Video Website powered by Einstein IndustriesThe Fertility Institute of New Orleans

DR. HEBER DUNAWAY: Now how we manage these patients will vary. For instance, patients who have pelvic adhesions from infections we initially turn to a procedure called laparoscopy or operative laparoscopy, where an incision is made while the patient is under general anesthesia in the naval. An instrument is passed through the naval for viewing purposes; it's called a laparoscope. Accessory incisions can be made for operating instruments.

The primary choice of therapy is going to be a laser, although sometimes we use special types of scissors or special types of cautery agents as well or instruments. The tissue is then resected and we try to restore a normal anatomy. In some instances, however, the adhesions are so severe that the patients may require what is called a laparotomy, where the abdomen is opened and we do what is called an open procedure.

Newer techniques being developed, we do robotics where sometimes we can do even very difficult cases through the laparoscope using robotic surgery, which is a totally different aspect of laparoscopic procedures.

Patients who have uterine fibroids many times have to be opened as an open procedure. These tumors once again are removed. The problem with any type of surgical procedure is a result of scar tissue formation. Special solutions, special meshes are used to prevent this from causing the patient any harm. Anytime you have surgery, obviously, adhesions are the postoperative concern for us. But utilizing these new techniques we greatly reduce that possibility.

We do have a few patients who come through the practice who have had tubal ligations where we do microsurgical repair to the fallopian tubes. The decision to be made at that point is whether you want to proceed to in vitro fertilization and bypass any type of open procedure or proceed on and do an open procedure, repair the fallopian tubes. It's strictly the patient's choice at this point.