Laparoscopic Surgery
Laparoscopy is a minimally invasive surgical technique that involves inserting a small camera near the belly button in order to look and possibly operate inside your abdomen. This is done under general anesthesia. Laparoscopy can be useful in evaluating or repairing the fallopian tubes, in removing ovarian cysts, in investigating or treating chronic pelvic pain, and in removing endometriosis. You should be able to go home the day of surgery and resume normal daily activities very quickly.
A laparoscopy is not recommended for every patient. However, on an individual basis, it may provide a diagnosis that would otherwise go undetected. Laparoscopy may help other fertility treatments work better.
Myomectomy
This refers to the removal of fibroids. Fibroids can be positioned in many locations: on the outside of the uterus, in the uterine muscle, and in the lining of the uterus. Removal of fibroids can be accomplished either by operating through the abdomen (robotic laparoscopy or laparotomy) or by way of hysteroscopy, depending of the size and location of the fibroids.
Fibroids can cause a variety of symptoms including pain, abdominal pressure, bladder irritation, painful intercourse, abnormal bleeding, and difficulty becoming pregnant. When considering treatment for fibroids, it is important to understand the limitations of each surgical method and to understand the goal of surgery, if necessary.
Salpingectomy
Salpingectomy is the removal of a fallopian tube. Sometimes one or both fallopian tubes may be damaged beyond repair. They may appear enlarged or swollen (hydrosalpinx) on ultrasound or on hysterosalpingogram. When this occurs, the damaged tube often reduces pregnancy rates and increases miscarriage rates, even with IVF treatment. In this case, your physician may recommend removing the tube(s) to increase your chances of becoming pregnant.
Sometimes your medical history may reveal a reason for a hydrosalpinx. In many women no identifiable risk factor is present. The presence of a hydrosalpinx may also increase your current and future risk for an ectopic pregnancy (tubal pregnancy) which can be dangerous. It is very important to discuss this with your physician.
Removal of Ovarian Cysts
Ovarian cysts are very common, especially in young women. Cysts often resolve on their own without requiring any treatment. Sometimes they grow larger or persist and require surgery. The majority of cysts are benign. However, a small percentage of cysts may prove to be cancer. Surgical therapy is the only way to make an absolute diagnosis.
Cysts may be diagnosed on physical exam and may be more closely followed by ultrasound. When removal of a cyst is necessary, most can be removed be laparoscopy without the need for a large incision. The presence of a cyst is sometimes reflective of an underlying disorder such an endometriosis. If you have a cyst or have had cysts previously, your physician can discuss how they may affect your treatment.
Endometriosis
Endometriosis is common in reproductive age women. Endometriosis can make it harder for women to become pregnant. It can also cause chronic pain and painful intercourse. Surgical therapy combined with medical therapy can improve pain symptoms. In addition, surgical removal of endometriosis, especially when a cyst of endometriosis (endometrioma) forms, can help improve your chances of conceiving.
The treatment of endometriosis can be complicated. Your response to any one therapy may change over time. It is important that treatment is provided by a specialist who can balance short term and long term therapy and tailor a treatment plan to your reproductive needs.