Surgical NaProTECHNOLOGY

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NaProTechnology uses the latest technology in modern medicine to restore normal reproductive functions. Often treatments include surgical procedures, which include techniques used to preserve fertility from scarring or adhesions. When appropriate, Dr. Gray uses minimally invasive robot surgery.

Surgical NaProTechnology

The American Board of Obstetrics and Gynecology approved sub-specialties several decades ago. These were developed in hopes of advancing three areas of women's health. The sub-specialties were gynecologic oncology, perinatology, and reproductive endocrinology.

Reproductive endocrinology training historically has placed emphasis on pelvic surgery. With the 1978 in vitro fertilization birth, this focus moved away from pelvic surgeries and younger reproductive endocrinologists are lacking the surgical skills needed for reconstructive pelvic surgeries.

The Society of Reproductive Surgeons has recognized this deficiency and has developed a postgraduate fellowship program that provides training in pelvic surgery, microsurgery, and laser surgical applications.

Surgical NaProTECHNOLOGY focuses on the reconstruction of the uterus, fallopian tubes and ovaries in a way that avoids pelvic adhesive disease. This is considered a "near-adhesion free" form of surgery.

"Near-Contact" Laparoscopy

The training programs of obstetrics and gynecology lack instruction for diagnostic laparoscopic techniques. These techniques are usually learned during laparoscopic sterilization. However this does not acknowledge the diagnostic techniques.

An important technique for diagnostic laparoscopy is "near-contact". This brings the laparoscope in close contact with the tissue. When the laparoscope is placed close to the tissue, endometriosis is visible within the background.

Excising Endometriosis

Pain relief and subsequent pregnancies are a few benefits of the surgical removal of endometriosis. The surgeon’s skill will influences the chances for success.

A Prolene suture is typically used to repair the uterus after the removal endometriosis on the front portion of the uterus. This is a non-reactive permanent suture. The superficial tissue is inverted to provide a smooth closure.

Wedge Resection for Polycystic Ovaries

Polycystic ovarian disease is made up of large ovaries with multiple cysts. The menstrual cycles are irregular and lead to infertility.

There was a 66 percent pregnancy rate following ovarian wedge in 1950. In the mid 1960's Clomid was introduced and the pregnancy rate dropped to around 30 percent. The perception at this time was that Clomid was a better form of treatment and the medical profession adopted it. Recently, a 23 percent pregnancy rate has resulted from using in vitro fertilization techniques.

A large number of pelvic adhesions were a result of using the ovarian wedge resection. This has been completely eliminated with the use of Surgical NaProTECHNOLOGY techniques. This technique uses a carbon dioxide laser to make an incision into the ovary. By removing the wedge of tissue and using a Prolene suture, we often find this results in excellent healing and no adhesions.

Preventing Adhesions

Multiple surgical steps are required at the time of surgery for the prevention of adhesions. The Medical and Surgical NaProTECHNOLOGY explains this in detail. Over the past 20 years, there was a decrease in the formation of adhesions with use of these techniques. In the time period from 1994 to 2004, the total adhesion score decreased from 33.3 to 6.0. This was a significant improvement over the previous 10 years where the reduction in adhesion scores went only from 33.8 to 18.1.

Selective Hysterosalpingography

Hysterosalpingography (HSG) is a common practice during infertility evaluation. While this provides tubal integrity and intrauterine cavity study, it does not provide the anatomic and functional integrity of the fallopian tubes.

Fluoroscopy and contrast material was used in 1966 to selectively evaluate the fallopian tubes. This procedure is also known as SHSG (selective hysterosalpingography). Transcervical catherterization of the fallopian tubes (TCFT) procedure was also added during this time period. Another important diagnostic tool is tubal perfusion pressure. In 1999 Hilgers and Yeung described a study of intratubal pressure (ITP) at the time of the SHSG obtained before and after TCFT.

Partially obstructed fallopian tubes can be identified because of an elevated pressure. Debris can form within the fallopian tube. A flexible-tip metal guidewire can be used to dislodged debris and clear the fallopian tube.

Differentiation of a complete obstruction and/or organic obstruction can be determined by the guidewire. This allows for the identification of candidates for reimplantation of the fallopian tubes.