Why is endoscopic surgery considered to be the golden standard for diagnosing of infertility and treating gynecological diseases – Dr. Giorgi Dolidze’s recommendations.
Why is endoscopic surgery considered to be the golden standard for diagnosing of infertility and treating gynaecological diseases – Giorgi Dolidze’s recommendations. Endoscopic surgery is the golden standard for infertility diagnosing and treatment and gynaecological diseases. In fact, which role plays hysteroscopy and laparoscopy in solving the problem of infertility, how can we connect laparoscopy, hysteroscopy and in vitro fertilization – about this and other interesting themes in the program “Visit to a doctor” talked a gynaecologist, surgeon – laparoscopist of the Clinic for Artificial Fertilization and Reproductive Health “In Vitro” Giorgi Dolidze.
Mr. Giorgi, let’s start with what directions are introduced at “In Vitro” Clinic?
We mainly have directions of gynaecological nature. Artificial fertilization requires surgical support, stipulating that in a short period we will deliver healthier patient to our reproductologysts.
What role does endoscopy play in modern gynaecology?
In any surgery, endoscopy already plays a leading role. It stipulates a minimal intervention; the patient’s rehabilitation passes quickly. Defects on the body are minimal and the less is pain, the more satisfied is the patient. 95 % of our operations are performed with the endoscopic approach.
What kinds of operations are performed at “In Vitro”?
According to what pathology we deal with, intervention is respective. If we talk about internal pathologies of the uterine cavity, hysteroscopy is required. This is the most modern approach and stipulates visualization, that is to say, we see what we do. Such manipulations – when there were polyps, nodes, etc., previously ended with endometrectomy and now the problem is eliminated with minimal damage and with the maximum result. As concerns pathologies that are present on the uterus, for example, large-sized nodes, changes of tubes, etc., the intervention is performed from the abdomen, by endoscopic approach.
What is the role of hysteroscopy and laparoscopy in solving the problem of infertility?
If pregnancy does not occur in a couple living together for one year, it is considered that we deal with a primary diagnosis of infertility. We begin to check the hormonal status, conduct necessary investigations and if necessary – we also interfere. It is possible this or that pathology is not echoscopically visible, this time the specialist considers it necessary to prescribe a diagnostic hysteroscopy.
Is it possible or not to perform hysteroscopy without any indications and minimum how many years’ diagnosis of infertility should be this time?
There exists such a term – idiopathic infertility, when no investigations can reveal pathology. This time we perform a diagnostic hysteroscopy and check if there is any pathology in the uterine cavity. In addition, during infertility treatment or before in vitro, it is better to perform scratching of the uterine cavity, that is to say, to scratch or increase reception in the uterine cavity, during which the positive result is higher. If pregnancy does not occur during one year against the background of regular sexual intercourse, performance of hysteroscopy is considered to be one of the golden standards.
How frequent are cases when after hysteroscopy pregnancy occurs quickly?
Within one or two months usually it by all means occurs. There were cases when women were preparing for in vitro, we performed hysteroscopy, increased the reception and when the embryo transfer was planned, pregnancy was detected. Hysteroscopy is quite effective together with increase of reception.
Let’s talk about the most frequent pathologies (in the cavity) of the uterus…
At our Clinic endoscopy is performed not only for infertility problems, radical surgery is also performed. Are implied those pathologies that are not subject to correction and interference is more necessary. If a patient addresses us due to infertility problem, this can be a polyp, a myomatic node, a septum or adhesion process – all this stipulates hysteroscopic correction. Years ago it was difficult to diagnose all this and women often were removed uterus, now hysteroscopy makes easier all this. The process is recorded. Gaining the patient’s confidence is the greatest priority. We can simply show the patient what procedure we performed and the confidence factor will very positively reflect on subsequent results as well.
What is the difference between hysteroscopy and laparoscopy, let’s talk about this procedure in more detail…
Once again I explain what hysteroscopy is. Hysteroscopy stipulates internal examination of the uterine cavity under the visual control and laparoscopy, passing through the navel, endoscopically stipulates examination of the abdominal cavity. It is a minimally invasive procedure and is the most informative for the specialists.
How can we connect laparoscopy, hysteroscopy and in vitro fertilization?
If everything is investigated and within one year the pregnancy does not occur, exactly after this the additional thorough investigations are required. As for connection, the patient does not visit us if she does not have a problem. Women come to “In Vitro” when after visits to the reproductologyst it is revealed that there is pathology. We prepare patients for surgical procedures, in the main cases hysteroscopy and laparoscopy are performed together in order to perform both investigations under one anaesthesia. A corrected patient again returns to the reproductologyst, who continues treatment.
I would like to ask you about appealability of patients, mainly which contingent addresses you?
Appealability is from 18 to 50 years. We have patients who decided to have a child in late age. Our reproductologysts manage such patients with great professionalism. We are also addressed with gynaecological problems and we perform such large-scale operations as hysteroscopy with additives that in a certain age represents a necessity.
Which questions are the most frequently asked about operations, the same fears and expectations?
The most frequently asked question is how long the procedure continues, when a patient is in a state of sedation, she is not able to determine the time and as a rule it should not matter how long the operation will last. Questions related to food are also frequent. Most often they wonder whether they will have a child or not. I promise our patients that we will put diagnose and they will know if they have a chance. This is very important so that the patient would not lose time and move to the stage of artificial fertilization, etc.
What role does the interrelation with patients play?
Patient trusts us, comes – for us it is a usual day and working procedure and for her – one episode of life. We have to explain to her all the details and we must have a very good attitude. We try to make friends, gain confidence. Relationship between the patient and the doctor should be the best; no question should be left so that not to lose a pleasant charge.
What do innovations imply in laparoscopy and hysteroscopy?
Any particular innovation does not exist. This direction in Georgia is very well developed. One can say that it meets international standards. Very good doctors work in endoscopy. Once again I note that pain is maximally less and the rehabilitation passes very quickly. In Italy and France there is a tendency to mini and micro laparoscopy. Trocar is an instrument that is placed in the abdominal cavity and from here the instrument is introduced. Its diameter decreased from five millimetres to 3.5 millimetres and this means that the moment of pain is smaller. Cosmetic fact is also of great importance. As for hysteroscopy, the best standard is considered to be Bettocchi hysteroscope. Without widening a neck of uterus we can obtain information from the uterine cavity. All those operations, called for by modern standards, are conducted at us on a high level.