Conventional gynecologic surgery uses vaginal or abdominal incisions to treat conditions that cannot be managed safely or effectively with minimally invasive techniques alone. It remains an essential option for some benign diseases, complex anatomy and specific fertility situations.
Even though laparoscopy and hysteroscopy are widely used, there are still cases in which an open abdominal approach or a vaginal approach offers better visibility, control and safety. The key is not to “avoid” open surgery at any cost, but to choose the route that gives the best balance between benefits and risks for you.
In Lisbon, Dra. Joana Faria plans and performs conventional gynecologic surgery in Portuguese, English, French, and Spanish. She explains clearly why a vaginal or abdominal approach is recommended and how the operation fits into your overall treatment plan.
This page focuses on conventional surgery for benign diseases and infertility. For more detail you can also read the pages benign diseases and infertility surgery, minimally invasive gynecologic surgery, myomas, adenomyosis, ovarian and tubal cysts and masses and endometriosis.
What it is
Conventional gynecologic surgery includes operations performed through:
- Vaginal approach the uterus is accessed through the vagina, without abdominal incisions. This is often used for vaginal hysterectomy and some prolapse repairs.
- Open abdominal approach (laparotomy) a larger incision is made on the abdomen to access the pelvic organs directly. This route is used when lesions are very large, anatomy is distorted or complex reconstructive surgery is required.
Typical benign indications for conventional surgery include:
- Very large myomas that cannot be removed safely by laparoscopy.
- Pelvic organ prolapse requiring a vaginal repair or hysterectomy.
- Benign ovarian or tubal masses that are large, suspicious or difficult to remove with minimally invasive techniques.
The goal is to treat the disease in a safe and complete way, while preserving fertility and hormonal function whenever possible.
Main symptoms and when to worry
Conventional surgery is usually considered when symptoms are intense, long lasting or significantly impair quality of life, and when imaging suggests that minimally invasive surgery may not be the safest option.
Common symptoms and scenarios include:
- Very heavy bleeding and pelvic pressure due to a very enlarged uterus, often with multiple fibroids.
- Chronic pelvic pain or painful periods due to extensive endometriosis or adhesions, especially after previous surgeries.
- Visible or palpable vaginal bulge, heaviness or difficulty emptying the bladder or rectum due to pelvic organ prolapse.
- Large ovarian cysts or masses causing pain, pressure or repeated torsion episodes.
You should seek a gynecologic opinion if symptoms persist despite medical treatment or if ultrasound and MRI repeatedly show large or complex lesions. It is important to discuss early whether surgery may become necessary, so that you have time to prepare.
You should seek urgent care if you have sudden intense abdominal pain, pain with fever and malaise, very heavy bleeding with dizziness or fainting, or signs of bowel or urinary obstruction. These may be emergencies and can require rapid evaluation and, occasionally, emergency surgery.
Diagnosis: exams and what to expect before surgery
Before proposing conventional surgery, a detailed preoperative assessment is carried out. The aim is to understand your symptoms, confirm the indication, plan the surgical route and anticipate possible difficulties.
The evaluation usually includes:
- Clinical history and examination
Discussion about symptoms, menstrual pattern, pregnancies, previous surgeries, family history, medical conditions and medicines. Pelvic examination helps to assess the size and mobility of the uterus, presence of prolapse, pain points and masses. - Transvaginal and abdominal ultrasound
Key exam to evaluate fibroids, adenomyosis, ovarian and tubal masses, endometriosis and prolapse. When the uterus is very large or extends above the pelvis, abdominal ultrasound is particularly useful. - Additional imaging
Pelvic MRI or other imaging tests may be requested to clarify the relationship of lesions with bladder, rectum, ureters and major vessels, especially in complex endometriosis or reoperative surgery. - Laboratory tests
Blood tests include haemoglobin and iron, coagulation, kidney and liver function, and, when needed, tumour markers and hormonal profile. - Anesthesia consultation
You meet the anesthesiologist, who reviews your general health, discusses anesthesia options, assesses cardiac and respiratory risk and plans postoperative pain control.
During this phase, you receive clear written information about fasting, medicines to stop or adjust, hospital admission, expected length of stay and how to prepare your home and support for the first days after surgery.
Treatment options and realistic expectations
Conventional surgery is one of several options in the treatment of benign disease and infertility. It is chosen when it offers a better safety margin or a more complete treatment than minimally invasive techniques.
Main options and considerations include:
- Medical treatment and monitoring
In some women, symptoms can be controlled with hormonal treatment, pain medication and regular follow up. This is often considered when lesions are moderate, fertility is still desired or surgery carries high risk. - Minimally invasive surgery
Laparoscopy or hysteroscopy are preferred when technically feasible and safe. However, if imaging suggests that the procedure would be very long, incomplete or risky, a planned open approach may be wiser. - Vaginal surgery
A vaginal approach can be used for hysterectomy and prolapse repair, often with shorter recovery and without abdominal scars. It requires favourable anatomy and sufficient vaginal access. - Open abdominal surgery
Used when fibroids are very large, the uterus is extremely enlarged, there are dense adhesions, severe endometriosis or when complex reconstruction is needed. Recovery is longer, but the surgeon has direct access and tactile feedback, which can improve safety in difficult cases.
Realistic expectations are essential. Conventional surgery usually implies more pain in the first days, longer hospital stay and a slower return to normal activities than minimally invasive surgery. On the other hand, it can definitively solve severe symptoms and prevent repeated incomplete procedures.
As with any major surgery, there are risks, including bleeding, infection, thrombosis, injury to bladder, ureters, bowel or blood vessels, and, rarely, the need for transfusion or additional procedures. Dra. Joana Faria will discuss these risks in detail and answer your questions before you decide.
How Dra. Joana Faria approaches conventional gynecologic surgery
Dra. Joana Faria believes that conventional surgery should never be seen as a failure of minimally invasive techniques. It is a valuable option that, when used at the right time and for the right reasons, can bring real relief.
In daily practice she:
- Starts from your story, your symptoms and your priorities, including fertility plans and work and family responsibilities.
- Explains clearly why vaginal or abdominal surgery is recommended instead of, or in addition to, minimally invasive options.
- Plans conservative and fertility sparing procedures whenever possible, preserving ovaries and uterus when they are healthy and you wish to keep them.
- Works in a multidisciplinary way with anesthesia, internal medicine, urology, colorectal surgery and physiotherapy when needed.
- Provides detailed written instructions on preparation, hospital stay and recovery, including pain control, movement, wound care, driving, work, exercise and sexual activity.
The goal is that you feel informed and supported before and after surgery, with realistic expectations and enough time to ask everything that is on your mind.
