Surgical Treatments Guide

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A practical guide to office procedures, day surgeries, laparoscopic operations, V-NOTES, prolapse surgery, and gynecologic emergencies.

Guide Intro

Surgical treatment is not limited to the day of the procedure itself. Good outcomes depend on correct patient selection, appropriate planning, safe technique, and structured follow-up after treatment. From office procedures that can be performed without anesthesia to day surgeries, minimally invasive operations, and gynecologic emergencies, each intervention should be tailored to the patient's needs.

This guide brings together the main topics from IUD and implant placement to hysteroscopy, LEEP, curettage, cesarean delivery, cerclage, laparoscopic surgery, V-NOTES, tubal ligation, vaginal hysterectomy, prolapse surgery, and genital aesthetic procedures. The content is educational and should not replace direct physician evaluation or treatment planning.

Topic

Office-Based Procedures Without Anesthesia

IUD Insertion

An intrauterine device (IUD) is a highly effective, long-acting, reversible contraception method placed inside the uterus. It is usually inserted by an obstetrician-gynecologist during a short office procedure. Because it does not require daily medication and provides long-term protection, it is a practical and reliable option for many patients. Fertility usually returns quickly after removal.

Insertion is often planned during menstruation or shortly after bleeding ends, when the cervix may be slightly more open and pregnancy can be excluded more easily. The procedure usually takes only a few minutes. Some patients feel short cramp-like pain during insertion, but most return to daily life immediately afterward.

Copper IUD Options

Copper IUDs do not contain hormones. They work mainly by changing the uterine environment and impairing sperm motility, which helps prevent fertilization. Depending on the model, they may remain effective for approximately 5 to 10 years.

They are often a good option for patients who do not want hormones or are not suitable candidates for hormonal contraception. They can also be used during breastfeeding. However, in some patients they may increase menstrual bleeding or menstrual cramps, so patient selection is important.

Hormonal IUD

A hormonal IUD releases a low dose of levonorgestrel. It helps prevent pregnancy by thinning the uterine lining, thickening cervical mucus, and making it harder for sperm to reach the uterus. It is highly effective and may provide protection for around 5 years depending on the model.

One of its major benefits is that it often reduces menstrual bleeding. In some patients, periods become much lighter or may even stop completely. For this reason, hormonal IUDs may also be preferred in patients with heavy menstrual bleeding, painful periods, or endometriosis-related complaints.

Subdermal Implant Insertion

A subdermal implant is a thin, flexible rod placed under the skin of the inner upper arm to provide long-acting contraception. It contains a low dose of progesterone and gradually releases the hormone over time. Because it does not require daily use and provides very high contraceptive protection, it is considered a modern and reliable method.

The implant is usually inserted under local anesthesia through a short office procedure and is effective for about 3 years depending on the product. It is also suitable for breastfeeding patients and for those who cannot use estrogen-containing contraceptive methods.

The most common side effect is change in bleeding pattern. Some patients develop irregular spotting, while others have much lighter periods or no bleeding at all. This is usually not harmful, but should be explained before insertion.

Cervical Polyp Removal (Cervical Polypectomy)

Cervical polyps are usually benign tissue growths that extend from the cervical canal. They are often noticed during routine gynecologic examination, but may also cause intermenstrual bleeding, postcoital spotting, or vaginal discharge.

Removal can usually be performed in the office without anesthesia. The polyp is gently grasped with an instrument and rotated around its stalk until it is removed. The procedure is short and usually causes only mild, cramp-like discomfort. The tissue is then sent for pathology.

Colposcopy and Cervical Biopsies

Colposcopy is a diagnostic procedure that allows magnified examination of the cervix, vagina, and sometimes the vulva. It is commonly recommended after an abnormal smear test, a positive HPV result, or a suspicious cervical appearance. The aim is to identify abnormal areas more clearly and obtain targeted biopsies when needed.

The procedure is performed in the office and usually does not require anesthesia. Special solutions are applied to the cervix so abnormal areas become more visible. If necessary, small tissue samples are collected for pathology. Colposcopy is one of the most important tools in the early detection and prevention of cervical precancerous lesions and cervical cancer.

Genital Wart (Condyloma) Treatments

Genital warts are contagious skin lesions caused by human papillomavirus (HPV). They may appear as single or multiple lesions, can enlarge over time, and may lead to itching, irritation, or cosmetic concern. The aim of treatment is to remove visible lesions, reduce spread, and improve quality of life.

Laser ablation is one of the effective options, especially in patients with multiple, recurrent, or anatomically sensitive lesions. Laser energy vaporizes wart tissue in a controlled way and minimizes damage to surrounding healthy tissue. Cryotherapy may also be used in selected smaller lesions.

Even after treatment, HPV may remain in the body, which means recurrence can occur. For this reason, follow-up, immune support, and vaccination when appropriate remain important parts of care.

Genital Laser and Aesthetic Applications

Genital laser and aesthetic procedures are designed to improve both function and appearance in the female genital region. Pregnancy, childbirth, aging, hormonal changes, and genetic anatomy can all contribute to tissue laxity, dryness, pigmentation differences, or shape-related concerns.

Laser applications can stimulate collagen production and tissue renewal. In selected patients, they may help with mild vaginal laxity, vaginal dryness, or selected complaints related to comfort and quality of life. Aesthetic procedures such as labial reshaping, tissue contouring, postpartum scar revision, and external genital rejuvenation are planned individually.

Genital Lightening

Genital lightening refers to procedures intended to reduce hyperpigmentation in the external genital region and make skin tone appear more even. Darkening in this area can be related to hormones, pregnancy, childbirth, friction, hair-removal methods, aging, and genetic factors.

Laser-based pigment treatments are among the most commonly used approaches. These procedures are planned carefully according to skin type, tissue sensitivity, and expectations. Since this is an aesthetic rather than a medical necessity, realistic goals and appropriate patient selection are essential.

Vaccinations (HPV, Pregnancy Vaccines, Rh Immunoglobulin)

Vaccination is an important preventive part of gynecologic and obstetric care. HPV vaccination helps reduce the risk of cervical cancer and other HPV-related disease and is ideally given before exposure to the virus, although it may still be beneficial later in selected age groups.

Vaccines recommended during pregnancy help protect both the mother and the baby. Tdap, influenza, and RSV vaccination may be advised according to gestational timing and clinical guidance. In Rh incompatibility, anti-D immunoglobulin plays a critical role in preventing sensitization and protecting future pregnancies.

Topic

Day Procedures Under Anesthesia

D&C / Pregnancy Termination Under Anesthesia

Pregnancy termination or uterine evacuation under anesthesia is a short gynecologic procedure performed under safe clinical conditions when medically indicated or when legally and ethically appropriate. The aim is to complete the procedure in a controlled manner while prioritizing patient safety and comfort.

The procedure is generally performed under short anesthesia. Recovery is usually rapid, but patients should still receive clear information about bleeding expectations, pain, warning signs, and follow-up.

Endometrial Biopsy Under Anesthesia (Probe Curettage)

Endometrial biopsy under anesthesia is used to sample tissue from the uterine lining, especially in patients with abnormal bleeding, suspected endometrial thickening, or when more accurate sampling is needed. Performing the procedure under anesthesia improves patient comfort in selected cases.

The tissue is then evaluated in pathology, helping identify benign changes, hormonal effects, polyps, hyperplasia, or more serious conditions when present.

Hysteroscopy

Hysteroscopy is a modern diagnostic and therapeutic method in which a thin camera is passed through the vagina and cervix to directly visualize the uterine cavity. Because it is performed through the natural passage, no abdominal incision is required.

It is used to evaluate or treat polyps, submucosal fibroids, adhesions, uterine septa, and abnormal bleeding. In operative hysteroscopy, diagnosis and treatment can often be completed in the same session.

LEEP

LEEP is a procedure used to remove abnormal tissue from the cervix using a thin electrified loop. It is commonly recommended after biopsy-proven cervical dysplasia or selected abnormal colposcopic findings.

The purpose is to remove the abnormal tissue completely while preserving as much healthy cervical tissue as possible. It is usually a short procedure and provides both treatment and a specimen for definitive pathology.

Bartholin Cyst Surgery (Marsupialization)

Bartholin cysts develop when the duct of the Bartholin gland becomes blocked and fluid accumulates. When the cyst becomes painful, infected, enlarged, or recurrent, surgical treatment may be required.

Marsupialization is a commonly preferred method. Instead of simply draining the cyst, a small permanent opening is created so fluid can continue to drain naturally, which helps reduce recurrence. It is considered an effective and reliable treatment option.

Topic

Surgical Procedures

Cesarean Delivery

Cesarean delivery is the birth of the baby through surgical incisions made in the abdominal wall and uterus. It may be planned in advance or performed urgently depending on maternal or fetal indications. With modern surgical techniques and anesthesia, it is one of the most commonly performed obstetric surgeries.

The procedure is usually performed under spinal or epidural anesthesia so the mother may remain awake, although general anesthesia may be required in emergency situations. Recovery planning, wound care, pain control, and postpartum support are essential parts of cesarean care.

Cervical Insufficiency (Cerclage)

Cerclage is a procedure used when the cervix is unable to remain closed during pregnancy. In selected patients with cervical insufficiency or a strong history suggesting that risk, a suture is placed around the cervix to support the pregnancy and reduce the risk of pregnancy loss or preterm birth.

Timing and indication depend on the patient's history, examination, and ultrasound findings. With appropriate selection, cerclage can be a safe and effective preventive treatment.

Laparoscopic (Minimally Invasive) Surgery

Laparoscopic surgery is a minimally invasive approach performed through small incisions in the abdomen using a camera and specialized instruments. Because the abdomen is not opened through a large incision, patients often experience less pain, smaller scars, shorter hospitalization, and faster recovery.

It is used for many gynecologic problems and forms the basis of several different procedures such as hysterectomy, myomectomy, ovarian cyst surgery, and endometriosis surgery.

Laparoscopic Hysterectomy

Laparoscopic hysterectomy is removal of the uterus through a minimally invasive approach. It may be indicated in fibroids, treatment-resistant abnormal bleeding, adenomyosis, chronic pelvic pain, or other selected gynecologic conditions.

Compared with open surgery, it usually offers less blood loss, lower infection risk, and a faster return to normal activities.

Uterus-Preserving Surgery: Myomectomy

Myomectomy is the removal of fibroids while preserving the uterus. It is especially important in patients who wish to maintain fertility or avoid hysterectomy.

When performed laparoscopically in suitable cases, the fibroids are removed carefully and the uterine wall is reconstructed anatomically. This allows treatment of symptoms while protecting reproductive potential.

Laparoscopic Ovarian Cyst Removal

Ovarian cyst surgery may be recommended when a cyst is large, painful, growing, recurrent, or suspicious on imaging. The goal of laparoscopic cystectomy is to remove the cyst while preserving as much healthy ovarian tissue as possible.

This is especially important in reproductive-age patients, where ovarian reserve should be protected whenever feasible.

Endometriosis Surgery (Deep Pelvic Endometriosis)

Endometriosis surgery is often planned when disease causes severe pain, organ involvement, infertility-related problems, or poor response to medical treatment. In deep pelvic endometriosis, the lesions may affect the uterosacral ligaments, bowel, bladder, rectovaginal septum, and other complex pelvic structures.

The aim is not only to burn visible lesions, but to remove diseased tissue carefully while protecting pelvic anatomy and organ function. In selected patients, this may improve pain control and may also support fertility planning.

Scarless Surgery / Model Surgery (V-NOTES)

V-NOTES stands for vaginal natural orifice transluminal endoscopic surgery. It allows some gynecologic operations to be performed through the vaginal route using endoscopic visualization, without external abdominal incisions.

Because there are no visible abdominal scars, it is sometimes described colloquially as a scarless or “model” surgery. In appropriate patients, it may offer less pain, quick recovery, and excellent cosmetic outcomes.

Tubal Ligation

Tubal ligation is a permanent contraception procedure in which the fallopian tubes are surgically closed, clipped, or sealed. This prevents the egg and sperm from meeting and therefore prevents pregnancy.

It is usually performed laparoscopically and is best suited to patients who are certain they want permanent contraception. It does not directly affect hormones, menopause timing, or sexual desire.

Vaginal Hysterectomy

Vaginal hysterectomy is removal of the uterus entirely through the vaginal route without an abdominal incision. It is especially useful in uterine prolapse and in selected benign gynecologic conditions.

Its main advantages are the absence of visible abdominal scars, relatively low postoperative pain, and rapid recovery in appropriate patients.

Urinary Incontinence Surgery

Urinary incontinence surgery is often considered in stress urinary incontinence, especially when symptoms affect daily life despite conservative measures. One of the most commonly performed procedures is placement of a mid-urethral sling.

These surgeries aim to improve support under the urethra and reduce leakage during coughing, sneezing, exercise, or exertion. The treatment plan should always be individualized and may include urodynamic evaluation in selected patients.

Pelvic Organ Prolapse Surgery

Pelvic organ prolapse occurs when the support structures of the uterus, bladder, rectum, or vaginal walls weaken and the organs descend. Patients may feel a vaginal bulge, pressure, urinary problems, or discomfort during intercourse.

Surgical treatment is planned according to the severity of prolapse, symptoms, age, and reproductive plans. Vaginal repairs, suspension procedures, hysterectomy when appropriate, or minimally invasive options may all be considered.

Genital Aesthetic Surgery (Labiaplasty and Clitoral Hood Surgery)

Genital aesthetic surgery includes procedures intended to improve physical comfort and appearance in the external genital area. Some patients seek treatment because of irritation, asymmetry, discomfort in clothing or sports, hygiene difficulty, or self-image concerns.

Labiaplasty reshapes the labia minora when tissue is enlarged, asymmetric, or elongated. Clitoral hood procedures can be combined with labiaplasty in selected patients to improve contour while preserving anatomy carefully.

Vaginal Tightening (Vaginoplasty)

Vaginoplasty is a surgical procedure intended to tighten the vaginal canal when tissue laxity has developed after childbirth, aging, or other connective tissue changes. The operation may improve structural support and, in selected patients, address functional or quality-of-life concerns.

Planning is individualized according to symptoms, anatomy, birth history, and expectations. In some patients it may be combined with perineal repair.

Birth Scar Revision (Perineoplasty / Perineal Repair)

Perineoplasty is used to revise scarring, deformity, or laxity in the perineal region after vaginal birth or episiotomy. In some patients, healing in this area may leave discomfort, hygiene difficulties, vaginal widening, or esthetic concerns.

The goal is to reconstruct tissue anatomy and improve both function and appearance. When appropriately planned, it can provide meaningful improvement in postpartum pelvic comfort.

Topic

Gynecologic Surgical Emergencies

Gynecologic emergencies are rapidly evolving conditions that may become life-threatening if not recognized and treated quickly. Sudden severe pelvic pain, faintness, heavy bleeding, or nausea and vomiting may all be warning signs.

Ruptured Ectopic Pregnancy

In ectopic pregnancy, the fertilized egg implants outside the uterus, most commonly in the fallopian tube. If the tube ruptures, serious internal bleeding may occur. Severe pelvic pain, dizziness, shoulder pain, faintness, and vaginal bleeding may be seen.

This is a true emergency. Surgical treatment is often performed laparoscopically in order to control bleeding and remove the ectopic tissue while preserving fertility whenever possible.

Ruptured Ovarian Cyst

When an ovarian cyst ruptures, fluid or blood may leak into the abdomen. Some patients improve with observation and pain control, but significant bleeding may require surgery.

Ultrasound findings and the patient’s overall condition guide treatment. When surgery is needed, laparoscopy is often used to control bleeding and treat the underlying lesion.

Ovarian Torsion

Ovarian torsion occurs when the ovary twists around its supporting structures and blood flow becomes compromised. It usually presents with sudden severe pelvic pain, often with nausea and vomiting.

Because prolonged interruption of blood supply can permanently damage ovarian tissue, early diagnosis is critical. Treatment usually involves urgent laparoscopy to untwist the ovary and preserve the organ whenever possible.

Important Note

The content is for informational purposes; definitive diagnosis and treatment require physician evaluation.

Op. Dr. Berrak Beyoğlu Oruç

Obstetrics and Gynecology Specialist

I care about offering each patient a personalized, clear, and reassuring follow-up and treatment plan in women’s health, pregnancy care, and surgical processes.

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