In this webinar, Dr. Elias Tsakos, FRCOG, Medical Director of Embryoclinic, Thessaloniki, Greece has been talking about fertility surgery like laparoscopy, hysteroscopy etc. as a valuable tool in fertility care.
It is very difficult to say. I mean, I always quote that the best person to advise how long after surgery you’re fit to get pregnant is the surgeon who performed the surgery. The standard time is between 6 and 12 months. In my practice, invariably we suggest 6 months when we perform the surgery, and if somebody else has performed the surgery, we ask them to describe in specific the operations, how many fibroids there were, location, how big was the incision to the uterus, how were the sutures afterward, and so forth. In general, 6 to 12 months is the norm depending on the size and the number of fibroids. With regard to your symptoms after surgery, this is likely to occur because of the adhesions. In my opinion, at some stage, it may be worth having a laparoscopy to diagnose that and perhaps improve those adhesions by laparoscopic adhesiolysis.
Absolutely, I mean, of course, it affects fertility. Any surgery may potentially affect fertility, in particular open surgery. I have huge respect for all surgeons, but in my opinion, the same way most of the oncology cases are now managed by oncologists. I think fertility surgery should be managed by very experienced fertility surgeons, particularly, the ones with the appropriate equipment, in the right facility. We don’t like open surgery for many reasons, and one of the reasons is that sometimes the scarring tissues are creating problems afterward. The straight answer is that indeed any surgery may affect fertility, an open surgery by laparotomy may affect it even more than standard conventional laparoscopy. I think this has to be evaluated. I cannot answer if you need to be operated on again or not. This depends on the size, location, and symptoms of fibroids, and a careful evaluation of this by some sort of, imaging initially either scanning or CT Canning. or MRI scanning would give us a clear picture of what we need to do.
I haven’t seen any scientific evidence to support that. I don’t think it’s valid, however, a healthy diet is a healthy diet, and it has a lot of other benefits. The natural history of fibroids is very variable and depends vastly on the individual. In general, we prefer 1 or 2 large fibroids compared to much smaller, multiple fibroids invariably multiple fibroids they grow back in again, and this is simply because there’s a lot of little nuclei, little seeds of fibroid tissue all over the uterus, so if somebody has multiple fibroids, let’s say in the early 30s, and they have them removed, then we have to take advantage of the window of 2,3,4 years before more fibroids grow back in and they should get pregnant during that window.
I don’t want to sound too enthusiastic, but I am. Robotic surgery is suitable for any fibroids anywhere because it’s giving us the absolute tools of identifying and operating on. Fibroids that are located anywhere in the uterus or even outside the uterus. On top of this, one of the added advantages of robotic surgery is suturing, so we can be very confident in suturing the uterus because this has always been the key factor in performing laparoscopic surgery for fertility and suturing fibroids following the removal. Another benefit for operating via the Da Vinci system is that we have this special scanning facility by which we can scan and identify fibroids which cannot be felt or cannot be visible from the outside observation of the uterus by a laparoscopy. For any complex fibroid surgery, Da Vinci is an amazing tool. For standard surgery, myomectomy is recommended. If somebody has fibroids that have 3,4 centimeters, this can be easily managed laparoscopically. There is a place for conventional laparoscopy, as there is a place for robotic surgery.
It’s very difficult to answer this. It is a very complex history, but HyCoSy it’s not very valuable in diagnosing hydrosalpinx. With your history, there is a good chance that you may have hydrosalpinx, and there are two ways of diagnosing that. One is by a standard X-ray HSG or by laparoscopy, so I think either one of those would be indicated because you have a strong history to suggest that. With regard to the rest, someone has to look into your history in detail. What I was trying to show today is the fact that endoscopy is something that we shouldn’t forget about. Sadly, because of the progress in IVF and an increase in the IVF success rates, we have neglected that. I don’t think laparoscopy or hysteroscopy, or robotic surgery is indicated for perhaps the majority of the patient. Perhaps, the majority of the patients may not require that, however, we should consider these methods, we should consider evaluating the internal female organs, the internal pelvic organs in the process of IVF and fertility investigation and treatment, that was my message for today.