Partners in Obstetrics & Women’s Health

Gynecology Services

We provide gynecological care for women of all ages. We focus on care for the well-women (preventive care) as well as treatment for known reproductive disorders. Yearly visits are recommended to maintain good health. As gynecologists, we treat a full range of women’s health issues such as:

• Annual health exam
• Diagnosis and treatment of pelvic disorders
• Basic infertility treatment
• Breast exam and mammography
• Minimally Invasive Surgery
• Major Gynecologic Surgery
• Diagnosis and Management of Urinary Incontinence
• Management of Menopausal Symptoms
• Diagnosis and Treatment of Osteoporosis
• Management of PCOS (Polycystic Ovarian Syndrome) and Endometriosis
• Treatment of Recurrent or Persistent Vaginal Infection

Our goal is to provide personalized, high quality, accessible care from childhood until after menopause. In the case of infertility, we encourage spousal involvement and consult with endocrinologists and urologists when necessary. We are happy to coordinate your care with other medical professionals.

Minimally Invasive Surgery

Hysteroscopy

Hysteroscopy is a surgical technique by which the internal cavity of the uterus can be visually inspected by inserting a hysteroscope (a thin fiber optics lens that is 3-5mm in diameter with a built in light source) through the cervical os (the opening of the vagina into the uterine cavity). Fluid is introduced simultaneously through an accessory port of the hysteroscope and permitted to flow out another port. The control of the fluid (hydrostatic) pressure serves to help expand the walls of the uterus and thus facilitate the visualization of the uterine cavity. Flow of the fluid in and out of the cavity also ensures clarity of view by continuously flushing out obscuring blood, particles, and/or debris.

Hysteroscopy can be coupled with specialized surgical instruments small enough to fit through additional small accessory ports of the scope, thus allowing the surgeon to biopsy, destroy or remove lesions such as polyps or fibroids from the uterine cavity.

Because of the relatively non-invasive nature of the procedure, the patient can undergo the procedure with minimal post operative pain, blood loss and a rapid post operative recovery. As previously stated, the instrument is introduced through the cervical os, which is an existing orifice in the uterus, and therefore no incisions in the uterine and or abdominal wall are required during the procedure.

Endometrial Ablation

Endometrial ablation is a procedure utilized to resolve abnormal uterine bleeding (excessive in amount, duration or frequency) that can occur as a consequence of hormonal imbalance, and/or perimenopause.

Abnormal bleeding can also be caused or aggravated by other problems such as fibroids, endometrial polyps and/or malignancies of the uterus. It is therefore imperative for the patient to have an appropriate workup to rule out these possibilities. This workup may include an endometrial biopsy (sampling of the inner lining of the uterus) and/or a visual examination of the uterine cavity. Menstrual periods are the consequence of the monthly regeneration and shedding of the endometrial lining of the uterus in a cyclic fashion.

The purpose of the ablation is to destroy the endometrium. The end result of destroying the endometrium is that the uterus loses the ability to regenerate and shed this lining on a monthly basis. As a result, the patient’s menstrual periods become scant, sometimes disappearing altogether. Because of the targeted nature of the procedure, only the endometrium is affected, and therefore other reproductive organs (i.e. ovaries) are spared and remain functioning in their normal manner.

It is a good alternative for a woman with excessive or irregular menses with bleeding that has not been effectively controlled by medications such as oral contraceptive pills. Sometimes the patient has had previous dilatation & curettage (D&C) procedures that have had short acting or temporary effect, and are seeking a more permanent therapy. Most important, endometrial ablation offers an effective treatment modality to eliminate excessive and/or irregular bleeding for the long term (current data show >85 % absence of periods rate for greater than 5 years), without having to recur to more serious surgical procedures, such as a hysterectomy.

The procedure is performed at a hospital on an outpatient basis, and can be done under general or spinal anesthesia. The total duration of the procedure including the examination of the uterine cavity is approximately 35 minutes. The patient is released the same day, and post-operative discomfort is limited to mild to moderate uterine cramps that are effectively managed at home with pain medications such as Ibuprofen.

There are different protocols or techniques for performing the ablation, but two of the safest and best studied methods utilize thermal energy from a circulating liquid to achieve this goal.

The first ablation method is called balloon thermal ablation (Thermachoice™ by Gynecare®). In this method, a silicone balloon is inserted through the cervical os (the opening leading from the vagina to the uterine cavity) and then inflated once inside the uterine cavity, so that as it expands, the walls of the balloon are in close contact with the endometrium. A device connected to the balloon then circulates fluid inside the balloon at a constant temperature of 87 degrees Centigrade for 8 minutes. The thermal energy from the fluid is transmitted through the wall of the balloon, and absorbed by the inner lining of the uterus. Thus the endometrial lining is ablated or destroyed. Upon completing the prescribed treatment time the fluid is drained from the balloon and the balloon is removed from the uterine cavity.

This method is very effective provided that the uterine cavity has a smooth, even contour and is devoid of structural anomalies (large polyps or uterine fibroids). Any disruption of the normal architecture of the uterus may lead to difficulty in achieving a good contact between the surface of the balloon and the endometrium. In addition, the balloon is limited by the amount of fluid with which it can be safely inflated. In this case an enlarged uterus or an irregularly shaped uterine cavity makes the balloon method less effective.

Alternatively, a new ablation method, (HydroThermalAblation™ by Boston Scientific®), circulates the heated fluid directly in the uterine cavity, bypassing the use of the balloon altogether. This method maintains constant circulation of saline solution heated to 87 degrees Centigrade for 10 minutes. In contrast to the balloon ablation method, this procedure is not limited by the irregularities in the contour or volume of the uterine cavity, thus making it effective in women with large fibroids. It also has the added benefit that it allows the surgeon to maintain constant visualization of the uterine cavity (via a camera) during the entire duration of the procedure.

It is important to note that since the intended purpose of the procedure is to destroy the endometrium, it is not recommended for women who desire future fertility. This procedure will most likely seriously impair the ability to conceive and carry a pregnancy. By the same token, the procedure does not guarantee sterility, and is not intended as a mode of contraception

Laparoscopy

Similar in concept to a hysteroscopy,this technique involves the direct visualization of abdominal and pelvic organs via the introduction of a small fiber optic lens 5-10 mm in size (with a built in light source) into the abdominal cavity. Entry to the abdominal cavity is achieved by making a small incision at the level of the umbilicus (navel), inserting a multipurpose access port, and passing the fiber optic lens through the port into the abdomen. In contrast to hysteroscopy where fluid is used to expand the uterine walls, in laparoscopy, nitrogen gas is used to expand the abdominal walls, and therefore obtain good visualization of the abdominal and pelvic organs.

Additional access ports may be placed in strategic places along the abdominal wall in order to facilitate the passage of multiple specialized surgical instruments. The net effect is to permit the surgeon to perform intra-abdominal/pelvic surgery without the need of a large surgical incision. Again, post operative pain is substantially decreased and post operative recovery time is minimized.

Procedures traditionally performed through “open” incisions are now routinely handled through laparoscopic interventions. Examples of these procedures are diagnostic procedures, destruction of endometriosis lesions, hysterectomies, surgeries for urinary incontinence, removal or drainage of ovarian cysts, removal of ovaries and/or Fallopian tubes, bilateral tubal ligation and evacuation of ectopic (tubal) pregnancies.