The area of Reproductive Surgery continues to witness advances in surgical
technology. Minimally Invasive Surgery is associated with new and innovative
procedures for our patients. Specifically, when faced with an ovarian cyst we
are more often than not capable of complete removal of the cyst via a laparoscopic
approach. Specifically, when a patient is under general anesthesia, carbon dioxide
is introduced into the abdominal cavity creating a space for insertion of a telescope,
i.e. a laparoscope. This allows the operating surgeon to evaluate the reproductive
organs. Additionally, very small, 5mm, ports, usually 2-3 are placed in the lower
abdominal area to allow for manipulating the pelvic organs. The surgeon then
makes an incision into the outer membrane, cortex, of the ovary, thus allowing
separating off and dissecting the cyst from remaining normal ovarian tissue.
More often than not normal ovarian tissue can be preserved and less commonly
is it required to remove the entire ovary. Laparoscopic minimally invasive surgery
allows for assessment of all pelvic organs and the placement of dye from the
cervix into the fallopian tubes to assess whether the fallopian are open or not.
In a women who has a problem with painful menstrual periods, termed dysmenorrhea,
and perhaps with discomfort during intercourse, dysmenorrhea, and problems getting
pregnant the underlying diagnosis may be Endometriosis. This is a disease entity
that may be associated with many symptoms or virtually none except perhaps for
inability to conceive. Endometriosis is defined as the lining of the uterus outside
of the uterine cavity and can be located on the ovary, on the abdominal cavity,
or virtually anywhere including within the rectal wall. A laparoscopic or minimally
invasive approach to surgical correction of this problem has many rewards including
alleviation of pain, ability to conceive and when done in this manner as opposed
to a more elaborate or “open” laparotomy approach, the chances
of scar tissue formation laparoscopically, i.e. adhesions is less.
One other concern for patients in the reproductive years is the presence
of fibroids, also termed myoma’s. These are tumors of the uterus which
are almost always benign and can be associated with infertility, recurrent pregnancy
loss, heavy menstrual bleeding and associated cramping pain. The treatment may
be nothing more than observation or better termed “expectant”,
or surgical, i.e. myomectomy. The surgical approach includes hysteroscopic myomectomy
which allows shaving of the segment of the fibroid that is in the endometrial
cavity or a laparoscopic or Mini-laparotomy approach. The latter involves making
a small, several inch incision in the lower abdomen and removal or excision of
the fibroid. Research has noted that the presence of fibroids, in part depending
on size and location may play a role in achieving a pregnancy of carrying a pregnancy.
Unfortunately there is currently no good medical therapy for fibroids. If a woman
has completed her childbearing she may be a candidate for uterine artery embolization
to shrink the fibroids but she should not plan to get pregnant after this procedure
since the obstetrical complication rate is high.
One other problem facing a woman trying to conceive is that of a polyp in
the lining of the uterus, i.e. endometrium. Specifically, while the research
is somewhat divided, a local inflammatory response may occur surrounding the
polyp and thus interfering with implantation of a fertilized egg. The approach
to correction of this problem is use of hysteroscopy, looking directly into the
uterine cavity, to identify the polyp and removing it under direct visualization.
The operating Gynecologist may also do a D&C to scrape the lining of the
uterus and thus remove any remaining polyps or other concerns involving the lining
of the uterus.
If a woman has had her tubes tied and wishes additional pregnancies she may
be a candidate for Microsurgical Tubal Reanastomosis or rejoining the fallopian
tubes. One alternative is In Vitro Fertilization where the fallopian tubes are
bypassed and sperm and egg link outside the human body, i.e. in vitro.
Thus The Center For Fertility & Reproductive Endocrinology offers the latest
technical advances designed to assist you with pelvic pain, infertility, abnormal
menstrual flow and the array of problems responsible for your gynecologic problem.
