Laparoscopic Sergery (Key Hole)
Total Laparoscopic Hysterectomy (Vessel Sealer)
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What is Total Laparoscopic Hysterectomy ?

The total laparoscopic hysterectomy (TLH) offers women an option that is far less invasive than other surgical approaches. The need for a hysterectomy is an important and difficult decision.

The surgical removal of the uterus can be lifesaving for those suffering from gynecological cancers or the severe pain and heavy bleeding due to or endometriosis.

Today, there are several surgical approaches that are far less invasive than a total abdominal hysterectomy, which is still widely performed. Using a laparoscope — a slender, fiber-optic tube equipped with a miniature camera, lights and surgical instruments — surgeons have the ability to see inside the abdomen and technical access to the uterus, ovaries and fallopian tubes without having to make a large incision.

In the past few years, many gynecologists have performed a portion of the hysterectomy using a laparoscope. Called a laparoscopically assisted vaginal hysterectomy (LAVH), the procedure requires an incision deep within the vagina, through which the uterus and related organs are removed. The LAVH still involved a transvaginal approach and decreased healing time, similar to a total vaginal hysterectomy.

With advanced laparoscopic skills, gynecological surgeons are able to perform TLH. The surgery is completed utilizing only four tiny abdominal incisions less than one-quarter to one half an inch in length. Even a large uterus can be removed laparoscopically using this technique. A traditional open hysterectomy requires an abdominal incision of four to eight inches.

Hysteroscopic Surgeries
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What Is Hysteroscopy?

Hysteroscopy is a procedure that allows your doctor to look inside your uterus in order to diagnose and treat causes of abnormal bleeding. Hysteroscopy is done using a hysteroscope, a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus. Hysteroscopy can be either diagnostic or operative.

Diagnostic hysteroscopy is used to diagnose problems of the uterus. Diagnostic hysteroscopy is also used to confirm results of other tests, such as hysterosalpingography (HSG). HSG is an X-ray dye test used to check the uterus and fallopian tubes. Diagnostic hysteroscopy can many times be done in an office setting.

Additionally, hysteroscopy can be used with other procedures, such as laparoscopy, or before procedures such as dilation and curettage (D&C). In laparoscopy, your doctor will insert an endoscope (a slender tube fitted with a fiber optic camera) into your abdomen to view the outside of your uterus, ovaries and fallopian tubes. The endoscope is inserted through an incision made through or below your navel.

Laparoscopic Removal of Ectopic pregnancy and Ovarians

Laparoscopy generally has a shorter healing time than open surgery. It also leaves smaller scars. A gynecologist, general surgeon, or other specialist may perform this procedure.

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What Is a Myomectomy?

Myomectomy means the surgical removal of just the fibroid, with reconstruction and repair of the uterus. There are now a number of techniques used to perform myomectomy: through an abdominal incision, vaginal incision, with a laparoscope, or with a hysteroscope. Myomectomy relieves symptoms in more than 75% of women. “The restoration and maintenance of physiologic (normal) function is, or should be, the ultimate goal of surgical treatment”, said Victor Bonney, an early advocate of abdominal myomectomy, in 1931. However, women are often told that myomectomy is not appropriate for them because hysterectomy is safer, is associated with less bleeding or that uterine muscle cancer (sarcoma) may be present. However, recent studies dispute all of those claims.

Studies show there may actually be less risk of complications during myomectomy than during hysterectomy. One study of women who had myomectomies and women who had hysterectomies for fibroids of the same sizes (about 4 months pregnancy size) found surgery took slightly longer in the myomectomy group (200 v. 175 min), but there was more blood loss in the hysterectomy group. The risks of bleeding, fever, life-threatening complications, need for another surgical procedure or re-admission to the hospital were not different. The authors of the study concluded that there was no difference in complications and with an experienced surgeon myomectomy is a safe alternative to hysterectomy.

Tubal Ligation
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What is Tubal ligation ?

Tubal ligation is surgery to block a woman's Fallopian tubes. Tubal ligation is a permanent form of birth control. After this procedure, eggs cannot move from the ovary through the tubes (a woman has two Fallopian tubes), and eventually to the uterus. Also, sperm cannot reach the egg in the Fallopian tube after it is released by the ovary. Thus, pregnancy is prevented.

This procedure is also called tubal ligation or having one's "tubes tied." More formally, it is known as bilateral tubal ligation (BTL).

Currently, about 700,000 of these procedures are performed each year in the United States. Half are performed right after a woman gives birth. The rest are elective procedures performed as a one-day operation in an outpatient clinic. Eleven million US women aged 15 to 44 years rely on sterilization as a means of birth control to prevent pregnancy. More than 190 million couples worldwide use surgical sterilization as a safe and reliable method of permanent birth control.

Prior to the 1960s, female sterilization in the United States was generally performed only for medical problems or when a woman was considered "too old" to have children or at risk to her health. The changing cultural climate in the 1960s resulted in safe, minimally invasive female sterilization procedures.

What is Tubal Ligation Procedure ?

While the patient is under anesthesia, one or two small incisions (cuts) are made in the abdomen (usually near the navel), and a device similar to a small telescope on a flexible tube (called a laparoscope) is inserted.

Using instruments that are inserted through the laparoscope, the tubes (Fallopian tubes) are coagulated (electrocoagulation), cauterized (burned), or a small clip is placed on the tube. The skin incision is then closed with a few stitches. Most patients feel well enough to go home after the procedure in the outpatient surgery center after a few hours.

The health care professional may prescribe to manage pain.

Most women return to normal activities, including work, in a few days, although some women may be advised not to exercise for several days. Most women resume sexual intercourse when they feel ready.

Tubal Cannulation
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What is Tubal Cannulation?

This is a procedure devised for the treatment of cornual occlusion (or proximal tubal blockage) in women with known tubal factor infertility. A tiny wire is placed through the cervix, uterus and in to the tube either under x-ray guidance or via a hysteroscope (a small telescope).
Hysteroscopic tubal cannulation allows visualisation of the entire uterine cavity, which may be useful in diagnosis and treatment of other coexisting problems at the same time of cannulation. In 2004 the National Institute for Health and Clinical Excellence (NICE) guideline for the management of infertility has recommended tubal cannulation as a treatment option in cases of proximal tubal occlusion.

Tubal blockage occurs in approximately 11% of women who have had one episode of pelvic inflammatory disease (PID), increasing to 23% after two episodes and 54% after three episodes. Other causes of tubal occlusion include fibrosis and endometriosis (7-14%), salpingitis isthmica nodosa and cornual polyps (10%). Tubal blockage secondary to tubal spasm or intratubal debris may cause a reversible tubal occlusion.

Tubal cannulation gently helps to open the tube and may relieve an obstruction in the cornual area. Laparoscopy can be performed at the same of the hysteroscopy to ensure that the tubes are not perforated with the wire and also to inject some dye through the uterus into the tubes to verify that they are open.

Laparoscopic treatment of tubal adhesions and fimbrial phimosis.
Some patients with an otherwise normal fertility evaluation can have subtle adhesions over the fallopian tubes and ovaries. These adhesions appear like cobwebs (or cling-film) over the surface of these organs and can prevent the release of the egg during ovulation, prevent the tubes from picking-up the eggs and limit the motility of the tubes. Injury to the distal end of the tubes may also result in loss of or damage to the feathery appendages of the tube (fimbria), known as fimbrial phimosis. Patients at high risk for these problems include those who have had intrauterine devices for long time, those with a history of pelvic inflammatory disease (PID), appendicitis or ruptured ovarian cyst. The adhesions and the fimbrial phimosis can be treated successfully by laparoscopy (keyhole surgery).

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What is a Tuboplasty?

Procedures involving the repair or reconstruction of the fallopian tubes are known as tuboplasty. This encompasses the most common technique of neosalpingostomy.

In a neosalpongostomy procedure to reverse tied tubes, a new opening is created in the end of a dilated and non-functional tube. This opening is then folded open and secured into place using very fine suture. This new opening takes the place of the normal fimbriated end of the fallopian tube.

There is a risk of reocclusion of the tube, though most all tubes will remain open. Because of a history of damage to the fallopian tube, there is thought to be an increased risk of ectopic pregnancy.

There is some evidence suggesting patients with hydrosalpinges, or dilated tubes filled with fluid, may have an improvement in their in vitro fertilization success rate following a neosalpingostomy. This comes from the possibility that the fluid may reflux into the uterine cavity and decrease implantation rates.

There is a significant amount of debate about this subject in the current medical literature. For more information or consideration for this procedure to reverse tied tubes, please schedule an appointment with one of our physicians at our Durham, NC office.

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