Reproductive Surgery

 

Women

Surgery remains an important step in the treatment of infertility. Reproductive surgery includes a wide range of operations designed for different purposes for men and women. In most instances these procedures are minimally invasive and patients can return to their usual daily routine quickly, frequently within one or two days

For women reproductive surgery falls into two categories

Diagnostic Surgical procedure

It evaluates the integrity of the
Reproductive organs & their
Relationship to other pelvic
Structures. For e.g.:
-Laparoscopy
-Hysteroscopy
-Dilatation  & Curettage
-Endometrial Biopsy

Therapeutic reproductive surgery

It is used to treat infertility. Secondary to organic pelvic disease

It includes procedures like
* Tubal fertility surgery
– Tuboplasty of damaged tubes
– Post Tubectomy [recanalization of tube] – Adhesiolysis
– Fulguration of Endometriosis

* Corrections of uterine abnormalities
– Removal of Scar tissue
– Removal of fibroids
– Removal of Endometriosis
– Endometrial polypectomy
– Asherman’s syndrome
– Ovarian cysts [Functional or chocolate cysts]

Diagnostic Surgical Procedure
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Diagnostic Laparoscopy
Diagnostic Hysteroscopy
Dilation & Curettage [D & C]
Endometrial Biopsy [EB]

Through a small incision in the    belly button, the Laparoscope will transfer the video images of pelvic structure

Useful to diagnose endometriosis, uterine fibroids, other structural abnormalities,ovarian cyst,adhesions and ectopic pregnancy

Performed soon after menstruation because the uterine cavity is more easily evaluated immediately after Menstruation

Hysteroscope is inserted through the cervix into the uterus in order to look for abnormalities inside the uterus

Generally recommended for those whose HSG reports shows a uterine abnormality,for repeated pregnancy loss, ultrasound shows evidence of an intra uterine growth such as polyp or fibroid

Performed soon after menstruation because the uterine cavity is more easily evaluated immediately after Menstruation Performed on an outpatient basis

D & C involves dilation of cervix & inserting instruments to scrape the superficial layers of endometrium

The tissue is often used for microscopic examination for the presence of pathology

Generally D & C is performed for  – Irregular bleeding
– Too much bleeding
– Fibroids & polyps
– Endometrial cancer
– It helps as a treatment too-cervical canal is open for sperm    transfer & scraping of endometrium help the implantation factors to increase.

The removal of a tissue sample from the endometrium (lining of the uterus) for examination under microscope.

Indication for EB are
– Abnormal uterine   bleeding
– Post menopausal   bleeding
– cancer screening and   detection of   precancerous   hyperplasia
– Follow up of previously   diagnosed endometrial     hyperplasia
– Evaluation of uterine   response to hormone   therapy
– Evaluation of patient with   one year of amenorrhea
– Evaluation of repeated   early miscarriages
– Dating of endometrium   in   Follicular phase or leuteal   Phase and to correct   leuteal phase deficiency

Therapeutic Reproductive Surgery

Most of the surgeries are performed on an out patient basis through the laparoscope or hysteroscope
Operative Laparoscopy
During operative laparoscopy, many abdominal disorders can be safely treated through the laparoscope at
the same time that the diagnosis is made.
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Once pelvic disease identified

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Possible therapies by viewing through laparoscope
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Adhesions
Endometriosis
Tubal fertility surgery
Ovarian cysts
Ectopic pregnancy
Unknown lesion
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Bands of Fibrous scar tissue that may bind the pelvic organs &/orloops of bowel together

It can result from previous Infections, endometriosis or Surgeries

The presence of small  implants of endometrial tissue [the lining of the uterus] outside the uterus in abnormal locations such as ovaries, tubes, and abdominal cavityTuboplasty  – opening of tubes blocked by infection at the fimbrial end (hydrosalpinx) or at the uterine margin (corneal)

Post Tubectomy Recanalization of tube

Adhesions or endometriosis

Cystic collection
of fluid in ovary
most common in the fallopian tube
Biopsy
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– fibroids are fibrotic (scarred) muscle tumors, also myomata- It can be in the /outside muscle wall, inside the uterine cavity.

cystic removal along cyst wall
some times expressing the contents of tube to save the tubeIf repair is not possible Tube is removed
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Adhesiolysis – It is a procedure used to remove   scar tissue inside the uterus and   in the reproductive tract.

– Adhesiolysis can be   done through
– Blunt dissection
– Cautery
– Laser
– Scissors
– Thermal

Ablation vaporization – Ablation is the removal or destruction of endometrium  
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Laser Cauterizaiton
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irrigation

Laser Laparoscopy
The Laser has revolutionized the role of laparoscopy from a purely diagnostic one to that of first line operative intervention.

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Types of Laser
Laser beam

Co2 Laser
Fiber Argon KTP-532
Nd:Yag Sapphire tips
Operative Hysteroscopy:
Operative hysteroscopy is similar to diagnostic hysteroscopy except that a wider hysteroscope is used to allow operating instruments
such as scissors, biopsy forceps, electrosurgical or laser instruments.
Identification of Lesion, hysteroscopically
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Uterine synechiae (Adhesions)Intracavitary myoma polyputerine septumproducts ofAsherman’s syndromeMalignant disease
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Lysis – Hysteroscope- Scissors – Resectoscope – LaserRemoval of myoma or  polyp Resectoscope LaserResectoscope Laser Scissors
D & C
It is a scarring inside the uterine cavity, which prevents normal implantation   Biopsy
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Removal of scar through hysteroscope