Surgery, step by step

Procedures

The procedures, at a glance

Six families of procedures. Click one to go to its sheets, further down this page — intimate surgery has its own page.

Procedures

The procedures explained

Simplified diagrams, for general information. After your consultation, you receive by e-mail detailed information tailored to your situation, an informed-consent form and a quotation, to be accepted by electronic signature.

Uterus

Dedicated page: Uterine fibroids

Cervix

Dedicated page: HPV, abnormal smear & colposcopy

Ovaries and tubes

Dedicated page: Ovarian cysts

Endometriosis

Dedicated page: Endometriosis

Pelvic floor

Dedicated page: Incontinence & prolapse

Other procedures

Procedures performed at the Clinique de la Muette, without a dedicated sheet.

Information

Risks and complications: what to know before deciding

Every operation carries risks; Dr Gatri goes through them with you at the consultation and gives you the CNGOF information sheet for the procedure planned. The points below are common to gynecological surgery; each sheet sets out its own.

• Common and not serious — after a laparoscopy, the CNGOF sheet describes the possible side effects of anesthesia (anaesthesia) — nausea, vomiting, drowsiness — and pain, mainly in the abdomen and sometimes spreading to the shoulders, caused by the gas used during the operation; modern pain management tends to reduce these effects. A hematoma (haematoma) or an infection (abscess) may occur at the incision, usually needing only simple local care. Recovery after a hysteroscopy is usually simple and painless, and conisation causes no post-operative pain, at most some passing discomfort similar to painful periods. After a myomectomy, the sheet states that the first 48 hours are often painful and require strong painkillers, and that a usually mild urinary infection is not uncommon.
• Rare — perforation of the uterus may occur during a hysteroscopy and prevent completion of the planned procedure. After a conisation, the main risk is bleeding: the sheet states that it exists from the first hours and during the 15 days following the procedure. The risk of phlebitis and pulmonary embolism is exceptional after a laparoscopy. Very exceptionally, serious injury to the internal organs of the abdomen — bowel, blood vessels, urinary tract — may occur and require opening of the abdomen and, in some cases, a blood transfusion. During a hysterectomy or a myomectomy, life-threatening bleeding exceptionally calls for a transfusion of blood or blood products. As with any surgery, these operations may very exceptionally involve a life-threatening risk or serious after-effects.
• What increases them — the CNGOF sheets put it in the same words: certain risks may be increased by your condition, your medical history or by treatment taken before the operation. It is essential to tell the doctor about your personal and family history, about all the treatments and medicines you take, and about any allergies. They add that smoking increases the risk of surgical complications of any operation, and state that stopping smoking six to eight weeks before the procedure removes this additional risk.
• Warning signs — when to call — once home, the hysterectomy sheets list the symptoms that should prompt you to seek advice: burning or frequent urination, which suggests a urinary infection; abnormal or foul-smelling vaginal bleeding, or a high temperature, which suggests an infection or an infected hematoma; nausea and vomiting with fever; a red and painful scar. Calf pain or difficulty breathing call for prompt contact, to rule out phlebitis. After a conisation, continuous bleeding should prompt you to seek advice as soon as possible.
• The sheet you are given — each procedure has its own, handed to you and talked through at the consultation: CNGOF patient information sheet — Laparoscopy · CNGOF patient information sheet — Hysteroscopy · CNGOF patient information sheet — Myomectomy · CNGOF patient information sheet — Vaginal hysterectomy · CNGOF patient information sheet — Laparoscopic hysterectomy · CNGOF patient information sheet — Abdominal hysterectomy · CNGOF patient information sheet — Conisation.

Fees

Fees and reimbursement

Consultations, tests and procedures listed in the French national schedule are partly covered by the French health insurance (Assurance maladie). The practice applies direct billing to the French national health insurance (tiers payant): with an up-to-date carte Vitale, you do not pay that part upfront. What remains payable by you includes the excess fee (dépassement d'honoraires), which may be reimbursed by your complementary insurer (mutuelle), depending on your policy. The practice's quotation details Dr Gatri's fees, distinguishing the part paid by the Assurance maladie from the excess fee (dépassement d'honoraires), and is provided before any procedure; procedures carried out for aesthetic reasons fall outside the schedule and come with a written quotation, a fifteen-day cooling-off period and VAT; clinic charges and the anesthetist's fees are arranged directly with the Clinique de la Muette. Fees are listed in the fee schedule and displayed at the practice. The information framework of this site is described on the Patient information and ethics page.

Consultation for surgery: €120 to €160. This consultation takes place at the practice: Dr Gatri examines your situation and explains the options. If a procedure is decided on, you receive a quotation and an informed-consent form to sign; a date is then set for the procedure at the clinic. All fees and the framework: Fees.