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GYN conditions can lead to acute, chronic, or cyclic pelvic pain. Women who have endometriosis, fibroids, adenomyosis, and other complex GYN conditions often suffer with pain during their menstrual cycle. If left undiagnosed, pain can become ongoing. Pain can be also associated with urination, defecation, and physical activity or intercourse. Pelvic pain can be moderate to severe depending on many factors including the underlying condition and its severity. Pain can be caused by the intestines (gastrointestinal), the bladder (urologic), the reproductive organs (gynecologic), pelvic muscles and joints (musculoskeletal), and mental health issues (psychological).
It is important to find a GYN specialist who is an expert in diagnosing pelvic pain to avoid further complications. The wrong treatment can make some conditions worse.
The CIGC Laparoscopic GYN Specialist Advantage
The CIGC laparoscopic pelvic pain specialists have made a commitment to diagnosing conditions that can cause pelvic pain, and performing the most minimally invasive procedures with advanced, modern techniques. Even the most complex GYN surgeries at CIGC are performed with exceptional outcomes.
DualPortGYN® and LAAM-BUAO® (laparoscopic assisted abdominal myomectomy) were developed to improve patient outcomes of GYN surgery. DualPortGYN and LAAM® take advantage of advanced surgical techniques that enhance the safety of each procedure.
The CIGC Laparoscopic Gynecologic Techniques
- DRASTICALLY REDUCE SURGERY TIME
- DECREASE THE NUMBER & SIZE OF INCISIONS
- REDUCE RECOVERY TIME & PAIN
- ALLOW PATIENTS TO RETURN HOME THE SAME DAY
What Causes Pelvic Pain?
Gyn Conditions That Cause Pelvic Pain
Gynecologic causes account for approximately 20 percent of pelvic pain.
- Endometriosis: This is the most common cause of GYN pain and is present in about 70% of women with chronic pelvic pain.
- Pelvic Inflammatory Disease (PID): PID is infection of the tubes, ovaries, and uterus and is caused by an untreated sexually transmitted infection.
- Pelvic Adhesions (scar tissue): Dense adhesions from infection, endometriosis, or prior surgery can cause chronic pelvic pain. Adhesions involving the bowel can cause abdominal bloating, constipation, and pain. Adhesions involving the uterus and the bladder are found in patients with multiple cesarean deliveries.
- Adenomyosis: This condition causes heavy bleeding and pain with menstruation. Pain is due to bleeding and swelling of endometrial cells in the uterine muscle.
- Ovarian Tumor or Pelvic Mass: An abnormal growth on the ovary or in the pelvis can cause pain. The pain can be caused by twisting of the ovary or pressure of the mass on surrounding organs.
- Fibroids: Large fibroids can cause pressure. Acute pain can occur with degeneration (dying), twisting, or expulsion of the fibroid through the cervix.
What Are The Symptoms Of Pelvic Pain?
Pelvic pain can be acute (sudden), chronic, intermittent, or cyclic in nature. Cyclic pain is usually associated with the menstrual flow. Pain can also be associated with urination, defecation, physical activity or intercourse.
Diagnosing GYN Conditions That Cause Pelvic Pain
Gyn Conditions That Cause Pelvic Pain Are Diagnosed In Multiple Ways
Due to many causes of pelvic pain, diagnosis can be difficult. Medical history, physical examination, psychological assessment, and counseling may require several visits to get a complete diagnosis.
Radiological: Identifying Masses
- Pelvic Ultrasound: Can identify pelvic masses, ovarian cysts and fibroids. (Less reliable for distinguishing between benign and malignant masses, or diagnosing adenomyosis).
- MRI: Adenomyosis, clarifying abnormalities on ultrasounds.
- CT Scan: Diverticular disease, pelvic masses, colon or bladder masses.
Laboratory Studies: Tests For Infection Or Pregnancy
- Blood tests
- Urine tests
- Sexually transmitted infection tests
Laparoscopic Diagnostic Surgery: Endometriosis, Pelvic Adhesions
Endometriosis and pelvic adhesions (scar tissue) cannot be diagnosed by radiological or laboratory studies. In cases where pain persists and non-invasive testing fails to confirm diagnosis, a laparoscopic procedure is necessary. If any abnormality is identified, it can be treated at the same time.
Additional Scope Tests: Cystoscopy And Colonoscopy Are Performed To Evaluate Non-GYN Causes Of Pelvic Pain
- Cystoscopy is performed to rule out a urological disorder with a thin camera inserted into the bladder.
- Colonoscopy is performed to identify colon tumors or inflammatory bowel disease.
What Are The Treatment Options For Pelvic Pain?
Pelvic pain treatment is based on the underlying cause. More than one condition can be the cause of pelvic pain. That’s why it is important to seek a GYN specialist who will work with other specialists to ensure a proper program of treatment.
Medical Treatment Options
- Pelvic Inflammatory Disease: Treated with broad-spectrum antibiotics. In some cases, a patient requires hospitalization for IV antibiotics.
- Urinary Tract Infection (Bladder or kidney infection): Oral antibiotics are prescribed for specific bacteria found during a urine analysis. Recurrent bladder infections sometimes require daily antibiotic therapy for suppression. Hospitalization and IV antibiotic therapy are required in cases of complicated kidney infections.
- In some cases, GYN conditions like endometriosis and fibroids may have hormonal protocols before surgical treatment.
Surgical Treatment Options
Hysterectomy: Patients who are not interested in future child bearing, and who desire a permanent solution to some conditions that cause pelvic pain may consider a laparoscopic hysterectomy.
In most cases, hysterectomy refers to removal of the uterus only. At CIGC, frequently, the cervix and fallopian tubes are also removed. If the ovaries are not removed they can continue to make estrogen, the female hormone. This can prevent patients from going into menopause. Common conditions that can be treated with hysterectomy include:
- Endometriosis (along with laparoscopic endometriosis excision)
- Endometrial Hyperplasia
- GYN Cancers
Learn more about the DualPortGYN hysterectomy.
Myomectomy: A laparoscopic myomectomy preserves fertility while removing fibroids from the uterus. A CIGC LAAM myomectomy is an advanced technique that makes it possible to have a thorough fibroid removal with a rapid recovery. Learn more about the LAAM myomectomy. In some cases, doctors may treat the symptoms rather than the condition if a diagnosis cannot be confirmed.
Resection of Pelvic Adhesions: Laparoscopic removal of scar tissue is the most effective in patients with dense adhesions and adhesions involving the bowel. In cases of mild adhesions cutting down of adhesions may not treat the pain and other
causes of pain need to be considered. If scar tissue is caused by multiple cesarean deliveries, a hysterectomy may be necessary to avoid adhesion reformation and additional surgery.
Ovarian Cystectomy: Ovarian cystectomy refers to the removal of an ovarian cyst or tumor while preserving the ovary. Every effort is made to preserve the ovary for patients who desire fertility. Cysts or ovarian masses that are suspected to be cancerous may require complete removal of the ovary to avoid rupture. The CIGC laparoscopic ovarian cystectomy is an outpatient procedure, with excellent pain control and rapid recovery. Most patients are back to work within seven days.
Laparoscopic Uterosacral Nerve Ablation (LUNA): This procedure destroys the uterine nerve fibers located in the uterosacral ligament. A 2cm segment of the uterosacral ligament is removed. This procedure is used in patients with unexplained pelvic pain, and the removal of the uterine nerves is thought to help relieve the pain. Some studies have shown that patients with unexplained painful periods remained pain free for 12 months following the procedure. Success rates of this procedure de-cline rapidly over several years, possibly due to the regrowth of nerves.
Laparoscopic Presacralneurectomy (LPSN): LPSN is the resection of the group of nerves (sacral nerve plexus) located in the pelvis that are thought to cause pelvic pain. This procedure is technically more difficult than LUNA because of the presence of large vessels and ureters near that area of dissection. This procedure is considered most effective for relieving pelvic pain located in the middle of the pelvis versus the right or left side. LPSN is more effective than LUNA for unexplained menstrual pain. As with LUNA, success rates decline over several years due to the regrowth of nerves.
- Physical Therapy
- Trigger-Point Injections
- Local Anesthetic Patches
- Behavioral and relaxation therapies
- Nerve Stimulation
DualPortGYN Minimally Invasive Technique For All GYN Conditions
The state-of-the-art techniques used in the DualPortGYN surgeries create a safer procedure so that women can have surgery and return home the same day. Laparoscopic procedures that can be performed with DualPortGYN include hysterectomy, endometriosis excision, ovarian cystectomy and other minimally invasive GYN procedures.
The CIGC minimally invasive specialists are able to perform complex surgeries while ensuring the patient has an exceptional procedure with fast recovery. After a DualPortGYN laparoscopic GYN procedure, Most patients can return to normal activity, including work and school, in about 1 week. All patients should follow the recovery recommendations specifed by their surgeon.
Two 5 MM Incisions
One at the belly button
One at the pubic bone
Recovery is fast
Approximately 1 week
A Safer Minimally Invasive GYN Surgery
LAAM Minimally Invasive Fibroid Removal for Fertility – An Advanced Laparoscopic Myomectomy
The CIGC state-of-the-art LAAM procedure is one of the most advanced fibroid removal techniques available for maintaining fertility. This procedure is only performed on women who are able to maintain fertility.
LAAM CANDIDATES ARE:
- Women age 45 and younger with fibroids who are able to maintain fertility.
- A woman’s age is the single most important factor affecting her fertility. Fertility decreases exponentially after 40. (Age 40, the chance of conceiving is about 5%. At age 43-44 the chance of conceiving with IVF is 1%.)
- A myomectomy is not recommended for women who are unable to maintain fertility or who are no longer interested in childbearing.
- There is a higher risk of a patient needing future surgery after a myomectomy, exposing them to additional anesthesia, additional recovery time.
- If childbearing is no longer possible or desired, a hysterectomy for fibroids is a cure, eliminating the need for future surgery.
- Women with fibroids who have pre-arranged for a donor egg or IVF options.
- Depending on the viability of the uterus, it is possible for some women over the age of 45 to conceive with IVF or with donor eggs.
- These arrangements must be made and confirmed prior to consulting with a CIGC surgeon.
LAAM makes it possible to remove small and large fibroids while preserving the uterus using just two small incisions. LAAM is a hybrid technique that combines the best of laparoscopic and open myomectomy procedures. The incisions are small (one 5 mm incision at the belly button, and one 3 cm incision at the bikini line) and the fibroids are thoroughly removed.
The combined techniques retroperitoneal dissection, uterine artery ligation/occlusion, and strategically placed incisions set LAAM apart from all other fibroid removal techniques. The CIGC specialists use these advanced techniques to ensure a safe, thorough and effective procedure, and recovery is fast. Most patients can return to normal activity, including work and school, in about 10-14 days. All patients should follow the recovery recommendations specified by their surgeon.
- The smaller incisions help with faster healing, compared to open or robotic procedures that have longer recovery times. Robotic procedures can take up to 4 weeks for recovery. Open procedures can take up to two months for recovery.
- The lower incision allows the surgeon to feel all of the fibroids in the uterus for a thorough procedure. It is important to remove all of the fibroids from the uterus. If fibroids are left behind, they can grow and continue to cause problems, which may result in the patient needing additional procedures.
LAAM techniques outperform other standard laparoscopic techniques. Non-LAAM laparoscopic myomectomy procedures can leave fibroids behind, either because they are small and missed by the surgeon, or because blood loss is not well controlled and the procedure has to be stopped for the safety of the patient. Open procedures can cause long painful recoveries, and create extensive pelvic adhesions. Myomectomy procedures that do not use RP Dissection or Uterine Artery Ligation have higher risks of complications.
NOTE: LAAM minimally invasive myomectomy is performed on women who are able to maintain fertility. When fertility is no longer a viable option (1% or less), and fibroids interfere with day-to-day activities, a myomectomy is not recommended due to the potential for the need for future surgery. With any myomectomy procedure, fibroids can return. Performing fibroid removal alone (a myomectomy), versus removing the uterus (hysterectomy), when fertility is no longer possible increases the risks to the patient. Women 45 or over, unless they have arranged to have a donor egg prior to having fibroid removal, should consider the benefits of a hysterectomy to ensure fibroids do not grow back.
Two small incicions
5 mm incision at the belly button; 1.5 in incision at the pubic bone
Approximately 10-14 days
Trying To Conceive
Patients are required to wait a minimum of six months after myomectomy before trying to conceive. The layers of the uterus must heal properly. This is essential for ensuring a safe pregnancy. All patients should follow the recovery recommendations specified by their surgeon.
TRYING TO CONCEIVE
Patients are required to wait a minimum of six months after myomectomy before trying to conceive. The internal layers of the uterus must heal properly. This is essential for ensuring a safe pregnancy. All patients should follow the recovery recommendations specified by their surgeon.
ADVANCED LAPAROSCOPIC GYN SURGERY TECHNIQUES MAKE IT POSSIBLE TO RETURN HOME THE SAME DAY & RECOVER FASTER WITH LESS PAIN
- Return home same day
- Less pain
At CIGC, controlling blood loss and improving visibility makes it possible for our advanced laparoscopic GYN specialists to perform minimally invasive outpatient surgery for complex GYN conditions that may normally be performed as open procedures by non-laparoscopic surgeons.
The incisions used for the CIGC surgeries are very small, and placed in the midline, away from the abdominal muscles. The size and placement of these incisions allows patients to feel better faster.
CIGC never uses electronic morcellation techniques with any of its procedures, including the DualPortGYN technique for hysterectomies as well as for removal of fibroids during myomectomies.