Reproductive Surgery: Current Techniques to Optimize Fertility

Foreword
The Book
References
Contents
Contributors
1: Double Uterus with Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA)
	Introduction
	Development
	Classification
	Presentation
	Diagnosis
	Management Objectives
	Operative Approach
	Procedural Steps
		Vaginal Approach
		Abdominal Approach
	Reproductive Outcomes
	Conclusion
	References
2: Surgical Techniques for Vaginal Agenesis With and Without a Functioning Uterus
	Müllerian Anomalies
		Background and Terminology
		Embryology
		Classification Systems
	Vaginal Agenesis With and Without a Functional Uterus
		Differential Diagnosis
		Evaluation and Diagnosis
		Reproductive Considerations
	Vaginal Agenesis with a Functioning Uterus (Distal Vaginal Atresia)
		Presentation and Management
	Müllerian Agenesis (Vaginal Agenesis Without a Functioning Uterus)
		Nonsurgical Management (Primary Vaginal Dilation)
		Surgical Management
		Techniques for Surgical Vaginal Construction (Neovagina)
			Active Dissection of the Perineal Space
			Autologous Pelvic Peritoneum
			Active Perineal Dilation
			Intestinal Vaginoplasty
			Labial Skin Flap or Vulvovaginal Pouch
		Complications and Outcomes of Surgical Neovagina Techniques
			Active Dissection of the Perineal Space
			Autologous Pelvic Peritoneum
			Active Perineal Dilation
			Intestinal Vaginoplasty
			Labial Skin Flap or Vulvovaginal Pouch
	Conclusion
	References
3: Overcoming the Challenging Cervix
	Development
	Cervical Pathology
	Cervical Stenosis
	Preoperative Management
	Intraoperative Management
	Post-procedure Prevention Strategies
	Post-procedure Medical Management
	Cervical Stenosis in the Infertile Population
	Conclusion
	References
4: Septate Uterus: Diagnosis and Management
	Introduction
	Development
	Classification
	Diagnosis
	Impact on Fertility and Obstetric Outcomes
	Operative Technique
	Procedural Steps
		Partial Septate Uterus
		Complete Septate Uterus
	Assessing for Adequacy of Septum Incision and Adhesion Formation
	Attempting Pregnancy Following Septum Incision
	Conclusion
	References
5: Intrauterine Adhesions
	Background
	Etiology
	Pathophysiology
	Clinical Presentation
	Diagnosis of Intrauterine Adhesions
	Classification of Intrauterine Adhesions
	Surgical Considerations
	Postoperative Management
	Postoperative Outcomes
	Conclusions
	References
6: Intraoperative Management of FIGO Type 2 Fibroids
	Classification
	Fibroids and Fertility
	Preoperative Considerations
		Imaging
		Evaluation of Hemoglobin/Iron Stores and Other Possible Causes of Heavy Menstrual Bleeding
		Use of Gonadotropin Releasing Hormone (GnRH) Analogs and Antagonists
		Use of Cervical Ripening Agents
		Timing of Hysteroscopic Surgery
	Intraoperative Considerations
		Use of Preoperative Antibiotics
		Choice of Distension Medium for Hysteroscopy
			High Viscosity Distension Medium
			Low Viscosity Distension Medium
				Hypotonic Distension Medium
				Isotonic Distension Medium
		Choice of Hysteroscopic Surgical Instruments
		Miscellaneous Tips and Tricks for Deeply Seated Type 1, and Type 2 Fibroids
	Intra- and Postoperative Complications
		Uterine Perforation
		Acute Bleeding/Cervical Trauma
		Air/Gas Embolism
		Fluid Overload
		Postoperative Intrauterine Adhesions
	Summary
	References
7: Proximal Tubal Obstruction
	Pathophysiology
	Occlusion
		Salpingitis
		Salpingitis Isthmica Nodosa (SIN)
		Endometriosis
	Obstruction
		Mucus Plugs
		Uterotubal Spasms
	Diagnosis
		HSG
		Sonohysterosalpingography (HyCoSy)
		Air-Contrast Sonohysterography (SHG)
	Surgical Treatment of Proximal Tubal Blockage
		Microsurgical Anastomosis Technique
		Radiographic Selective Salpingography
		Laparoscopy with Hysteroscopic Tubal Cannulation
		Pregnancy Rates
	References
8: Diagnosis and Surgical Management of Adenomyosis
	Introduction
	Pathogenesis
	Presentation
	Diagnosis
	Adenomyosis and Fertility Outcomes
	Management
		Surgical Management
	Conclusion
	References
9: Hydrosalpinges: Repair or Excise
	Introduction
	Diagnosis
	Impact of Hydrosalpinx on IVF
	Neosalpingostomy
	Salpingectomy
	Proximal Tubal Ligation
	Hysteroscopic Proximal Tubal Occlusion
	Alternatives to Salpingectomy: Aspiration and Sclerotherapy
	Conclusion
	Bibliography
10: Cesarean Scar Defects
	Introduction
	Prevalence and Risk Factors
	Signs, Symptoms, and Complications of Cesarean Scar Defects
		Infertility
		Ectopic Pregnancy
		Effects on Gynecologic Procedures
		Other Complications
	Diagnosis
		Imaging Studies
			Transvaginal Ultrasound
			saline infusion sonohyterogram
			Hysteroscopy
			Hysterosalpingogram and Magnetic Resonance Imaging
	Management
		Medical Management
		Hysteroscopic Revision of Cesarean Scar Defects
			Consent
			Patient Preparation
			Instruments
			Surgical Steps
		Laparoscopic Repair of CSD
			Patient Evaluation
			Counseling
			Patient Preparation
			Instruments
			Surgical Steps
		Vaginal Approach to CSD Repair
			Patient Evaluation
			Consent
			Patient Preparation
			Surgical Steps
		Combined Procedures
	Considerations for Pregnancy
	Conclusion
	References
11: Fertility-Enhancing Ovarian Cystectomy
	Introduction
	Overview of Cysts in Women of Reproductive Age
	Preoperative Approach and Evaluation
		Medical History
		Imaging
		Laboratory Evaluation
	Patient Selection and Preoperative Counseling
		Elements to Include in Surgical Consent
	Operative Techniques and Surgical Approach
		Approach to the Endometrioma
		Approach to the Mature Cystic Teratoma (Dermoid Cysts)
	Special Considerations: Ovarian Cystectomy in the Pregnant Patient
	Special Considerations: Ovarian Cystectomy in Pediatric and Adolescent Patients
	Postoperative Care
	References
12: Ovarian Transposition
	Introduction
	Radiation Effects on the Ovary
	Candidate Selection
	Surgical Approach: Laparotomy to Laparoscopy
	Preoperative Considerations
		Location of Transposition
		Management of Fallopian Tubes
		Risks of the Procedure
	Surgical Technique: Lateral Ovarian Transposition
	Ovarian Function After Ovarian Transposition
	Pregnancy Outcomes After Ovarian Transposition
	Concurrent Fertility Preservation Strategies
	Conclusion
	References
13: Imaging Modalities to Preoperatively Detect Fibroid Location
	Summary
	References
14: Image-Based Surgery: Treating Fibroids You Can’t See
	Introduction
	History of Ultrasound Imaging
	Integrating Ultrasound into Gynecology
	Fluorescent Imaging: How Indocyanine Green Is the New Black
	3D Models and Augmented Reality: Seeing Is Believing
	Conclusions
	References
15: Cervical Fibroids
	Introduction
	Diagnosis
	Imaging
	Surgical Approach
		Presurgical Considerations
		Abdominal
		Laparoscopy
		Robotic-Assisted Laparoscopy
		Hysteroscopy
		Vaginal
		Postoperative Considerations
	Conclusion
	References
16: Adenomyomectomy by the Triple-Flap Method
	Introduction
	Indications and Preoperative Examinations
	The Triple-Flap Method
		Step 1: Diagnostic Laparoscopy
		Step 2: Exteriorization of the Uterus and Placement of a Tourniquet Around the Proximal Cervix
		Step 3: Bisection of the Uterus/Adenomyosis
		Step 4: Excision of Adenomyotic Tissue
		Step 5: Reconstruction of the Uterine Wall by the Triple-Flap Method
		Step 6: Final Laparoscopy and Adhesion Prevention
	Results of the Triple-Flap Method
		Surgery-to-Pregnancy Interval
		Laparotomy Versus Laparoscopy
		Wound Healing Disturbance Due to Excessive Electrocoagulation
		Postoperative Recurrence and Pathological Examination of the Removed Uterus
	Conclusion
	References
17: Uterine Transposition
	Introduction
		Indications
		Contraindications
	Preoperative Workup
	Surgery Technique
		First Surgery (Uterine Transposition to the Upper Abdomen)
			Traditional Laparoscopy
			Robotic Assisted Laparoscopy
				Intracorporeal Approach to Attach the Uterus and Ovaries
		Postoperative Care of the First Surgery
		Second Surgery (Uterine Repositioning in the Pelvis)
			Postoperative Care of the Second Surgery (Uterine Repositioning)
		Results
			Uterine and Gonadal Preservation and Function (Hormonal)
				Surgical Complications
				Fertility Rate
				Oncological Outcomes and Radiotherapy Delay
	Conclusions
	References
18: Recognition and Management of Iatrogenic Injury to the Genitourinary System
	Introduction
	Iatrogenic Injury to the Bladder
		Mechanisms of Bladder Injury
		Diagnosis of Bladder Injury
			Imaging of the Bladder
		Repair of Bladder Injury: General Principles
			Extraperitoneal Injury
			Intraperitoneal Injury
		Follow-Up
	Iatrogenic Ureteral Injury
		Mechanism of Ureteral Injury
		Diagnosis of Ureteral Injury
			Imaging Studies
		Management
			Intraoperative Recognition of Ureteral Injury
			Delayed Postoperative Recognized Ureteral Injury
		Follow-Up of Ureteral Injuries
	Conclusion
	References
19: Retroperitoneal Dissection
	Introduction
	Retroperitoneal Anatomy
		Avascular Spaces
			Paravesical and Pararectal Spaces
			Prevesical Space
			Vesicocervical and Vesicovaginal Spaces
			Rectovaginal Space
			Presacral Space
		Ureter
		Pelvic Vasculature
		Pelvic Nerves
	Dissection Techniques
		Millimeter by Millimeter
		Gentle Teasing and Wiping
		Push and Spread
		Traction–Countertraction
		Tenting of the Tissues
		Small Incisions
		Hydrodissection and Pneumodissection
		Shaving Techniques
	General Tips
	Step-by-Step Dissection of the Pelvic Sidewall
		Step 1: Perform a Systematic Survey of the Pelvis
		Step 2: Open the Peritoneum, Ideally at the Pelvic Brim
		Step 3: Identify the Landmarks for the Three Layers of the Pelvic Sidewall
		Step 4: Develop the Avascular Spaces
	Conclusion
	References
20: Deep Infiltrating Endometriosis: Diagnosis and Fertility-Sparing Management in the ART Patient
	Introduction
		Definition
		Epidemiology
		Risk Factors
		Pathophysiology
	Diagnostic Considerations
		Clinical Picture
		Diagnosis
		Interventions
	Preoperative Considerations
		Surgical Candidacy
		Workup
		Imaging
	Operative Approach
		Prior to Surgery
		Intraoperative Evaluation
		General Surgical Management
			Rectovaginal Endometriosis
			Gastrointestinal Tract Endometriosis
		Advanced Operative Techniques for Bowel DIE
			Shaving Technique
			Discoid Resection
			Segmental Resection
			Genitourinary Endometriosis
			Diaphragm Endometriosis
	Postsurgical Considerations
		Postsurgical Complications
		Postsurgical ART Outcomes
	Conclusion
	References
21: Crisis Management in the Office Setting
	Introduction
	Crisis Management
	Understanding and Managing Human Behavior During a Crisis
	Team Leadership
	Simulation Training
	Panic Control
	Patient Case [1]
	Patient Case [2]
	Patient Case [3]
	Conclusion
	References
22: Risk Mitigation Strategies for Physicians
	Introduction
	Historical Perspectives on Medical Malpractice
	Legal Elements of a Medical Malpractice Claim
	The Current Landscape of Physician Medical Malpractice in the United States
	Common Categories of Malpractice Claims
	Minimizing Medical Malpractice Risk
	The Experience of Being Sued
	Conclusion
	References
23: Complications of Oocyte Retrieval
	Introduction
	A Brief History of Oocyte Retrieval Techniques
	Complications of Oocyte Retrieval
	Bleeding Associated with Oocyte Retrieval
		Bleeding Complications
		Minimizing Bleeding Complications
	Urinary Tract Injuries
		Bladder Injuries
		Ureteral Injuries
		Minimizing Injuries to the Urinary Tract
	Infectious Complications
		Pelvic Infections
		Endometriomas and Pelvic Infections
		Hydrosalpinges and Pelvic Infections
		Minimizing Infectious Complications
	Pain and Anesthesia Complications
		Minimizing Pain and Anesthesia Complications
	Special Circumstances
	Conclusion
	References
24: Reproductive Surgery in Austere Settings
	Introduction
	Kenya as a Case Study in MIRS in Low-Resource Settings
	References
Index