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Fertility Surgery

Minimally invasive fertility surgery is used in cases of unexplained infertility, fibroid removal, tubal reversal, and endometriosis ablation. We perform some of these surgeries at our own surgical center.

At a Glance

  • Minimally invasive surgery involves less recovery time, less risk of infection and other complications than open surgery (less blood loss, less risk of scar tissue formation)
  • Complex procedures like fibroid removal, tubal reversal, and endometriosis ablation can be done
  • Myomectomy to treat fibroids can now be done by laparoscopy by advanced laparoscopic-trained surgeons
  • Laparoscopy and hysteroscopy are types of minimally invasive surgery, and can include robot-assisted techniques

Minimally Invasive Surgery

Minimally invasive surgery involves several small incisions in the abdomen instead of the large incision from open or traditional surgery. Thanks to minimally invasive surgery, infertility specialists can carefully examine internal organs for endometriosis, which has no other way to be diagnosed and may be a cause of infertility. Fibroids can also be treated through minimally invasive surgery.

In-Office Hysteroscopy

Hysteroscopy, a type of minimally invasive infertility procedure, can be used to investigate the endometrial cavity for causes of infertility and miscarriage. The hysteroscope, a type of telescope with a light and an optical system, allows the doctor to see the inside lining of the uterus by entering through the vagina, needing no incisions. This small telescope can be placed in the office in order to diagnose problems with the uterus affecting fertility. Minor conditions like polyps, small fibroids, small septums, and intrauterine adhesions can be removed through hysteroscopy. Along with the convenience of in-office hysteroscopy, the patient has no need for general anesthesia.

Laparoscopy

Laparoscopy is a type of minimally invasive surgery in which a fiber-optic instrument is inserted through the abdominal wall to view the internal organs or permit a surgical procedure. A telescope is used with a camera to investigate the tubes, ovaries and uterus. During the laparoscopy, surgical approaches can be used to correct certain problems.

Robotic Laparoscopy

Robotic surgery is a type of laparoscopic surgery where the surgeon, instead of holding the surgical instruments in his/her hand, manipulates them from a computer console. One of the main advantages is that the surgeon is guided by 3-D, high definition images as opposed to the 2-D images provided through the camera on the laparoscope. Additionally, the robot has similar dexterity to the human hand. Rigid laparoscopic instruments are limited in this dexterity.

When considering a minimally invasive procedure for infertility, our doctors can advise you on the procedure that is most likely to have positive results. Women who have had multiple fibroids removed and have persistent infertility may consider laparoscopy, a surgical removal of fibroids. Some doctors perform a cesarean section-type incision to perform a myomectomy. We recommend minimally invasive surgery through the use of a robot with advanced laparoscopy to remove fibroids without a major incision, dramatically lowering the recovery time and risk of scar tissue formation.

Difficult or complex procedures can be done with the aid of a robot, such as:

  • fibroids can be removed
  • tubes that have been tied can be reanastomosed or put back together
  • ovarian cysts can be removed
  • ectopic tubal pregnancies can be treated
  • endometriosis can be ablated or excised by electric current or laser

Young patients, particularly those who have pain with their periods, should consider the possibility of laparoscopy before concluding that they do not have an explanation for their infertility. A very common finding at laparoscopy is a disorder called endometriosis.

Some patients have surgery and conceive within a reasonable amount of time, not needing further treatment. However, sometimes once fibroids are removed, if tubal disease is present, or rarely, scar tissue forms in the tubes interfering with tubal transport of sperm, IVF may be required for pregnancy.

Myomectomy for fibroid removal

Fibroids, also called myomas, can cause infertility. The number and size of myomas, as well as their location are important factors in determining the best treatment. A myomectomy, surgical removal of fibroids, allows up to 50% of women under age 40 to conceive spontaneously within a few months. Removing fibroids can restore the ability of the uterus to implant an embryo and develop a pregnancy. Myomectomy through hysteroscopy, a procedure where a thin, lighted tube is inserted into the vagina, can remove some small fibroids found inside the uterus.

Recovering from myomectomy

Recovery after minimally invasive myomectomy is significantly faster with fewer complications than open/traditional myomectomy when the abdomen has a large incision. Both the hysteroscopic and laparoscopic myomectomies are outpatient procedures. Hysteroscopy typically allows the patient to resume normal activity the following day. Laparoscopy may take one to two weeks before normal activity levels are resumed. Your surgeon will inform you on what activities are acceptable and when.

Tubal ligation reversal

Sometimes a woman has her “tubes tied” through a tubal ligation because she thinks her family is complete. And sometimes circumstances change, and she would like to have more children. Most often the woman has a new partner, and sometimes a married couple decides they want another baby after their children are older. In a tubal ligation, the fallopian tubes are cut or permanently blocked to prevent pregnancy. In a tubal ligation reversal, or reanastamosis, the surgeon unblocks or reconnects the fallopian tubes. This outpatient procedure, performed through a robotic minimally invasive surgery, can result in up to 70% success of getting pregnant in the following 18 months. This success depends on many variables including the health of the fallopian tube segments, scar tissue, and no male factor infertility. One advantage of tubal reversal surgery in patients over 40 or with diminished ovarian reserve (DOR), is that the cumulative pregnancy rate after tubal reversal surgery can be greater since every month offers another chance for pregnancy compared to one IVF cycle with a low pregnancy rate after which your tubes remain tied and the only possibility is paying for another IVF cycle. It is important to have an experienced tubal reversal surgeon who can analyze your unique situation carefully and help you decide if this procedure is your best option to have a baby.

Are my chances to have a baby better with IVF or tubal ligation reversal?

There are many factors that are weighed in this decision. The two main questions revolve around how damaged the fallopian tubes are and the age of the woman. If the tubes have a lot of scar tissue or the remaining segments of the tubes are too short to reconnect properly, the chances of a successful reanastamosis are very low. If the woman’s tubes are healthy, she is under 35, and there is no male factor infertility, a tubal reversal can offer an excellent chance to get pregnant again and is an especially good choice if she wants more than one child. For women of advanced reproductive age, time is not on their side. The amount of time it takes to have the surgery and recover from it and then the months of trying to conceive naturally, can be lost time if the tubal reversal does not work. And with each year that passes after the tubal reversal procedure, the risk of an ectopic pregnancy increases. Traditional IVF can have success rates of 35-40% in women under 35, with that number dropping after 35, and dropping more precipitously after age 40. Women with diminished ovarian reserve can also consider Natural IVF or Mini Stim IVF, where no or low doses of medication are used, and a 3-cycle package often results in the same pregnancy results as one traditional IVF cycle. The tubal reversal vs. IVF decision is extremely complex. Our doctors are experienced in both and can help you determine the path that will offer the best chances of having a baby.

Essure removal & reversal

There have been mounting complaints about Essure, a non-surgical method of sterilization for women, due to the risks from side effects. An allergic reaction to nickel, one of such side effects, has resulted in women desperate to have the devices removed from their body. Some surgeons claim that a hysterectomy is the only way to resolve this side effect. Rather than removing the entire uterus, through robotic surgery, Dr. Dourron safely removes the Essure device, along with a portion of the fallopian tube, relieving the nickel reaction side effect, and preventing unnecessary hysterectomies. He also performs Essure reversal for patients who desire another pregnancy.

Affordable Robotic Surgery

We strive to make robotic, minimally invasive surgery affordable and convenient. Our expert surgeon, Dr. Edward Dourron, has been an American Association of Gynecologic Laparoscopists designee to the Center of Excellence in Minimally Invasive Gynecology since 2012.

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