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ReproductiveSurgery

Reproductive Surgery

Reproductive surgery is a subspeciality that treats anatomical abnormalities interfering with normal reproductive function. The body, on injury, makes new tissue, including scar tissue as part of the healing process. Unfortunately, this natural defence can work against us. Surgery, meant to treat a problem, can create more problems. Scar tissue (adhesions) that form can stick to the normal tissue around it, pulling on it and disturbing the normal anatomy and function of the structures involved. Reproductive surgeons use meticulous surgical technique to decrease the formation of pelvic adhesions postoperatively to obtain optimal results.

Reproductive surgeons use Microsurgery or Endoscopic Surgery to treat the following conditions

FEMALE

The following are the surgical procedure for female infertility :-

Fallopian Tube Sterilization Reversal (Microsurgical tubal reanastomosis)

Tubal ligation is a permanent form of contraception which will not allow you to change your mind and attempt pregnancy unless you undergo another major surgical procedure. The best results are obtained with microsurgery, requiring 3-4 days of hospitalisation, and a scar similar to a caesarian section

This operation is known as Microsurgical tubal reanastomosis or a Microsurgical reversal of tubal sterilization. The surgery is considerably more complicated than the operation performed for the sterilization and may take from one to two hours to perform. This procedure employs the use of very fine microsutures to carefully join the tubes back together. It is necessary to use an operating microscope to adequately visualize the tubal anatomy and gentle tissue handling to minimise scar formation.

The success of this type of surgery is dependent upon several factors, most importantly, the expertise of the surgeon. The other factors relate to where and how the sterilisation procedure has been performed. If the sterilisation is done in the isthmic or narrow part of the tube using a clip, band or bipolar cautery, then pregnancy rates of 80- 85% can be expected. The length and the anatomy of the tube remaining is determined by reviewing the operative report from the sterilization operation or from a pre-operative diagnostic laparoscopy . If the surgery involves removing more than ˝ of the broader part (ampulla) of the fallopian tube or the terminal end (fimbria) of the fallopian tube then the chances of getting pregnant after this operation would be poor, and the patient would more likely achieve pregnancy by undergoing In Vitro Fertilization (IVF).

- Mid Tubal Blocks

The treatment of choice in this situation would be Microsurgical tubal reanastomosis.

 - Cornual Block

The cornua is the point where the tube joins the uterus and is the narrowest part of the Fallopian tube.

Hysteroscopic/ Laparoscopic Fallopian tube catheterisation or fluoroscopy guided cornual cannulation is the procedure of choice to overcome the block and ‘open’ the tube, as very often, a cornual spasm or menstrual debris near the cornua may mislead the surgeon into diagnosing a cornual block.

However, if there is a pathology at the cornua, Microsurgical tubal reanastomosis. is a viable option if In Vitro Fertilization (IVF) is not acceptable.

 - Hydrosalpinx

- Adhesiolysis

- Uterine Fibroids

- Endometriosis

MALE

The following are the surgical procedure for male infertility :

  • Vaso-Vasal Anastomosis (V.V.A.): A VVA is performed to reverse a vasectomy. This is a microsurgical procedure with a very high success rate. When the VVA is done within 5 years of the vasectomy the chances of success are over 95%. When the duration since the vasectomy is over 10 years there is a possibility of damage due to back pressure and the success rate drops. However, we have successfully reversed vasectomies done over 25 years ago. PESA or TESA ICSI are the other options available.
  • Vaso-Epididymal Anastomosis (V.E.A.): Some men have normal sperm in their testes but have no sperm in their semen due to a block in their epididymis (the tube that connects the testes to the vas). These men can be helped by a VEA which would bypass the block and allow them to achieve normal sperm counts. The surgery is performed under an operating microscope that magnifies the structures up to 25 times. The vas is rejoined to the tiny epididymal tube (0.3 mm in diameter) above the level of the block, thus bypassing the obstruction and allowing sperm to come out through the natural pathway. Because this is such a delicate procedure the tube can get blocked again during the healing phase. Hence, the success rate of the procedure is between 40- 70% (depending on the extent of the block) Also, it can take up to one year after surgery for the sperm count to reach normal levels. Hence, a VEA is ideal for young couples, while older couples are better off with epididymal sperm aspiration (PESA) and ICSI which offers a quicker result.
  • Varicocelectomy: A varicocele is a dilatation of the veins of the testes. It occurs when the valves in the testicular vein do not function properly, allowing blood to flow down to the testes (instead of towards the heart). As a result there is congestion of blood around the testes and the local temperature rises. Some men appear to have no deleterious effect due to the varicocele and have normal sperm counts, while in other cases the testes may become small and normal sperm parameters may be affected, resulting in infertility. The results after surgery to cure a varicocele are unpredictable- some experts state that varicocele surgery confers no benefit while others claim that surgery can benefit 70% of those who are operated. The safest technique is microsurgical varicocelectomy in which the varicocele is operated upon through a small incision in the lower abdomen and an operating microscope is used to identify and divide all the malfunctioning veins. This is a minor procedure needing just a day's hospitalization and a few days rest thereafter. Improvement can be expected in 3 - 6 months. If there is no result in that time then IUI or ICSI would be required.  

 

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