Historically, all major surgeries in gynecology were performed in two ways: abdominal – through an incision in the anterior abdominal wall, and vaginal – surgeries through the vagina. Endoscopic methods have spread worldwide since the late 1990s and early 2000s. These methods, based on the use of special optical systems, allow looking inside (abdominal cavity, uterus) and solving the problem with minimal trauma and maximum effectiveness. Nowadays, open abdominal surgeries in gynecology are performed very rarely: only in exceptional cases. The "classic" curettage of the uterine cavity has been completely replaced by hysteroscopy, which is far more efficient and safer.
Plastic surgery continues to improve, with new, more effective labioplasty techniques being used. The treatment of pelvic organ prolapse in some cases is performed laparoscopically, the vaginal approach is being refined, and mesh implants are widely utilized (TVT-o system for urinary incontinence correction, mesh tapes in pectopexy, promontofixation, sacrospinous fixation).
This section presents the main hysteroscopic, laparoscopic, and vaginal surgeries performed by the doctor. A small percentage of surgeries remains performed via open abdominal access when laparoscopy is practically impossible or impractical.
Main surgeries performed by the doctor
and interesting clinical cases
An individual approach to each patient and the ability to create comfortable conditions in the hospital make it possible to achieve the maximum treatment effect.
Hysteroscopy
Today, hysteroscopy is the primary method for diagnosing and treating uterine cavity pathologies. This method is also widely used in infertility evaluations.
Hysteroscopy is performed by introducing an optical system into the uterine cavity, allowing assessment of the endometrial condition, detection of changes, sampling of tissue for research, and evaluation of the uterine walls. Ultra-thin hysteroscopes can be used for this purpose, enabling surgery without dilating the cervical canal and avoiding trauma. Surgeries are performed under both general and local anesthesia.
Examples of surgeries and interesting clinical cases:
Laparoscopy
In modern operative gynecology, laparoscopy has almost completely replaced open surgery. Operations no longer require an incision in the anterior abdominal wall; they are performed through 2–4 small punctures with minimal trauma and significantly better outcomes. Using modern instruments and optical systems allows reducing the hospital stay to 1 day in many cases.
Laparoscopy is frequently used in infertility treatment to check and restore fallopian tube patency, drill or puncture the dense ovarian capsule in polycystic ovary syndrome and anovulation. In the treatment of leiomyoma, temporary compression of uterine arteries has been introduced into practice, enabling large fibroids to be removed effectively with minimal blood loss while fully suturing the surgical bed. The approach to endometriosis treatment has been refined: endometrioma excision is performed with maximum preservation of healthy ovarian tissue using Mannes clamps, subcapsular Remestip injection, and finding the correct surgical plane. The use of mesh implants has significantly improved the treatment of apical prolapse.
Laparoscopic surgery in various gynecological conditions:
Vaginal Surgery
Many gynecological procedures are performed vaginally. These interventions take place on an operating table configured as a gynecological chair. Primarily, these include procedures for pelvic organ prolapse or vaginal wall relaxation, such as anterior and posterior colporrhaphy with levatorplasty and sacrospinous fixation. Vaginal hysterectomy is also routine.
Reconstructive surgeries for congenital genital anomalies include vaginal septum resection in doubled vaginas and neovagina creation in congenital aplasia.
Cervical procedures: reconstruction after birth trauma or scarring, radiofrequency or laser ablation, conization, or trachelectomy for dysplasia and early-stage cervical cancer.
Vaginal surgery also encompasses cosmetic procedures on the labia (labioplasty) for size and shape adjustment, hymenotomy, or hymenoplasty.
Open Surgery
As in the past, open abdominal surgery still holds a place in operative gynecology. These operations are mainly performed in advanced stages of disease, huge uterine fibroids when laparoscopic access is impossible or impractical, or certain oncological conditions—although laparoscopic possibilities continue to expand. Conversion to open surgery is also possible during laparoscopic complications such as severe bleeding.
In most cases, surgical access is made in the lower abdomen along the bikini line (Pfannenstiel incision). The anterior abdominal wall is reconstructed layer by layer using absorbable sutures. At the end of the procedure, skin closure is performed with an intradermal cosmetic suture for optimal esthetic results.