Greenville Health System (GHS) offers a full array of surgical procedures to meet women’s health needs.
GHS offers many surgical services through Greenville Health System, our multispecialty physician practice. Surgeons in the GHS departments of Surgery and OB/GYN are specially trained in surgeries that are unique to women, including the following:
Prolift® for Prolapsed Pelvic Organs. Pelvic organ prolapse occurs in women when the muscles and tissues that hold the pelvic organs in place begin to weaken. Subsequently, the uterus, bladder and rectum may press against the vaginal walls, causing them to protrude into the vagina. Symptoms include back or pelvic area pain as well as urine leakage or difficulty in starting to urinate. Pelvic organ prolapse also can cause bowel problems, including constipation, or a sensation of vaginal bulging or heaviness. Women who have had multiple vaginal births are at greatest risk for pelvic organ prolapse, which occurs in some form (cystocele, rectocele and/or uterine prolapse) in half of women older than 50.
For women with moderate to severe symptoms, a new surgical technique uses the Gynecare Prolift® Pelvic Floor Repair System to restore the prolapsed organ or organs to a correct position. GHS urogynecologist Jeffrey B. Garris, M.D., FACOG, FACS, was the first physician in the United States to receive certified training on the system, and he has performed more Prolift repairs than any other urogynecologist in the Upstate.
- TVT Secur® for Stress UI. GHS also offers a minimally invasive surgical treatment for stress urinary incontinence (UI), a condition that afflicts up to half of U.S. women on occasion and 10 percent frequently. Stress UI is the unintentional loss of urine during periods of bladder pressure or stress. It occurs with coughing, sneezing, standing and lifting, among other circumstances, and is the most common type of incontinence.
Tension-free vaginal tape (TVT) surgery, also known as suburethral sling surgery, has become the most popular operation to treat moderate to severe stress UI during the past decade. The latest modification of TVT is called TVT Secur.
- InterStim® for Urge UI. For patients who suffer from incontinence when they have the urge to urinate, GHS offers InterStim Therapy, among other treatment options. Described as a pacemaker for the bladder, InterStim Therapy works by sacral neuromodulation.
Developed by Medtronic Inc. and FDA-approved since 1997, InterStim Therapy has been in the mainstream for several years. Dr. Garris is a national InterStim preceptor and one of very few physicians in the Upstate offering this therapy.
Minimally Invasive Hysterectomy
Gynecologists at GHS are experienced in minimally invasive approaches to hysterectomy as well as procedures that provide relief from symptoms that in the past would have required the operation.
There are two traditional types of hysterectomy: abdominal and vaginal. With vaginal hysterectomy, the surgeon makes an incision at the top of the vagina and removes the uterus through it.
“Vaginal hysterectomy tends to be many physicians’ first choice because there is no incision needed on the outside of the body, and there’s a quick recovery time,” said Laura Wang, M.D., FACOG, a GHS gynecologist. “But some women are not candidates for it.”
Some conditions that preclude vaginal hysterectomy include an enlarged uterus (often the result of fibroids), previous operations, history of severe endometriosis with adhesive disease, small pelvis, a malignant or premalignant condition or simply the need for better exposure to the abdomen.
Laparoscopic hysterectomy requires only a small incision near the navel for the insertion of a laparoscope and then other quarter-inch incisions (ports) in the abdomen for other surgical instruments. Benefits include less bleeding and scarring, reduced pain and much shorter hospital stay and decreased recovery time of abdominal hysterectomy.
Three Laparoscopic Approaches
- Total laparoscopic hysterectomy (TLH). This procedure involves removing the entire uterus, including the cervix, through the vagina. The top of the vaginal opening inside the abdomen is then sewn together using instruments inserted through a laparoscope.
- Laparoscope-assisted vaginal hysterectomy. In this operation, the surgeon inserts a laparoscope through the abdomen to inspect the upper abdomen extensively during the procedure. A surgeon might opt for this approach if the patient has pelvic adhesive disease that may have rendered a straightforward vaginal approach unsafe. This technique also may be preferred if the surgeon plans to remove the ovaries. During the procedure, the surgeon uses port access to disconnect the uterus and other structures, which then are removed through the vagina.
- Laparoscopic supracervical hysterectomy (LSH). This less-invasive approach is preferred by surgeons who believe it may be associated with a decrease in future incidence of vaginal prolapse. The surgeon detaches the uterus from the cervix but leaves the cervix and its fibrous support structures intact. The uterus is cut into small strips, which then are pulled out through ports.
William Coleman, M.D., FACOG, and Greg Johnson, M.D., FACOG, of Gynecology Specialists, have performed more LSH and TLH procedures than any other gynecologists in the Greenville area.
Alternatives to Hysterectomy
- Myomectomy. With this operation, the surgeon cuts away large uterine fibroids (myomas), common noncancerous tumors of the uterine musculature, without removing the uterus, so that a woman can maintain her ability to bear children. Removal of the fibroids tends to weaken and scar the uterine wall, so future deliveries may have to be performed by cesarean section. Myomectomy may not be recommended for women who do not desire future fertility or who are menopausal.
- Uterine artery embolization. This minimally invasive hysterectomy alternative preserves the uterus but is not advised for women who want to become pregnant. Sometimes called uterine fibroid embolization, the operation blocks the arteries carrying blood to the uterus as well as the fibroids. Interventional radiologists perform the procedure. The procedure typically relieves heavy menstrual blood loss as well as pelvic pressure and pain caused by large fibroids.
- Endometrial ablation. This operation, which also is not recommended for women who want to bear children, can reduce or stop abnormal uterine bleeding by using electrical energy, heat or cold to destroy the endometrium (tissue lining the inside of the uterus).
For women who desire permanent sterilization but do not want to undergo an abdominal operation, GHS offers the Essure® Micro-Insert System. The first FDA-approved hysteroscopic approach to tubal sterilization, Essure requires no incision or general anesthesia and can be performed in approximately 30 minutes in an outpatient setting.
Laser Vaginal Rejuvenation®
Age, childbirth and other issues can cause the vagina to stretch and its supportive muscles to lose tone and control, diminishing sexual gratification. Laser Vaginal Rejuvenation (LVR®) is a one-hour outpatient surgical procedure that addresses these issues. LVR can decrease the internal and external vaginal diameters as well as build up and strengthen the perineal body – the area immediately outside the vagina and above the anus.
GHS urogynecologist Jeffrey B. Garris, M.D., FACOG, FACS, performs LVR and the companion procedures of Designer Laser Vaginoplasty® (DLV®). DLV operations are intended to aesthetically enhance the vulvar structures. Dr. Garris was trained in both LVR and DLV by Los Angeles-based gynecologic surgeon David Matlock, M.D., who pioneered the procedures.
Minimally Invasive Surgery
Technology in gynecologic surgery is ever-changing. We offer the latest in techniques including:
Total Laparoscopic Hysterectomy
Laparoscopic Supracervical Hysterectomy
Essure® Permanent Birth Control
Endometrial Ablation Procedures
Vecchietti Procedure for Vaginal Agenesis
Each year about one in 4,500 women is born with vaginal agenesis, a condition in which the vagina is absent or shorter than normal. Also known as Mayer-Rokitansky-Kuster-Hauser Syndrome, vaginal agenesis may occur in isolation or with the absence of the cervix and uterus. It usually is diagnosed in girls age 15 to 18 who have not yet begun to menstruate.
The laparoscopic Vecchietti procedure for addressing vaginal agenesis has been widely accepted in Europe since the 1980s but has remained less familiar in the United States. GHS is one of the few U.S. hospital systems to offer this procedure, which is performed by physicians of the Division of Reproductive Endocrinology & Infertility (REI), part of GHS –Department of OB/GYN. Paul B. Miller, M.D., FACOG, an REI specialist with the group, initiated the laparoscopic Vecchietti procedure in the Upstate.
In many cases of pelvic pain and infertility, women may have conditions inside their bodies that require surgical evaluation rather than medical treatment alone. Typically, this type of evaluation is performed using a telescope inserted through the navel (laparoscopy) while the patient is asleep and under anesthesia. A small amount of carbon dioxide gas in infused into the abdominal cavity to improve visualization of pelvic and abdominal organs. In some cases, the extent of the surgery may be limited to simply flushing colored fluid through the cervix and uterus and out through the fallopian tubes. In other cases, complicated procedures such as myomectomy (removal of fibroids), resection of endometriosis, and even tubal reanastomosis (untying of tubes) can be completed using the laparoscope. In all but a few cases, patients are sent home on the same day as their surgery and are able to return to work in a fraction of the time that it would take if their procedure were completed via an open abdominal incision.
The doctors in the GHS Division of Reproductive Endocrinology & Infertility have trained with nationally known surgeons and have developed their own new techniques for improving patient outcomes. Hundreds of patients pass through our surgery program yearly, each receiving individualized care based on their underlying condition.
Sometimes problems related to infertility, bleeding, miscarriage, or pain can be due to abnormalities inside the uterine cavity. In such cases, the best way to evaluate and treat patients is with a procedure called hysteroscopy. Hysteroscopy involves inserting a small (approximately 5 mm) telescope through the cervix and into the uterus while clear, sterile fluid is used to push the front and back walls of the uterus away from each other. Using this technique, abnormalities like polyps (benign growths from the uterine lining) or fibroids (benign muscle tumors arising from the wall of the uterus) can be diagnosed and treated. Hysteroscopy may also be used in cases where women have an abnormal shape to their uterus (e.g., septum) to correct this potentially devastating condition.
Many hysteroscopic procedures can be completed successfully in the office with little discomfort, preventing the loss of work and recovery time that often comes with procedures performed in an operating room.
Fibroids are benign muscle tumors arising in the wall of the uterus that can cause heavy bleeding, menstrual cramping, pain, infertility, and miscarriage. In our center, women diagnosed with fibroids undergo comprehensive evaluation with sonohysterography, a procedure where sterile fluid is squirted into the uterus through the cervix during a vaginal ultrasound exam. Using the latest ultrasound technology, computer-driven, 3-D images can be created that allow the doctor to know the exact size and location of the fibroids. This assists them in counseling patients about future risks and the possible need for treatment.
For many women, treatment of uterine fibroids is accomplished by surgical removal, either by laparoscopy or an open abdominal incision. The goal of both approaches is to reduce the number of fibroids and restore normal anatomy as best as possible. With years of expertise in laparoscopic treatment, we currently remove fibroids through abdominal incisions in less than ten percent of cases. The advantages of laparoscopy are less scar tissue formation and faster return to normal activities afterward.
In cases where women have symptoms of bleeding or pain due to fibroids and do not wish to have more children, they may be referred to consultants in the Department of Interventional Radiology for shrinkage of fibroids using a technique called uterine artery embolization. This procedure involves insertion of a small catheter into a vein in the neck or groin, similar to the ones that are used for heart catheterization. In this case, the catheter is inserted into the blood vessels that supply the fibroids where they are used to make permanent blockages to blood flow. In this way, the fibroids are deprived of essential nutrients and oxygen, causing them to shrink or die off. While this procedure is not for everyone, it is part of the full list of choices available to our patients.
Reversal of Tubal Ligation
Many women undergo tubal ligation as a form of permanent sterilization during their reproductive years. Unfortunately, social situations may change, leading to a desire to have the tubes "untied" to allow for more children. GHS Division of Reproductive Endocrinology and Infertility doctors have received special training to perform this delicate form of surgery successfully, sometimes through a small incision in the lower abdomen, other times using a laparoscope. The choice of which technique to use depends on the way in which the tubes were ligated. Regardless, couples who pursue this option for pregnancy enjoy pregnancy rates of 60-75%. In some cases where reversal is not possible, couples may be referred to our in vitro fertilization program where fallopian tubes are "bypassed" by the procedure.