Pelvic and Reproductive Surgery
A reproductive surgeon is an obstetrician
gynecologist specifically trained in the surgical
correction of anatomical disorders that affect
reproductive function. Reproductive surgery may
be performed through a major surgical procedure,
termed laparotomy, or a relatively minor surgical
procedure, termed endoscopy.
In a laparotomy procedure, 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). Endosurgic procedures are
usually performed on an out-patient basis.
Penn Fertility Care offers the following pelvic
or reproductive surgeries:
Tuboplasty
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.
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Tubal Reanastomosis
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.
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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.
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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 our surgical
outpatient unit via laparoscopy. Scar tissue that
has developed within the uterine cavity may also
be removed via hysteroscopy performed as an outpatient.
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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.
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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.
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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.
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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.
Penn Fertility Care has long been a leader in
treating endometriosis. This can be done via medication
or through laparotomy or laparoscopy.
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