Endoscopic Surgery - Reproductive Medicine JHB

ENDOSCOPIC PROCEDURES THAT WE OFFER

PROCEDURE: HYSTEROSCOPY
Hysteroscopy is a procedure to examine the inside of the uterus. A thin telescope called a hysteroscope is passed through the cervix. The hysteroscope allows the gynaecologist to inspect the lining of the uterus and the openings of the fallopian tubes. It also allows to look for any abnormalities. This procedure is minimally invasive helps to diagnose uterine problems and can be use to treat some conditions like endometrial polyps, intracavitary myoma, endometrial adhesions/bands, and uterine septum.

PROCEDURE: LAPAROSCOPY

A laparoscope is a surgical procedure to examine the abdominal cavity and pelvic organs on a video monitor which is commonly known as keyhole surgery. It is performed under general anaesthesia. Two to 4 small cuts are be made in the skin to introduce the telescope and operative instruments into the abdominal cavity. The cuts will be closed, usually with a dissolvable stitch or sticky tape.

PROCEDURE: EXCSISION ENDOMETRIOSIS

Endometriosis is a chronic, inflammatory disease that commonly causes severe pelvic and abdominal pain in women. In endometriosis, the cells similar to those lining the inside of the uterus (womb) are found in other parts of the body, but most commonly in the pelvis, abdomen, bowel, Pouch of Douglas, uterosacral ligaments, ovaries, and fallopian tubes. During a laparoscopy, endometriosis can be diagnosed and treated at the same time. Endometriosis can cause organs in the pelvis and abdomen to get stuck together, this is called adhesions. In order to perform a safe operation, adhesions have to be divided and tissues separated

PROCEDURE: EXCISION ADENOMYOSIS

Adenomyosis refers to abnormal growth of endometrial glands into the uterine smooth muscles. These glands form clusters and groups and may look similar to a degenerating fibroid. Adenomyosis causes pelvic pain, painful periods, heavy menstrua bleeding and subfertility. Excision of adenomyosis is similar to myomectomy, but more challenging due to the soft nature of glands and a lack of a defining capsule to guide a complete excision. Hence, ii can be removed completely or partially. The result is a reduction or disappearance of the symptoms caused by adenomyosis.

PROCEDURE: MYOMECTOMY

Myomas or fibroids are solid, abnormal fibromuscular growths in the uterus also known as fibroids. They can cause subfertility or infertility depending on their location on the uterus.Submucous or intra-cavitary fibroids, and intramural fibroids that distort the cavity are associated with decreased pregnancy and implantation rates in women who attempt to conceive spontaneously or with IVF. According to research, women with intramural fibroids appear to have reduced implantation rates compared to women without intramural fibroids,

Myomectomy refers to the surgical removal of uterine leiomyoma’s or myomas also known as fibroids. In contrast to a hysterectomy the uterus remains preserved and the woman retains her reproductive potential.

TUBAL RECONSTRUCTIVE SURGERY

The fallopian tube is both the conduit (pathway) and the transporter of the sperm to the ovum. Tubal function also aids transport of sperm to the site of fertilization. Fertilization of the egg by the sperm occurs in the fallopian tube.

The fallopian tubes are thus essential and necessary in normal, natural, unassisted reproduction in women.

The fallopian tubes extend from the uterine cavity to the ovary. They capture the ovum after ovulation and serve as a pathway for the travel of the fertilized egg and developing embryo toward the uterus.

They provide the environment and conditions for conception and for the early development of the embryo.

Before the surgery, A basic fertility evaluation must assess

The ability of the woman to ovulate,
Whether the woman has a healthy reproductive tract, and
The availability of viable sperm.

These components are the essentials necessary to have a possibility of pregnancy; therefore, if a tubal factor is identified early during the evaluation of a couple, a woman should not undergo tubal reconstruction unless it has been established that she can ovulate, that her uterus is otherwise normal, and that her male partner has adequate sperm.

The initial history, physical examination, and laboratory evaluation should focus on uncovering risk factors for infertility.

Age is very important in the evaluation of female fertility. Fertility in women decreases with increasing age, reflecting decreased ovarian function.
The decrease in female fertility starts at approximately age 35 years. Fertility decreases with advancing age and there is increased risk of miscarriage, congenital malformations, and complications during pregnancy.

The menstrual history
is essential to evaluate a possible ovulatory factor.

The obstetrical history
establishes whether the woman has ever been able to conceive and whether she has had any pregnancy complications, such as an ectopic pregnancy or septic miscarriage that may have compromised her reproductive tract.

The gynaecological history
reveals possible problems with the reproductive organs that may affect fertility or the possibility of pregnancy.

A history of Asherman syndrome or adhesions in the endometrial cavity with extensive destruction of the endometrial surface may preclude the possibility of embryonic implantation.

The presence of congenital or acquired malformations of the reproductive tract such as fibroids, bicornuate uterus, uterine septum, malformations secondary to intrauterine diethylstilbestrol exposure may affect the uterine cavity in a way that prevents a foetus from developing to viability at birth.

The surgical history
should focus on the pelvis because any surgery on the reproductive organs, bowel, or bladder can cause pelvic inflammation, adhesions, and tubal damage.

The physical examination
should confirm normal pubertal development with the presence of normal secondary sexual characteristics.
The presence of hormonal disorders that can affect ovulation, such as hirsutism or galactorrhea(inappropriate milk secretion), should be sought.

Examination of the abdomen
may reveal scars from previous surgeries that may have affected the reproductive organs.

A pelvic examination
may reveal gross abnormalities of the reproductive tract.

It is important to note that pregnancy after a tubal sterilization reversal procedure is mostly likely to occur within the first year. Most pregnancies occur within 6 months after surgery.

The medical and endocrine history
uncovers possible causes of ovulatory dysfunction secondary to hypothalamic/pituitary disorders or intrinsic ovarian malfunction.

A history of PID, endometritis, and other causes of pelvic inflammation, such as endometriosis or appendicitis, should be elicited.
Correctible medical contraindications to pregnancy (and surgery), such as uncontrolled diabetes, hypertension, or cardiac or renal disease, should be excluded or corrected.

Tubal surgery is done using microsurgical techniques. These may be done during open surgery on the belly or using hysteroscopy and laparoscopy.

SALPINGOSTOMY
is also done when the end of the fallopian tube is blocked by a build-up of fluid. This procedure creates a new opening in the part of the tube closest to the ovary. But it’s common for scar tissue to regrow after a salpingostomy. This can re-block the tube. To prevent this, the end of the tube is everted, and an adhesive barrier is placed near the surgical site.

SELECTIVE TUBAL CANNULATION
for a tubal blockage next to the uterus using fluoroscopy or hysteroscopy to guide the tools, a doctor inserts a catheter, or cannula, through the cervix and the uterus and into the fallopian tube.

FIMBRIOPLATY
may be done when the part of the tube closest to the ovary is partially blocked or has scar tissue. These problems can prevent normal egg pickup. This procedure rebuilds the fringed ends of the fallopian tube.

TUBAL RE-ANASTAMOSIS
is done to reverse a sterilization also known as tubal ligation or to repair a part of the fallopian tube damaged by disease. The blocked or diseased part of the tube is removed. Then the two healthy ends of the tube are joined. This procedure can be done through an incision in the belly (laparotomy), but some specialists can do this procedure using laparoscopy

Contra-indications to tubal surgery are dependant on several different factors, as well as the reason for the surgery.

Aged 40 years or older
Male Factor Infertility
Decreased ovarian reserve
Premature ovarian insufficiency
Tubal infertility not amenable to tubal reconstruction
Extensive tubal damage
Hydrosalpinx with a diameter of more than 3 cm
Inadequate proximal or distal tubal segment for anastomosis, that is the tube is shortened.
Projected tubal length of less than 3 cm after the reconstruction procedure (same as above)
Extensive pelvic or peri-tubal adhesions
Abnormal uterine cavity
Any contraindication to pregnancy or surgery
Severe male factor infertility or male sterility

Mild male factor infertility
Endometriosis: A condition that may require a delay in the procedure
Obesity: Being overweight can increase the risk of complications
Coagulation disorders: Conditions that may increase the risk of complications

ENDOSCOPIC PROCEDURES THAT WE OFFER

PROCEDURE: LAPAROSCOPY

PROCEDURE: EXCSISION ENDOMETRIOSIS

PROCEDURE: EXCISION ADENOMYOSIS

PROCEDURE: MYOMECTOMY

TUBAL RECONSTRUCTIVE SURGERY

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