GynoFiles

Most endometriosis is like what is seen in this picture, a small powder burn hidden deep in the pelvis seen at the time of laparoscopy. But some endometriosis is found by the presence of a cyst of the ovary. Indeed that cyst, known as an endometrioma, probably is due to a simple ovarian cyst that is invaded by endometriosis. Cysts are relatively easy to find, the endometriosis shown here is much harder to find. And now a study by the Ovarian Cancer Association Consortium is pointing out the links between ovarian cancer and endometriosis and the importance of controlling endometriosis to help prevent ovarian cancers. Pelvic endometriosis is most often found when evaluating a patient for pelvic pain, infertility, or literally stumbled upon when a woman is getting pelvic surgery for another reason. Endometriosis is common, occurring in 1/10 women. Endometriosis, however is rarely felt on exam, found on an x ray or an ultrasound, unless a woman has a large ovarian mass. For most, this...

For many years we have said that if a woman has one estrogen dependent cancer, she will likely be at risk for others. Cancer treatments also put one at risk for future cancers. So increased vigilance in getting all screenings are important for those with risk as well as those who have had disease. Women with BRCA1 mutations are at risk for developing breast and ovarian cancer, and now a link is suggested for some rarer types of uterine cancer in these patients. Given that all of these cancers may be estrogen dependent in some way, it is biologically plausible that there is an underlying link with the BRCA1 mutation. The reason this is extra important is that women who are  could be at increased risk of developing rare types of aggressive uterine cancer, in addition to their already well-known increased risk for breast and ovarian cancer, a new study shows. Because the link with ovarian cancer, some women have selected to have risk reducing surgery with just taking out the tube...

Much of gyno surgery is done with the aid of carbon dioxide (CO2) in the abdomen so the physician can see well in the pelvis and work freely from the other structures. But as a result the rise of the abdomen, and the tilt of the bed to head down lead to changes of the lung pressures during these surgeries. As a result the lung cannot breath in as much air, and the airways themselves actually get increased pressures in their channels and this leads to more carbon dioxide accumulating in the lungs. Routine use of chest x-rays in studies of patients after these changes that there is some small amount of lung collapse in nearly half of patients that have these surgeries. It may be the anesthesia, the effect of the diaphragm dysfunction, or perhaps pain itself that lead to the lung issues, but probably it is the effect of the gas. Those that do best do not smoke, do not take muscle relaxers or other medications that can interfere with lung function, and exercise regularly so their normal l...

 The first step to getting a pfannenstiel incision, often known as a bikini incision, is a cut in the abdominal skin, , it's just above the hair line. Once the skin is opened it exposes the underlying fat, which may have blood vessels that have to be burned or tied off. In the case of obesity, the overlying fat layer can be quite thick and require a bit of time to open. Then the middle of the fascia layer, known as the linea alba, is opened. Next this whole fascial layer has to be cut, in many cases this can be done bluntly by finger dissection. Many women will have a tiny muscle called the pyramidalis muscle shown here that may have to be dissected off the lower level of the rectus muscle.The rectus muscle runs down the middle of your abdomen. Most pfannenstiel incisions avoid avoid the deep epigastric vessels that are over on the side of the rectus muscles. The next step is working the fascia off the muscles so that a big enough opening for the surgery y...

  People say tummy tuck, and really they are asking about a variety of operations designed to reduce fat, remove extra skin, improve old scars, or generally rearrange the lay of the skin and fat of the lower abdomen. The most bothersome aspect of some weight gain in early adulthood is often just a simple excess of the lower skin. In the most significant cases the excess develops into an overhanging area of tissue. I often get asked if that tissue can get removed at the time of a C-section. The correct term for an operation that removes an area of over-hanging skin is panniculectomy. And it's usually done with a wedge-shaped incision. In the days before prophylactic antibiotics (everyone gets at least a dose or two of antibiotics during their surgeries) infections of the incision at the time of C-section was much more common, and we didn’t want to risk any increased risk with extra surgery. It is also true that much of the abdominal fat is going to resolve naturally and that many...