Minimally Invasive Surgery & Robotic Surgery for Fertility Treatment
Minimally invasive surgery & robotic surgery for fertility treatment at a glance
- Surgery to address issues causing infertility can often be performed using minimally invasive techniques that involve smaller incisions and quicker recovery time.
- Complex gynecologic conditions related to infertility may be treated with robotic surgery using the da Vinci Surgical System, which allows the surgeon increased dexterity and precision.
- Conditions causing infertility that may be treated surgically include uterine fibroids and anomalies, tubal blockage, ovarian cysts and endometriosis.
The role of surgery in treating infertility
Surgery can play a vital role in treating infertility and helping a woman conceive. A fertility doctor may perform a surgical procedure that allows a woman to conceive naturally or increases her odds of success with fertility treatments such as IUI (intrauterine insemination) or IVF (in vitro fertilization).
A number of abnormalities and conditions, listed below, can hinder or prevent a woman from getting pregnant. Beyond causing reproductive problems, these abnormalities can produce unpleasant side effects such as chronic pelvic pain and heavy bleeding. Surgical intervention may be the most effective option for providing relief from these symptoms.
When it is determined that surgery may improve a woman’s chances of conceiving, minimally invasive techniques such as laparoscopy and hysteroscopy can often be used. These techniques use small incisions and high-definition cameras that project the area of operation on a monitor rather than large, open incisions traditionally used in surgery. This reduces pain, recovery time, risk of infection and blood loss, and generally leads to better surgical outcomes.
Patients facing complex diagnoses may also benefit from minimally invasive robotic surgery, which uses computer-controlled instruments that are precisely guided by the surgeon.
Types of surgeries that address infertility
There are several surgical approaches for treating conditions contributing to infertility. Ultimately, the surgeon will discuss these options with the patient and explain the recommended method based on the patient’s specific condition and its severity. Minimally invasive techniques such as laparoscopy and hysteroscopy often lead to improved outcomes and faster healing time, but there are certain cases in which laparotomy (open surgery with larger incisions) is the best course of action.
Surgeries performed laparoscopically use a long, thin device called a laparoscope. It is inserted through a small incision, typically 5 to 10 mm (about ¼” to ½”). The device is outfitted with a small, HD camera that sends a live feed to a monitor in the operating room. The surgeon may use other specially-designed tools along with the laparoscope, often making one or more additional small incisions in the same area.
Laparoscopy may be used to treat many conditions that contribute to infertility including ovarian cysts, fibroids and endometriosis.
The hysteroscope is a slender device that is inserted vaginally through the cervix and into the uterus. It allows the doctor view the inside of the uterus without making any incisions. There is a light on the end that is inserted, and an eyepiece on the opposite end.
Diagnostic hysteroscopy is used to view and diagnose abnormalities such as uterine bleeding, uterine fibroids, endometrial scarring and endometrial polyps. Operative hysteroscopy can often then be used to treat the abnormalities. Hysteroscopy is sometimes used in conjunction with laparoscopy.
Da Vinci robotic surgery
The da Vinci Surgical System is a robotic machine that allows the surgeon to perform complex gynecologic surgeries using minimally-invasive techniques. It improves the surgeon’s control and access, offering increased dexterity, precision and vision compared with traditional laparoscopy.
Laparotomy (open surgery)
In a few cases minimally invasive or robotic surgical techniques are not the best way to address a condition. In these cases a laparotomy, which is a surgery involving a larger incision that grants the surgeon direct access, may be the best technique. A gynecologic surgeon specializing in fertility issues can help a patient make the best choice regarding the approach to surgery.
Conditions causing infertility that may be treated surgically
Outlined below are some of the more common infertility-causing conditions that can be surgically addressed.
Fibroids are muscular growths in any part of the uterine wall. Whether they are symptomatic or cause infertility depends on their size, number and location. In far greater than 99 percent of cases, they are benign (noncancerous). They affect up to 1 in 5 women of reproductive age, and for many women they do not cause symptoms. However, they can cause infertility and have a negative effect on IVF outcomes.
Surgery to remove uterine fibroids is called myomectomy. Fibroids are one of the most common reasons that patients at Women & Infants’ Fertility Center receive surgery.
Müllerian anomalies (sometimes called “uterine anomalies”) refer to various defects of the vagina, cervix, uterus or fallopian tubes that are present from birth. These defects can make it difficult or impossible for a woman to conceive. Minimally invasive surgical procedures are often an effective method to address Müllerian anomalies.
The fallopian tubes connect the ovaries and uterus. Following intercourse the egg is fertilized by sperm within the fallopian tubes. Once fertilized the egg travels to the uterus where it develops as an embryo and into a fetus.
For a number of reasons, a woman’s fallopian tubes may be damaged or blocked, which can interrupt the process of both the sperm reaching the egg and the fertilized egg reaching the uterus. It may be possible to surgically reopen and repair damaged or blocked tubes but surgical repair is only possible if the damage is mild. Damaged fallopian tubes can also lead to ectopic pregnancies; laparoscopy is very commonly used to treat these abnormal pregnancies. Women with tubal factor infertility may also opt for IVF, in which fertilization occurs in a lab rather than in the fallopian tubes.
Ovarian cysts are fluid-filled sacs that form in or upon the ovaries, a pair of organs responsible for producing a woman’s eggs. Some cysts will go away on their own, but they can interfere with a woman’s ovulation and therefore fertility. This is particularly true in the case of polycystic ovary syndrome (PCOS).
While PCOS is generally not treated with surgery, sometimes surgeons use minimally invasive techniques to view and diagnose ovarian cysts. It is also sometimes used to remove cysts in a procedure called a cystectomy.
Endometriosis is a chronic condition in which tissue from the lining of the uterus (called the endometrium) grows outside of the uterus. This can adversely affect other reproductive organs, causing pelvic pain and infertility. Laparoscopy may be used to treat endometriosis when it is thought to be the cause of a woman’s infertility or contributes to her painful symptoms.