Gynecological Surgery

The Mardaleishvili Clinic performs major gynecological/oncogynecological/urogynecological operations:

Radical hysterectomy

Hysterectomy with removal of appendages, dissection of pelvic lymph nodes, dissection of paraaortic lymph nodes.

Hysterectomy with removal of appendages, omentectomy, excision of paraaortic lymph nodes, selective and wide excision  of the peritoneum.

The clinic performs the standard gynecological operations – by open, endoscopic and laparoscopic methods:

  • Cervical conization
  • Curettage of the uterus body and cervix
  • Excision of the Bartolin’s gland
  • Hysteroresectoscopy
  • Hysterectomy by open and laparoscopic method
  • Vaginal hysterectomy with laparoscopic assistance
  • Conservative myomectomy by open and laparoscopic method
  • Transvaginal myomectomy
  • Laparoscopic complete and partial resection of ovarian cysts
  • Laparoscopic salpingo-oophorectomy

The following urogynecological surgeries are performed in the clinic:

Urogynecology – laparoscopic colpopexy after preliminary hysterectomy (treatment of urinary incontinence, urethro-vaginal prolapse) TOT surgery (in case of  stress urinary incontinence),  anterior and posterior colporrhaphy


Endometriosis is a common chronic disease, characterized by the growth of endometrial tissue outside the uterine cavity. It affects 10% of women of reproductive age worldwide and is a benign process, with a risk of malignant transformation of 1-2.5%.

The leading complaints are pelvic pain, menstrual pain, pain during sex, urination or defecation. Most patients are infertile, which is typical for endometriosis. A visit to a gynecologist is necessary to diagnose the disease. The diagnosis can be made on the basis of complaints, examination and ultrasound, although sometimes a diagnostic laparoscopy is necessary.

There are different forms of endometriosis: the most common are uterine and ovarian endometriosis. Chocolate cysts form in the ovaries and often require surgical treatment. There are also endometriosis  forms of  the ligaments of the pelvic peritoneum, bladder and rectum and, in rare cases, in the abdominal organs or of  the skin scar.

Treatment depends on the symptoms, the age of the patient and the form of the disease. Symptomatic treatment, hormonal therapy and surgical treatment are used..

Cervical cancer remains a challenge for the modern world. Diagnosing cervical lesions is therefore of great importance in the prevention of the disease. There are distinguished mostly benign cervical lesions (polyps, condylomas, fibroids, endometriosis, ulcers, etc.).

Of particular importance are cervical dysplastic lesions, which are precancerous conditions and, according to US figures, affect between 250,000 and one million women every year. The presence of a sexually transmitted papillomavirus infection is a leading factor in the formation of precancerous lesions.

These types of lesions are characterized by an asymptomatic course, which is why screening is crucial.

Diagnostic tests include:

  • Cervical cytology PAP-TEST
  • Colposcopic examination
  • Morphological examination.

The method of treatment depends on the degree of damage. It depends on the age of the patient, the patient’s history and the presence of risk factors.

Gynecological endocrinology is a gynecological discipline aiming at detecting and treating disorders caused by hormonal imbalance in the female body, which include:

  • Menstrual disorders (long, heavy, painful menstruation, bleeding between periods, cessation or delay of menstruation);
  • Overweight, obesity, colored striae, underweight;
  • Hypertrichosis, acne;
  • Polycystic ovarian syndrome;
  • Benign ovarian masses (cysts);
  • Hyperprolactinemia syndrome;
  • Congenital adrenal hyperplasia;
  • Hypogonadism;
  • Primary ovarian insufficiency;
  • Management of the physiological menopause, the post-operative period (bilateral oophorectomy) and primary ovarian insufficiency syndrome;
  • etc.

Infertility is diagnosed when a pregnancy does not occur after one year of regular unprotected sexual activity. It is now a worldwide problem, occurring in 19-25% of women. The causes of infertility in women include ovarian, Fallopian tube, cervical canal, functional or anatomical abnormalities.

Diagnosis is based on a careful examination of the couple. Hysterosalpingography is an important tool in the study of female infertility. It is an X-ray performed by injecting a contrast medium into the uterine cavity in order to evaluate the during which we can assess the structural anomalies of the uterine cavity, the cervix and the patency of the tubes. Infertility treatment methods are based on treating the underlying cause, which may include medication and surgery as well as assisted reproductive technologies, including IVF.

Inflammatory diseases of the female genitalia include diseases of the external genitalia and the internal genital organs, such as vulvovaginitis, vaginitis, cervicitis, endometritis, salpingitis, salpingo-oophoritis, etc. Vulvovaginitis and cervicitis are the most common reasons for visiting a women’s clinic. Patients mainly complain of abnormal discharge from the genital tract, burning, itching, pain during sexual intercourse, blunt pain in the pelvis, etc. The treatment of diseases depends on the diagnosis and the etiological factor.

Premenstrual syndrome is characterized by physiological and behavioral changes before menstruation. The leading symptoms are:

Increased breast sensitivity, abdominal bloating, headaches, hot flushes, fatigue, mood swings rapid irritability, anxiety or depression.

These conditions are diagnosed by a gynecologist after a detailed anamnesis, differential diagnosis with appropriate laboratory tests and an individualized treatment plan.

Pregnancy (fetal) losses – spontaneous abortion, i.e. spontaneous termination of pregnancy before 22 weeks of gestation.

15-20% of clinically established pregnancies end with spontaneous abortions. Most frequent causes of spontaneous abortions on early stages of gestation (before 12 week – I trimester) are fetal chromosomal abnormalities incompatible with life. Among other causes should be mentioned amniotic sac without fetal ovary (anembrionia), endocrine disorders (lutein failure, thyroid gland dysfunctions, diabetes mellitus, etc.).  Spontaneous abortions in I and II trimesters of pregnancy are conditioned by uterine organ damages (congenital uterine pathologies – septum, double-horned (bicornuate) or single-horned (unicornuate) uterus, uterine adhesions,  myoma of the uterus, cervical insufficiency, etc.), infections in women (ureaplasma, mycoplasma, chlamydia, cytomegalovirus, herpes, toxoplasmosis, etc.).

According to current data, recurrent pregnancy losses occur in the population at a rate of up to 1-2%. Their causes are diverse, including organic lesions of the uterus and cervix (uterine malformations, fibroids, uterine scars, cervical insufficiency, etc.), endocrine disorders (thyroid gland dysfunctions, diabetes mellitus, insulin resistance, prolactin level increase, progesterone deficiency, male hormones increase, etc.), autoimmune disorders (antiphospholipid syndrome, autoimmune thyroiditis, presence of antiembrional and antiendometrial antibodies), Rhesus conflict, balanced (compensated) chromosomal structural disorders in women and/or men, genetically-determined disorders of the woman’s blood coagulation system (thrombophilia genes mutations). In some cases, there may be several causes, and in all such cases it is necessary to perform thorough , complex examination.

If a cause is identified, it can be treated with appropriate conservative and/or surgical methods, but in all cases the cause has to be identified and treated before a new pregnancy occurs, and then the pregnant woman has to be monitored throughout the pregnancy until delivery.

The sexually transmitted infection group includes all infections that are transmitted directly through sexual contact, so all sexually active people represent the risk group for the disease and its spread.

Particular risk factors include the following:

  • Unprotected sexual contact. Not use, improper or inconsistent use of condoms can increase the risk of infection transmission. Oral sex may be less risky, but infections can still be transmitted without a latex condom or other protection.
  • Having sex with more than one partner. The more sexual contacts you have, the higher your risk of getting an infection.
  • History of sexually transmitted infections. Once you get infected once, it is easier to get another sexually transmitted infection.
  • Resisting rape or assault is very difficult but it is important to seek medical attention, treatment and emotional support as soon as possible.
  • Alcohol or drug abuse. Substance abuse can impair your thinking, making you more likely to engage in risky behavior.
  • Intravenous drug use. Sharing needles spreads many serious infections, including HIV, hepatitis B and hepatitis C.
  • Half of new infections occur between the ages of 15 and 24.

Sexually transmitted infections are often asymptomatic or present with minimal symptoms, so diagnosis and treatment are essential to avoid further complications.

Contact your doctor immediately if:

  • You are sexually active and think you may have a sexually transmitted infection;
  • You have signs and symptoms of an STI.
  • You have heavy vaginal discharge, burning, itching, frequent painful urination, bloody discharge after intercourse, pelvic pain with or without sex, any kind of rash or growths on the external genitalia.
  • When are you planning to be sexually active
  • Before planning a pregnancy

Some STIs – such as gonorrhea, chlamydia, HIV and syphilis – can be passed from mother to child during pregnancy or delivery. Infection in babies can cause serious problems or even death.

Possible complications include:

  • Pelvic pain
  • Complications of pregnancy
  • Eye inflammation
  • Arthritis
  • Pelvic inflammatory disease
  • Infertility
  • Heart problems
  • Certain cancers, such as HPV-related cervical and colon cancer

Diagnostic tests

Laboratory tests can identify the cause and detect a co-infection, which your doctor will assess in relation to other findings.

  • Blood tests
  • Examination of urine samples
  • Smear examination
  • Examination of fluid samples (if you have open genital ulcers, the fluid and samples from the ulcers are examined to determine the type of infection).

Who should be tested for sexually transmitted infections?

  • Everyone. One STI screening test recommended for all people aged 13 to 64 is a blood or saliva test for human immunodeficiency virus (HIV), the virus that causes AIDS. Experts recommend that people at high risk get tested for HIV every year.
  • Women aged 21 years and older (HPV). A Pap test checks for changes in the cells of the cervix, including inflammation, precancerous changes and cancer. Cervical cancer is often caused by certain strains of HPV. Experts recommend that women have a Pap smear every three years from the age of 21. After the age of 30, have an HPV test and a Pap test every five years or a Pap test only or an HPV test only every three years.
  • Sexually active women under 25 (chlamydia, gonorrhea). Experts recommend that all sexually active women under 25 be tested for chlamydia. Get tested every time you have a new partner, as you can be infected with chlamydia more than once. Testing for gonorrhea is also recommended for sexually active women under 25 years of age.
  • Pregnant women (chlamydia, syphilis, hepatitis B and C, HIV);
    • Homosexual men. Compared to other groups, homosexual men are at higher risk for STIs. Many public health groups recommend annual or more frequent STI screening for these men. Regular testing for HIV, syphilis, chlamydia and gonorrhea is particularly important. Testing for hepatitis B may also be recommended.
    • People diagnosed with HIV. If you have HIV, this greatly increases the risk of contracting other STIs, so testing for syphilis, gonorrhea, chlamydia and herpes is recommended as soon as you are diagnosed.
    • People who have multiple partners;
    • People who have a new partner.


Bacterial STDs or STIs are easier to treat. Viral infections can be treated, but not always cured.

If you are pregnant and have an STI, immediate treatment can prevent or reduce the risk of your baby being infected.

Treatment for STIs, depending on the cause, includes:

Antibiotics. Antibiotics can treat many bacterial and parasitic sexually transmitted infections, including gonorrhea, syphilis, chlamydia and trichomoniasis. Gonorrhea and chlamydia are usually treated at the same time, as these two infections often occur together.

In addition, it is important to abstain from sexual intercourse for seven days after the end of antibiotic treatment and after the ulcers have healed. Experts also advise women to have a repeat examination after about three months, as there is a high chance of reinfection.

Antiviral drugs. If you have herpes or HIV, your doctor will prescribe antiviral medicines.

Antiviral medicines can control your HIV infection for many years. But you will still have the virus and you can still transmit it, although the risk is lower.

The earlier you start treatment, the more effective the HIV treatment will be. If you take your medicines exactly as prescribed, you can lower the viral load in your blood to an extent that makes it difficult to detect.


There are several ways to prevent or reduce your risk of getting an STD or STI:

  • The most effective way to prevent sexually transmitted infections is to abstain from sexual contact.
  • Another reliable way to prevent STIs is a long-term relationship in which both people only have sexual contact with each other and neither partner is infected.
  • Vaccination at an early stage, before sexual contact, is also effective in preventing some types of STIs. There are vaccines for the prevention of human papillomavirus (HPV), hepatitis A and B. Ask your doctor for more information on vaccinations.
  • Use a new latex condom every time you have sex.

The vulva is the female external genital organ. Various types of lesions can develop that require medical attention.

Noteworthy are:

  • Itching of the vulva
  • Alteration of the skin structure in the vulval area
  • Changes in pigmentation
  • Appearance of growths/warts, etc.

All of the above require gynecological examination and diagnosis. The early detection of vulval carcinomas or precancerous lesions is important and can be done by vulviscopy and biopsy. Treatment is based on the diagnosis.