Commentary on Surgery in Restorative Reproductive Medicine
DOI:
https://doi.org/10.63264/v8yt9r80Keywords:
surgery, restorative surgery, restorative reproductive medicine, alternatives to IVF, optimal excision, adhesion preventionAbstract
Restorative reproductive surgery has emerged to become an exciting and promising field of surgery that can transform the way that we treat patients, especially regarding fertility. As a prime example of this type of surgery, restorative reproductive surgery for endometriosis, a common and debilitating disease that can lead to infertility and pelvic pain, offers a root cause treatment to remove the actual disease and to optimize the reproductive anatomy, for best patient outcomes. Optimal excision of endometriosis and prevention of pelvic adhesions has been shown to lead to reduce symptoms, to lead to high natural fertility rates, and to lead to very low rates of the need for repeat surgery. Patients have improved symptoms and quality of life, in addition to improved fertility chances for one and subsequent pregnancies (if desired), demonstrating the link between wellness and fertility.
There is an urgent need for more resources, training, advocacy, research and publication for this exciting area of restorative reproductive surgery. Its time has come.
References
1. Duffy J, et al. Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev. 2014 Apr 3;(4):CD011031. https://doi.org/10.1002/14651858.CD011031.pub2.
2. Hilgers, TW. Near Adhesion-Free Reconstructive Pelvic Surgery: Three Distinct Phases of Progress Over 23 Years. J. Gynecol. Surg. 2010;26(1):31-40. https://doi.org/10.1089/gyn.2009.0031.
3. Hilgers TW, Yeung P. Intratubal pressure before and after transcervical catheterization of the fallopian tubes. Fertil Steril. 1999 Jul;72(1):174-8. https://doi.org/10.1016/s0015-0282(99)00165-x.
4. Kasia JM, Ngowa JD, et al. Laparoscopic Fimbrioplasty and Neosalpingostomy in Female Infertility. J Reprod Infertil. 2016 Apr-Jun;17(2):104-9.
5. Gomel V. The place of reconstructive tubal surgery in the era of assisted reproductive techniques. Reprod Biomed Online. 2015 Dec;31(6):722-31. https://doi.org/10.1016/j.rbmo.2015.09.010.
6. Su H, et al. Restoring tubal patency with laparoscopic tubocornual anastomosis. Taiwan J Obstet Gynecol. 2022 Sep;61(5):858-862. https://doi.org/10.1016/j.tjog.2021.10.009.
7. van Seeters JAH, Chua SJ, Mol BWJ, Koks CAM. Tubal anastomosis after previous sterilization: a systematic review. Hum Reprod Update. 2017 May 1;23(3):358-370. https://doi.org/10.1093/humupd/dmx003.
8. Amer SA, et al. Long term follow-up of patients with polycystic ovarian syndrome after laparoscopic ovarian drilling. Hum Reprod. 2002 Aug;17(8):2035-42. https://doi.org/10.1093/humrep/17.8.2035.
9. Yildirim M, Noyan V, et al. Ovarian wedge resection by minilaparotomy in infertile patients with polycystic ovarian syndrome: a new technique. Eur J Obstet Gynecol Reprod Biol. 2003 Mar 26;107(1):85-7. https://doi.org/10.1016/s0301-2115(02)00348-2.
10. Duleba AJ, Banaszewska B, et al. Success of laparoscopic ovarian wedge resection is related to obesity, lipid profile, and insulin levels. Fertil Steril. 2003 Apr;79(4):1008-14. https://doi.org/10.1016/s0015-0282(02)04848-3.
11. Kalaitzopoulos DR, Themeli MZ, et al. Fertility, pregnancy and perioperative outcomes after operative hysteroscopy for uterine septum. Arch Gynecol Obstet. 2024 Mar;309(3):731-744. https://doi.org/10.1007/s00404-023-07109-2.
12. Baldini GM, Lot D, Malvasi A. Isthmocele and Infertility. J Clin Med. 2024 Apr 10;13(8):2192. https://doi.org/10.3390/jcm13082192.
13. Jensen CFS, et al. Varicocele and male infertility. Nat Rev Urol. 2017 Sep;14(9):523-533. https://doi.org/10.1038/nrurol.2017.98.
14. Della Corte L, et al. The Burden of Endometriosis on Women's Lifespan. Int J Environ Res Public Health. 2020 Jun 29;17(13):4683. https://doi.org/10.3390/ijerph17134683.
15. Darbà J, Marsà A. Economic Implications of Endometriosis: A Review. Pharmacoeconomics. 2022 Dec;40(12):1143-1158. https://doi.org/10.1007/s40273-022-01211-0.
16. Harris A, Tsaltas J. Endometriosis and infertility: a systematic review. J Endometr Pelvic Pain Disord. 2017 Jul;9(3):139-149. https://doi.org/10.5301/jeppd.5000296.
17. Hadfield R, Mardon H. Delay in the diagnosis of endometriosis. Hum Reprod. 1996 Apr;11(4):878-80. https://doi.org/10.1093/oxfordjournals.humrep.a019270.
18. Arruda MS, et al. Time elapsed from onset of symptoms to diagnosis of endometriosis. Hum Reprod. 2003 Apr;18(4):756-9. https://doi.org/10.1093/humrep/deg136.
19. Brown J, Farquhar C. Endometriosis: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2014 Mar 10;2014(3):CD009590. https://doi.org/10.1002/14651858.CD009590.pub2.
20. Yeung P Jr, Sinervo K, et al. Complete laparoscopic excision of endometriosis in teenagers. Fertil Steril. 2011 May;95(6):1909-12, 1912.e1. https://doi.org/10.1016/j.fertnstert.2011.02.037.
21. Rindos NB, Fulcher IR, Donnellan NM. Pain and Quality of Life after Laparoscopic Excision of Endometriosis. J Minim Invasive Gynecol. 2020 Nov-Dec;27(7):1610-1617.e1. https://doi.org/10.1016/j.jmig.2020.03.013.
22. Arcoverde FVL, et al. Surgery for Endometriosis Improves Major Domains of Quality of Life: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol. 2019 Feb;26(2):266-278. https://doi.org/10.1016/j.jmig.2018.09.774.
23. Yeung, P, Mohan A, Gavard J. The Long-term Rate of Repeat Surgery After Optimal Excision Surgery of Endometriosis. Acta Scientific Women’s Health. 2024 Sept;7(1):10. https://doi.org/10.20944/preprints202409.1485.v1.
24. Yeung PP Jr, Logan I, Gavard JA. Deep Retraction Pockets, Endometriosis, and Quality of Life. Front Public Health. 2016 May 9;4:85. https://doi.org/10.3389/fpubh.2016.00085.
25. Gupta S. Endometriosis in Hydatid Cysts of Morgagni. J Minim Invasive Gynecol. 2017 May-Jun;24(4):653-658. https://doi.org/10.1016/j.jmig.2017.02.011.
26. Kennedy S, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005 Oct;20(10):2698-704. https://doi.org/10.1093/humrep/dei135.
27. Singh SS, Suen MW. Surgery for endometriosis: beyond medical therapies. Fertil Steril. 2017 Mar;107(3):549-554. https://doi.org/10.1016/j.fertnstert.2017.01.001.
28. Pundir J, et al. Laparoscopic Excision Versus Ablation for Endometriosis-associated Pain. J Minim Invasive Gynecol. 2017 Jul-Aug;24(5):747-756. https://doi.org/10.1016/j.fertnstert.2017.01.001.
29. Panvino F, et al. Endometriosis in Adolescence: A Narrative Review. Diagnostics (Basel). 2025 Feb 24;15(5):548. https://doi.org/10.3390/diagnostics15050548.
30. Yeung PP Jr, Shwayder J, Pasic RP. Laparoscopic management of endometriosis: comprehensive review of best evidence. J Minim Invasive Gynecol. 2009 May-Jun;16(3):269-81. https://doi.org/10.1016/j.jmig.2009.02.007.
31. Takenaka M, et al. Exploratory study of pre-surgical medications with dienogest or leuprorelin in laparoscopic cystectomy of endometrial cysts. J Obstet Gynaecol Res. 2015 Aug;41(8):1234-9. https://doi.org/10.1111/jog.12701.
32. Sutton CJ, Ewen SP, Whitelaw N, Haines P. Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with endometriosis. Fertil Steril. 1994 Oct;62(4):696-700. https://doi.org/10.1016/s0015-0282(16)56990-8.
33. Vitale SG, et al. Sexual Function and Quality of Life in Patients Affected by Deep Infiltrating Endometriosis. J Endometr Pelvic Pain Disord. 2018;9(4):270-274. https://doi.org/10.5301/jeppd.5000303.
34. Yeung, PP, Jr., et al. Fertility after expanded polytetrafluoroethylene use after endometrioma cystectomy: a pilot study. Front Reprod Health. 2023;5:1231029. https://doi.org/10.3389/frph.2023.1231029.
35. AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL position statement: route of hysterectomy to treat benign uterine disease. J Minim Invasive Gynecol. 2011 Jan-Feb;18(1):1-3. https://doi.org/10.1016/j.jmig.2010.10.001.
36. Meuleman C, et al. Laparoscopic treatment of endometriosis. Minerva Ginecol. 2013 Apr;65(2):125-142. PMID: 23598780.
37. Koninckx PR, Ussia A. “Centers of excellence in endometriosis surgery” or “centers of excellence in endometriosis”. Gynecological Surgery. 2010;7(2):109-111. https://doi.org/10.1007/s10397-009-0549-4.
Published
Issue
Section
Categories
License
Copyright (c) 2025 Patrick Yeung, Jr.
This work is licensed under a Creative Commons Attribution 4.0 International License.
CC-BY-4.0 permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.