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In-office surgeries mean quicker recovery, less cost and no general anesthesia

by Kevin Fleishman, MD, FACOG

At Premier Women’s Care of Southwest Florida, we place a priority on comfort and convenience for our patients. 

This includes performing in-office procedures that offer the advantages of avoiding hospital visits and general anesthesia, along with a quicker recovery, less post-operative pain and more reasonable costs to patients and insurance companies.

We offer both diagnostic and operative in-office procedures using Level 1 protocols, meaning local anesthesia combined with oral and intravenous pain management. These include diagnostic and operative hysteroscopies, dilation and evacuations, Loop Electrical Excision procedures and colposcopies with biopsies.

Colposcopies are recommended to evaluate abnormal Pap smears and abnormal lesions of the vulva. The way I like to explain it to my patients, colposcopies are like longer Pap smears. We use solutions and microscopy to look for color and pattern changes that might suggest precancers and cancers of the cervix, vagina and vulva. Almost all of these are caused by HPV, or human papillomavirus. Most patients experience very little discomfort with colposcopies. Some feel a small pinch but no severe pain. There is minimal bleeding, and the procedure usually takes less than 5 to 10 minutes.

LEEP stands for Loop Electrosurgical Excision Procedure. We use a LEEP to remove precancerous changes of the cervix that, if left untreated, can become cervical cancer. A LEEP works by passing a mild electric current through a loop-like wire that allows us to remove the abnormal cervical tissue while leaving the normal cervical tissue. We usually block pain in the cervix with local anesthesia. The procedure normally takes only a few minutes, and most patients experience only mild discomfort. Removing the cells also enables us to examine them and determine appropriate follow-up. The results come back in about a week. 

Hysteroscopies involve the use of a thin, lighted tube that allows us to evaluate abnormalities of the endometrium, the innermost lining inside the uterus, in patients with abnormal or heavy periods or postmenopausal bleeding. These abnormalities can include polyps or fibroids, which can be removed as part of the procedure. Hysteroscopic evaluation is much more accurate than blind dilation and curettage, also known as D&C. For instance, a D&C can reach an accurate diagnosis at most 75% of the time and cannot remove the whole lesion, whereas a hysteroscopic-directed evaluation has almost 100% accuracy and can almost always remove the entire pathology. The procedure lasts less than 10 minutes, and with the protocol used at Premier Women's Care of Southwest Florida, most patients have very mild discomfort. 

An endometrial ablation is a procedure indicated for heavy and/or irregular periods. It involves surgically treating the lining of the uterus to reduce bleeding. First, we usually conduct an ultrasound to rule out any other pathology, as well as a biopsy. Premier Women's Care of Southwest Florida is one of the few practices to offer endometrial ablation in the office under local anesthesia. We use the NovaSure radiofrequency endometrial ablation procedure. In general, 60% of patients have no further bleeding, and more than 90% of patients are satisfied with the procedure. At Premier Women's Care of Southwest Florida, we use the latest hysteroscopic equipment and resection technologies and follow strict protocols that result in good outcomes and excellent patient experiences.

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