Reproductive Surgery

Structural disorders of the female reproductive tract can lead to infertility. Various surgical techniques are used to treat problems such as uterine anomalies, uterine fibroids, endometriosis, pelvic adhesions, diseased or blocked fallopian tubes, or ovarian cysts. As a reproductive endocrinologist, I help to diagnose conditions of the female reproductive tract and advise when and what types of surgical procedures should be utilized to improve fertility rates. I am trained in minimally invasive surgical techniques such as hysteroscopy, laparoscopy, and robotic surgery.

Uterine Anomalies

Mullerian anomalies are congenital (present at birth) abnormalities of the female reproductive system, including the uterus, cervix, and fallopian tubes. There are several types of Mullerian anomalies but the most common include uterine septum (a wall of tissue dividing the uterine cavity into two halves), bicornuate uterus (a heart-shaped uterus with two separate cavities), unicornuate uterus (a single-horned uterus), and uterus didelphys (double uterus). These anomalies can cause infertility, repeated miscarriages, and other pregnancy complications. A uterine septum can be corrected with a same day hysteroscopic procedure where a small camera is passed through the cervix into the uterus. The septum is visualized with the scope and cut with small scissors. More complex uterine anomalies may require advanced laparoscopic techniques for correction.

Fibroids

Fibroids are benign tumors that develop in the uterus. They are made up of muscle and fibrous tissue and can range in size from <1cm to large masses. Fibroids are very common, and the cause of fibroids are unknown. Symptoms of fibroids can include heavy or prolonged menstrual periods, painful periods, pressure, or bloating. In some cases, fibroids can cause infertility or repeated miscarriages.
Treatment options for fibroids depend on the size, location, and symptoms they are causing. For women with small fibroids and few or no symptoms, no treatment may be necessary. For women with larger fibroids or significant symptoms, treatment may include hormonal medications, minimally invasive procedures, or surgery.

A submucosal fibroid is a type of uterine fibroid that grows within the uterine cavity. They are more likely to cause abnormal bleeding, infertility, or adverse pregnancy outcomes; therefore, removal is usually recommended in women trying to conceive. The diagnosis of a submucosal fibroid is made using an office procedure called a saline infusion sonohysterogram (SIS). During this procedure a thin flexible catheter is inserted into the uterine cavity. Saline is infused into the uterus through the catheter while a pelvic ultrasound is performed. The saline distends the uterine cavity allowing for the detect of submucosal fibroids. Hysterosalpingography can also be used to detect submucosal fibroids. Submucosal fibroids are typically removed with a surgical procedure called a hysteroscopy. With this procedure, a small camera is introduced through the cervix into the uterine cavity. The submucosal fibroid is visualized, and then shaved away using an instrument. The procedure typically takes under one hour and patients go home the same day with minimal recovery time.

Endometriosis

Endometriosis is a condition in which the tissue that normally lines the inside of the uterus (the endometrium) grows outside of the uterus on the ovaries, fallopian tubes, and other organs causing pain and infertility. This abnormal endometrial tissue is not able to be shed during menstrual periods, and therefore causes inflammation, pain, and scar tissue around the uterus and ovaries. The exact cause of endometriosis is not known, but it is believed to be related to hormonal imbalances, genetic factors, and immune system problems.
The symptoms of endometriosis can include painful menstrual cramps, pain during intercourse, fatigue, and infertility. The severity of symptoms can vary widely, with some women experiencing only mild discomfort, while others may experience severe pain and other complications. Treatment for endometriosis may include medications, such as pain relievers and hormone therapy, or laparoscopic surgical procedures to remove the endometrial tissue from the surfaces of the ovary, fallopian tubes, or pelvic walls. In some cases, fertility treatments, such as in vitro fertilization (IVF), may be recommended to help patients with endometriosis conceive.

Hysteroscopy

Hysteroscopy is a diagnostic and therapeutic procedure that allows a doctor to look inside the uterus using a thin, lighted scope called a hysteroscope. The hysteroscope is inserted through the vagina and cervix into the uterus, allowing the doctor to examine the inside of the uterus and perform certain procedures if necessary. Hysteroscopy is typically performed to diagnose and treat conditions of the uterus, such as abnormal bleeding, fibroids, and polyps.
Hysteroscopy is generally performed as an outpatient procedure and does not require an incision. It can be performed under local or general anesthesia, depending on the reason for the procedure and the patient’s preference. Recovery after hysteroscopy is usually quick, with most women returning to normal activities within a few days. In some cases, hysteroscopy may cause minor discomfort or side effects, such as cramping, bloating, or light vaginal bleeding.

Laparoscopy

Laparoscopy is a minimally invasive surgical procedure that allows a doctor to examine the organs inside the abdomen and pelvis. It is performed using a laparoscope, a thin, lighted tube with a camera. The laparoscope is inserted through small incisions in the abdomen, allowing the doctor to see the organs and perform certain procedures if necessary.
Laparoscopy is typically performed to diagnose and treat conditions of the reproductive system, such as endometriosis, fibroids, and pelvic inflammatory disease. It can also be used to diagnose and treat infertility, including the removal of scar tissue or diseased fallopian tubes (hydrosalpinx).
Laparoscopy is generally performed as an outpatient procedure and does not require a large incision. It can be performed under general anesthesia, and recovery after laparoscopy is usually quick, with most women returning to normal activities within two weeks. In some cases, laparoscopy may cause minor discomfort or side effects, such as pain at the incision site, bloating, or constipation.