Reproductive Endocrinology and Fertility at the Palo Alto Medical Foundation offers surgical options for the treatment of a variety of infertility causes, including tubal disease, endometriosis, ovulation problems, anatomical abnormalities in the uterus, such as endometrial polyps, uterine septum and fibroids, as well as reversal of tubal ligations.
As Board Certified Reproductive Endocrinologists, our doctors apply the highest level of expertise to your fertility care. Their training for this specialty includes extensive experience in reproductive surgery and microsurgery.
- Diagnostic and Operative Laparoscopy for:
- Endometriosis, adhesions and tubal occlusion
- Diagnosis and treatment of pelvic pain
- Diagnosis and treatment of adnexal masses and ovarian dysfunction
- Hysteroscopy for:
- Septum Resection
- Tubal Cannulation
- Microscopic Tubal Ligation Reversal
- Locations for Reproductive Surgery
Laparoscopy is an outpatient procedure performed under general anesthesia to diagnose and treat endometriosis and tubal disorders, or to remove scar tissue. An instrument attached to a camera is inserted through a small incision under the navel. The cavity is inflated with a small amount of carbon dioxide to make visualization easier.
The operating microscope provides excellent visualization of the uterus, ovaries and fallopian tubes, and improves the ability to detect any scar tissue or endometriosis.
Additional instruments are placed through small incisions just above the pubic hairline and these instruments allow the operator to grasp or incise. The incision is closed with several stitches.
The most common side effects are a sore throat, shoulder pain, abdominal bloating and general stiffness. These side effects usually resolve in one to two days. Normal activities and work can be resumed shortly after the procedure.
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Operative laparoscopy is used to treat ectopic pregnancies, ovarian cysts and tumors, endometriosis and pelvic adhesions. When used properly, operative laparoscopy offers numerous advantages. The surgeon can avoid an open abdominal incision, allowing an outpatient procedure. It minimizes discomfort and visible surgical scars. Most importantly, the laparoscopic approach often produces better results than other types of surgery. This is probably due to decreased tissue trauma and lessened adhesion formation.
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Diagnostic or Operative Hysteroscopy
Hysteroscopy is a procedure that allows a visual examination of the interior of the uterus and is often performed at the time of laparoscopy. This procedure is done by inserting a long, slender instrument directly into the uterus via the cervix. The diagnostic procedure usually takes a few minutes.
If intrauterine lesions such as myomas, polyps or scar tissue are found, the doctor can perform an operative hysteroscopy. This is done by placing small instruments through the operative port, which enables the doctor to remove or resect abnormal tissue. When extensive lesions are found in the uterine cavity, it may be necessary to place a catheter in the cavity for a few days to lessen the development of scar tissue.
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Myomectomy is a surgical procedure in which fibroids or myomas are removed from the uterus. Myomas are the most common tumors found in the female genital tract. They are estimated to occur in 20 and 50 percent of women in their later reproductive years. Not all myomas need to be removed. Patients with no symptoms who want to get pregnant could attempt conception for six to 12 months. However, some myomas cause irregular bleeding, heavy menstrual flow, abdominal distension or other symptoms. Symptomatic women who want to conceive should consider surgery.
For myomas located only in the uterine cavity, a hysteroscopic approach is performed. For myomas located in the muscle, an open approach (abdominal myomectomy) is often recommended for patients wishing to become pregnant. This operation is traditionally done through a laparotomy via a “bikini” or transverse incision. As with all surgeries, there are risks related to laparoscopic myomectomy, which should be discussed thoroughly with your doctor.
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Tubal cannulation is used to help clear a blockage in the fallopian tubes. The procedure is done by guiding a catheter through the fallopian tube. Tools to help remove the blockage are guided through the catheter. Tubal cannulation is often done at the same time as a hysterosalpingogram, when dye is used to determine any blockages in the fallopian tubes.
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Reversal of Sterilization / Microsurgical Tubal Reanastomosis
Microsurgical tubal reanastomosis is a procedure used to reverse tubal sterilization. It is traditionally performed through a mini-laparotomy incision or "bikini-cut" and operating microscope. Many variables affect the success rates of tubal reanastomosis, including type of initial procedure, health, age of the female and time interval from sterilization to anastomosis. In general, success rates range from 55 to 85 percent. For men who had prior vasectomies, we recommend seeing a doctor at our Department of Urology.
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Reproductive Surgery Facilities
PAMF Fertility procedures are performed at credentialed, state-of-the-art surgery centers. When your procedure requires overnight recovery, your procedure will be done at one of our regional partner hospitals. If your procedure will require minimal recovery it will be performed in an ambulatory (outpatient) surgical center.
Surgery Center San Jose (PAMF)
Directly next to our embryology laboratory and fertility offices in San Jose/Los Gatos, Surgery Center San Jose offers patients the highest level of care before, during and after minimal, outpatient surgical procedures. PAMF Fertility patients undergoing IVF will have their procedures done at this facility.
Surgery Center Palo Alto (PAMF)
The PAMF Surgery Center in Palo Alto is a patient-centered, state-of-the-art ambulatory surgery center located at the Palo Alto campus of the Palo Alto Medical Foundation (PAMF). In a national patient survey administered by Press Ganey, the Surgecenter of Palo Alto received a 95th percentile rating for patient satisfaction in the first quarter of 2013.
Surgery Center Mountain View
Rated the most productive Bay Area Freestanding Surgery Center by the San Jose Business Journal in August 2011, this facility performs more than 26,000 outpatient procedures on an annual basis. The Mountain View surgery center is accredited by the Institute for Medical Quality, demonstrating adherence to the highest standards of quality care. Our physicians, anesthesiologists, nurses and support staff are the best in their field and are wholly dedicated to providing you with exemplary and compassionate care.
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