Range of treatment

Endometriosis is an extremely complex disease. It can produce powerful symptoms ranging from pain to intestinal and bladder problems to infertility; however, in some cases the patient can be completely asymptomatic. It depends above all on where the endometrial lesions occur. Endometrial lesions are – metaphorically speaking – offshoots of the endometrium. This is the tissue which normally lines the womb, and which bleeds during menstruation. If islands of the same type of cells appear in the ‘wrong’ place, we call it endometriosis. Every month their presence leads to severe irritation of the surrounding tissue, with all of the problems that this entails. Endometriosis can either be treated with medication that suppresses menstruation, or the problematic tissue can be surgically removed. Often a combination of the two options is recommended. As the patient with endometriosis often experiences most of her symptoms at child-bearing age, counselling and surgical technique are extremely important. In most cases, endometriosis can be dealt with using minimally invasive surgery, i.e. laparoscopic methods, via small incisions.

Breast cancer is the most common malignant cancer in women. However, in the female breast there may even be benign changes whose removal is either advisable or essential. It is especially in the treatment of mammary gland disorders that the important of good collaboration among a network of outstanding female doctors comes into its own; particularly, in such cases, surgical oncologists and plastic surgeons. The aim is to retain the natural beauty of the breast, even if malignant changes have occurred.

The ovaries sit to the left and right of the womb. They are responsible for hormone and egg production from the start of puberty until the menopause. During the course of a woman’s life they can be the origin of disorders that require surgical intervention. 

A relatively common problem is ovarian cysts that are benign, but that still require surgery. Endometriosis is another disorder in which not just the ovary, but sometimes even the whole lower abdomen is affected. In most cases, interventions on the ovaries take place using minimally invasive surgery, i.e. via laparoscopy. Infertility can also sometimes be treated by laparoscopic methods, depending on the underlying cause.

Endometriosis is another example of a condition in which the patient gains huge benefit from interdisciplinary planning, and hence from a properly functioning network of designated specialists, as this disorder often affects several organs.

Malignant disorders of the ovaries are rare.

Changes to the womb and cervix are common. Changes in the womb are generally manifested via abnormal bleeding, pain or a sensation of the presence of a foreign body in the lower abdomen. They can also be responsible for problems with passing water or emptying the bowels. It is challenging to advise women on operations on the womb, especially if they may want to have children in the future. Nowadays, for typical changes such as fibroids and polyps, there are gentler surgical methods after which the patient would have no problem in carrying a pregnancy to term. In cases like these it is particularly important to provide the patient with comprehensive advice. Should the patient decide, following in-depth advice, on the removal of the womb, or if it is unavoidable from a medical point of view, then this can also be carried out via the minimally invasive technique of laparoscopy.

Changes in the cervix are looked for and discovered during routine examinations (annual screening). Thanks to these regular checks and the vaccination that is available today, cervical cancer has become rare in Switzerland. Any precancerous changes are discovered during checks, and so can be treated early by removing only part of the cervix. The patient then generally has no problem becoming pregnant.

Operations on or via the vagina are common in our field. The typical reason for these operations is a prolapse. These means that the womb, bladder or rectum slip out of position, either individually or together. This most often occurs following childbirth, in overweight patients, or in old age. The strengthening of the vaginal walls, and possibly the removal of the womb through the vagina and the return of the perineum to its original height is an operation that involves little pain, but requires extensive counselling. The patient should be instructed to train her pelvic floor, and any changes in bowel or bladder habits must be discussed. The vagina and vulva play a central role in a woman's sexual well-being, and time needs to be allowed for counselling on this topic in a gynaecological practice.

The most common disorder of the aorta is its enlargement (aneurysm), generally caused by chronic high blood pressure that has been left untreated (or, rarely, due to a connective tissue disorder). Whatever the cause, an operation is needed when the diameter of the ascending aorta exceeds 5.5 cm in an adult (or, in cases of Marfan syndrome or other connective tissue disorders, 5 cm).

During the operation, the surgeon only replaces the portion of the aorta that is enlarged.

If the aortic root and the aortic valve are both defective, then the entire aortic root can be replaced in one operation.

If the aortic arch is also enlarged, then this can also be replaced at the same time.

Disorders of the heart valves most commonly affect the aortic valve, followed by the mitral valve.

Heart valve disorders are usually caused by age-related degeneration or a connective tissue disorder. The resulting changes in the valves can, in severe cases, cause problems that hinder patients in their daily lives and can even lead to heart failure. If this is the case, the valve has to be repaired (mitral valve) or replaced (aortic valve) in order to prevent lasting damage to the heart.

If only one or two valves are affected, these interventions are carried out using minimally invasive methods, through a small incision between the ribs.

A tumour in the heart (myxoma) is a very rare occurrence, and is usually benign. It has to be removed once diagnosis is confirmed, due to the risk of embolism. Removal can be conducted by minimally invasive surgery.

Coronary heart disease is one of the most common heart diseases. It is a disease of the blood vessels that supply the heart. Deposits (fat, calcium or blood clots) narrow the blood vessels. As a result the blood supply to the heart is reduced, which comes with the risk of a heart attack or cardiac insufficiency. Chest pain (angina pectoris) is a typical symptom of heart disease.

The therapy strategy for patients with coronary heart disease depends on how they present (number of diseased blood vessels) and the stage of their illness.

If all three coronary vessels are affected, then a bypass operation is usually performed. The severely constricted vessels are bypassed using the patient’s own blood vessels (arteries, veins) in order to restore optimal blood supply to the heart muscle. The operation can be carried out either via keyhole surgery without a heart-lung machine, or even just via a small incision between the ribs.