Reproductive surgery is a form of gynecological surgery designed to cure an underlying problem while preserving or restoring reproductive function. The physicians and surgeons affiliated with the Brigham and Women’s Center for Infertility and Reproductive Surgery are board certified by the American College of Obstetrics and Gynecology in Obstetrics and Gynecology, Reproductive Endocrinology, and Infertility. They are also members of the American Society for Reproductive Medicine and the Society of Reproductive Endocrinologists and the Society of Reproductive Surgeons. Therefore, they are experts when it comes to minimally invasive surgical techniques such as laparoscopy and hysteroscopy. Most procedures can be performed on an outpatient basis. We provide the most advanced microsurgical techniques including flexible CO2 laser surgery and robot-assisted surgery, resulting in minimum tissue damage and improved recovery.
Robot-Assisted Reproductive Surgery
The Center for Infertility and Reproductive Surgery has pioneered computer-assisted reproductive surgery, most commonly referred to as robot-assisted reproductive surgery.. Dr. Antonio Gargiulo and Dr. Serene Srouji launched our robot-assisted reproductive surgery program when they performed New England’s first successful laparoscopic tubal sterilization reversal in January 2007. The robotic surgery team at our Center has since conducted over 700 robot-assisted reproductive surgeries at BWH including tubal ligation reversal, myomectomy, excision of severe endometriosis, and other complex pelvic surgeries. Our team members regularly lecture and teach others throughout the world.
Employing the revolutionary da Vinci Surgical System with its miniaturized arms, Dr. Gargiulo and Srouji are able to leverage increased precision, dexterity and vision to enhance their surgical skills and improve surgical outcomes. These enhanced capabilities allow virtually all reproductive surgical procedures to be performed laparoscopically. The benefits of laparoscopic surgery over open surgery are many:
- Less blood loss
- Reduced post-surgical pain/less medication
- Fewer complications
- Less scarring
- Rapid recovery and return to normal activity
The endometrium (the lining of the uterus that is shed monthly) can implant and grow outside the uterus. This can cause a chronic inflammatory reaction around the delicate reproductive organs in the female pelvis. Symptoms include pelvic or abdominal pain, pressure or fullness in the pelvis, severe menstrual cramps, pain with intercourse, and infertility. Common surgical intervention consists in laparoscopic or open excision of the endometriosis.
Cysts are fluid-filled cavities within the ovary that may develop as part of the follicle which forms monthly with the developing egg. Cysts can also form independently of the ovarian follicular function. Ovarian Cysts are usually benign and sometimes without symptoms but they can also be found in association with acute pelvic pain, pelvic pressure, infertility, abdominal enlargement, and if large enough, bowel or bladder symptoms. If surgical intervention is needed the cyst can be removed laparoscopically or (rarely) with open surgery.
Uterine Fibroids are benign solid tumors within the uterine wall. These can also be called fibromyomas, fibromas, myofibromas, and myomas. Fibroid tumors are the most common form of solid pelvic tumor found in women. Uterine Fibroids cause symptoms in approximately 25 percent of women of reproductive age. Symptoms can vary greatly but may include:
- Abnormal uterine bleeding often for periods lasting more than seven days.
- Enlarged uterus causes pelvic pressure
- An enlarged and irregularly shaped uterus can cause frequent urination, incontinence or impact the bowel to cause constipation.
- Infertility or repeated miscarriage.
Because malignant cells are found in roughly one in a thousand women of reproductive age who have Uterine Fibroids, surgery is not always recommended for these tumors. Many uterine fibroids can be followed with periodic ultrasounds and pelvic examinations and will regress after menopause. Surgery is only recommended for Uterine Fibroids that are symptomatic or that are thought to represent an impediment to reproductive efforts. Significant advances and a number of minimally invasive techniques for the treatment of uterine fibroids have become available in recent years. The experts at the Brigham and Women’s Hospital Center for Infertility and Reproductive Surgery have been pioneers in the safe and effective development of these procedures. If you believe you have uterine fibroids we encourage you to meet with us for an initial consultation.
Tubal Ligation Repair/Reversal (TLR)
Women who have damaged fallopian tubes or have had them “tied” can have a minimally-invasive procedure to repair or even reverse these conditions. The tubes may be reconnected during an outpatient (same-day) procedure. Our fertility specialists will evaluate your condition, and discuss the likelihood of procedural success. In cases where this surgery is not indicated or desired, the alternative of assisted reproduction (in vitro fertilization) is also expertly discussed and offered.
A number of benign gynecologic conditions can have a negative impact on a woman’s ability to become pregnant or complete a pregnancy. Such conditions are best treated by fertility experts that are experts at minimally invasive procedures (reproductive surgeons).
Other conditions that are candidates for minimally invasive surgical interventions:
- Ectopic pregnancy
- Pelvic adhesions
- Congenital malformations
- Uterine polyps