Minimally Invasive Reproductive Surgery

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Be in the Know. Reproductive Surgery at a Glance.

  • Some fertility-related issues, such as endometriosis, fibroids, uterine abnormalities and blocked fallopian tubes, may need to be diagnosed and/or treated through minimally invasive surgery (MIS).
  • Unlike open surgery, minimally invasive surgery utilizes small surgical incisions (or no incisions) to reduce recovery time while improving outcomes.
  • The most common types of minimally invasive surgery performed by Fertility Specialists Medical Group (FSMG) are laparoscopy and hysteroscopy to diagnose and treat infertility in women.
  • Laparoscopy is a minimally invasive surgical procedure that uses a laparoscope (a small tube with a light and camera) and small instruments inserted through two or more tiny incisions in the abdomen to view, diagnose and repair problems with the reproductive organs.
  • Hysteroscopy uses a hysteroscope (also a small tube with a light and camera) that is inserted into the vagina and through the cervix to view, diagnose and sometimes repair problems in the uterus.
  • Both procedures can last between 30 and 90 minutes and usually do not require an overnight hospital stay.

What is Minimally Invasive Reproductive Surgery?

The physicians and surgeons at Fertility Specialists Medical Group often use minimally invasive surgical procedures to diagnose and treat various fertility-related conditions such as uterine polyps, fibroids, endometriosis, and others.

The two procedures we perform the most are laparoscopy and hysteroscopy. Both procedures utilize a small tube with an attached camera that is inserted into the body. The feed from the camera is then transmitted to a monitor in the operating room to provide the surgeon with a magnified view to diagnose and potentially treat causes of infertility.

What are the Benefits of Minimally Invasive Surgery?

  • Shorter hospital stays and recovery – minimally invasive surgical patients usually go home the same day
  • Less pain medication needed during recovery
  • In the case of laparoscopy, very small incisions
  • With hysteroscopy, no incisions
  • Doctors are able to fix any issues discovered at the time of surgery, rather than scheduling an additional procedure

San Diego Center for Reproductive Surgery

Our surgery center, the San Diego Center for Reproductive Surgery, is fully accredited by the American Association for Accreditation of Ambulatory Surgery Facilities.

Our reproductive endocrinologists are skilled in surgery to diagnose, treat, and restore fertility. We also perform surgery at several local hospitals.

Laparoscopy

Laparoscopy is a minimally invasive surgical procedure that uses a laparoscope.

This consists of a small tube attached to a camera, as well as associated thin surgical instruments that can be inserted through small incisions in the abdomen.

These allow the fertility surgeon to efficiently diagnose and repair issues in the reproductive organs. A laparoscopic procedure requires two or more small incisions in the abdomen, one usually through the belly button, in order to minimize visual scars and decrease pain and healing time.

Laparoscopy typically takes about 30-90 minutes to complete and is typically performed under minimal general anesthesia. In order to achieve the best view of the organs, the abdominal cavity is inflated with carbon dioxide gas to move the organs away from the abdominal wall for optimum safety and visibility.

During the procedure, the surgeons may take tissue samples, drain or remove cysts, remove scar tissue, or excise fibroids. Once finished, the surgeon removes the instruments, clears the gas from the abdomen, and repairs the small incision(s).

When is Laparoscopy Beneficial for Fertility Treatment?

With fertility medicine, laparoscopy is typically used after reproductive imaging tests have identified an abnormality. Sometimes, it is performed on women with unexplained infertility in an effort to find a diagnosis.

Some of the main fertility issues laparoscopies may diagnose and treat include:

  • Abnormalities of the uterus or ovaries
  • Blocked or scarred fallopian tubes
  • Adhesions (scar tissue)
  • Uterine fibroids
  • Endometriosis (can only be confirmed with laparoscopy)

What to Expect When Having Laparoscopic Surgery

A patient must typically stop eating at midnight the evening before the procedure and arrange for someone to drive her home after the surgery. Once at the surgical center or hospital, the patient will remove all jewelry, contacts, glasses, etc.

  • The patient will be given a surgical gown to wear and an IV will be placed in the arm. All patients will have a chance to meet with the anesthesiologist prior to the procedure.
  • Once in the operating room, anesthesia will be administered.
    • A breathing tube and/or catheter may be placed.
    • Pubic hair may be shaved.

Hysteroscopy

A hysteroscopy is a surgery that involves a hysteroscope, similar to the laparoscope.

The hysteroscope is a small tube with a light and camera, which is inserted into the uterus through the vagina and the cervix to view the inside of the uterine cavity.

Through a port attached to the hysteroscope, the uterus is filled with saline (sterile water) to open up the cavity and allow for optimal visualization. A diagnostic hysteroscopy allows the doctor to assess the size, shape, and lining (endometrium) of the uterus.

Hysteroscopy is performed to diagnose abnormalities that may affect a woman’s fertility or cause other gynecological issues like heavy vaginal bleeding.

The surgeon may decide to correct any conditions identified during the procedure, so the diagnostic hysteroscopy becomes an operative hysteroscopy. Small instruments are inserted through the hysteroscope to correct such problems as adhesions (scar tissue), fibroids, polyps or abnormalities in shape.

When is Hysteroscopy Beneficial for Fertility Treatment?

A hysteroscopy procedure is used to diagnose and treat uterine abnormalities, many of which can cause infertility. Physicians may recommend a hysteroscopy to evaluate the following:

  • Abnormal bleeding
  • Recurrent miscarriage
  • Abnormally shaped uterus, like a septum
  • Uterine fibroids and polyps
  • Ovarian cysts

A hysteroscopy is usually done after less invasive reproductive imaging techniques have identified an abnormality.

Hysteroscopy is usually performed at a specific time in the woman’s menstrual cycle or while she is on oral contraceptive pills to optimize visualization of the uterine cavity.

What to Expect When Having Hysteroscopic Surgery

A hysteroscopy can be performed by using a sedative to make the woman more comfortable and relaxed during the procedure, or with IV anesthesia. If IV anesthesia is used, the patient must not eat or drink after midnight the evening prior to the surgery.

  • Prior to the hysteroscopy, the patient will empty her bladder and put on a hospital gown. If anesthesia is being used, an IV will be placed in the arm.
  • The patient will lie face up on the exam table, with her feet supported in stirrups.
  • The surgeon will insert a speculum into the vagina to visualize the cervix. She will then dilate (gentle stretch open) the cervical opening to accommodate the hysteroscope.
  • The surgeon will guide the hysteroscope through the cervix and into the uterus, which will then be distended with saline (sterile water).
  • Once the hysteroscope is inside the uterus, the doctor can view and repair any issues found in the cavity by using special surgical instruments inserted through the hysteroscope.
  • After the procedure, the patient will be monitored for 30-45 minutes. She should have someone prepared to drive her home.

Common Side Effects of a Hysteroscopy

  • Bloating from the liquid used to expand the uterus
  • Minimal vaginal bleeding, ranging from light spotting to at most a menstrual-like flow

What Are the Risks of Minimally Invasive Surgery?

Minimally invasive surgery, like any surgical procedure, is not without some risks. Approximately 1-2 percent of procedures involve complications that include:

  • Negative side effects from anesthesia (vomiting, nausea, headache, allergic reaction, lung infection)
  • Formation of adhesions (scar tissue)
  • Infection
  • Excessive bleeding
  • Injury to surrounding tissues such as bowel, bladder, nerves and blood vessels

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