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New Updated Video: Uterine Septum

Dear Readers,

Yes, it has been quite a while since I’ve written. I hope you all have been well and I am excited to return to the blog sphere. It’s not that I have been slacking; I have been writing extensively in other areas, but I do miss the blog so it’s good to be back.
The attached link is to a patient education piece that I produced on uterine septums, which was accepted and presented at the latest meeting of the American Society of Reproductive Medicine. I am very pleased with this final version and I hope some of you find it helpful.

Patient Education: Uterine Septum Video

More to come!

Frederick Licciardi, M.D.
Professor OGBYN
NYU Langone Medical Center

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Dr. Licciardi Performing Surgery to Repair Uterine Septum

Today’s blog is a little different, as it is the first one of mine that uses a video.What you will see is actual footage of me performing surgery to repair a large uterine septum.I have viewed many such videos on line and feel that they leave room for improvement. The explanations are not clear; plus I am not impressed with the techniques of many of the surgeons.

Because there is a difference among surgeons, it is wise to seek a second opinion always. Even if you love your own doctor, I would be happy to give you the peace of mind of a second opinion. I have seen many, many women avoid surgery all together simply by taking the extra precaution of a second opinion. It’s well worth it.

Click the link and the video will appear. http://www.youtube.com/watch?v=pf0XIPNnPlo&feature=feedu

For more important information, see my other blogs about uterine septums.

Thanks for viewing, and please read disclaimer 5.17.06.

Dr. Licciardi

More About Fibroid Surgery

So why not just remove all fibroids to treat infertility and to prevent pregnancy complications? Because the operation is not without discomfort and risk. Overall, myomectomy is a safe procedure, however complications are possible.

One complication is bleeding. If the surgeon is meticulous, the odds are bleeding are lower, however you doctor can’t control everything. Even in the best of hands, transfusion may be necessary. The odds are related the to number of fibroids being removed. Most people with a few fibroids do not need transfusions. If there are more than 10-20 fibroids, your odds will be much higher.

Transfusion risk can be lowered using a machine called the “cell saver”. This machine takes blood you lose during an operation and recycles it back into your veins.

Can a myomectomy make infertility worse? In some cases yes. There is about a 30% chance that a myomectomy will cause scar tissue to form around the tubes, ovaries or uterus. During the fibroid surgery incisions are not made in the ovaries or tubes. However, as the uterus heals, scar tissue can form throughout the pelvis that can envelop the ovaries and tubes. This scar tissue, also called adhesions, can make it more difficult for an egg to get from the ovary to the tube.

This can be dealt with in different ways. A few months after the myomectomy, a hysterogram can be performed to look for tubal blockage. If blockage were present, you would have the option of a laparoscopy to evaluate and possibly treat the adhesions. Or, you could bypass the laparoscopy and go straight to IVF.

What about pregnancy? There are cases where the fibroid is clearly the cause of premature delivery, but these cases are not that common. Here the fibroids grow considerably during pregnancy. Most do not, and even those that do grow are usually not a problem. But again, its impossible to predict which ones will be problematic.

Another problem is degeneration. If the fibroid grows quickly during pregnancy, it can outgrow its blood supply. This causes the center of the fibroid to die, and this can cause considerable pain. As a result, inflammatory substances are produced, and these can trigger premature delivery.

Throughout this post I have been somewhat fibroid sympathetic, but I need to be clear. Yes I believe that some myomectomies may be unnecessary. However, any fibroid needs to be taken seriously. I perform myomectomies. There is an important place for fibroid surgery.

Pros of myomectomy are that the surgery is rather routine. The procedure is not much different than a c-section. If there was any problem with pregnancy related to fibroids, the patient would have wished she had the myomectomy before getting pregnant. Therefore some would recommend having the surgery from the get go.

As usual, the main point here is do your homework, and get second opinions.
Please see disclaimer 5/17/06.

Dr. Licciardi

References:

  • American Association of Gynecologic Laparoscopists (AAGL): Advancing Minimally Invasive Gynecology Worldwide. AAGL practice report: practice guidelines for the diagnosis and management of submucous leiomyomas. J Minim Invasive Gynecol. 2012 Mar-Apr; 19(2):152-71.
  • Giatras K, Berkeley AS, Noyes N, Licciardi F, Lolis D, Grifo JA. Fertility after hysteroscopic resection of submucous myomas. J Am Assoc Gynecol Laparoscopy. 1999 May; 6(2):155-8.
  • Klatsky PC, Tran ND, Caughey AB, Fujimoto VY. Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. Am J Obstet Gynecol. 2008 Apr; 198(4):357-66.
  • Munro MG. Uterine leiomyomas, current concepts: pathogenesis, impact on reproductive health, and medical, procedural, and surgical management. Obstet Gynecol Clin North Am. 2011 Dec; 38(4):703-31.