| Surgical Procedures |
Reproductive problems often require surgical diagnosis and treatment. Dr. Damien has over twenty years experience with reproductive surgery. In
the 1980's most infertility surgical procedures were performed by a large abdominal incision (laparotomy). Modern laparoscopic and hysteroscopic
techniques are currently employed to provide the best possible results for our patients. These "small incision" techniques utilize lasers and small
scopes. They have become the predominant surgery performed for infertility problems.
RECOVERY
Most women who have a hysteroscopy and/or laparoscopy will be able to return home the same day as their surgical procedure. For the first one
or two days after the surgery patients experience mild abdominal bloating and discomfort as well as some discomfort in the shoulders. By four to
seven days after the procedure most women have resumed normal activities. Small amounts of vaginal bleeding are common for up to seven to ten
days after surgery.
the 1980's most infertility surgical procedures were performed by a large abdominal incision (laparotomy). Modern laparoscopic and hysteroscopic
techniques are currently employed to provide the best possible results for our patients. These "small incision" techniques utilize lasers and small
scopes. They have become the predominant surgery performed for infertility problems.
RECOVERY
Most women who have a hysteroscopy and/or laparoscopy will be able to return home the same day as their surgical procedure. For the first one
or two days after the surgery patients experience mild abdominal bloating and discomfort as well as some discomfort in the shoulders. By four to
seven days after the procedure most women have resumed normal activities. Small amounts of vaginal bleeding are common for up to seven to ten
days after surgery.
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LAPAROSCOPY
This procedure is performed under general anesthesia. A laparoscope is a telescope
about 1/2 an inch in diameter. It is placed into the abdomen through a small incision in the
navel. It is then possible to view the organs in the abdomen and pelvis including the
surface of the uterus, bladder, the fallopian tubes and the ovaries. A second incision
(occasionally a third or fourth) is made in the skin just above the pubic hair. The incisions
are usually less than 1/3 of an inch long and are used to pass other instruments into the
abdomen to assist in the laparoscopy.
The most common conditions found during a laparoscopy are endometriosis and scar
tissue (adhesions). Endometriosis and adhesions are found primarily on the uterus,
fallopian tubes, or ovaries but may also involve deeper parts of the pelvis including the
ureters, bladder, and large blood vessels.
This procedure is performed under general anesthesia. A laparoscope is a telescope
about 1/2 an inch in diameter. It is placed into the abdomen through a small incision in the
navel. It is then possible to view the organs in the abdomen and pelvis including the
surface of the uterus, bladder, the fallopian tubes and the ovaries. A second incision
(occasionally a third or fourth) is made in the skin just above the pubic hair. The incisions
are usually less than 1/3 of an inch long and are used to pass other instruments into the
abdomen to assist in the laparoscopy.
The most common conditions found during a laparoscopy are endometriosis and scar
tissue (adhesions). Endometriosis and adhesions are found primarily on the uterus,
fallopian tubes, or ovaries but may also involve deeper parts of the pelvis including the
ureters, bladder, and large blood vessels.
Adhesions (Pelvic)
Adhesions in the pelvis my result from previous surgery, infection, or any inflammatory
process in the abdomen. The body "walls off" injured areas with scar tissue or
adhesions. The major impact is on the function of the fallopian tubes. The end of the
tubes have finger-like projections called fimbria. They help sweep the egg into the
tube after ovulation. The egg and the sperm meet in the tube where fertilization takes
place. The embryo is transported down the tube to the uterus where implantation
takes place. When scar tissue involves the tube or fimbria then normal transport of
egg, sperm, and embryo are interrupted and the possibility of pregnancy is markedly
reduced. Removing the scar tissue will improve normal tubal function.
A laser is often used to treat these conditions. It is an intense beam of light which can
cut and remove (ablate or vaporize) abnormal tissues. Removal of scar tissue
(adhesiolysis), ablation of endometriosis, and repair of fallopian tubes can therefore
be performed. Removal of severely diseased fallopian tubes or ovarian cysts can also
be performed. The advantage of using a laser is that it minimizes injury to surrounding
areas and facilitates precise cutting and removal of abnormal tissues.
Adhesions in the pelvis my result from previous surgery, infection, or any inflammatory
process in the abdomen. The body "walls off" injured areas with scar tissue or
adhesions. The major impact is on the function of the fallopian tubes. The end of the
tubes have finger-like projections called fimbria. They help sweep the egg into the
tube after ovulation. The egg and the sperm meet in the tube where fertilization takes
place. The embryo is transported down the tube to the uterus where implantation
takes place. When scar tissue involves the tube or fimbria then normal transport of
egg, sperm, and embryo are interrupted and the possibility of pregnancy is markedly
reduced. Removing the scar tissue will improve normal tubal function.
A laser is often used to treat these conditions. It is an intense beam of light which can
cut and remove (ablate or vaporize) abnormal tissues. Removal of scar tissue
(adhesiolysis), ablation of endometriosis, and repair of fallopian tubes can therefore
be performed. Removal of severely diseased fallopian tubes or ovarian cysts can also
be performed. The advantage of using a laser is that it minimizes injury to surrounding
areas and facilitates precise cutting and removal of abnormal tissues.
Endometriosis
This disease is caused by the abnormal presence of endometrial tissue (lining of the uterus) on
the surface of pelvic organs. Women with endometriosis are twice as likely to be infertile as
women without this condition. Endometriosis can only be confirmed and classified by
laparoscopy. A uniform system of classification that takes into account the amount and location
of endometriosis and adhesions is used. This staging system, formulated by the American
Society for Reproductive Medicine classifies the disease as minimal, mild, moderate, and
severe (stages I - IV).
Treatment of endometriosis may be surgical or hormonal and is based on a confirmed
laparoscopic diagnosis, the patient's age, and the extent, location, and severity of the disease.
Endometriosis has many different appearances. A high level of expertise and experience is
necessary to identify this abnormal tissue in its many forms. Initial treatment should be
accomplished at the time of laparoscopy. The use of conventional electrocoagulation is often
utilized. Nevertheless, an ultrasonic knife and lasers can be more effective in removing the
disease and decreasing future scarring.
This disease is caused by the abnormal presence of endometrial tissue (lining of the uterus) on
the surface of pelvic organs. Women with endometriosis are twice as likely to be infertile as
women without this condition. Endometriosis can only be confirmed and classified by
laparoscopy. A uniform system of classification that takes into account the amount and location
of endometriosis and adhesions is used. This staging system, formulated by the American
Society for Reproductive Medicine classifies the disease as minimal, mild, moderate, and
severe (stages I - IV).
Treatment of endometriosis may be surgical or hormonal and is based on a confirmed
laparoscopic diagnosis, the patient's age, and the extent, location, and severity of the disease.
Endometriosis has many different appearances. A high level of expertise and experience is
necessary to identify this abnormal tissue in its many forms. Initial treatment should be
accomplished at the time of laparoscopy. The use of conventional electrocoagulation is often
utilized. Nevertheless, an ultrasonic knife and lasers can be more effective in removing the
disease and decreasing future scarring.
HYSTEROSCOPY
The hysteroscope is a telescope that is slightly wider than a pencil. It passes through
the natural opening in the cervix and into the cavity of the uterus. With this instrument
we can identify and frequently correct abnormalities in the uterus which lead to
miscarriage, infertility, or abnormal bleeding. Insertion of the hysteroscope
(hysteroscopy) most often requires that the opening in the cervix be dilated and may
be accompanied by a scraping of the uterine lining (curettage). Hysteroscopy is
commonly performed at the same time that a laparoscopy is being done.
The hysteroscope is a telescope that is slightly wider than a pencil. It passes through
the natural opening in the cervix and into the cavity of the uterus. With this instrument
we can identify and frequently correct abnormalities in the uterus which lead to
miscarriage, infertility, or abnormal bleeding. Insertion of the hysteroscope
(hysteroscopy) most often requires that the opening in the cervix be dilated and may
be accompanied by a scraping of the uterine lining (curettage). Hysteroscopy is
commonly performed at the same time that a laparoscopy is being done.
Fibroid / Polyp
Polyps or fibroids, lesions of glandular or muscle tissue, are found on the wall of the
uterus. They disrupt the uterine cavity and may result in repeated pregnancy losses or
heavy/irregular menstrual bleeding. The uterine cavity shape can initially be evaluated
by hysterosalpingogram (HSG) or sonohysterogram. These radiologic and ultrasound
procedures can image the uterine cavity. They would be seen as a filling defect.
Polyps and fibroids can be removed by hysteroscopic resection.
Polyps or fibroids, lesions of glandular or muscle tissue, are found on the wall of the
uterus. They disrupt the uterine cavity and may result in repeated pregnancy losses or
heavy/irregular menstrual bleeding. The uterine cavity shape can initially be evaluated
by hysterosalpingogram (HSG) or sonohysterogram. These radiologic and ultrasound
procedures can image the uterine cavity. They would be seen as a filling defect.
Polyps and fibroids can be removed by hysteroscopic resection.
Adhesions (Intrauterine)
Intrauterine adhesions or scarring can be formed by extensive surgical instrumentation of the uterus,
retained pregnancy tissue, or by a uterine infection. Examples include curettage for retained tissue after
a delivery, spontaneous or therapeutic abortion, or removal of a fibroid from the uterus (myomectomy).
This condition may present as infertility or recurrent spontaneous pregnancy losses. The appearance of
filling defects on hysterosalpingography (HSG) may be the first evidence this condition exists. Treatment
is by hysteroscopic guided lysis of adhesions.
Intrauterine adhesions or scarring can be formed by extensive surgical instrumentation of the uterus,
retained pregnancy tissue, or by a uterine infection. Examples include curettage for retained tissue after
a delivery, spontaneous or therapeutic abortion, or removal of a fibroid from the uterus (myomectomy).
This condition may present as infertility or recurrent spontaneous pregnancy losses. The appearance of
filling defects on hysterosalpingography (HSG) may be the first evidence this condition exists. Treatment
is by hysteroscopic guided lysis of adhesions.
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