Reproductive surgery

Reproductive Surgery

Introduction

Reproductive surgery is a branch of reproductive medicine that involves conservation of fertility in both men and women. It is performed by specialized reproductive surgeons who mainly focus on fertility enhancement by restoring and maintaining the reproductive function. They are mostly obstetrician-gynecologist or a urologist who specializes in reproductive surgery. They also perform surgery for contraception in men and women. There are different Ways in which surgery could be done – Hysteroscopy, Laparoscopy, etc.
Today, assisted reproductive technology (ART) has become more prevalent. Hence, the surgeries on fallopian tubes or ovaries have become less frequent. However, reproductive surgery can still make a huge difference.
Why is it performed?
Reproductive Surgery is performed to treat various conditions or restore the normal functions of the reproductive organs, such as ovaries, uterus, and tubes. The common reproductive problems in women are;

• Tubal disease

• Uterine polyps

• Ovarian cysts

• Uterine fibroids

• Tube ligation

• Uterine septum

• Endometriosis

• Pelvic Adhesions

Tubal fertility Surgery

To achieve fertilization, the eggs, and the sperm must pass through the fallopian tube. It is only after this process that they can implant on the uterus. However, fallopian tube disorders prevent this from happening. It can be due to a blockage or the scar tissue. If the patient has experienced pelvic infections, endometriosis, or a surgery, it can lead to blocked tubes.
If the tubes are damaged severely, it must be removed in order to achieve conception through IVF as the fluid buildup in the tubes is not a safe environment for implantation. Tubal surgeries can improve the fertility by clearing the blockage and more. A few common terminologies you will hear during the repair of the tubes are a microsurgical tubal reversal, anastomosis, and anastomosis.
Endometriosis
It is a condition where the tissue lining, which is supposed to grow inside the uterus, starts growing outside the uterine cavity. Common symptoms of endometriosis are; painful periods, vaginal bleeding in between the periods, and infertility. But, please note that some women don’t display any symptoms, despite suffering from this disorder.
Fibroid Tumors
It is believed that almost 30% of the patients suffer from fibroids. They may be asymptomatic or can cause severe uterine bleeding, recurrent miscarriages, pain, anemia, etc.
Pelvic Adhesions
Adhesions are one of the major causes of infertility. Although it can be rectified with the help of a surgery, a surgery can also cause adhesions. So, if you have previously undergone pelvic or abdominal surgery, the risk of tubal infertility increases.
Ovarian Cysts
They are most common of all reproductive issues. Mostly, the cysts dissolve on their own, but if they are large or persistent and last for several months then surgery is required. Usually, these cysts are non-cancerous and are a result of endometriosis or some other benign process.
Congenital Structural Abnormalities
When the fetus is developing, some may experience abnormalities in the uterus, tubes or vagina. This can cause infertility, severe pelvic pain, and even recurrent miscarriages.

Acquired uterine abnormalities
The uterus is an organ where the implantation and the growth of the fetus takes place. However, with uterine abnormalities, it can decrease the fertility, cause miscarriage, and even lead to several complications.

How is it performed (women)?
Laparoscopy
This is a minimally invasive diagnostic and surgical procedure, where a tiny incision is made through which a narrow tube with a light and camera attached is inserted to visualize the inside of your abdomen. Any scarring, adhesions or abnormal growths can be diagnosed and treated if possible.

Mini-laparotomy
Your doctor would use this procedure to explore the pelvic area to surgically correct any gynecological problem by making a small section on the abdominal wall, just above your pubis.

Laparotomy
Here, the doctor will make an incision on the lower abdomen, allowing him to access the structures of the pelvis directly. If you are suffering from severe pelvic disease, then this procedure may be used. Also, the patient will be hospitalised for a few days post-laparotomy and will need 4-6 weeks to recover.

Hysteroscopy
Hysteroscopy is the visualization of the inside of the uterus and the opening of the fallopian tubes. This is done using a narrow tube with a camera and light source inserted through the cervix.
Surgery can also be performed such as removal of intrauterine fibroids and adhesions

Fallaposcopy
During this treatment, the fallopian tubes are inspected for any abnormalities, such as tube obstruction, scars, and damage to the inner lining. Here, a fiber optic scope is inserted to see if everything is okay. This will also help your physician to check for any other infertility problems.

In men the following common conditions affect reproduction and require surgery:
• Hydrocele – fluid accumulation in the scrotum

• Varicocele – enlargement of blood vessels in the spermatic cord

• Epididymal Cyst – fluid or pus accumulation in the scrotum

• Vasectomy reversal

• Surgery for Ejaculatory duct obstruction

• Sperm extraction procedures

Male Surgical treatments
1.Testicular Biopsy
In this procedure, several tissues are removed from the testicles and examined for sperm. This treatment is also used in fertility procedures.

2.Testicular Sperm Aspiration (TESA)
During this procedure, a sample of the tissue is taken directly from the testicles using needle biopsy. It is also used to extract sperm for IVF or ICSI.

3.Percutaneous Sperm Aspiration (PESA)
During this treatment, the needle is directly inserted into the epididymis to locate and aspirate the sperm pouch.

4.Vasecetomy Reversal
This procedure is an outpatient one and is done to reverse the previous vasectomy. With the help of this procedure the sperm will be release into the semen.

5.Vasoepididymostomy
It is a surgical procedure that treats the epididymal blockages, like cysts and scars. Due to this, the pathway of the sperm to the vas deferens gets blocked. This is a microsurgical procedure, but you will need to get it done through an experienced surgeon.

6. Varicocelectomy
This is a very common procedure amidst the male infertility treatments. Here, the varicoceles are repaired. What happens sometimes is that the additional blood from the varicoceles increases the temperature of the testicles. And, this can lead to low sperm count, decrease in the quantity of the sperm, etc. Thus, the doctor will discard the additional blood by cutting the veins that transport blood to varicoceles, making sure the fertility is improved.

Benefits
The main benefit of reproductive surgery is that it enhances fertility by treating various conditions, such as a blockage in the fallopian tube, fibroids, cysts, etc. Also, it can correct the internal errors of the reproductive organ of a woman, avoiding serious complications.

Risks
Surgeries are always risky because of the complications it can give birth to. It can be mild, moderate or severe, depending on the procedure. But, it is not mandatory. Most patients enjoy a risk-free environment post-surgery. So, with reproductive surgery, possible complications may arise, such as; infection, bleeding and negative reactions to anesthesia. Also, during a laparoscopy, there is a possibility of the intestine or the urinary tract injury. During hysteroscopy or falloposcopy, the uterus can be injured. And, tubal surgery can cause tubal pregnancy. However, you need not worry. These risks are extremely uncommon, and you must discuss it with your specialist before your surgery.

FAQs
1. Is laparoscopy a painful procedure?

Since anesthesia will be given before the procedure, you will not experience any pain.

2. Will I experience any discomfort after the procedure?

You may feel a slight pain or throb in areas of the incision. And, some even experience shoulder pain because of the carbon dioxide gas, which is used to inflate your abdomen for the surgery.

3. How do I prepare for my surgery?

Firstly, relax. Talk to your doctor about all the medications you are currently under, even the herbal ones. Also, get the prescribed tests done on time, maybe your doctor will ask you to go for x-rays, blood tests, etc. And, you must not eat or drink prior to your surgery. Therefore, talk to your specialist about all the details. Finally, take a companion with you on the day of your surgery. If not for moral support, you will need someone to take you home as you may remain drowsy because of the anesthesia.

4. Laparoscopy can be performed on what organs?

Usually, when the noninvasive procedures such as, ultrasound, X-rays fail, the specialist will opt for a laparoscopy. It can help examine; appendix, gallbladder, liver, pancreas, small intestine, large intestine, spleen, stomach, pelvic and reproductive organs.

5. What are the risks of laparoscopy?

After the procedure, always keep an eye out for any infections. If you experience; fever, chills, redness, swelling, nausea, vomiting, persistent cough, breathlessness, inability to urinate, or lightheadedness, contact your doctor immediately. There is a mild risk of damage to the organs during this treatment, if punctured, blood and other fluids may leak out of the organs. And, then you will have to undergo another surgery to repair it. However, it is very uncommon. The other risks are; complications because of anesthesia, inflammation of your abdominal wall, and blood clot.

6. What are the risks of hysterectomy?

Although uncommon, the complications include; urinary incontinence, vaginal prolapse, fistula formation, and chronic pain.

7. What can I expect after hysterectomy?

During the procedure, if the doctor removed your ovaries then you will enter menopause. However, if the ovaries remain intact, there are chances you will enter menopause earlier than you were supposed to. At least for six weeks, you will have to avoid heavy lifting and sex. And, after the treatment, majority of the women feel that the problem they had before the surgery, goes away completely. Example; heavy bleeding during periods.

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