Mastectomy is surgery to remove all breast tissue from a breast to treat or prevent breast cancer. Breast-conserving surgery (lumpectomy), where only the tumor is removed from the breast, may be another option.

The goals of minimally invasive breast surgery are to reduce the length of incisions, place them where they are least visible, and when possible, place them away from the nipple to minimize effects on blood flow or sensation. This type of surgery is typically performed through smaller, remote incisions that are less obvious.

Here are two examples of minimally invasive breast surgeries

Lumpectomy with breast conserving surgery: Cancer and lymph nodes are removed through a single incision in the underarm. This approach avoids the need for a second incision and hides it where it is less visible and less likely to interfere with nipple function. Just like normal breast cancer surgery, the tumor is removed in one piece with a surrounding border of normal tissue to ensure complete removal.

Skin-sparing mastectomy: Mastectomies are routinely performed through long incisions on the front of the breast. This can interfere with nipple blood flow and produce unsightly scars. Skin-sparing mastectomy is performed through one or two short incisions at the edges of the breast: one in the crease under the breast and sometimes a second in the crease of the underarm. Breast reconstruction is done through these same incisions, during the same procedure.

If your doctor has told you that you need to have a LEEP procedure, it’s because your annual Pap smear showed the presence of abnormal cervical cells. LEEP involves the removal of the part of the cervix affected by precancerous cells.  LEEP is one of several procedures available to help diagnose and treat abnormal cervical cells.

The LEEP procedure takes about 20-30 minutes. Similar to a pelvic exam, you will lie on the exam table with your feet in stirrups. A local anesthetic will be injected into the cervix. A lighted magnifying device called a colposcope will be used to guide your doctor to the affected area. Your cervix will be prepared with solutions that enable the doctor to more easily see the abnormal area.

A wire loop will then pass through the surface of your cervix to remove the lesion. Your doctor will use an electrode to stop any bleeding. You will be able to leave soon after the procedure.

A colposcopy is an examination of the cervix to detect irregularities. Your doctor may also want you to have a colposcopy either before or during the LEEP procedure. The colposcope is a lighted magnifying device. It allows the doctor to see problems that would be missed by the naked eye.

A colposcopy can be used to diagnose:

• Cervical cancer
• Genital warts
• Inflammation of the cervix (cervicitis)
• Precancerous changes in the tissue of the cervix, vulva or vagina
• Vaginal or vulvar cancer

The procedure typically takes 10-20 minutes. Similar to a pelvic exam, you will lie on the exam table with your feet in stirrups. The doctor uses a metal speculum to hold the walls of your vagina open in order to see the cervix.

A bright light is shown into your vagina, and your doctor looks through the lens, as if using binoculars. The doctor may apply a vinegar solution that helps to highlight areas of suspicious cells. A camera can be attached to the colposcope to take pictures or videos to document changes in your condition. You will be able to leave soon after the procedure.

Hysteroscopy is a procedure that allows your doctor to look inside your uterus in order to diagnose and treat causes of abnormal bleeding. Hysteroscopy is done using a hysteroscope, a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus. Hysteroscopy can be either diagnostic or operative.

A hysteroscopy is used both to treat and diagnose abnormal vaginal bleeding. The technology used in this procedure makes it possible to examine the inside of the uterus without making an incision in the abdomen.

Prior to the procedure, your doctor may prescribe a sedative to help you relax. You will then be prepared for anesthesia, which may be local or general.

The doctor will dilate (widen) your cervix to allow the hysteroscope to be inserted. The hysteroscope is inserted through your vagina and cervix into the uterus. Carbon dioxide gas or a liquid solution is then inserted into the uterus, through the hysteroscope, to expand it and to clear away any blood or mucus.

Next, a light shone through the hysteroscope allows your doctor to see your uterus and the openings of the fallopian tubes into the uterine cavity. Finally, if surgery needs to be performed, small instruments are inserted into the uterus through the hysteroscope.

The time it takes to perform hysteroscopy can range from less than five minutes to more than an hour. The length of the procedure depends on whether it is diagnostic or operative and whether an additional procedure, such as laparoscopy, is done at the same time. In general, however, diagnostic hysteroscopy takes less time than operative.

Endometrial ablation destroys the endometrium — the lining of your uterus — with the goal of reducing your menstrual flow.

Each month during menstruation, you shed the lining (endometrium) of your uterus. Endometrial ablation treats excessive menstrual blood loss, which may be indicated by:

• Unusually heavy periods most months
• Enough blood loss to soak through a pad or tampon every hour on the heaviest days
• Anemia from excessive blood loss

Endometrial ablation is done under anesthesia. Using medication, the opening in your cervix is dilated to allow for the passage of the instruments used in endometrial ablation. Endometrial ablation procedures vary by the method used to destroy your endometrium. Options include:

Electrosurgery

This method uses a slender scope to see into the uterus during the procedure. An instrument passed through the scope becomes hot and is used to carve furrows into the endometrium. Electrosurgery requires general anesthesia and generally takes 30 minutes or less to complete.

• Extreme cold. Cryoablation uses extreme cold to create two or three ice balls that freeze and destroy the endometrium. Real-time ultrasound allows the doctor to track the progress of the ice balls. Each freeze cycle takes up to six minutes to complete; the number of cycles needed depends on the size and shape of your uterus.
• Free-flowing hot fluid. Heated saline fluid is circulated within the uterus for about 10 minutes. This method can be more painful than other office-based methods, but it is the method most likely to get complete coverage.
• Heated balloon. A balloon device is inserted through your cervix and then inflated with heated fluid. method takes about 10 minutes to complete.
• In this method, the doctor inserts a slender wand that emits microwaves, which elevate the temperature of the endometrial tissue. Total treatment time is usually three to five minutes.
• A more automated method of endometrial ablation uses an instrument that unfurls a mesh electrode array within the uterus. The mesh transmits radiofrequency energy that vaporizes the endometrial tissue within 80 to 90 seconds.

A hysterectomy is an operation to remove all or part of the uterus. After a hysterectomy, you no longer have menstrual periods and cannot become pregnant. A hysterectomy is the second most common surgery among women in the United States.

Hysterectomy may be the best option if you have uterine cancer in terms of eradication of the cancerous tissue and prevention of recurrence.

There are different ways that your doctor can perform a hysterectomy. It will depend on your health history and the reason for your surgery.

• Abdominal hysterectomy: This is done through a 5- to 7-inch incision in the lower part of your belly. The cut may go either up and down, or across your belly, just above your pubic hair.
• Vaginal hysterectomy: This is done through a cut in the vagina. The doctor will take your uterus out through this incision and close it with stitches.
• Laparoscopic hysterectomy: A laparoscope is an instrument with a thin, lighted tube and small camera that allows your doctor to see your pelvic organs. Your doctor will make three to four small cuts in your belly and insert the laparoscope and other instruments. He or she will cut your uterus into smaller pieces and remove them through the incisions.
• Laparoscopically assisted vaginal hysterectomy (LAVH): Your doctor will remove your uterus through the vagina. The laparoscope is used to guide the procedure.

Recovering from a hysterectomy takes time. For hysterectomies that are performed due to uterine cancer, most women stay in the hospital 3-5 days.

The time it takes for you to resume normal activities depends on the type of surgery. Recovery for abdominal surgery takes 4-6 weeks. Vaginal or laparoscopic surgery takes 3-4 weeks. 

Vaginal taping involves placing a mesh tape (like a sling or hammock) under your urethra to improve support and to keep it in its normal position.

Vaginal taping is designed to provide support for a sagging urethra so that when you cough or move vigorously or suddenly, the urethra can remain closed with no accidental release of urine.

There are two procedures to help with urinary incontinence, each done in slightly different ways:

• Transvaginal Taping (TVT): The doctor makes a small cut in your vagina through to your urethra. He or she then places the tape under the middle part of your urethra. Your body makes scar tissue that grows into the tape and keeps it in place. This gives extra support for your urethra, making it less likely that urine leaks. Tape ends are passed upwards through a space behind your pubic bone. They are brought to the surface through two tiny cuts in your belly, just above the pubic area.
• Transobturator Taping (TOT): In this method, the tape ends are passed sideways through a natural space in your hip bone. They are brought to the surface through tiny cuts just to the side of the lips of the vagina. Unlike the TVT method, the tape doesn’t go near your bladder and cutting your belly can be avoided.

Most patients go home the same day that surgery is performed.