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Additional Reproductive Endocrinology Procedures

Congenital defects, fibroids and other growths, endometriosis, scar tissue and blockages affecting the reproductive anatomy are leading causes of infertility. In many cases, surgery can correct these problems and restore your chance to conceive and carry a child to term. These procedures include laparoscopy, hysteroscopy, laparotomy and myomectomy.  The high pregnancy rates of IVF have replaced reversals of tubal ligations.

At one time, reproductive surgeries were major, invasive procedures requiring lengthy hospital stays and recovery periods. Advances in medicine have resulted in new, microsurgical techniques that rely on sophisticated scopes and delicate instruments. These minimally invasive procedures are usually performed on an outpatient basis in less time and with a significantly shorter recovery period. The most common reproductive surgeries are:

Laparoscopy

Laparoscopy, usually performed on an outpatient basis, requires general anesthesia. The procedure relies on a small, lighted telescopic device, a laparoscope, to view and treat problems with the ovaries, fallopian tubes and the outer wall of the uterus. During the procedure, a needle is inserted through a half-inch incision near your navel and into the abdomen. Carbon dioxide gas is pumped in to expand the abdominal cavity and move the organs away from the abdominal wall, helping to avoid puncture as the laparoscope enters the space through the same incision. A probe is inserted through a second, smaller incision in your lower abdomen, above the pubic area. It is used to move your reproductive organs so the doctor can view different angles or uncover hidden problems. Other small incisions may be made for surgical instruments to be used for problems such as an ovarian cyst or ectopic pregnancy.

What to Expect

Because operative laparoscopy requires general anesthesia, you should not eat or drink anything after midnight. An average procedure takes about one to two hours, but the time varies depending on the extent of the surgery. You will spend another few hours in the recovery room before being discharged to someone who can drive you home and stay with you. You may experience some discomfort after the procedure and be precluded from normal activities for a day or two. Laparoscopy can cause tenderness and bruising of the abdomen and naval area, and you may feel pain in your shoulders and abdomen from gas bubbles that escape during the procedure.

Risks and Side Effects

Although there are risks associated with laparoscopy, they are very rare and affect less than 1% of every 100 women who have the procedure. Complications, usually not serious, may include pelvic or abdominal infections, blood clots, allergic reactions, skin infections near the incisions, nerve damage, bladder infection or complications from anesthesia. The greatest risk associated with laparoscopy is puncture of the bowel, bladder, blood vessels and other organs. Although occurring rarely, if a puncture cannot be fixed during the procedure, additional surgery may be required.

Call us if you develop a high fever or notice redness and swelling around the incisions. These symptoms, a high fever, discharge from the incisions or burning with urination, could indicate infection.

Hysteroscopy

This outpatient procedure is best performed after menstruation and prior to ovulation, when your physician can best view the uterine lining. It requires general or local anesthesia, and it relies on a lighted telescope-like device called a hysteroscope. Unlike laparoscopy, which allows for examination and treatment of problems in and on the outer wall of the uterus, hysteroscopy provides a view of fibroids, scar tissue, polyps and anatomical defects inside the uterine cavity.

What to Expect

You should not eat or drink anything after midnight if this procedure is being performed under general anesthesia. Your doctor will use a speculum to widen your vagina and cervix so the hysteroscope can be inserted. Fluid is injected through the scope, enlarging the uterus and washing away blood and other debris from the uterine wall. This allows your physician to get a clear picture of any obstructions so they can be removed using the hysteroscope.

Hysteroscopy usually lasts for about an hour to 90 minutes, but the length of time will vary. You will spend two or three hours in the recovery room and you will need someone to drive you home. You should avoid tampons or sexual intercourse for 48 hours or as otherwise instructed by your doctor. You also should avoid strenuous activity for a few days but you can resume normal activities at a pace that is comfortable for you.

Risks and Side Effects

During the recovery period, you may experience cramping or discharge, but serious complications from hysteroscopy occur in fewer than 1 to 2% of cases. Rarely, if a fluid is used to dilate the uterus, some may escape to the lungs, causing difficulty breathing. The greatest risk associated with hysteroscopy is perforation of the uterine lining, which usually can be repaired during the procedure or it will heal by itself. In very rare instances, patients experience an allergic reaction, blood clots or hemorrhage.

Some bleeding, clotting and discharge is common for a few days after a hysteroscopy. Ibuprofen can help with mild cramping but you should call us if you experience severe cramping or abdominal pain. Also call if bleeding is heavier than during a menstrual period, if you experience unusual vaginal discharge, you are dizzy or lightheaded, or your temperature goes over 100.4o F

Laparotomy

If your physician requires a wider view of your reproductive organs, he or she may recommend laparotomy instead of laparoscopy or hysteroscopy. Laparotomy is major invasive surgery performed on an inpatient basis with the patient under general anesthesia.

What to Expect

Laparotomy requires a 4 to 6 inch, vertical or horizontal  incision just above the pubic bone. Using traditional surgical instruments, your physician is able to examine the pelvic area and remove growths, scar tissue or other obstructions affecting your reproductive organs. The extent of the damage will determine how long the surgery takes but, on average, laparotomies take one to three hours. Because this is major surgery, you will have a catheter to collect urine for approximately 24 hours after the procedure and you will be required to stay in the hospital for a few days. Recovery at home takes an additional 2 to 6 weeks, depending on individual circumstances. Your doctor will tell you when you can resume normal activities and return to work.

Risks and Side Effects

Although laparotomy is somewhat riskier than laparoscopy and hysteroscopy, complications from this major surgery are rare and usually not serious. They may include pelvic or abdominal infections, bleeding or blood clots in the abdomen, allergic reactions, skin infections near the incision, nerve damage, bladder infection or complications from anesthesia. Like other abdominal surgeries, other risks include puncture of the bowel, bladder, blood vessels and other organs. Although occurring rarely, a puncture may require additional surgery for repair.

Myomectomy

Uterine fibroids can cause infertility and, in very serious cases, require complete removal of the uterus (hysterectomy). In other cases, one or more of these masses can be removed and the uterine wall repaired during a myomectomy. Also known as fibroidectomy, this procedure often is performed by laparotomy; however, laparoscopy or hysteroscopy are less invasive options for fibroid removal in some cases.

What to Expect

When a myomectomy is done by laparotomy, a 4 to 6 inch, vertical or horizontal incision is made just below the pubic hairline. Uterine tissue covering the fibroid is cut, the mass is detached from the uterine wall, which is repaired if needed. The number and location of the fibroids will determine how long the procedure takes but myomectomy by laparotomy usually takes one to three hours. It is performed on an inpatient basis and general anesthesia is required so you cannot eat or drink anything after midnight. You will be required to stay in the hospital for a few days following the procedure and 2 to 6 more weeks are required before you can return to work and other normal activities.

Myomectomy also can be performed by the less invasive, outpatient laparoscopy or hysteroscopy (see laparoscopy and hysteroscopy). Because these are minimally invasive procedures, the surgery usually takes less time than a laparotomy, scarring is less, recovery is shorter and you are allowed to return to work and normal activities within 3 to 7 days.

Risks and Side Effects

Although myomectomy by laparotomy is somewhat riskier than laparoscopy and hysteroscopy, complications from this major surgery are rare. Even in these cases, complications usually are not serious but they may include pelvic or abdominal infections, bleeding or blood clots in the abdomen, allergic reactions, skin infections near the incision, nerve damage, bladder infection or complications from anesthesia. Other risks include puncture of the bowel, bladder, blood vessels and other organs, which may require additional surgery for repair.