Why Day Surgery?
Over the past decade in Australia, day surgery has become progressively more prevalent and is rapidly increasing in popularity. This is not only because of improvements in anaesthetic and surgical techniques but is also due to advances in pharmacological agents. Day surgery has progressed from a few simple procedures performed under local anaesthetic to a myriad of procedures performed under a variety of anaesthetic techniques. Simply put, surgical health care is moving away from traditional hospitalisation.
For patients requiring surgery, the day centre is seen as a more pleasant and convenient environment than the traditional hospital setting. The patient is regarded as a healthy person coming to the facility for a minor procedure in an atmosphere that is positive and cheerful. The care is more convenient, more flexible and less of an imposition on patients and their families. Overall, the potential unpleasantness of the medical setting is reduced.
Importantly, recent emphasis on health care cost containment is often cited as a major reason for the remarkable popularity of day surgery. There is absolutely no doubt that an operation in a day centre costs significantly less than a similar procedure in a hospital setting.
The emphasis in a day surgery, therefore, is to provide a friendly, relaxed atmosphere for patients and their families as well as medical, nursing and support staff.
Procedure: Dilatation and Curettage
Dilatation and Curettage (D&C) is an operation performed to widen the uterine cervix and sample the endometrium of the uterus.
Post operatively, slight to moderate vaginal bleeding is normal. It should only last for a few days but occasionally persists longer.
Endometrial ablation is a method of controlling menorrhagia (heavy periods) by the destruction of the endometrium (lining of the uterus). Menorrhagia may be due to hormonal disturbances, uterine fibroids, polyps, overgrowth of the uterine lining (hyperplasia) or cancer. Medical conditions such as bleeding disorders or thyroid disease may also contribute. If no specific anatomical cause is identified or if hormonal disturbances do not improve with hormone therapy, endometrial ablation may be an alternative to a hysterectomy.
It is performed by resecting or cauterising the endometrium to remove the glands, leaving only myometrium (muscle) and fibrous tissue, so there is no regeneration each month. It eliminates the need for a hysterectomy in many women with abnormal bleeding, unless there is a serious disease present.
It must be realised that the operation is irreversible and you will no longer be able to fall pregnant. It is thus only suitable for women who have finished their family planning.
Endometrial ablation procedures can be performed through a variety of techniques.
a) Endometrial resection
A telescope encased in a metal sleeve (Hysteroscope) is passed into the uterus through the cervix. A continuous flow of fluid under light pressure is used to distend the cavity for better vision and to wash out any blood that may be present. There is a metal loop on the end of the hysterscope which can be moved back and forth. When activated it is used to resect or cut the endometrium down to the myometrium.
b) Balloon endometrial ablation
A triangular balloon is placed into the uterus and filled with fluid. The fluid in the balloon is then heated for several minutes. During this time, most of the lining of the uterus is destroyed. Cramping may be severe after the procedure. Pain medication will be administered during the recovery period.
c) Microwave endometrial ablation
While the procedure can be performed at any time of the month, the optimum time is at the tail end of the period when the endometrium is as thin as possible. A pre-operative diagnostic laparoscopy and curette may be performed prior to the endometrial ablation to rule out any abnormal pathology.
Hysteroscopy, as a general rule, only takes a few minutes to perform. It may be performed alone or in conjunction with a laparoscopy. It is used to inspect the inside walls of the uterus for the following:
- Length and width of the uterus
- Any abnormality with the anatomy of the uterus
- Presence of fibroids (non cancerous tumors composed of fibrous tissue)
- Presence of polyps (non cancerous tumors of the lining of the uterus)
- Cancer of the endometrium (lining of the uterus)
A speculum is placed into the vagina to hold the vaginal walls apart allowing a clear view of the cervix. The cervical canal is gently opened and the hysteroscope is passed through the opening into the uterus. Fluid or carbon dioxide may be passed through the hysteroscope to gently expand the uterus allowing the surgeon a clearer view of the walls and shape of the uterus. Irregularities or growths can be seen and biopsies can be taken of any suspected abnormality. The internal openings of the fallopian tubes can also be seen.
Initially, bloodstained fluid may drain from the vagina. A small amount of vaginal bleeding for a few days is normal, but it should not be more than the flow of a normal period. Cramps, similar to period cramps, may be experienced.
Please go to the following link to find out more information about the IVF process: www.monashivf.edu.au.
This type of operation may also be called key-hole surgery and it is one of the lesser forms of invasive surgical treatment available today. Laparoscopic surgery when performed successfully affords less post operative discomfort and a faster recovery than conventional surgery.
A small incision is made near the navel. A thin hollow needle is inserted and carbon dioxide is passed into the abdominal cavity. This gently inflates the abdomen raising the abdominal wall above the uterus. A long thin instrument called a laparoscope is then carefully inserted into the inflated abdomen. The laparoscope is like a miniature telescope and is equipped with a lens for a clear view. A special attachment transmits light down through the tube, into the abdomen, so that the surgeon can see the ovaries, fallopian tubes and nearby organs.
If necessary, special instruments may be inserted through one to four other small cuts, usually near the pubic hairline. These instruments can be used by the surgeon to move pelvic organs for a clearer view or they may also be used to perform surgical treatment.
Laparoscopy may be performed alone or in combination with hysteroscopy.
Once the procedure is complete, the instruments are removed, the gas is released and the incisions are closed. Stitches (sutures) may be used to close the incisions.
Your recovery will depend on how much surgery was performed. Some women feel well and able to return to work the next day, some take one to two days off. You may experience some symptoms that may last for several days:
- Muscle pain
- Mild nausea
- Pain or discomfort at the site of the incisions
- Pain in one or both shoulders that may extend into the neck This is thought to be caused by the carbon dioxide used during the procedure.
- •Cramps similar to period cramps
- Vaginal discharge or bleeding
- A sensation of swelling in the abdomen
Although rare, laparoscopy procedures do have a risk of complications, as do all surgical procedures. Smoking, obesity and other significant medical problems can cause greater risks of complication.
Our Services - Post Operative Care
Specific discharge instructions following anaesthesia will be provided to you at discharge prior to leaving the hospital.