Surgery

Bilateral Salpingo-Oophorectomy

Used primarily to treat gynecological cancers and in rare cases pelvic inflammatory disease, a bilateral salpingo-oophorectomy can also be conducted during a hysterectomy. During this procedure, the surgeon removes both of your ovaries as well as the fallopian tubes. Because this surgery will bring on the onset of menopause, it is a serious decision for a woman to make. The doctors at Florida Hospital’s Center for Advanced Gynecologic Surgery will discuss this option with you in great detail so that you understand why it’s needed and what kind of follow-up care will be required to offset the effects of menopause.

Cone Biopsy

A cone biopsy can be used to perform diagnostics as well as a treatment itself. If a Pap smear indicates abnormalities, a cone biopsy may be taken to see if the cells are cancerous or not.  During a cone biopsy, your physician will remove a cone-shaped wedge of tissue. The goal is to remove the abnormal cells as well as the healthy tissue surrounding it. If all the abnormal cells were removed during the cone biopsy, it is considered a treatment and no further procedures are required.

Doctors at Florida Hospital routinely perform cone biopsies and our labs can quickly assess the sample to see if there are precancerous or cancerous conditions that need additional follow-up. The procedure itself is pretty straightforward and is performed on an outpatient basis. You are under general anesthesia during the entire procedure. Once the cone biopsy is complete, the surrounding tissue is either stitched back together or cauterized.

Cryosurgery

Also known as cryotherapy, this procedure uses extremely cold temperatures to kill abnormal cells or diseased tissue. Usually, liquid nitrogen or argon gas is used to create the freezing temperatures, which can sometimes be -50 degrees Celsius. The super cold temperatures cause ice crystals to form inside the tissue, causing the cells to break apart.

During cryosurgery, the liquid nitrogen or argon gas is routed through a hollow tube known as a cryoprobe. This device is placed in contact with the area that needs to be frozen. As ice crystals form around the probe, the nearby cells are frozen. These frozen cells are absorbed naturally into the body as they die off. It is a fairly non-invasive procedure that offers surgeons at Florida Hospital a very precise method of killing problem areas while leaving the surrounding healthy tissue untouched. For patients who are not good candidates for more invasive procedures, cryosurgery may be the best option. If your age or other medical conditions prevent you from having traditional surgery, your doctor at Florida Hospital may discuss the use of cryosurgery.

Cryosurgery is effective for many internal disorders, including cervical cancer. Researchers are also looking into the effectiveness of cryosurgery in treating breast cancer. As a leading research facility, Florida Hospital has access to new innovations in cryosurgery as they emerge from the world’s premier labs and regularly conducts clinical trials of these new approaches at the hospital.

Hysterectomy

Doctors at Florida Hospital are highly skilled in performing hysterectomies, including a minimally invasive hysterectomy.

There are two basic types of hysterectomies, a simple hysterectomy and a total hysterectomy. In a simple hysterectomy, the tissues surrounding the uterus, sacrum and vagina are left intact. In a total hysterectomy, these are removed.

At Florida Hospital, surgeons perform hysterectomies in one of three ways. The traditional approach is to make an incision in the abdomen and remove the tissues through the opening. This is known as an abdominal hysterectomy. Surgeons at the hospital also perform vaginal hysterectomies where the tissues are removed through the vagina using laparoscopic tools and techniques.

The hospital helped pioneer robotic hysterectomies and this has proven particularly successful. After making a series of small incisions, microscopic tools are inserted and the surgeon manipulates them robotically, viewing the entire surgical environment in high definition 3-D. The result is a highly precise, minimally invasive surgery that leaves the surrounding tissues and nerves alone.

The benefits of laparoscopic and robotic surgery are a far shorter stay in the hospital and fewer complications, including less blood loss, pain and scarring.

Hysterectomy with Bilateral Salpingo-Oophorectomy

During your hysterectomy, your surgeon may elect to conduct a bilateral salpingo-oophorectomy at the same time. This means that both of your ovaries as well as your fallopian tubes will be removed along with the other tissues in a simple or total hysterectomy.

Laser Surgery

Laser surgery can be used for a number of health issues, including killing vaginal cancer and cervical cancer, ablating the pelvic region to reduce pelvic pain, removing the growths found in endometriosis or eliminating uterine fibroids.

Laser therapy can be used alone or in combination with other treatments, including chemotherapy and radiation therapy. Using a narrow beam of intense light that is contained in a flexible endoscope, surgeons at Florida Hospital are able to vaporize the cells with tremendous precision. As a result, lasers can often be an effective substitute for traditional surgical tools, as they cause less damage to surrounding tissues and patients usually experience less pain, bleeding, swelling and scarring.

Because of its minimally invasive nature, laser surgery is conducted at Florida Hospital on an outpatient basis. If laser surgery is a possibility, your doctor will review the procedure in greater detail and go over the benefits and predicted outcomes with you prior to laser surgery.

Lymph Node Surgery / Lymphadenectomy

If you suffer from cancer, surgeons at Florida Hospital may need to remove the lymph nodes in the region. After performing a lymph node dissection to see if the nodes indeed contain cancer cells, the decision will be made to remove the lymph nodes using a procedure known as a lymphadenectomy.

A lymphadenectomy is a complex procedure that requires the skill of a highly experienced surgical oncologist. At Florida Hospital our team of surgeons is skilled in removing the lymph nodes that are cancerous. This is an important step in preventing the further spread of cancer, since cancer can use the lymph system to spread into other parts of the body. Removing the affected lymph nodes can reduce the speed at which the cancer spreads, allowing doctors to follow-up with chemotherapy or radiation therapy to kill remaining cancer cells.

A lymphadenectomy is performed at Florida Hospital by a surgical oncologist. During the surgery you will be under general anesthesia so that you can be comfortable and at ease during this delicate procedure, which is often conducted during other cancer procedures.

After surgery your doctor will review the outcome with you and give you additional instructions for post surgery care, which can include additional therapies, including chemo and radiation.

Omentectomy

During your hysterectomy or oophorectomy, your surgeon may elect to remove the fold of abdominal tissue known as the omentum. It contains blood vessels, nerves, lymph vessels and lymph nodes. This procedure is usually conducted in cases of uterine endometrial cancer or ovarian cancer, as the cancer can spread to this region through the lymphatic system.

Partial Colectomy

If you have ovarian cancer or endometrial cancer doctors at Florida Hospital may need to remove part of your colon, if it also becomes cancerous. This procedure is known as a partial colectomy and is usually performed during other cancer surgery. Utilizing laparoscopic tools or by performing open surgery, your surgeon will remove the affected part of the colon. After it is removed, your surgeon will then rejoin the remaining portions of the colon using a procedure called anastomosis.

Following surgery, you will need to spend a few days to a week in the hospital, particularly if the partial colectomy was part of your cancer surgery.

Pelvic Exenteration

A pelvic exenteration is a very complex and involved surgical procedure that requires tremendous skill and expertise. It is used to treat vaginal cancer, when other forms of treatment have not proven effective. At Florida Hospital’s Center for Advanced Gynecologic Surgery we have an experienced surgical team that can tackle this major surgery that involves the removal of the urinary bladder, urethra, rectum and anus as well as the vagina, cervix, uterus, fallopian tubes, ovaries, and in some cases, the vulva. After pelvic exenteration, the urinary and intestinal tracts can be reconstructed to allow waste to be evacuated. The vagina can also be reconstructed by a plastic surgeon after you have recovered from the pelvic exenteration.

Radical Local Excision

Used to treat vulvar cancer, radical local excision involves the removal of cancerous growths as a well large amount of the surrounding healthy tissue. The goal is to remove enough of the area to ensure that there is no cancer remaining. In some cases, your surgeon may also remove some of the lymph nodes.

Splenectomy

In cases of ovarian cancer and uterine endometrial cancer, surgeons may need to remove the spleen if the cancer has mastesized and has moved into the spleen. Surgeons at Florida Hospital can perform a splenectomy one of two ways. The traditional method is an open procedure, where an incision is made in the left middle of the belly, just below the ribs.

Alternately, your surgeon may be able to remove the spleen laparoscopically. This minimally invasive surgery uses much smaller incisions to allow a scope with a video feed and small instruments to be inserted. As the surgeon watches the video images, the spleen can be surgically cut and removed through one of the small incisions. The benefit of this minimally invasive procedure is greatly reduced recovery time and fewer complications. If you’re facing a splenectomy, your Florida Hospital surgeon will be happy to discuss surgical options with you as well as expected outcomes of each approach.

Total Hysterectomy

In contrast to a simple hysterectomy where the connective tissue surrounding the uterus, sacrum and vagina remains, in a total hysterectomy the surgeon removes these as well.

Increasingly, surgeons at Florida Hospital’s Center for Advanced Gynecologic Surgery are utilizing our state-of-the-art robotic surgical system to perform hysterectomies. The da Vinci® robotic system allows the surgeon to use micro-instruments to perform the surgery with extreme accuracy. Viewing the surgical field with high definition, real-time 3-D, the surgeon can surgically remove these tissues using a technique that is minimally invasive, causes less pain and leaves little scarring, especially when compared to an abdominal hysterectomy, which used to be the standard procedure. Florida Hospital was one of the pioneers of the robotic hysterectomy so today we have some of the best surgeons in robotics right here.

Vaginectomy

In cases of vaginal cancer it may become necessary to remove part or all of the vagina. This is known as a vaginectomy. If only part of the vagina needs to be removed, it is called a partial vaginectomy. Removal of the entire vagina is known as a total vaginectomy. If the vagina is removed as well as the supporting tissues, it’s a radical vaginectomy.

Depending on the nature of the disease and your prognosis, you may be scheduled for reconstructive surgery with a gynecologic oncologist and a plastic surgeon at Florida Hospital to rebuild your vagina. Our goal is to recreate an artificial vagina that is cosmetically pleasing and functional so you can enjoy life to its fullest, including sexual intercourse.

Vulvectomy

When the vulva is affected by vulvar cancer, it may have to either skinned or removed entirely. Surgeons at Florida Hospital have four options available. The course of treatment depends on the nature of the disease:

• Skinning vulvectomy: In this procedure, your surgeon will remove the top layer of the vulva skin that is cancerous. Skin grafts from other parts of the body may be used to restore the area.

• Simple vulvectomy: Surgeons at the Florida Hospital surgically remove the entire vulva.

• Modified radical vulvectomy: In addition to the vulva, the surgeon removes some of the tissue surrounding it.

• Radical vulvectomy: In a radical vulvectomy, the surgeon not only removes the vulva but the clitoris and surrounding tissue as well. If the lymph notes are involved, these may also be removed.

Wide Local Excision

Similar to the radical local excision that is used to treat vulvar cancer, a wide local excision removes the cancerous tissue and a small margin around it of normal tissue.  The lymph nodes are not removed.