatment and will heal by itself. Rarely, there can be injury beyond the perforation to internal organs such as bladder, bowel or blood vessels. These injuries may require a further operation through the abdomen to repair (either at the time of operation or later down the track). Uncommonly, some pregnancy tissue or blood clots can be retained in the uterus and rarely may need a repeat suction D&C to remove. Infection, bleeding and reactions to the anaesthesia are some of the adverse effects rarely observed in few individuals.

You should seek immediate medical attention by going to the emergency department of your closest hospital or by contacting me if you experience any of the below mentioned conditions:

  • Fever
  • Heavy vaginal bleeding
  • Severe abdominal pain
  • Offensive vaginal discharge

LLETZ Procedure

This procedure is known by several names, including “LLETZ” (Large Loop Excision of Transformation Zone of the Cervix) or “LEEP” (Loop Electrosurgical Excision Procedure) or just as “loop procedure of the cervix”.

This is a minor day-procedure done in the hospital under a short general anaesthesia. The procedure will take around 10-20 minutes. You will go home the same day.
While under anaesthesia, a colposcopy will be done again to highlight the affect area on the surface cervix. Then electrosurgical current will be passed into an instrument with a wire loop at the end to remove the areas with abnormal cells.

The aim will be to remove the abnormal cells without removing too much normal cervix. Usually in pre-menopausal women this would be around 1cm thickness or less.

Risks of the procedure discussed with you at the time of consenting includes anaesthesia, infection, bleeding and re-operation for recurrence of abnormal cells. There can also be an increase in complications in future pregnancies such as premature labour or miscarriages, or cervical stenosis that may necessitate a caesarean section if the cervix does not dilate in labour. The overall chances of these complications in pregnancy are low, but it is higher compared with women who have not had cervical procedures.

You will go home on the same day. Post-operative discomfort is usually a lower abdominal cramping like period pain, not dissimilar to the cramps after your colposcopy. After your procedure you will also likely experience discharge, lasting for up to 2-3 weeks after the procedure. This discharge can vary in colour and consistency. Some women describe the discharge a few days after the procedure as looking like “chicken skin”. Please be reassured that this is an after effect of the medication applied during the operation for infection and bleeding control. Intercourse, spas or swimming pools, baths and other strenuous activities should be avoided until 1 week after the discharge settles, to minimise the chance of infection.

Fine Needle Aspiration (FNA) testicular biopsy

A fine needle aspirate testicular biopsy is a small procedure, done under local anaesthesia, in the andrology laboratory, to retrieve sperm directly from the testes.

Local anaesthetic is injected in to the scrotum first, to numb the skin. Then a very fine needle passed through the skin, into the testes to retrieve sperm.

In IVF, eggs will need to be retrieved first and then the sperm from the testes will be injected into the eggs through ICSI (intracytoplasmic sperm injection). The fertilise eggs will by grown to a blastocyst embryo, to then be placed back into the uterus for pregnancy.

The testicular biopsy takes approximated 15-30 minutes to perform, and sperm may be retrieved from one testis or both testes.

You will go home after your procedure. There is no incision through the skin or muscle for this procedure. It is normal to have some mild bruising, tenderness and slight swelling for a few days. You should avoid strenuous activities for a week. You should wear supportive underwear (briefs not boxers) for the first 48 hours after the procedure.

This procedure is usually well tolerated and complication rates are low (<5%). Uncommon complications include infection, bleeding and haematoma formation. Occasionally there can be chronic pain of the testes or disruption of testes hormonal function. A very rare, but very serious risk is disruption of the blood supply of the testes that can lead to loss of the testes.

You should seek immediate medical attention by going to the emergency department of your closest hospital or by contacting me if you experience any of the below mentioned conditions:

  • Increased swelling to the testes or scrotum
  • Testes or surrounding area is hot to touch
  • Fever
  • Discharge or increase bleeding from the wound
  • Any significant pain in your testes, which cannot be managed with pain killers
  • Significant increase in bleeding or bruising of the testes or scrotum

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