Physicians: Russell L. Wavrin, M.D., Mary Anne Jacob, M.D., Juan C. Angelats, M.D., Daniel T. Chow, M.D., Jennifer L. Schwab, M.D., Paige E. Persch, M.D.

Certified Nurse Practitioners: Jaimi L. Anderson, APRN, CNP, Vicki I. Buth, APRN, CNP, Heidi Helleck-Sprang, APRN, CNP, Shirley J. Jarcho, APRN, CNP

Diamond Women’s Center, Edina, MN, provides many gynecologic surgery procedures for our patients. We take operating on our patients very seriously. There always exist risks, benefits, alternatives, pros and cons to any surgical procedure. We always explain our rationale and recommendation for surgery and describe the nature of the procedure proposed. Some of the more common surgeries that we perform are listed below.


A minimally invasive way of performing surgery. A thin (usually ½ inch in diameter), lighted tube (laparoscope) is inserted into the abdomen (usually around the umbilicus) through a small incision. There is a camera within this laparoscope to allow visualization on monitors in the operating room. The abdomen and pelvis are insufflated with carbon dioxide gas for visualization purposes. Placement of other small ports (0.5-1 cm in size) is then accomplished for direct evaluation and treatment. Removal of ovarian cysts, hysterectomy and/or evaluation and treatment of endometriosis is often done with this type of surgery. Evaluation of possible causes of infertility can also be assessed and treated. Tubal Ligation (sterilization procedure) is also done with this approach.


Another minimally invasive surgical procedure. This surgery allows us to look inside the uterus. Placement of a lighted tube (less than ½ inch in diameter) with a camera through the vagina then through the opening of the cervix into the uterine cavity. Saline then distends the uterine cavity to allow visualization. Assessment of the uterine cavity with removal of polyps or fibroids is often done with this type of surgery.


Removal of the uterus and sometimes the ovaries. Indications for hysterectomy often include persistent abnormal bleeding, uterine fibroids, uterine prolapse or persistent pelvic pain. Different techniques exist to accomplish this.

Robotic (da Vinci)

Surgeon-controlled robot that controls laparoscopic instruments. Through small 1-2 cm incisions, surgeons can operate with greater precision and control, minimizing pain and risk associated with larger incisions. This mode of surgery also increases the likelihood of a faster recovery.

Laparoscopic-Surgeon-controlled laparoscopic instruments. See above.

Vaginal-When appropriate, hysterectomy can be performed through an incision in the vagina.

Laparoscopic Assisted Vaginal Hysterectomy (LAVH)

The first half of the hysterectomy is performed laparoscopically and the second half vaginally.

Open (Laparotomy)

Using a larger incision (usually low transverse “bikini incision”-similar to a C-section incision) to perform the hysterectomy. Often used to remove a very large uterus with fibroids or someone with a history of many surgeries with a concern of extensive scar tissue and adhesions.


Removal of uterine fibroids from the uterus (with preservation of the uterus) though laparoscopy, open or hysteroscopic approach. Type of surgery will depend on the location, number and size of one’s fibroids.

Endometrial Ablation

Destruction of the lining of the uterus. This procedure usually results in dramatically reduced or absent menstrual flow. Placement of a device (Novasure or Thermachoice) inside the cavity of the uterus. This device then heats up and cauterizes the lining of the uterus. Success rate 85-90%. Patients with very heavy bleeding with their menses and done with child bearing should consider this procedure as one of their options. After an ablation, some patients experience cramping and discomfort for a few days. Most will notice some discharge (mostly clear) for up to one month after the procedure.


Sterilization procedure. Insertion of permanent coils into the fallopian tubes with the use of the Hysteroscope. Over the next 12 weeks, the coils initiate scarring of the fallopian tubes. One needs to use birth control during this time. After 12 weeks, an HSG (see below) is performed to verify complete blockage of the fallopian tubes.

Loop Electrosurgical Excision Procedure (LEEP)

Procedure performed to remove abnormal cells from the cervix. Indication for this procedure is abnormal cells found on a Pap smear and confirmed by colposcopy. After placing a speculum into the vagina, the cervix is isolated. A numbing block (lidocaine) is then placed by injection around the cervix. Using a loop hooked up to electro-cautery, removal of a small portion of the cervix is accomplished. This specimen is then sent to a pathologist for analysis. After the procedure you may experience some mild cramping and discomfort. Taking over the counter ibuprofen and/or Tylenol can help. You will also notice some vaginal discharge for a time while your cervix heals. It is often recommended to do not place anything into the vagina (i.e. intercourse or use tampons) for about 4 weeks following the procedure. If you have persistent heaving bleeding or foul smelling discharge, you need to call the office.

Dilation and Curettage (D&C)

Procedure where the cervix is dilated and a curette is used to sample a portion of the endometrial lining of the uterus. These curettings are then analyzed by a pathologist to evaluate for abnormal cells (i.e. hyperplasia) or malignancy (i.e. cancer). This procedure is often done if someone is having heavy and/or abnormal uterine bleeding. This procedure is also often done along with Hysteroscopy. Using a suction tube instead of a curette, the contents of uterus can be removed in the case of a miscarriage.

Hysterosalpingogram (HSG)

An x-ray procedure done in a radiology office to assess the uterus and the patency of the fallopian tubes. A small tube (<5 mm in diameter) is placed through the opening of the cervix. Dye is then injected through this tube which fills the uterine cavity and ideally fills and spills from each fallopian tube. This procedure is often done as part of an infertility evaluation and also to confirm complete blockage of the fallopian tubes after an Essure procedure.