From a doctor’s perspective, what are the most complex and difficult gynaecological procedures?

The female reproductive system is fascinatingly complex. Diseases, trauma and chronic conditions are also fairly common to these organs, requiring medical and sometimes surgical intervention. While a century ago these conditions were rarely understood, and subsequently poorly treated, thanks to advancement in technology, Gynaecologists/Obstetricians can now perform surgeries with a very high success rate.

But despite these advancements, doctors are still faced with complicated cases. Some of these are:

Surgeries in Obese Women

Surgeries in obese women have been associated with difficult anaesthesia and postoperative complications,risk of infection at the surgical site, higher risk of blood clots, greater intraoperative blood loss, a longer operation timeand slower healing due to reduced blood flow in fat tissue. Obesity is also a major risk factor for various lifestyle diseases and co-morbidities like diabetes, hypertension, coronary heart disease, etc., which make surgeries riskier in patients.

High-risk pregnancy

High Risk pregnancy refers to cases where additional health factors pose risk to the mother and the baby. These include medical co-morbidities like diabetes and hypertension, diseases like HIV/AIDS, high maternal age, habits like excessive alcohol and tobacco consumption, multiple births and premature labour. Surgeries in these women requires optimisation of the medical illness, constant monitoring before and after the surgery, and complex surgical approach requiring a multi-disciplinary team.

Placenta Previa

Placenta Previa is a condition where placenta (a lining inside the uterus that protects and nurtures the baby) grows outside the uterus and covers the cervix, resulting in excessive bleeding at the time of birth. This can pose a huge risk to the mother and the unborn baby, and almost always requires a C-section.

Previous C-section delivery

Caesarean, or C-section deliveries are performed over vaginal deliveries for multiple reasons from abnormal labour to placenta previa. C-section deliveries are also strongly encouraged (and required in many cases) if the mother has given birth via a C-section before. This is due to a higher risk of uterine rupture and placental problems among other reasons.

Surgery for endometriosis

Endometriosis is a disorder in which tissue similar to the lining of your uterus grows outside of your uterine cavity, on your ovaries, bowel, and tissues of your pelvis.The laparoscopic surgical technique, the planning of surgery and the disease pattern by itself make it a challenging intervention. Complete resection of all visible foci of disease offers the best control of symptoms.

However, the possibility of achieving this goal is limited by the difficulty of detecting all foci and the risks associated with radical surgery. The excision of ovarian endometrioma can result in a significant impairment of ovarian function, while damage to the structures during surgery can lead to serious functional impairments. A detailed risk-benefit analysis is therefore necessary, and patients must be treated using an individual approach.