Advanced Surgery

When medication and non-invasive procedures are unable to relieve symptoms, surgery remains the accepted and most effective treatment for a range of gynecologic conditions. These include, but are not limited to, uterine fibroids, endometriosis, uterine prolapse, excessive bleeding, ovarian tumors, and pelvic pain.

Traditional open gynecologic surgery, using a large incision for access to the uterus and surrounding anatomy, has for many years been the standard approach to many gynecologic procedures. Yet with open surgery can come significant pain, trauma, a long recovery process and threat to surrounding organs and nerves. For women facing gynecologic surgery, the period of pain, discomfort and extended time away from normal daily activities that usually follows traditional surgery can understandably cause significant anxiety. Fortunately, modern less invasive options are used to minimize these concerns and to expedite a return to normal activity without compromising on safety. Most procedures are performed with minimal incisions using modern laparoscopic and robotic techniques.

Da Vinci Surgery

Da Vinci surgery is the use of a new innovative tool that gives a surgeon improved visualization and control during complex surgeries. Some gynecologic procedures enable surgeons to access the target anatomy using a vaginal approach, which may not require an external incision. But for complex hysterectomies and other gynecologic procedures, robot-assisted surgery with the da Vinci® Surgical System may be the most effective, least invasive treatment option. Through tiny, 1-2 cm incisions, surgeons using the da Vinci System* can operate with greater precision and control using the magnified high definition 3D image. At the same time, state-of-the-art robotic and computer technologies scale, filter and seamlessly translate the surgeon's hand movements into precise micro-movements of the da vinci instruments. This will minimize the pain and risk associated with large incisions while increasing the likelihood of a fast recovery and excellent clinical outcomes.

In our practice da vinci robot is used to perform a hysterectomy, myomectomy (removal of uterine fibroids), complex removal of endometriosis, ovarian tumors, and sacrocolpopexy (vaginal suspension for prolapse).

Below are 2 short videos demonstrating the finesse and control given to the surgeon by the da Vinci system.

Frequently Asked Questions about da vinci Surgery

Q. What are the benefits of da vinci Surgery compared with traditional methods of surgery?
A. Some of the major benefits experienced by surgeons using the da vinci Surgical System over traditional approaches have been greater surgical precision, increased range of motion, improved dexterity, enhanced visualization and improved access. Benefits experienced by patients may include a shorter hospital stay, less pain, less risk of infection, less blood loss, fewer transfusions, less scarring, faster recovery and a quicker return to normal daily activities. None of these benefits can be guaranteed, as surgery is necessarily both patient- and procedure-specific.

Q: Where is the da vinci Surgical System being used now?
A. Currently, The da vinci Surgical System is being used in hundreds of locations worldwide, in major centers in the United States, Austria, Belgium, Canada, Denmark, France, Germany, Italy, India, Japan, the Netherlands, Romania, Saudi Arabia, Singapore, Sweden, Switzerland, United Kingdom, Australia and Turkey.

Q. Has the da vinci Surgical System been cleared by the FDA?
A. The U.S. Food and Drug Administration (FDA) has cleared the da vinci Surgical System for a wide range of procedures.

Q. Will the da vinci Surgical System make the surgeon unnecessary?
A. On the contrary, the da vinci System enables surgeons to be more precise, advancing their technique and enhancing their capability in performing complex minimally invasive surgery. The System replicates the surgeon's movements in real time. It cannot be programmed, nor can it make decisions on its own to move in any way or perform any type of surgical maneuver without the surgeon's input.

Q. Is a surgeon using the da vinci Surgical System operating in "virtual reality"?
A. Although seated at a console a few feet away from the patient, the surgeon views an actual image of the surgical field while operating in real-time, through tiny incisions, using miniaturized, wristed instruments. At no time does the surgeon see a virtual image or program/command the system to perform any maneuver on its own/outside of the surgeon's direct, real-time control.

Q: What procedures have been performed using the da vinci Surgical System? What additional procedures are possible?
A. The da vinci System is a robotic surgical platform designed to enable complex procedures of all types to be performed through 1-2 cm incisions or operating “ports.” To date, tens of thousands of procedures including general, urologic, gynecologic, and cardiovascular procedures have been performed using the da vinci Surgical System.

For Further information:
http://www.davincisurgery.com/gynecology/
Dr. Syal’s da vinci surgery profile

Hysterectomy

Hysterectomy is the surgical removal of the uterus. A hysterectomy may be recommended to treat many uterine conditions, such as:

Endometriosis
Heavy menstrual bleeding
Fibroid tumors
Pelvic prolapse
Cancer

In the U.S., doctors perform approximately 600,000 hysterectomies a year, making it the second most common surgery for women.1 While this figure is lower in many other parts of the world, hysterectomy is still a common procedure. Fortunately, there are more choices than ever before for the type of hysterectomy as well as the surgical approach.

Types of Hysterectomy
All hysterectomies involve removal of the uterus but other reproductive organs may or may not also need to be removed. The type of hysterectomy your doctor recommends will depend on your specific condition. Keep in mind, if your hysterectomy involves removing the ovaries and you have not started menopause, removing the ovaries will cause menopause to begin. Your doctor may therefore recommend hormone replacement therapy if your ovaries are removed.
Types of hysterectomy include:

Total hysterectomy
A total hysterectomy refers to the removal of the uterus and the cervix only. This is the most common type of hysterectomy.

Partial or subtotal hysterectomy
A partial hysterectomy is also known as a supracervical hysterectomy. This procedure involves removing the upper part of the uterus, but leaving the cervix intact. The decision to keep the cervix is often based on patient preference.

Radical hysterectomy
A radical hysterectomy is the removal of the uterus, the tissue on both sides of the cervix, and the upper part of the vagina. This procedure is most often performed when cancer is present.
When a hysterectomy is performed for cancerous conditions – such as uterine, cervical, or ovarian cancer – the surgeon will remove the cancerous organ and certain lymph nodes. This is often referred to as a lymph node dissection or lymphadenectomy. Lymph nodes will be removed in certain areas based on the location and extent or stage of the cancer.

Your fallopian tubes and ovaries may or may not be removed during your hysterectomy. This will depend on several factors including your condition and age. Removal of the ovaries is called an oophorectomy. Removal of fallopian tubes and ovaries is called a salpingo-oophorectomy.

Approaches to Hysterectomy
Just as there are several types of hysterectomies, there are also several ways your doctor can perform the procedure, including:

Open hysterectomy
The uterus is removed through a large abdominal incision. The majority of hysterectomies are performed using this “open” approach. When both the uterus and cervix are removed, this is known as a TAH – Total Abdominal Hysterectomy. The main limitations of an open hysterectomy are the long incision required and lengthy recovery of 4-6 weeks.

Vaginal hysterectomy
The uterus is removed through the vagina. There are no abdominal incisions but the surgeon makes a small cut in the vagina to remove the uterus. This approach is often used if the patient’s condition is benign (non-cancerous), limited to the uterus, and the uterus is a normal size. When the uterus and cervix are removed through an incision deep inside the vagina, it is known as a TVH – Total Vaginal Hysterectomy, and is often used to treat pelvic prolapse.
The primary limitation of a vaginal hysterectomy is the surgeon’s limited view of the pelvic organs. This procedure can also be challenging if the patient has severe endometriosis or had prior pelvic surgeries such as a C-section that caused adhesions. Recovery from a vaginal hysterectomy can take 3-4 weeks.

Laparoscopic hysterectomy
The uterus is removed minimally invasively using instruments inserted through a few small incisions in the abdomen. One of the instruments is an endoscope – a narrow tube with a tiny camera – which allows the surgeon to see the target anatomy on a 2D monitor. When only the uterus is removed, the procedure is called LSH – Laparoscopic Supracervical Hysterectomy. When the uterus and cervix are removed, this is known as TLH – Total Laparoscopic Hysterectomy.
Laparoscopic hysterectomy can be challenging during complex procedures because of the long-handled, rigid instruments used, and recovery can take 3-4 weeks.

da Vinci Hysterectomy
Fortunately, there is a minimally invasive option for treating gynecologic conditions designed to overcome the limitations of traditional surgery – da Vinci Surgery.
If your doctor recommends a hysterectomy to treat your condition, you may be a candidate for da Vinci Surgery. Using state-of-the-art technology, a da Vinci® Hysterectomy requires only a few tiny incisions, so you can get back to your life faster.
The da Vinci System enables a doctor to perform a minimally invasive hysterectomy even for complex conditions with enhanced vision, precision, dexterity and control. da Vinci offers women many potential benefits over traditional surgery, including:

Less pain
Fewer complications
Less blood loss
Shorter hospital stay
Low risk of wound infection
Quicker recovery and return to normal activities

The da Vinci System is a state-of-the-art surgical platform with 3D, high-definition vision and miniaturized, wristed surgical instruments designed to help doctors take surgery beyond the limits of the human hand. By helping doctors to overcome the challenges of traditional open and laparoscopic surgery, da Vinci is changing the experience of surgery for women around the world.

When a hysterectomy is necessary our office can offer all the surgeries listed above. If needed additional treatments for pelvic prolapse or loss of urine can also be performed during this operation.

Incontinence Treatment

Stress urinary incontinence is the involuntary loss of urine during physical activity, which may include but is not limited to: coughing, laughing, or lifting. Incontinence occurs when the muscles that support the urethra (the tube that carries urine out of the body) are weakened or damaged. This can happen as a result of childbirth, trauma, hormone changes and many other reasons. You don’t have to live like this. This type of incontinence can be treated both surgically and with nonsurgical techniques.

Your body before urinary incontinence
The muscles and ligaments of the pelvic area support the bladder and urethra in their normal positions. They also provide proper muscle control, alternately constricting the urethra to store urine or constricting the bladder to remove urine from the body.

Your body with stress urinary incontinence
When the pelvic floor muscles and ring of muscles that surround the urethra (urinary sphincter) have been weakened or damaged by pregnancy, childbirth, menopause, or other causes, the urethra may relax from its normal position and be unable to close completely. So, if a woman coughs, sneezes, or laughs, the sudden pressure she places on her bladder may be too much for her weakened muscles to handle, and she may experience an embarrassing momentary loss of bladder control known as stress urinary incontinence.
Modern surgical treatments are very different from the treatments older patients may have had in the past. Today the procedure is completed with a small vaginal incision during an outpatient surgery. A small surgical mesh is placed under the urethra to give support during times of straining. Recovery time is minimal and the results are excellent and long lasting. Please note this is not the mesh associated with the FDA investigation. We have been using this mesh since 2004 without any problems.
Our office offers complete bladder testing and treatment for urinary problems.

Pelvic Reconstructive Surgery

Vaginal prolapse (also called pelvic organ prolapse, or vaginal organ prolapse) is what happens when organs inside the pelvis fall, bulge or protrude into the vaginal wall. This condition is due to weakened muscles or ligaments that can occur from a number of causes, including childbirth, previous surgeries, and obesity. There are a number of muscles, ligaments, and other tissues that elevate and support the pelvic area. They provide support for pelvic organs including the uterus, urethra, bladder, and the rectum.

Vaginal prolapse happens when pelvic organs, including the bladder or rectum, bulge into the vaginal wall due to a weakening of important muscles and supporting ligaments. If left untreated, these organs may fall or protrude to a point that they prolapse (bulge or push into)—the vaginal area. In extreme cases, the vagina can even fall to the point where it extends outside the body.

While many women do not have pronounced symptoms that accompany vaginal prolapse, weakened supporting muscles can sometimes cause a noticeable bulge or lump in the vagina, as organs sag or protrude into the vaginal wall. This causes a sense of vaginal “heaviness.” Symptoms to watch for include:

A feeling of heaviness in the vaginal area
Something protruding from the vagina
A pulling or stretching feeling in the pelvic area
Pain when standing
Painful sexual intercourse
Vaginal pain, pressure, irritation, bleeding or spotting
Frequent lower back pain
Occasional loss of bladder or bowel control
Difficulty with bowel movements
Difficulty urinating, or delayed or slow urinary stream

Different types of vaginal prolapse may have specific symptoms, because weaknesses in certain support muscles affect different areas of the pelvis. It’s not uncommon for women to have more than one type of prolapse at the same time, so familiarize yourself with the various types of prolapse and the accompanying symptoms:

Healthy pelvic area before prolapse

Vaginal vault prolapse

Vaginal Vault
For women who have had a hysterectomy the normal support from the uterus is no longer in place and prolapse can occur when the top portion of the vagina descends down into the lower vagina.

Vaginal vault prolapse symptoms may include:

A feeling of pelvic “heaviness”
Vaginal bulging or vaginal sagging into the vaginal canal which may make standing and walking difficult
Difficulty with bowel movements and/or emptying bowels
Involuntary release of urine (incontinence)
Backache

Bladder prolapse (cystocele)

Bladder prolapse (cystocele) symptoms may include:

Difficulty emptying bladder
A feeling that your bladder is not emptying completely
Loss of bladder control (stress urinary incontinence)
Discomfort or pain in the pelvic area

Rectal prolapse (rectocele)

Rectal prolapse (rectocele) symptoms may include:

Painful bowel movements
Fecal incontinence (inability to control bowel movements)
A feeling that something is bulging near the rectal area when wiping

Uterine prolapse

Uterine prolapse symptoms may include:

Difficulty with bowel movements and emptying bowels
Difficulty urinating and emptying the bladder
Pain that gets worse after periods of standing
Difficulty walking
Painful sexual intercourse

Small bowel prolapse (enterocele)

Enterocele
Enterocele occurs when the intestine bulges into the vagina. An Enterocele can occur from the front, back or top. This illustration shows an enterocele from the back.

Small bowel prolapse (enterocele) symptoms may include:

Difficulty with bowel movements and emptying bowels
Difficulty urinating and emptying bladder
Pain that gets worse after periods of standing

Most women with pelvic prolapse will have a combination of the various types of prolapse shown above. Various procedures are available to correct these defects to maximize your quality of life with or without a hysterectomy. Effective repairs can be performed without the use of mesh. If needed safe and successful use of mesh can be offered.

Frequently Asked Questions

How is vaginal prolapse treated? The treatment of prolapse is determined by the type of prolapse and the patient’s needs and health. Simple non-surgical treatments with Keegle exercises, use of a vaginal ring (called a pessary) and hormone therapy may suffice for mild prolapse. More severe conditions may require surgical intervention. Effective treatments can be done vaginally with and without the use of mesh to support the prolapsing tissue. Other treatments can be done using the da Vinci robot to attach the upper vagina to a strong ligament in the abdomen. This procedure is called a sacrocolpexy. All options have advantages and limitations. Only after a careful exam can specific recommendations be made.

How serious is vaginal prolapse? Vaginal prolapse can dramatically impact a woman’s quality of life. For women that don’t seek treatment, they often must deal with painful and embarrassing symptoms like:

Difficult or painful sexual intercourse
Vaginal pain, pressure, irritation, bleeding, or spotting
Urinary and fecal incontinence
Difficulty with bowel movements

How serious is urinary incontinence? The wetness and odor associated with urinary incontinence could dramatically impact your quality of life. In fact, studies show incontinence is linked to depression, anxiety, and stigmatization as a result of the potentially embarrassing symptoms. In severe cases, some women will avoid sexual intimacy, restrict their daily activities, wear dark clothing, and resort to managing their symptoms with pads and liners.
In addition to the negative impact on a woman’s well-being, urinary incontinence is also associated with a considerable financial cost that is related to the lifetime expense of pads and liners, as well as other medical related expenses.

Aren’t some of these symptoms just a normal part of what happens after childbirth? Is this really a condition? The strain on supporting muscles and ligaments during pregnancy and childbirth can naturally cause weakened muscles and ligaments. For some women, this is temporary and may heal. In others, the muscles may be damaged and don’t heal. Over time, this can lead to vaginal prolapse. But don’t resign yourself to believing that this condition is just a normal part of childbirth. Vaginal prolapse can be treated successfully, relieving women from its painful and embarrassing symptoms.

When should I consider surgical options for vaginal prolapse? With your doctor’s diagnosis, you’ll need to assess your condition and make an informed choice. You should determine whether your vaginal prolapse symptoms are affecting your quality of life, whether conservative measures have failed, and whether your condition is impacting your health–physically and/or emotionally.

If I don’t get treated for vaginal prolapse, will it get worse? Every woman’s body is different. But for most women, vaginal prolapse symptoms will not lessen over time, or heal on their own. This is why it’s important not to ignore symptoms, but to talk with a specialist. Remember, you don’t have to live with painful or embarrassing symptoms. There are treatment options that can make a real difference in your lifestyle.

Is there some medication I can take for vaginal prolapse? There is currently no medication to treat vaginal prolapse. Because it is a condition of weakened supporting muscles in the pelvic area, treatments are focused around strengthening muscles and/or providing support to weakened muscles and prolapsed organs.

What’s the right surgical option for me? Your specialist needs to understand and evaluate all aspects of your condition, and should recommend a treatment based on:

Type and degree of prolapse
Any issues related to your specific anatomy
Your age and activity level
Your sexual activity level

I have a friend who had vaginal prolapse surgery a few years ago. She was in the hospital for an extended stay. Is this what I can expect? Traditional prolapse surgery is invasive, and may require an extended hospital stay and a longer recovery period. But be reassured that newer, more minimally invasive options are available, and may involve less pain and a shorter recovery time. Most often, women who undergo a minimally invasive surgical procedure can return home the very next day. These newer minimally invasive procedures may use mesh to correct the prolapse. The mesh is used to repair the prolapse and restore your anatomy.
Vaginal prolapse surgery is not right for everyone, so be sure to discuss your concerns with your doctor—especially if you are pregnant, plan to become pregnant, suffer from blood coagulation disorders or have a compromised immune system.

What if I plan to have children in the future? What are my treatment options? If you’re planning a pregnancy, it’s important to talk with your specialist to understand the risks and benefits of vaginal prolapse surgery. The stretching and strain that comes along with pregnancy and delivery can damage your supportive tissues, undoing the benefits of surgical procedures. In the meantime, your specialist may recommend other options that will help you manage the condition.

What if I have both vaginal prolapse and incontinence symptoms? –Can I have both treated at one time? Quite often, the answer is yes. Vaginal prolapse surgery is often performed in conjunction with procedures to correct several pelvic area conditions.

How long is the typical recovery period for minimally invasive vaginal prolapse surgery? Will I be in the hospital? Depending on the procedure, women may be able to return home the day following their minimally invasive procedure—and return to work in one to two weeks. However, you may be advised to refrain from sexual intercourse, heavy lifting, and vigorous exercise for six to eight weeks after surgery.

Will having vaginal prolapse surgery affect my ability to have sex? On the contrary, vaginal prolapse surgery may eliminate painful sexual intercourse that some women experience when they suffer from this condition. However, you should refrain from sexual intercourse for six to eight weeks following your procedure to allow your body to heal.

After surgery, will things feel different during sex? A successful vaginal prolapse surgery should restore your pelvic organs to their normal positions, eliminating the pain and discomfort during sex that can sometimes be associated with prolapse. Corrective surgery also helps to restore the vaginal tone and appearance. After allowing your body to heal, you should enjoy the same intimate experiences you had before you began to suffer from symptoms of vaginal prolapse. In rare cases, some women do experience painful intercourse after the procedure.
Our office offers a complete range of treatment options for all types pelvic prolapse with and without the use of mesh.

Laparoscopy

Laparoscopy is the most common procedure used to diagnose and treat causes of pelvic pain such as endometriosis and ovarian cysts. Instead of using a large abdominal incision, the surgeon inserts a lighted viewing instrument called a laparoscope through a small incision. Directly viewing the pelvic organs is the only way to confirm whether you have endometriosis. If endometriosis or scar tissue needs to be removed, we will use one of various techniques, including cutting and removing tissue (excision) or destroying it with a laser beam or electric current (electrocautery).

Laparoscopy is used to examine the pelvic organs and to remove implants and scar tissue. This procedure is typically used for checking and treating:

Severe endometriosis and scar tissue that is thought to be interfering with internal organs, such as the bowel or bladder.
Endometriosis pain that has continued or returned after hormone therapy.
Severe endometriosis pain (some women and their doctors choose to skip medicine treatment).
An endometriosis cyst on an ovary (endometrioma).
Endometriosis as a possible cause of infertility. The surgeon usually removes any visible implants and scar tissue. This may improve fertility.

Post op recovery is usually rapid over 3-5 days. Full recovery is within 2 weeks.

Our office offers a wide range of treatments for pelvic pain, endometriosis, uterine fibroids, infertility, and ovarian cysts using operative laparoscopy.

Endometrial Ablation

Many women begin to experience heavy and/or irregular bleeding in their 30s and 40s, as they begin to get closer to menopause. Heavy periods are more than just a hassle - they take a physical, social, and emotional toll as well. Endometrial ablation is a procedure that destroys (ablates) the uterine lining, or endometrium. This procedure is used to treat dysfunctional or abnormal uterine bleeding. Sometimes a lighted viewing instrument (hysteroscope) is used to see inside the uterus. Most procedures can be performed in the office with mild sedation.

Endometrial ablation is used to control heavy, prolonged vaginal bleeding when:

Bleeding has not responded to other treatments.
Childbearing is completed.
You prefer not to have a hysterectomy to control bleeding.
Other medical problems prevent a hysterectomy.

When considering an endometrial ablation, ask yourself the following questions:

Does your period affect your quality of life?
Are your periods heavy or do they last a long time?
Would your quality of life improve if you could decrease or potentially eliminate your heavy periods?
Do your heavy periods affect your social, athletic or sexual activities or cause you to miss work?
Do you change protection frequently or carry large quantities of feminine products and/or a change of clothes?
Do your heavy periods cause anxiety, PMS, or pain?

Most women will have reduced menstrual flow following endometrial ablation. And up to half will stop having periods. If you would like to consider your options for a simple procedure to reduce menstrual bleeding, please contact the office for an appointment.

Permanent Birth Control

Permanent birth control is now offered as an office procedure with no incisions and minimal recovery. Essure is a permanent birth control procedure that works with your body to create a natural barrier to prevent pregnancy. The Essure procedure offers women benefits that no other permanent birth control can.

Surgery-free—A simple procedure performed in your doctor’s office in less than 10 minutes
Hormone-free—A more natural birth control method
Anesthesia-free—There’s no slowing down to recover, and most women return to normal activities in less than a day
Worry-free—Since 2002 over half a million women and their doctors have trusted Essure as the most effective *permanent birth control
The Essure procedure is usually performed in less than ten minutes in your doctor’s office. Most women go home within 45 minutes and return to normal activities in less than a day. For the next three months, your body works with the Essure inserts to create a natural barrier against pregnancy. Once the barrier is confirmed through an Essure Confirmation Test, you’ll enjoy the confidence that comes from knowing you are protected from unplanned pregnancy.

1.The procedure An Essure-certified doctor places soft, flexible inserts into each of your fallopian tubes through the natural pathways of your vagina and cervix. There is no incision necessary. The tip of each insert remains visible, so your doctor can confirm that placement is accurate.

2.The barrier Over the next three months, your body works with the Essure inserts to form a natural barrier within your fallopian tubes that prevents sperm from reaching your eggs. Your ovaries will continue to release eggs, but they will be absorbed naturally into your body. You must continue to use another form of birth control during these three months.

3.The confirmation After three months you’ll take the Essure Confirmation Test to confirm you can no longer get pregnant. A special dye is introduced into your uterus, then viewed on an x-ray to confirm that the inserts are in place and your fallopian tubes are fully blocked. Once you receive verification from your doctor, you can start relying on Essure for permanent birth control.

The Essure insert

Three key features of the Essure insert help make it the most effective* permanent birth control available: the shape, the size and the material from which it’s made.

Shape: The small, soft Essure inserts are designed to slide easily into each fallopian tube and stay in place.
Size: The Essure inserts stay secure, forming a long protective area. They also remain visible, so your doctor can confirm that they’re properly in place.
Material: The Essure inserts are made from the same trusted, silicone-free material used in heart stents. The material is flexible, so it conforms to the shape of your fallopian tubes.

Common Questions about Essure

What is Essure?
Essure is a proven, non-surgical, hormone-free permanent birth control procedure that works with your body to prevent pregnancy.

How effective is Essure?
Essure is 99.8% effective,* the highest of any form of permanent birth control.

How long has Essure been available?
Approved by the FDA in 2002, Essure is trusted by more than half a million women and their doctors worldwide.

What are the benefits of Essure?
Essure is the most effective* permanent birth control available, offering benefits no other birth control ever has:

No surgery—the simple, ten-minute procedure can be performed in the comfort of a doctor’s office
No slowing down to recover
No anesthesia necessary
No hormones—a more natural birth control method
Peace of mind—your doctor will confirm when you can start relying on Essure for permanent birth control
Trusted by over half a million women and their doctors since 2002
Covered by most insurance providers
*Based on four years of clinical data.

How does Essure work?
An Essure-certified doctor places soft, flexible inserts into each of your fallopian tubes through the natural pathways of your vagina and cervix. There is no incision necessary. The tip of each insert remains visible, so your doctor can confirm that placement is accurate.
Over the next three months, your body works with the Essure inserts to form a natural barrier within your fallopian tubes that prevents sperm from reaching your eggs. You must continue to use another form of birth control during these three months.
After three months you’ll take an Essure Confirmation Test to confirm that the inserts are in place, your tubes are fully blocked and you can begin relying on Essure for permanent birth control. Learn more about how Essure works.

What are the inserts made of?
The silicone-free inserts are made of a polyester fiber, nickel-titanium and stainless steel alloy. These are the same trusted materials that are used in heart stents and hundreds of other medical devices (e.g., heart valve replacements, blood vessel grafts and abdominal repair).

I think I have a nickel allergy. Can I still get Essure?
True nickel allergies are not as common as many people think. A good test is whether your skin reacts to the metal rivets in Levi’s® jeans, which are made from nickel. The amount of nickel released every day by an Essure insert is very, very small—less than one-thousandth of the amount in the average daily food intake. In the Essure clinical trials, no adverse reactions to nickel were reported. But if you have questions about a possible nickel allergy, talk with your doctor before scheduling your procedure.

Is the procedure painful?
Some women report mild discomfort or cramping, similar to a normal monthly cycle during or after the procedure.

What are the risks or considerations?
As with all medical procedures, there are risks and considerations associated with Essure:

No form of birth control should be considered 100 percent effective.
Not all women will achieve successful placement of both inserts.
During or after the procedure some women report mild discomfort or cramping similar to their normal monthly cycle.
Side effects during or immediately following the procedure may include mild-to-moderate cramping, nausea/vomiting, dizziness/light-headedness, bleeding and/or spotting.

Is the procedure safe?
Yes. The Essure procedure has been trusted by over half a million women and their doctors since 2002. The silicone-free inserts are made from the same proven materials that have been used successfully for many years in heart stents and other medical devices. Moreover, Essure enables you and your partner to avoid the risks and discomfort of surgical procedures like tubal ligation and vasectomy.

Is it covered by insurance?
Essure is covered by most health insurance providers. If the procedure is performed in your doctor’s office, the cost may be as low as a simple co-pay, depending on your insurance plan.

Is Essure easily reversible?
No. Like other forms of permanent birth control, including tubal ligation and vasectomy, Essure should not be considered reversible. It is for women who are certain that their family is complete.

How much time will I need to recover from the procedure?
Most women go home within 45 minutes of the Essure procedure and return to normal activities in less than a day.

Will I still get my menstrual period? How often? Will it be different?
You will still have your normal menstrual period. Some women report slightly lighter or heavier bleeding than usual, but these changes might result from discontinuing hormone-based birth control such as the Pill and returning to your normal cycle.
If you’ve experienced pain or heavy bleeding with your period over the years, ask your doctor about what treatment options are available to you.

Could the Essure procedure cause me to gain weight?
Since Essure does not contain hormones, it should not cause weight gain.

What is the Essure Confirmation Test?
The Essure Confirmation Test is a test performed three months after the procedure. A special dye is introduced into your uterus, then viewed on an x-ray to confirm that the inserts are in place and your fallopian tubes are fully blocked. Once you receive verification from your doctor, you can start relying on Essure for permanent birth control. Learn more about the Essure Confirmation Test.

Do I need an Essure Confirmation Test?
Yes. The Essure Confirmation Test not only verifies that your fallopian tubes are completely blocked, but also that the Essure inserts are properly in place. Therefore, until your doctor performs the test and confirms that you can begin relying on Essure, you should not consider yourself protected from unplanned pregnancy and must continue to use another form of birth control.

How is the Essure procedure different from having your tubes tied?
Tubal ligation, also known as “having your tubes tied,” is a surgery. The procedure is typically performed under general anesthesia in a hospital operating room. Recovery time is 4-6 days.
The Essure procedure is not surgery. It can be performed in your doctor’s office and requires no general anesthesia or incisions. Most women return to normal activities in less than a day. Essure also has a confirmation test that lets your doctor verify that the inserts are properly in place and your fallopian tubes are fully blocked. Tubal ligation does not.

Are there risks or complications associated with tubal ligation?
Because incisions are made in the abdomen and the laparoscope is inserted blindly into the abdomen, complications may include infection; bleeding; damage to blood vessels, nerves, or muscles; damage to the bladder, uterus, or bowel requiring surgical repair; blood clots; failure of the procedure resulting in pregnancy; and, in rare cases, death. Additionally, tubal ligation requires general anesthesia, which is also associated with certain risks.

What are the risks associated with the general anesthesia required for tubal ligation?
Negative reactions to general anesthesia may include nausea, slowness of the anesthesia to wear off, a sore throat if a tube is used during general anesthesia, seizure or heart attack, high temperature, confusion and death.

How is the Essure procedure different from a vasectomy?
Vasectomy is a permanent birth control surgery for men. Essure is a non-surgical permanent birth control procedure for women.
Vasectomy is a surgery in which the doctor punctures or makes an incision into a man's scrotum and cuts the vas deferens. Its ends are burned or clipped closed. A vasectomy takes about 15 to 30 minutes, and recovery is usually about 2-3 days. The man may also need to apply ice packs to the scrotum and wear an athletic supporter for several days to prevent swelling and bruising. With a vasectomy, it is recommended that a sperm test be performed three months after the procedure and repeated every ten years.
By contrast, Essure is non-surgical permanent birth control. The simple Essure procedure is performed in a doctor’s office in under ten minutes. Most women go home within 45 minutes and return to normal activities in less than a day.

What are some risks and complications associated with vasectomy?
There is a small chance of pregnancy, even many years following the procedure. Additionally, complications may include bruising on the scrotum, infection of the incision/puncture in the scrotum, painful testicles (epididymitis) and granuloma, small lumps caused by sperm leaking into the surrounding tissue in the scrotum.

If you are sure your family is complete and would like the benefits of permanent birth control, please call the office for an appointment.

Operative Hysteroscopy

A hysteroscopy is a procedure used to look inside the uterus. A thin instrument called a hysteroscope is passed through your vagina and cervix and into your uterus to help your doctor find the cause of a possible problem, to look for cancer in the lining of the uterus or to operate. Your doctor might suggest a hysteroscopy if you have:

heavy and/or long menstrual periods
bleeding between your periods
bleeding after menopause
irregular cycles
severe cramping
frequent miscarriages (lost pregnancies)
a displaced intrauterine device (IUD)
difficulty getting pregnant (infertility)

Operative hysteroscopy is used to treat any of the abnormalities that may be found. Removal of polyps, fibroids, and uterine adhesions is very common. Hysteroscopy may prevent the need for more complicated procedures. The procedure may be performed in the office or as an outpatient surgery.