Please contact us at: 732-758-6511

Surgery Procedures

Reproductive problems often require surgical diagnosis and treatment. Dr. Damien has over twenty years experience with reproductive surgery. In the 1980’s most infertility surgical procedures were performed by a large abdominal incision (laparotomy).

Modern laparoscopic and hysteroscopic techniques are currently employed to provide the best possible results for our patients. These “small incision” techniques utilize lasers and small scopes. They have become the predominant surgery performed for infertility problems.

Laparoscopy

This procedure is performed under general anesthesia. A laparoscope is a telescope about 1/2 an inch in diameter. It is placed into the abdomen through a small incision in the navel. It is then possible to view the organs in the abdomen and pelvis including the surface of the uterus, bladder, the fallopian tubes and the ovaries. A second incision (occasionally a third or fourth) is made in the skin just above the pubic hair. The incisions are usually less than 1/3 of an inch long and are used to pass other instruments into the abdomen to assist in the laparoscopy.

The most common conditions found during a laparoscopy are endometriosis and scar tissue (adhesions). Endometriosis and adhesions are found primarily on the uterus, fallopian tubes, or ovaries but may also involve deeper parts of the pelvis including the ureters, bladder, and large blood vessels.

Endometriosis

This disease is caused by the abnormal presence of endometrial tissue (lining of the uterus) on the surface of pelvic organs. Women with endometriosis are twice as likely to be infertile as women without this condition. Endometriosis can only be confirmed and classified by laparoscopy. A uniform system of classification that takes into account the amount and location of endometriosis and adhesions is used. This staging system, formulated by the American Society for Reproductive Medicine, classifies the disease as minimal, mild, moderate, and severe (stages I – IV).

Treatment of endometriosis may be surgical or hormonal and is based on a confirmed laparoscopic diagnosis, the patient’s age, and the extent, location, and severity of the disease. Endometriosis has many different appearances. A high level of expertise and experience is necessary to identify this abnormal tissue in its many forms. Initial treatment should be accomplished at the time of laparoscopy. The use of conventional electrocoagulation is often utilized. Nevertheless, an ultrasonic knife and lasers can be more effective in removing the disease and decreasing future scarring.

Adhesions (Pelvic)

Adhesions in the pelvis my result from previous surgery, infection, or any inflammatory process in the abdomen. The body “walls off” injured areas with scar tissue or adhesions. The major impact is on the function of the fallopian tubes. The end of the tubes have finger-like projections called fimbria. They help sweep the egg into the tube after ovulation. The egg and the sperm meet in the tube where fertilization takes place. The embryo is transported down the tube to the uterus where implantation takes place. When scar tissue involves the tube or fimbria then normal transport of egg, sperm, and embryo are interrupted and the possibility of pregnancy is markedly reduced. Removing the scar tissue will improve normal tubal function.

A laser is often used to treat these conditions. It is an intense beam of light which can cut and remove (ablate or vaporize) abnormal tissues. Removal of scar tissue (adhesiolysis), ablation of endometriosis, and repair of fallopian tubes can therefore be performed. Removal of severely diseased fallopian tubes or ovarian cysts can also be performed. The advantage of using a laser is that it minimizes injury to surrounding areas and facilitates precise cutting and removal of abnormal tissues.

Hysteroscopy

The hysteroscope is a telescope that is slightly wider than a pencil. It passes through the natural opening in the cervix and into the cavity of the uterus. With this instrument we can identify and frequently correct abnormalities in the uterus which lead to miscarriage, infertility, or abnormal bleeding. Insertion of the hysteroscope (hysteroscopy) most often requires that the opening in the cervix be dilated and may be accompanied by a scraping of the uterine lining (curettage). Hysteroscopy is commonly performed at the same time that a laparoscopy is being done.

 

Fibroid / Polyp

Polyps or fibroids, lesions of glandular or muscle tissue, are found on the wall of the uterus. They disrupt the uterine cavity and may result in repeated pregnancy losses or heavy/irregular menstrual bleeding. The uterine cavity shape can initially be evaluated by hysterosalpingogram (HSG) or sonohysterogram. These radiologic and ultrasound procedures can image the uterine cavity. They would be seen as a filling defect. Polyps and fibroids can be removed by hysteroscopic resection.

Adhesions (Intrauterine)

Intrauterine adhesions or scarring can be formed by extensive surgical instrumentation of the uterus, retained pregnancy tissue, or by a uterine infection. Examples include curettage for retained tissue after a delivery, spontaneous or therapeutic abortion, or removal of a fibroid from the uterus (myomectomy). This condition may present as infertility or recurrent spontaneous pregnancy losses. The appearance of filling defects on hysterosalpingography (HSG) may be the first evidence this condition exists. Treatment is by hysteroscopic guided lysis of adhesions.

Recovery

Most women who have a hysteroscopy and/or laparoscopy will be able to return home the same day as their surgical procedure. For the first oneor two days after the surgery patients experience mild abdominal bloating and discomfort as well as some discomfort in the shoulders. By four to seven days after the procedure most women have resumed normal activities. Small amounts of vaginal bleeding are common for up to seven to ten days after surgery.

Shrewsbury

Damien Fertility Partners
655 Shrewsbury Avenue
Shrewsbury, NJ 07702
Phone: 732-758-6511
Fax: 732-758-1048

Newark

Damien Fertility Partners
60 Park Place, Suite 210
Newark, NJ 07102
Phone: 973-732-2909
Fax: 732-758-1048

Jersey City

Damien Fertility Partners
138 River Drive South
Jersey City, NJ 07310
Phone: 201-377-0500
Fax: 732-758-1048