Reproductive surgery is used to remove adhesions (scar tissue) or endometriosis, which block the fallopian tube or interfere with its ability to pick up an egg. Advanced techniques have improved our ability to do this, often with a non-invasive laparoscopic approach or with a microsurgical approach to reconstruct the fallopian tubes or the uterus.
In a laparotomy, an incision is made in the lower abdomen which enables the surgeon to have direct access to all structures of the pelvis. This procedure requires hospitalization and a four to six-week period of recovery.
Reproductive surgery may also be conducted through endoscopy, which is an outpatient procedure. Endoscopy involves the use of either a laparoscope (a small telescope inserted into the abdominal wall) or a hysteroscope (a small telescope inserted within the uterine cavity). Endosurgical procedures are usually performed on an outpatient basis.
At Penn Fertility Care, we offer the following pelvic or reproductive surgeries:
Patients experiencing infertility may have a blockage of the fallopian tubes either at their insertion into the uterus (proximal occlusion) or at the ends (fimbria) of the fallopian tubes. To successfully reopen a fallopian tube, tuboplasty (surgery on the fallopian tubes) may be performed via laparotomy or laparoscopy.
If the obstruction is present at the proximal (where the fallopian tube inserts into the uterus) portion of the fallopian tube, success in opening the tube may be accomplished by hysteroscopy, an outpatient procedure. In this procedure, the blocked proximal portions of the tubes may be opened with a thin dilator. If the distal (farthest) portion of the fallopian tube is blocked, it may also be opened either through microsurgery or by laparoscopic laser surgery.
Patients who have had their fallopian tubes tied or cauterized may, for a variety of reasons, wish to restore their fertility. This may be accomplished by a procedure performed on the fallopian tubes termed tubal reanastomosis. Penn Fertility Care has been a pioneer in improving this procedure. In select cases, the success rate with this procedure has been excellent.
Correction of Uterine Abnormalities
During fetal development, abnormalities of the uterus, fallopian tubes and vagina may occur. Such malformations may contribute to infertility, severe pelvic pain, or recurrent pregnancy loss. Penn Fertility Care has been a pioneer in surgically correcting these problems. Many procedures can be performed on an outpatient basis — meaning patients can often return home on the same day the surgical procedure is performed.
Removal of Scar Tissue
Infertility or pelvic pain may be the result of scar tissue that has developed from previous abdominal or pelvic surgery, endometriosis or pelvic infections. In the majority of cases, adhesiolysis (removal of scar tissue) may be performed in Penn's surgical outpatient unit via laparoscopy. Scar tissue that has developed within the uterine cavity may also be removed via hysteroscopy performed as an outpatient.
Removal of Fibroid Tumors
Approximately 30 percent of patients will have leiomyomata uteri (fibroid tumors). Fibroid tumors may be asymptomatic or may cause excessive uterine bleeding, recurrent miscarriages, pain and pressure, or severe anemia. Penn Fertility Care excels in removing fibroid tumors via laparotomy or, in select cases, by outpatient hysteroscopy.
Removal and Evaluation of Ovarian Cysts
Ovarian cysts are a common condition for patients during their reproductive years. A variety of non-malignant cysts may occur in ovarian tissue and, depending on the cyst symptomology and characteristics, warrant removal. Occasionally, removal of the cysts may only be accomplished via laparotomy, a major surgical procedure. However, in many cases, such cysts may be removed during an outpatient procedure via advanced laparoscopic surgery.
Correction of Abnormal Uterine Bleeding
In many instances, women experience excessive menstrual bleeding which, at times, can be debilitating. If this bleeding cannot be corrected hormonally, Penn Fertility Care reproductive surgeons are skilled in performing a procedure known as endometrial ablation. In this outpatient procedure, the uterine lining may be destroyed in a safe and rapid manner with little postoperative discomfort.
Removal of Endometriosis
Endometriosis is a common cause of infertility. Up to 40 percent of patients with infertility may have this condition. Endometriosis is also one of the most common causes of severe pelvic pain in women of reproductive age and may cause severe pelvic adhesions. In addition, endometriosis involving the bladder or bowel may trigger progressive gastrointestinal and urinary problems.