Gynecology
Endometriosis
Tubal Reversal
Endometriosis
Endometriosis is one of the most common, benign (non-cancerous) gynecologic conditions. The endometrium is the tissue that lines the uterus. When this tissue grows outside of the uterus it is called endometriosis. Endometriosis is almost always confined to the pelvis where it may cause scarring and cysts in the ovary. It may be associated with pelvic pain, especially during menstruation as well as infertility.
Treatment for endometriosis can be either medical or surgical. Various oral and injectable hormones are available to suppress the growth of endometriosis. Although significant improvement results from initial treatment in some patients, most symptoms recur when the medication is discontinued. Nearly all cases of endometriosis can be managed as an outpatient with laparoscopic treatment. If your doctor recommends surgery, physicians at the Cleveland Clinic are known internationally for their experience in the laparoscopic treatment of endometriosis.
How is laparoscopic excision of endometriosis performed?
Laparoscopic surgery uses a thin, telescope-like instrument called a laparoscope, which is inserted through a small incision at the navel. The laparoscope is connected to a small video camera which projects a view of the operative site onto video monitors located in the operating room. The abdomen is inflated with carbon dioxide gas to allow your surgeon a better view of the operative area. Two or three additional small incisions are made in the lower abdomen through which the surgeon inserts specialized surgical instruments. The surgeon uses these instruments to remove the endometriosis and scar tissue around it, while preserving the uterus, tubes, and ovaries. If endometriosis involves the bowel, it can be removed at the same time. Following the procedure, the small incisions are closed with absorbable sutures below the skin. After a few weeks, the tiny puncture sites are barely visible.
What are the benefits of laparoscopic removal of endometriosis?
• Three or four tiny scars instead of one large abdominal scar
• Outpatient procedure
• Reduced postoperative pain
• Shorter recovery time – days instead of weeks – and quicker return to daily activities, including work
• Fewer complications
• Avoidance of the side effects often experienced with hormone therapy
• Preservation of ovarian function
• Increased fertility
What can I expect after surgery?
It is important to follow your doctor’s instructions after surgery. Most patients can resume full activity as soon as they feel up to it.
How safe is laparoscopic removal of endometriosis?
If performed by experts in this field, laparoscopic removal of endometriosis is as safe or safer than “open” surgery in the majority of cases.
Appointment
To schedule an appointment, please call the OB/GYN & Women's Health Institute 216/444-6601
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Tubal Reversal
Tubal anastomosis or tubal reversal, a surgical method used to reverse tubal ligation (an operation to prevent pregnancy by placing surgical clips or bands, burning or removing a small segment of the fallopian tubes) may be an option for women, who for various reasons, wish to re-establish their fertility.
All Cleveland Clinic physicians who perform this procedure have special training in obstetrics and gynecology, reproductive endocrinology and infertility and microsurgery.
What is the success rate?
The success of this operation depends on many factors:
• The length and health of the remaining fallopian tube segments to be rejoined
• Skill of the microsurgeon (a surgeon experienced with microsurgery)
• The woman’s age at the time of reversal surgery
• Method of tubal sterilization
• Scar tissue in the pelvis
• The sperm test results of the partner and other infertility factors
Re-opening of the tubes provides a high chance (but not a guarantee) for pregnancy if the woman’s tubes are healthy and there are no other infertility factors. Under optimal conditions, the pregnancy rate is 75 to 80 percent. This chance for success, as well as the time to achieve conception following tubal anastomosis surgery, is influenced by the above factors. Conception after the surgery usually occurs within the first year.
What does the operation involve?
Tubal anastomosis is a two to three hour operation performed under general anesthesia (being put to sleep). Usually, laparoscopy (placing a small scope through the naval) will first be done to evaluate the reversibility of the tubes. If conditions are appropriate, the reversal will be performed at the same time by one of two ways that will be discussed before surgery.
One way is to perform a mini-bikini cut, a small (side to side) incision that is made just above the pubic hair line. An operating microscope is used to connect the small ends of the tube together with very fine suture material. In some cases it may be performed by laparoscopy. If a laparoscopic approach is used, a robot such as the daVinci robot may be used to facilitate the anastomosis.
Typically, an overnight hospital stay is not necessary. After surgery, your physician will provide instructions and pain medications to take at home. Most patients return to normal activities within two weeks.
What are the risks?
Risks are extremely rare but, as in any operation, include potential anesthetic complications, bleeding, infection or damage to other organs. After tubal reversal, the risk of ectopic pregnancy (tubal pregnancy) increases from 1 in 100, to 5 in 100 pregnancies.
Is the operation covered by insurance?
Please check with your individual insurance carrier to determine if this procedure is covered, since often times this procedure is not covered.
What is the cost for the operation?
The total cost is approximately $7,000 for both the open or laparoscopic tubal reversal. This includes all professional and hospital fees and is about half the national average. However the fees are subject to change and this should be discussed with the department financial counselor.
Are you a candidate for tubal anastomosis?
You are a candidate if there are no medical contraindications to pregnancy, you have adequate tubal segments and your partner’s sperm analysis is normal. Keep in mind that older women have a greatly reduced chance for success.
What is required prior to surgery?
• Medical history and physical examination
• Male partner’s sperm analysis
• Copies of your operative report and pathology reports for the sterilization procedure at the time of your initial visit will be helpful
You may also be required to have additional x-rays, blood work and/or fertility tests prior to surgery.
Preoperative instructions:
• Schedule your surgery within the week following the end of your period.
• Do not eat or drink anything (even water) after midnight the day of surgery.
After surgery
• You will remain in the hospital for approximately three hours after the completion of your surgery before discharge.
• If you are not ready to go home, you may spend the night in the hospital at no extra charge.
• You should refrain from heavy lifting, otherwise there are no diet or activity restrictions.
• You should take your medications as directed.
This information is for educational purposes only and should not be relied upon as medical advice. It has not been designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient.
Appointment
To schedule an appointment, please call the OB/GYN & Women's Health Institute 216/444-6601
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