Dr. Sonia Naik, Principal Director Obstetrics & Gynaecology, Max Smart Super Speciality Hospital, Saket, Delhi
Not all infertility cases can be managed with medical treatment alone. Some patients require fertility-enhancing endoscopic procedures, which help both diagnose the cause of infertility and provide treatment. These procedures include hysteroscopy, laparoscopy, and robotic surgery. All are minimally invasive or keyhole procedures.
Infertility may result from problems in the uterus, which carries the pregnancy; the ovaries, which produce the eggs; or the fallopian tubes, which carry the embryo. Depending on the underlying pathology, hysteroscopy, laparoscopy, or robotic surgery may be used to treat the infertile woman.
It is important to understand that these women are generally young. Therefore, while operating on the uterus, its strength should be preserved, and while operating on the ovaries, healthy ovarian tissue should be conserved as much as possible, whether the procedure is performed laparoscopically or robotically. This is particularly important in surgical cases of fibroid uterus and adenomyosis.
To examine the uterine cavity, the space where the baby grows, hysteroscopy is performed. It helps diagnose and treat conditions within the cavity. Growths such as polyps or fibroids, adhesion bands, and uterine septa can all be treated hysteroscopically.
If there is any problem in the ovary, such as a cyst, tumor, or endometriosis, it is treated laparoscopically or robotically. Endometriosis is best managed with robotic surgery because it provides better magnification, a three-dimensional view, and superior instrumentation. A very gentle surgical approach is required to preserve as much healthy ovarian tissue as possible.
While laparoscopy and robotic surgery offer almost similar surgical outcomes, robotic surgery is associated with less postoperative pain, reduced blood loss, and greater surgical precision.
Any tubal pathology is investigated and treated through laparoscopy. Laparoscopy is also performed to determine whether the fallopian tubes are open. In cases of unexplained infertility, laparoscopy helps identify any underlying cause.
Laparoscopy, hysteroscopy, and robotic surgery are useful not only in infertility cases but also in the management of several other gynaecological conditions. In women with abnormal uterine bleeding, hysteroscopy is extremely beneficial for both diagnosis and treatment, including visual D&C and the removal of intracavitary lesions such as polyps and fibroids.
In cases of benign ovarian tumors or cysts, such as dermoid cysts, cystadenomas, and chocolate cysts, laparoscopy and robotic surgery are essential. Nowadays, in selected patients with early-stage malignant ovarian tumors, keyhole surgery may also be used. Robotic or laparoscopic surgery is also performed for lymphadenectomy and omentectomy in patients with ovarian cancer.
In patients with uterine cancer, robotic surgery is particularly helpful, including para-aortic lymph node dissection whenever required.
In patients with the complex and excruciating problem of endometriosis, robotic surgery, with its high magnification and ergonomically designed instruments, provides excellent results in managing such complex cases.
