Surgery: Overview

In addition to the full spectrum of fertility services offered through Duke University's Division of Reproductive Endocrinology and Infertility, there are many surgical procedures offered.

Our physicians have particular expertise with laparoscopy, endometriosis, uterine fibroids, and tubal re-anastomosis.

Below you will find an introduction to our facilities as well as the individual procedures offered. For a discussion f your individual options please schedule an appointment with one of our physicians by calling 919-572-HOPE (4673).

Facilities

We perform our surgical procedures at one of two facilities depending on the nature of the case.

Procedures requiring an inpatient stay are usually performed at Duke University's main operating facility located within Duke University Hospital. This facility is equipped to handle the full spectrum of gynecologic procedures including major cases, laparoscopy, hysteroscopy, and microsurgery.

The majority of the cases performed at Duke North Hospital are considered major cases. These include hysterectomy and some of the myomectomy procedures.

For cases that are likely to allow discharge on the same day of surgery or that require only a single night stay, the Ambulatory Surgery Center is frequently used.

The facility offers a state-of-the-art operating rooms combined with very attractive patient care areas. The patient rooms for overnight stays rival modern upscale hotels. Being in a university environment gives us unparalleled access to an outstanding anesthesia department as well as specialists from a wide range of other fields of medicine if needed.

Pre-Surgery

Once your surgery has been scheduled and you and your physician have discussed the operation to be performed, you will be scheduled for a preoperative appointment.

At this appointment you will have an exam and blood work, sign the consent paperwork, and meet with someone from anesthesia. Any specific instructions prior to surgery will be reviewed during this time.

You will also be given contact information for surgery scheduling. Your arrival time will be established the working day prior to the procedure.

Post Surgery

Following your surgery your recovery time will vary depending on the procedure performed.

Most laparoscopy cases are done as same day surgeries. Myomectomies and tubal reversals are most often done as extended outpatient procedures. This simply means the patient remains overnight but is not admitted as an inpatient (this allows for a significant cost savings).

Following your procedure you will be given written discharge and post operative instructions. Activities and diet are limited by your level of comfort. Start slowly and gradually progress your level of activity as tolerated.

Laparoscopy, hysteroscopy, and D&C; procedures have quicker recovery times than the more major procedures. You should be able to resume driving within 24 hours provided you are not taking medications that impair your abilities to drive.

The major procedures involving a laparotomy (large incision in the abdomen) will require a longer time of recovery. Do not attempt driving for up to four weeks.

Follow up visits are usually scheduled at the time your surgery is scheduled. They will range from one to four weeks after your surgery depending on the procedure and availability of appointments.

Procedures

There are many different types of surgeries that are possible when one considers the multiple combinations of procedures possible. Among these are the following:

Chromopertubation

This procedure is often done in combination with other procedures. Chromopertubation involves injecting colored liquid through the fallopian tubes and watching the ends of the tubes for the dye. Spillage of dye indicates open (patent) tubes.
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Hysterectomy

This is the removal of the uterus and cervix. There are many reasons for this procedure to be performed. Vaginal hysterectomies involve the removal of the uterus through the vagina while abdominal hysterectomies require a laparotomy (incision into the abdomen). Vaginal hysterectomy is usually associated with fewer complications and faster recovery.
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Hysteroscopy

Hysteroscopy involves the use of a thin scope to look into the cavity of the uterus. The scope can be used to guide operative instruments for diagnostic or operative purposes.
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Laparoscopy

Laparoscopy involves placing a scope into the abdominal cavity through a small incision at the navel. One and sometimes more smaller incisions may be made in the abdomen to introduce instruments used to explore the abdominal cavity and perform the necessary surgery. Laparoscopy may be performed for diagnostic or operative purposes.
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Myomectomy

A myomectomy is a procedure involving the removal of a fibroid or fibroids, also known as myomas or leiomyomas.
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Neosalpingostomy

This is a tuboplasty procedure where blocked or dilated tubes are opened and the ends of the tubes are surgically recreated. This allows attempts at achieving pregnancy without IVF.
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Oophorectomy

This is the removal of the ovaries. Removal of the ovaries does not have anything to do with the terms complete or partial hysterectomy (complete and subtotal (partial) depend on the removal of the cervix).
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Tubal Reversal

Tubal reversal, also known as tubal reanastomosis, is a microsurgical procedure where the ends of a previously interrupted tube (tubal ligation) are put back together. This allows for attempts at pregnancy following a tubal ligation without having to undergo IVF.
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