Minimally Invasive and Robotic Fertility Surgery Options
Laparoscopic Fertility Surgery
A laparoscopy is an outpatient procedure which is commonly performed by gynecologists and infertility specialists. During this outpatient procedure, 2-3 small incisions are made in the belly button and in the lower abdomen. The belly is then inflated with carbon dioxide in order to allow the abdominal and pelvic organs to separate from each other, creating a space in which the surgeon can work. An operative telescope (laparoscope) is then inserted through the belly button incision to allow the surgeon to view the pelvic cavity, including the uterus, fallopian tubes, ovaries, and surrounding tissues.
If there is evidence of endometriosis, laser therapy can be used to treat the disease. Cysts can also be removed from the ovaries during laparoscopy. If there is evidence of scar tissue, this can be treated or removed as well. The patency (‘open-ness’) of the fallopian tubes can also be established during laparoscopy by injecting dye into the uterus and watching for spillage from the ends of the fallopian tubes.
Most laparoscopic procedures take between 1-2 hours to complete. Following surgery, a patient needs a few hours of recovery before being discharged home with pain medications. It is recommend to take a few days off after surgery for full recovery before returning to your normal activities. More extensive procedures may require a longer recovery.
Hysteroscopy for Infertility
A hysteroscopy is similar to a laparoscopy in that a thin camera is used. However, during a hysteroscopy, the camera is placed through the vaginal opening into the uterus without making any incisions. A small amount of fluid is placed in the uterus to allow the surgeon to adequately visualize the uterine cavity. At this time, if fibroids, polyps, or scar tissue is present, they may be removed. A uterine septum (an abnormal band of tissue that extends from the top of the cavity into the lower part of the uterus) can also be removed during a hysteroscopy.
Following surgery, a patient will spend a few hours in the recovery area before discharge. Typically, a patient will make a full recovery within 24-48 hours.
Laparotomy, Traditional Surgery
A laparotomy refers to a surgery where a larger abdominal incision is made. This is often required if there are multiple fibroid tumors within the uterus or if endometriosis or adhesions (scar tissue) is so severe that treatment cannot be safely performed through the laparoscope. The incision is typically made in the area of the ‘bikini-line’. Care is taken to make the incision as small as possible while still allowing for the surgery to be safely performed.
Following surgery, patients will often require a short (1-2 day) hospital stay, though sometimes they are able to be discharged the day of surgery. Patients will usually require narcotic medication for pain relief following a laparotomy. You may usually return to work within 1-2 weeks following the performance of a laparotomy.