Surgery Center

Uterine fibroids is a high frequency disease that is said to effect 20~30% of women over 30 years of age and due to the change in lifestyles over the recent years it is also said to be on the rise.
It is a benign tumor that occurs in the uterus and the development of it is said to be related to the female hormone estrogen. The cause is still not exactly known.

In the case of uterine fibroids there are three patterns.

① Subserosal Fibroids: Develop on the outside(20%)
② Intramural Fibroids：Develop inside the muscle layer(70%)
③ Submucous Myoma：Develop underneath the endometrium(10%)

The one that is most related to infertility is ③, Submucous myoma.
It is thought that there is an influence on implantation depending on where the fibroid protrudes from within the uterine cavity.

Additionally due to impaired blood flow to the inner membrane, and because of that, it is thought of to be one of the causes of the endometrium becoming thin.

① Menorrhagia
② Irregular Bleeding
③ Dysmenorrhea(Menstrual pain)
④ Infertility, miscarriage, premature birth

Others as pressure symptoms to surrounding organs, there is lower back pain, constipation, frequent urination, urinary dysfunction, and urinary retention.

Other than questionnaires and pelvic examinations, we will diagnose by the following methods.

① Ultrasound(This is the easiest test that you can do at outpatient. We can grasp an idea of the about position and size of the fibroid.)
② MRI(This test can judge on a wide-range terms specifically the fibroid’s size, number, position, and the condition and such of the fibroid)
③ Sonohysterography(The uterine cavity is filled with water and the uterus is inflated while at the same time ultrasound is done.
In doing so, the fibroid protruding from the uterine cavity will float up. We can check the protruding condition to the cavity of the fibroid.
From that, it will become the decision making material as to surgery should be done or what kind of surgery would be the right choice.)
④Hysteroscope(In fact, by a small camera we look at the uterine cavity, and check for presence of protrusions and abnormalities.)

Uterine Fibroid Enucleation

As for the surgery of uterine fibroids at our clinic, it is mainly done for those patients whom are receiving infertility treatment.

When patient gets pregnant after enucleating the fibroids, it will most likely lead to a cesarean section, and considering that point and in order for the surgery to be done with safety, we are doing the surgery by laparotomy.
What’s more, the surgical wounds are treated in a humane manner, and we will strive to reduce them as much as possible by making a vertical incision. (It will vary by the type of body, but generally speaking it will be an incision of about 7-8cm in length.)

Regarding the submucous myoma, we are supporting it depending on the size and shape.
However, in regards to the type of fibroid that bleeds a lot, it is recommended to visit a general hospital that can handle the management of more severe patients.

① Subserosal Fibroids

Since there are often no symptoms, subserosal fibroids often do not become the target of surgery.
However, surgery will be necessary in cases where they get bigger, and there is back pain, constipation, frequent urination, urination dysfunction, and urination retention, or it is rare, but when there is cervical torsion accompanied by pain.

② Intramural Fibroids

Since we are aiming for a pregnancy, the fibroid enucleation that leaves the uterus and only takes the fibroid is an optimal treatment method.
As for the operative method, there is abdominal surgery and laparoscopic surgery.
However, in the case of laparoscopic surgery, it is difficult to extract all of the fibroids and there is a higher chance than with the abdominal surgery of the fibroids remaining.

③ Submucous Myoma

It is possible to extract the fibroid vaginally under the hysteroscope without open abdominal.
However, in cases where the size is big and the fibroid has appeared to have penetrated the muscle layer, and since just by using the hysteroscope alone we cannot take the fibroid we will use it in combination with the laparoscope to do the procedure.
When the diameter of the fibroid is under about 3~5cm, the protruding rate is over 50%, and more than 5mm of covered normal muscle layer thickness, then that shall be the adaptive criteria for fibroid enucleation under the hysteroscope.
Therefore, we can say that a correct diagnosis is needed for the adaptive decision of fibroid enucleation under the hysteroscope.

The thing most related to infertility is submucous myoma.
It is thought of that there is an influence on the implantation if there are fibroids protruding from within the uterine cavity.

Additionally, it is often the case that those with intramural myoma, and multiple fibroids will not directly be the cause, but because it brought about a deformation in the uterine cavity, and when there is a chance of implantation failure, and things like impaired blood flow of the endometrium (thinning of the inner membrane), and pick up failure, then if it doesn’t lead to pregnancy surgery is recommended.

If you have any of the above mentioned symptoms(menorrhagia, irregular bleeding, dysmenorrhea) or something like them, and it has become somewhat of an obstacle in everyday life, then we will guide you to one option of surgery.

Endometriosis is an illness which main symptoms are throbbing pain and infertility started as menstrual pain and in recent years, that increase has been pointed out.
It is also said that about 10% of pubescent females are diseased with it.
Additionally, to aging and falling birth rate, it is the most serious problem for infertility and low births.
Endometriosis can also exactly be called the disease that significantly loses the quality of life of modern women.

Generally, it is a disease in which the endometrial tissue(the part that peels off and falls out with menstruation) generates growth outside the uterine cavity, and infiltrates more, and forms a surrounding tissue and strong adhesion.
As a typical lesion, there is the ovarian chocolate cyst(chocolate cyst) that forms in the ovary.
Inside the ovary, a chocolate like, brown fluid is stored.
There are others, such as peritoneal lesions, and Douglas’s cul-de-sac lesions.

he main symptoms are dysmenorrhea(menstrual pain), menorrhagia, defecation pain, and pain during sexual intercourse.
Especially with endometriosis, there is a very painful abdominal pain and back pain associated with menstruation, every time menstruation occurs the pain gradually becomes more horrible.
If the adhesion progresses, then there will be abdominal pain even when not menstruating.

We will test you by questionnaire, pelvic examination, ultrasound, MRI, CT, and/or blood test(tumor marker).

Endometriosis Surgery

or endometriosis, depending on the objective the treatment will change.
If one has strong menstrual pain, there’s a way of doing it with laparoscope for the diagnosis.
Treatment will occur at that time if there are mild findings of endometriosis.
Additionally, in the case of it being associated with infertility, usually we will do alcohol fixation of chocolate cyst cells in order to preserve ovarian function.
For those with strong adhesion, we are doing alcohol fixation and the opening of the cyst by laparotomy.
However, the reoccurrence rate is high at close to 100%.

If the objective is to remove the pain from adhesion, it will be necessary to have a radical operation of endometriosis done.
Usually, it will lead to the lesion resection of hysterectomy and both sides of the appendage, but we do not do that at our clinic.
There are many cases of endometriosis surgery done while cooperating with surgical and urology and we cannot do so at our clinic.

First of all, we recommend the step up of infertility treatment as soon as possible.
Even if that won’t lead to pregnancy, and for those with obvious lesions of endometriosis, surgery will be taken into account.
However, depending on the surgery, and because there might be a decrease in the ovarian function, to do the surgery will be prudently supported.

There is treatment by medicine and by surgery.
We’ll match your desire to the condition, and we would like to decide on your treatment method.

Hydrosalpinx is a thing that happens when an adhesion of the tubal mucosa or an obstruction of the ovarian cavity occurs, and within the ovarian cavity a secretion is stored, causing a condition that swells up like a sausage.

Hydrosalpinx is one of the causes of infertility, brings about implantation failure when the stored secretion in the oviduct flows into the uterus, and is said to cause stunt of growth of the fertilized oocyte.

As for the cause, the fallopian tube is infected by a bacteria and inflammation occurs, and also from the effects of having an abdominal surgery in the past.
As for Chlamydia infection and other sexually transmitted diseases, they are attracting attention as the cause of the inflammation that happens in the fallopian tubes.
Additionally, if endometriosis or adhesions occur around the fallopian tubes, it becomes the cause of tubal blockage.

Fever, abdomen pain, vaginal discharge of pus(during period), etc.
There are people who especially don’t have any symptoms at all.

Questionnaire, ultrasound, uterosalpingography, MRI.

Hydrosalpinx Excision

Since hydrosalpinx will lead to infertility, especially implantation failure, in regards to those who will be receiving ART of IVF, it is recommended to cut out the fallopian tubes.
The surgery will be done under the laparoscope.
As for those who have strong inflammation of the fallopian tubes and adhesions, in order to lower even by a little the possibility of peritonitis of after surgery, we will do it by laparotomy.

Since it causes tubal infertility, depending on if it was cut out in surgery, we consider that we can correct the implantation dysfunction and development disorder.

If it is the cause of fever or abdominal pain, administration of antibiotics will be done.
If it gets better, it’s good once, but is recognized that 1/4 of cases will be chronic.
Therefore, it is necessary to consider the cutting out of the lesions by laparoscope and abdominal surgery.

Benign tumors of the ovary.

In the ovary there exist benign, borderline malignant and malignant tumors.
In fact, we will predict how it will be classified from things such as images and the tumor marker, but in the end the tumors will be removed and we will judge it by the results of the pathological exam.

As a typical ovarian benign cyst, we can see in high frequency mature cystic teratoma(a tumor that includes hair, fat tissue, and teeth), and serous cycstadenoma(the inside is made up of free flowing liquid).
Also, there is a kind of tumor that we can seen from the influence of hormones, known as a functional cyst, which as time elapses is a thing that will gradually disappear so discrimination is necessary.

In the early stages, there are almost no objective symptoms.
As it progresses, and as the cyst becomes enlarged, you will begin to notice it from the outside by touch, and things such as abdominal pain, back pain, frequent urination and constipation will occur.
Also, as the cyst becomes large to some extent, the occurrence of the dangerous torsion that the ovarian roots will completely be twisted, and there are also cases that you will know by the occurrence of severe pain.

We will make a judgement in a comprehensive manner by means of questionnaire, pelvic examination, ultrasound, MRI, CT, and blood test(tumor marker).

In regards to the benign ovarian tumors⁄ cysts(since they will be confirmed accurately by pathological diagnosis of post-operative, and the potential of a benign tumor is very high), depending on that position and size, we will be doing surgery under the laparoscope or abdominal surgery.
The laparoscopic surgery done at our clinic is basically done using the in vitro(outside the body) method.
The reason is because if there is damage done to the tumor while during the procedure using the corpus(inside the body) method and the intraperitoneal matter is scattered, then there will be a possibility that peritonitis will occur.
Of course it is often that if plenty of washing is done there will be no problem, but the placement of a drain(procedure to drain the water and matter from the abdominal section, and to suppress the inflammation) is required.
For that reason, the utmost in safety is considered and it is done by in vitro method.
However, when compared to the corpus method, the incision of one place will be about 1~2cm bigger.
As in the abdominal surgery, just as the same as the uterine fibroid enucleation, we will treat the wound in a humane manner, and it will be done by a wound as small as possible.
It varies by the conditions of the surgery, but we will be making a vertical incision of about 4~5cm in length.
If it is like this, there is no big difference when compared to the laparoscopic surgery.

Laparoscope Surgery(Laparo)

If the size of the cyst is under 6cm, in some cases we will watch the progress, but because there are cases in which it is good to think about surgery in response to the kind of cyst and position it is in, we will carefully consider it and we will make the decision while discussing it with the patient.

If the size of the cyst is over 6cm, or even if there is no symptoms and with an increasing tendency we think that it is good to have surgery.
Even if it is under 6cm, and if you have a doubt about torsion and⁄ or rupture, we recommend surgery.

It is a condition that becomes a benign disease from the inner membrane gland and stroma protruded from a localized area of the surface of the endometrium.
With predilection in 40-50’s, around 20-30% are multi-occurrences.
It is thought to be one of the causes of infertility amongst women in reproductive years.
There are many cases of it occurring with the use of tamoxifen that is a therapeutic agent for hormone replacement therapy and breast cancer, and it is also thought of that the decreased expression of hormone receptors of the stroma are the cause of polyp formation.

You can see things like irregular vaginal bleeding and menorrhagia.
When left standing, anemic symptoms will also appear.

Questionnaire, ultrasound, sonohysterography, MRI, hysteroscope.

Endometrial Polyps

There are cases of endometrial polyps present with implantation failure.
At our clinic, for those with inner membrane polyps that we can check with ultrasound, we will do surgery after checking it with the hysterofiberscope.
Especially those who are receiving the treatment of ART of in vitro fertilization, we proactively recommend the removal of the polyp under the hysteroscope.

Hysteroscopic Surgery (Resectoscope)

We are actively doing surgery because this is one of the causes of implantation failure.

For those with things like irregular vaginal bleeding and menorrhagia, in the case of the possibility of a malignant disease, surgery is adapted for the definitive diagnosis and treatment.

In regards to those with azoospermia, we will perform TESE (Testicular Sperm Extraction) to collect the sperm from the testes.
For details, please see the Male Infertility Page .

We will perform the procedure using the laparoscope and the vaginal (approach from the vagina).

We are doing other small surgeries as well.

As for the anesthesia at our clinic, the anesthesiologist is performing it.
Often we are using the laryngeal mask for fault reduction to the trachea during general anesthesia.
Additionally, for those who desire so, we can control the pain of post surgery by using an epidural anesthesia.

We are here to prepare for, and make sure that the surgery is done with the utmost safety at mind.
However, to have a blade pointed at the human body is in fact a very dangerous action.
During the surgery there is hardly anything that leads to trouble, but there is that certain probability that things that can not be predicted occur.
Amongst them, the ones that comparatively seem to occur easily are damage to surrounding organs, bleeding after surgery, infection, deep-vein thrombosis, and side-effects of the anesthesia to name a few.

In regards to damage to the surrounding organs, in cases of adhesion, damage occurs easily to intestines, bladder, urinary duct, and blood vessels.

Regarding post-operative bleeding, it may occur when the scar tissue (scab) of the hemostasis part comes off, or by when the thread used to stop the blood vessels comes off by stimulation.

Surgical wounds are weak to bacteria, and often infections occur from the indigenous bacteria of the skin and intestines, but originally, it occurs more easily in people with salpingitis and endometriosis and those with rupture of an ovarian cyst.

Deep-vein thrombosis causes organ damage when a blood clot (hardened blood) forms in the vein and that goes up into the lungs or the heart.
The frequency is low, but because there is a high fatality rate, at our clinic we are doing the treatment to lower the occurrence rate by having the patient wear elastic stockings.

Regarding complications of anesthesia, it may cause a severe headache during epidural anesthesia and spinal anesthesia, and by the reaction of the medicine.

Since the operating range is limited in surgery by the laparoscope, there is a tendency for complications being likely to occur.
In that case, due to safety we will change to laparotomy without hesitation.
In the case where it is difficult to support the complications at our clinic, there are times when we will be allowed to transport you to another medical facility.

It might not be called a complication, but after the operation for a certain amount of time there will be pain until the wound heals.
The pain, along with the recovery of the wound will gradually decrease.
Compared to be previously, the improvement of surgical treatment and various new medicines have been made and will continue to improve, but even so the pain can not be obliterated completely.
It is necessary to bare the pain for 1 day after the operation.
Also the period for hospitalization as compared to previously has become shorter.
Things like the improvement of surgical techniques and improvement of surgical materials are big, but it will take a certain amount of time for the wound to heal.
It is necessary to rest for about 1~2 weeks at home after being released for those who had the ovarian cyst surgery with no trouble in post-op.
2-3 weeks of rest is necessary for patients after release of myoma enucleation.
Additionally, in regards for those after having myoma enucleation, it will usually take about 6 months before you will be permitted to have a pregnancy.