Reproductive surgery remains an essential element of reproductive medicine.

B Urman, B Ata, V Gomel
Author Information

Abstract

Background: Reproductive surgery has long been neglected and is perceived to be simple surgery that can be undertaken by all gynaecologists. However, given the ever-expanding knowledge in the field, reproductive surgery now comprises surgical interventions on female reproductive organs that need to be carefully planned and executed with consideration given to the individuals symptoms, function of the organ and fertility concerns.
Objectives: To discuss the different perspectives of reproductive surgeons and other gynaecological surgeons, e.g., gynaecological oncologists, and advanced minimally invasive surgeons, regarding diagnosis and management of pelvic pathology that affects reproductive potential. Furthermore, to highlight the gaps in knowledge and numerous controversies surrounding reproductive surgery, while summarising the current opinion on management.
Materials and Methods: Narrative review based on literature and the cumulative experience of the authors.
Main outcome measures: The paper does not address specific research questions.
Conclusions: Reproductive surgery encompasses all reproductive organs with the aim of alleviating symptoms whilst restoring and preserving function with careful consideration given to alternatives such as expectant management, medical treatments, and assisted reproductive techniques. It necessitates utmost technical expertise and sufficient knowledge of the female genital anatomy and physiology, together with a thorough understanding of and respect to of ovarian reserve, tubal function, and integrity of the uterine anatomy, as well as an up-to-date knowledge of alternatives, mainly assisted reproductive technology.
What is new?: A holistic approach to infertile women is only possible by focusing on the field of reproductive medicine and surgery, which is unattainable while practicing in multiple fields.

References

  1. J Minim Invasive Gynecol. 2020 Sep - Oct;27(6):1308-1315 [PMID: 31600574]
  2. Fertil Steril. 1995 Nov;64(5):924-9 [PMID: 7589635]
  3. J Minim Invasive Gynecol. 2013 Jan-Feb;20(1):22-42 [PMID: 23312243]
  4. J Gynecol Obstet Hum Reprod. 2021 Oct;50(8):102143 [PMID: 33862265]
  5. JSLS. 2014 Jul-Sep;18(3): [PMID: 25392649]
  6. Surg Innov. 2019 Feb;26(1):72-76 [PMID: 30047311]
  7. Best Pract Res Clin Obstet Gynaecol. 2005 Aug;19(5):757-67 [PMID: 16087405]
  8. J Minim Invasive Gynecol. 2012 Jan-Feb;19(1):63-7 [PMID: 22070929]
  9. Fertil Steril. 2016 Oct;106(5):1025-1031 [PMID: 27692286]
  10. Fertil Steril. 1980 Jun;33(6):587-97 [PMID: 7380045]
  11. J Obstet Gynaecol Res. 2018 Jul;44(7):1268-1273 [PMID: 29845687]
  12. J Reprod Med. 1996 Jan;41(1):35-41 [PMID: 8855074]
  13. Fertil Steril. 2018 Mar;109(3):406-417 [PMID: 29566853]
  14. J Pain Res. 2019 Jun 27;12:1917-1924 [PMID: 31303783]
  15. J Obstet Gynaecol Can. 2016 Apr;38(4):362-5 [PMID: 27208606]
  16. Fertil Steril. 1995 Mar;63(3):464-8 [PMID: 7851571]
  17. Fertil Steril. 2022 Nov;118(5):915-923 [PMID: 36175206]
  18. Gynecol Oncol. 1992 Nov;47(2):223-7 [PMID: 1468701]
  19. Fertil Steril. 2022 Oct;118(4):758-766 [PMID: 35985862]
  20. J Minim Invasive Gynecol. 2016 Sep-Oct;23(6):893-902 [PMID: 27393285]
  21. Hum Reprod. 2020 Nov 1;35(11):2627-2629 [PMID: 32968815]
  22. J Minim Invasive Gynecol. 2021 Jul;28(7):1303-1312.e5 [PMID: 33582380]
  23. Reprod Biomed Online. 2015 Dec;31(6):722-31 [PMID: 26511873]
  24. J Obstet Gynaecol. 2018 Jan;38(1):85-89 [PMID: 28764594]
  25. Am J Obstet Gynecol. 2001 Jun;184(7):1340-2; discussion 1342-4 [PMID: 11408850]
  26. Hum Reprod. 1998 Jan;13(1):99-103 [PMID: 9512237]
  27. J Ultrasound Med. 2022 Apr;41(4):917-923 [PMID: 34196967]
  28. J Minim Invasive Gynecol. 2020 Sep - Oct;27(6):1331-1336 [PMID: 32380241]
  29. Hum Reprod Open. 2021 Apr 19;2021(2):hoab015 [PMID: 33898760]
  30. Cochrane Database Syst Rev. 2013 Feb 28;(2):CD009174 [PMID: 23450598]
  31. Arch Gynecol Obstet. 2021 Jan;303(1):3-16 [PMID: 32979078]
  32. Eur J Obstet Gynecol Reprod Biol. 2023 Jan;280:174-178 [PMID: 36508855]
  33. BMJ Open. 2018 Apr 9;8(4):e018924 [PMID: 29632080]
  34. Minerva Ginecol. 2005 Feb;57(1):21-8 [PMID: 15758863]
  35. Fertil Steril. 2018 Mar;109(3):380-388.e1 [PMID: 29566850]
  36. J Minim Invasive Gynecol. 2015 Mar-Apr;22(3):363-72 [PMID: 25573183]
  37. J Clin Med. 2023 Aug 16;12(16): [PMID: 37629367]
  38. Acta Obstet Gynecol Scand. 2017 Jun;96(6):715-726 [PMID: 28556124]
  39. BJOG. 2017 Mar;124(4):615-621 [PMID: 27921379]
  40. Fertil Steril. 2020 Apr;113(4):765-766 [PMID: 32147176]
  41. Semin Reprod Med. 2015 Nov;33(6):422-8 [PMID: 26594869]
  42. Transplantation. 2023 Jan 1;107(1):10-17 [PMID: 35951434]
  43. Int J Gynaecol Obstet. 2023 May;161(2):356-366 [PMID: 36317541]
  44. Hum Reprod Update. 2019 Sep 11;25(5):592-632 [PMID: 31318420]
  45. BMC Womens Health. 2022 May 25;22(1):190 [PMID: 35614405]
  46. Ann N Y Acad Sci. 1994 Sep 30;734:433-44 [PMID: 7978945]
  47. Turk J Obstet Gynecol. 2023 Sep 4;20(3):206-213 [PMID: 37667481]
  48. Fertil Steril. 2017 Sep;108(3):416-425 [PMID: 28865538]
  49. Facts Views Vis Obgyn. 2019 Jun;11(2):151-157 [PMID: 31824636]
  50. Best Pract Res Clin Obstet Gynaecol. 2018 Aug;51:102-110 [PMID: 29545114]
  51. Obstet Gynecol. 1978 Nov;52(5):591-6 [PMID: 724178]
  52. Curr Opin Organ Transplant. 2021 Dec 1;26(6):616-626 [PMID: 34636769]
  53. Eur J Obstet Gynecol Reprod Biol. 2017 Feb;209:81-85 [PMID: 26968428]
  54. Acta Obstet Gynecol Scand. 2017 Jun;96(6):688-693 [PMID: 28419418]
  55. Cochrane Database Syst Rev. 2011 Jun 15;(6):CD008576 [PMID: 21678380]
  56. J Minim Invasive Gynecol. 2015 Nov-Dec;22(6S):S133 [PMID: 27678721]
  57. Hum Reprod. 2010 Oct;25(10):2475-9 [PMID: 20719814]
  58. Nat Rev Endocrinol. 2019 Nov;15(11):666-682 [PMID: 31488888]
  59. Fertil Steril. 2023 Mar;119(3):377-389 [PMID: 36574916]
  60. J Clin Med Res. 2018 Mar;10(3):166-173 [PMID: 29416572]
  61. JBRA Assist Reprod. 2021 Apr 27;25(2):303-309 [PMID: 33656838]
  62. Clin Obstet Gynecol. 1980 Dec;23(4):1301-10 [PMID: 7004708]
  63. J Minim Invasive Gynecol. 2023 Jan;30(1):32-38 [PMID: 36228863]
  64. Gynecol Minim Invasive Ther. 2018 Apr-Jun;7(2):47-55 [PMID: 30254937]
  65. J Minim Invasive Gynecol. 2013 Sep-Oct;20(5):562-72 [PMID: 23680518]
  66. Minerva Ginecol. 2011 Aug;63(4):365-73 [PMID: 21747345]
  67. Cochrane Database Syst Rev. 2020 Jan 29;1:CD003857 [PMID: 31995657]
  68. Reprod Biomed Online. 2023 Feb;46(2):332-337 [PMID: 36564221]
  69. Reprod Sci. 2022 Mar;29(3):761-767 [PMID: 35020188]
  70. Hum Reprod. 2021 Apr 20;36(5):1260-1267 [PMID: 33793794]
  71. Hum Reprod Update. 2007 Sep-Oct;13(5):465-76 [PMID: 17584819]
  72. Minerva Obstet Gynecol. 2022 Feb;74(1):3-11 [PMID: 33876900]
  73. Am J Obstet Gynecol. 2022 Oct;227(4):599.e1-599.e9 [PMID: 35752301]
  74. Fertil Steril. 2017 Jul;108(1):84-95.e5 [PMID: 28579408]
  75. JAMA Surg. 2022 Sep 1;157(9):790-797 [PMID: 35793102]
  76. Hum Reprod Update. 2015 Nov-Dec;21(6):809-25 [PMID: 26168799]
  77. Prog Clin Biol Res. 1993;381:45-9 [PMID: 8316569]
  78. Hum Reprod. 2005 Jun;20(6):1632-5 [PMID: 15760959]
  79. J Obstet Gynaecol India. 2022 Jun;72(3):236-242 [PMID: 35734352]
  80. Hum Reprod. 2015 Feb;30(2):299-307 [PMID: 25432923]
  81. J Minim Invasive Gynecol. 2021 Mar;28(3):619-643 [PMID: 32977002]
  82. Fertil Steril. 2016 Aug;106(2):322-329.e9 [PMID: 27114330]
  83. Best Pract Res Clin Obstet Gynaecol. 2019 Aug;59:115-131 [PMID: 30837118]
  84. Gynecol Obstet Invest. 2023;88(2):81-90 [PMID: 36724750]
  85. Hum Reprod. 2020 Jan 1;35(1):89-99 [PMID: 31885047]
  86. Ann Transl Med. 2022 Jul;10(14):786 [PMID: 35965788]
  87. Am J Obstet Gynecol. 2024 Sep;231(3):346.e1-346.e11 [PMID: 38154502]
  88. Fertil Steril. 1986 Nov;46(5):807-10 [PMID: 3781001]
  89. Ultrasound Obstet Gynecol. 2019 Jan;53(1):107-115 [PMID: 29536581]
  90. Minerva Ginecol. 2010 Jun;62(3):225-36 [PMID: 20595947]
  91. BJOG. 2022 Oct;129(11):1935-1936 [PMID: 35434942]
  92. J Am Assoc Gynecol Laparosc. 2000 Aug;7(3):355-61 [PMID: 10924630]
  93. Curr Opin Obstet Gynecol. 2012 Jun;24(3):136-40 [PMID: 22327738]
  94. J Minim Invasive Gynecol. 2018 May - Jun;25(4):622-631 [PMID: 29366966]
  95. Fertil Steril. 1978 Apr;29(4):380-7 [PMID: 148372]
  96. Curr Opin Obstet Gynecol. 2007 Jun;19(3):229-37 [PMID: 17495638]
  97. J Pediatr Adolesc Gynecol. 2011 Dec;24(6):376-9 [PMID: 21906976]
  98. J Clin Med. 2022 Nov 14;11(22): [PMID: 36431203]
  99. Acta Obstet Gynecol Scand. 2021 Mar;100(3):531-537 [PMID: 33029804]
  100. Fertil Steril. 2014 Oct;102(4):1203-8 [PMID: 25150389]
  101. Fertil Steril. 2023 Jun;119(6):996-1007 [PMID: 36813123]
  102. Fertil Steril. 2019 Aug;112(2):183-196 [PMID: 31352957]
  103. J Minim Invasive Gynecol. 2018 May - Jun;25(4):608-621 [PMID: 29305234]
  104. Hum Reprod. 2002 May;17(5):1141-5 [PMID: 11980729]
  105. J Minim Invasive Gynecol. 2019 May - Jun;26(4):628-635 [PMID: 30599196]
  106. Cochrane Database Syst Rev. 2020 Oct 22;10:CD002125 [PMID: 33091963]
  107. Hum Reprod. 2002 Mar;17(3):782-5 [PMID: 11870136]
  108. Fertil Steril. 2020 Apr;113(4):836-844 [PMID: 32145929]
  109. J Clin Med. 2022 Jun 08;11(12): [PMID: 35743362]
  110. Reprod Biomed Online. 2018 Jul;37(1):77-84 [PMID: 29759886]
  111. Front Endocrinol (Lausanne). 2021 Nov 25;12:745548 [PMID: 34899597]
  112. Placenta. 2011 Sep;32 Suppl 3:S238-42 [PMID: 21764126]
  113. Ultraschall Med. 2014 Oct;35(5):440-4 [PMID: 24557634]
  114. Hum Reprod. 2000 Nov;15(11):2379-82 [PMID: 11056137]
  115. Hum Reprod. 2009 Feb;24(2):254-69 [PMID: 18948311]
  116. Ann Surg Oncol. 2009 Jul;16(7):1799-808 [PMID: 19444524]
  117. J Minim Invasive Gynecol. 2021 Jul;28(7):1291-1302.e2 [PMID: 33839308]
  118. Hum Reprod Open. 2019 Jun 12;2019(3):hoz009 [PMID: 31206037]
  119. Hum Reprod. 2021 Jan 25;36(2):349-357 [PMID: 33491057]
  120. BMC Womens Health. 2015;15:24 [PMID: 25783654]
  121. J Reprod Med. 1992 Mar;37(3):247-50 [PMID: 1532990]
  122. Ultrasound Obstet Gynecol. 2013 Mar;41(3):247-61 [PMID: 23208748]
  123. Arch Gynecol Obstet. 2020 Jan;301(1):33-52 [PMID: 31989288]
  124. Curr Opin Obstet Gynecol. 2022 Aug 1;34(4):244-249 [PMID: 35895967]
  125. Hum Reprod. 2015 Mar;30(3):569-80 [PMID: 25534461]
  126. Gynecol Oncol. 2008 Jul;110(1):43-8 [PMID: 18445505]
  127. Hum Reprod Update. 2010 Jan-Feb;16(1):1-11 [PMID: 19744944]
  128. J Minim Invasive Gynecol. 2018 Feb;25(2):265-276 [PMID: 28739414]
  129. Reprod Biomed Online. 2010 Nov;21(5):700-5 [PMID: 20864409]
  130. Am J Obstet Gynecol. 2022 Oct;227(4):609.e1-609.e8 [PMID: 35662547]
  131. Fertil Steril. 2014 Jul;102(1):143-150.e2 [PMID: 24794315]
  132. Fertil Steril. 2023 Mar;119(3):390-391 [PMID: 36669554]

Word Cloud

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