Surgical Fertility Treatment
At one time, surgery was the one the mainstays of testing and treatment for fertility issues. Today, with the success of assisted reproductive technologies, reproductive surgery is used less frequently and for more specific reasons. These are some of the procedures we perform at the University Medical Center of Princeton at Plainsboro:
Hysteroscopy involves insertion of a telescope through the cervix into the uterine cavity. This enables the surgeon to inspect the lining of the uterus and to diagnose and treat disorders in the uterine cavity including:
- Adhesions/scar tissue inside the uterine cavity.
Dr. Derman was the lead author on one the first papers to evaluate the long term effectiveness of hysteroscopic fibroid surgery.
Laparoscopy involves filling the abdominal cavity up with carbon dioxide gas under anesthesia and then inserting a telescope-like device into that cavity through a button hole incision. One or more additional small incisions may be required as well. This enables the surgeon to inspect the outside surfaces of the pelvic organs (uterus, ovaries, fallopian tubes). With laparoscopy, we can diagnose and treat:
- Pelvic adhesions/scar tissue
- Damaged fallopian tubes
Da Vinci Robotic Surgery
The daVinci surgical robot is a laparoscopic device that enables the surgeon to perform operations laparoscopically that might otherwise require open surgery. The robot enables the surgeon to manipulate the instruments in ways that would very difficult with regular laparoscopy. The daVinci laparoscope also has high quality 3D optics that provides the surgeon with outstanding detail.
In reproductive medicine and gynecology, robotic surgery can be used for:
- myomectomy (removal of fibroids)
- hysterectomy (removal of the uterus)
- reversal of tubal ligation
- difficult endometriosis cases
- other types of operations on the ovaries and tube.
The DaVinci surgeons at Delaware Valley OBGYN and Princeton IVF are among the most experienced in the area.
Laparotomy refers to surgery in which an open incision is used, similar to the incision one would have for a cesarian section or hysterectomy. While laparoscopy is the preferred procedure since it is less invasive, sometimes open surgery is required due to excessive scar tissue or concerns about cancer.
Myomectomy refers to the surgical removal of fibroid tumors of the uterus. Fibroids, properly known as myomas, are benign tumors but may affect fertility or disrupt a woman's menstrual cycle or ability to carry a pregnancy, depending on their location and/or size. Myomectomies can be done with open surgery (laparotomy). laparoscopically (usually with the Da Vinci surgical robot) or hysteroscopically. The method of myomectomy that can be used also depends on location and size of the fibroids.
Tubal reanstomosis, also known as tubal reversal or tuboplasty is an operation used to restore fertility in women who have had their fallopian tubes tied (or cut or burned). It is usually done as an open surgery (laparotomy) but may be done laparoscopically with the daVinci robot. Although we offer this surgery to women with prior sterilization, most couples will chose IVF instead of the operation.