Outpatient Surgical Procedures
The two most common surgical procedures for infertility are hysteroscopy and laparoscopy. The physicians at Carolina Conceptions perform outpatient (same-day) surgeries at Blue Ridge Surgery Center.
Hysteroscopy is a surgery that allows the surgeon to look inside the uterus and remove any abnormal tissue that may be lowering your chance of pregnancy. Abnormalities inside the uterine cavity such as scar tissue (from prior infection or pregnancy), fibroids, polyps, proximal tubal blockage (we perform tubal cannualization), or uterine malformations (such as uterine septum) can be both evaluated and treated surgically at the time of hysteroscopy.
Hysteroscopy involves the placement of a small (typically 4 mm) telescope (the hysteroscope) through the cervix, directly into the uterine cavity. No incisions are required. Next, saline is infused into the uterus so we can identify any abnormal tissue. If a polyp, fibroid, or septum is identified, then we can use a special operative device to remove it. Cases typically take about 15-45 minutes, depending on what is found inside the uterus.
Almost every instance hysteroscopy is an outpatient procedure, which means “in and out” without the need for overnight observation in a hospital. The recovery from a hysteroscopy alone is generally only 24 hours, and women are usually back to work the following day. The risks associated with hysteroscopy are very minimal, and include very low chances of bleeding, infection, or injury to the uterus (uterine perforation).
Laparoscopy is minimally invasive surgery in which very small incisions are made on the abdomen. Then a telescope (laparoscope) is inserted into the abdominal cavity in order to evaluate and treat the pelvic organs including the uterus, fallopian tubes, and ovaries. Some of the most common indications for laparoscopy are pelvic scar tissue, abnormal fallopian tubes (hydrosalpinx), endometriosis, and fibroids. These conditions can cause pelvic pain, abnormal bleeding, and infertility.
The laparoscope is inserted through a small (1-centimeter) incision in the belly button. One or two additional small incisions are made in the lower pelvis, and surgical instruments are inserted through these ports. These instruments can be used to improve fertility by removing scar tissue, excising abnormal fallopian tubes or ovarian cysts, and eradicating visible areas of endometriosis.
It depends on what is found, but the average laparoscopy takes about 30-60 minutes, and is an outpatient procedure. In less than 1% of surgeries, admission to the hospital for observation, blood transfusion, pain management or other reasons is necessary. Following laparoscopy, 3-4 days of recovery is the average time most patients need to feel basically back to normal. Some amount of abdominal pain often persists for a few days, so please take the narcotics given to you to control this pain before it gets severe, rather than letting it get to out of control. The anesthesia effect (“feeling washed out”) can also last several days. In addition, surgical suture (stitches) are used to close the small incisions. This suture dissolves in 4-6 weeks on its own and does not need to be removed post-operatively.
Day of Surgery
It is important not to eat or drink anything after midnight before your day of surgery. It is okay to brush your teeth the following morning with little water. You should arrive for your surgery one hour before its scheduled time, at which time you will be greeted by the nurses and later by your doctor. Wear comfortable clothing, and no nail polish, so that the oxygen monitor, which the anesthesiologist will place on your fingertip, can function optimally. The person accompanying you can wait with you until minutes before the surgery is to begin, and he/she may join you in the recovery room shortly after the surgery is over.
Immediately after the surgery, your doctor will explain the findings to you, your partner, or a family member. After anesthesia, you will not remember much of the conversation. We will explain the findings in detail and even show photographs taken during the surgery at your post-operative visit one to two weeks later in the office. At that visit, we will discuss the next steps in your treatment plan.
Most surgeries are covered by insurance. Our insurance coordinators assist you with any questions you may have regarding insurance coverage. Each plan varies, and you need to know in advance the terms of your specific policy. Pre certification for surgery is required.