Reproductive surgery helps correct anatomical problems, both acquired and congenital, to allow for healthysexual and reproductive function. Both Dr. Koopersmith and Dr. Landay have completed extensive training to achieve expertise in performing these procedures.
Laparoscopy and Hysteroscopy
We use minimally invasive techniques whenever possible. Laproscopy is a procedure that allows us to look inside the abdomen with a telescope inserted through a small incision in the umbilicus. We are able to visualize scarring/adhesions, endometriosis, ovarian cysts, and blocked fallopian tubes that can all be the cause of infertility. Opening or removal of the fallopian tubes, resection of endometriosis or removal of small fibroids is often performed laparoscopically.
Hysteroscopy is another minimally invasive technique, performed either in our office or an outpatient surgery center. With hysteroscopy we are able to visualize the inside of the uterus with a telescope placed through the cervix and into the uterus. Diagnostic hysteroscopy allows us to visualize the inside of the uterine cavity to determine if it is normal or if there are conditions such as polyps, fibroids, scarring or congenital defects that can contribute to infertility or miscarriage. When found, these uterine conditions can be corrected directly through the hysteroscope.
When a problem is too extensive for laparoscopy or hysteroscopy, we perform traditional open procedures. In these cases, a larger incision in the abdominal wall, or laparotomy, is performed allowing for greater ability to correct the defects. Removal of uterine fibroids, extensive pelvic scarring, large ovarian cysts or difficult tubal surgery is often performed by this technique.
At the Valley Center for Reproductive Health, we perform a variety of reproductive surgical procedures using both traditional and robotic laparoscopy (www.davincisurgery.com), hysteroscopy, or laparotomy including:
- Myomectomy: removal of uterine fibroids
- Polypectomy: removal of uterine polyps
- Ovarian cystectomy: removal of ovarian cysts
- Salpingectomy: removal of one or both fallopian tubes (usually because of damage that cannot be repaired)
- Salpingostomy: making an incision in a fallopian tube either to repair a closed tube or to remove an ectopic pregnancy
- Tubal ligation: separating a fallopian tube from its attachment to the uterus (performed in lieu of salpingectomy in specific cases prior to performing IVF)
- Tubal ligation reversal: rejoining of segments of the fallopian tubes that were separated by tubal ligation in the past
- Metroplasty: removal of a uterine septum
- Vaginal septoplasty: removal of a vaginal septum
- Lysis of adhesions: cutting and removal of scar tissue
Myomas or fibroids are noncancerous tumors of muscles, usually found in the uterus. They are very common: some estimates say that 50% of women have fibroids in their uterus. Removal of fibroids is not always necessary: the location and size of the fibroid are important variables that determine whether the fibroids cause symptoms and need treatment. Leiomyomas can cause heavy menstrual bleeding as well as symptoms of discomfort such as pressure and pain and frequent urination. In addition fibroids may be associated with infertility and poor obstetrical outcomes.
There are different treatment options for leiomyomas.
Hysterectomy, or removal of the entire uterus, is a permanent treatment for those women who are done with childbearing.
Myomectomy is the removal of the fibroids only, with repair of the uterine muscle tissue.
Minimally invasive surgery is surgery that allows the patient to return to regular activities much faster than traditional surgery, usually because the incisions are much smaller than traditional incisions. Small fibroids that are inside the cavity can be removed from the endometrial cavity through the cervix using a hysteroscope (telescope) and scissors or cautery. Fibroids in the wall of the uterus need to be removed from the myometrium (uterine muscle) and then the muscle layers need to be reapproximated surgically with suture.
Robotic Myomectomy Advantages
Intuitive Surgical’s da Vinci® Surgical System,” the robot” has made myomectomy possible via the laparoscope or minimally invasive technique. The robot gives the surgeon dexterity of the wrists which allows the surgeon to easily suture the uterus together. This, together with improved magnification and 3D high definition vision make the use of the robot an excellent option for minimally invasive myomectomy. The morcellator is the instrument used to chop the tumors into small pieces to remove through the small incisions. Even for large fibroids, myomectomy can now be done as an outpatient procedure and patients can return to routine activities in a fraction of the time from traditional laparotomy and myomectomy.
Other Fibroid Treatment Options
There are other treatment options for fibroid treatments such as uterine artery embolization and traditional laparotomy and MRI focused ultrasounds. You should discuss your treatment with the doctor to choose the best option in your particular case.
Schedule a Consultation
Take the first step toward parenthood and schedule a consultation with one of our highly trained fertility specialists. Drs. Koopersmith and Landay are available to answer any question you may have and help you achieve your dream of having a healthy baby. Follow this link to fill out a short contact form and we will be in touch with you shortly to schedule a consultation. We look forward seeing you soon.