with over 15 years of experience in Performing Ob/Gyn Surgeries, Treating Infertility and Controlling Pregnancies
Dr. Saffarzadeh has worked in different training hospitals in France for 6 years under supervision of specialists.
The 1st Thermachoice Endometrial Ablation in Iran was performed in Erfan Hospital by Dr. Saffarzadeh.
Dr. Saffarzadeh is specialist in performing Ob/Gyn surgeries using laparoscopy and hysteroscopy.
Dr. Saffarzadeh provides consultation and articles on Ob/Gyn for several national magazines.
Vaginal dryness treatment, vaginal bleaching, vaginal rejuvenation and MonaLisa Touch - Labiaplasty
speciallist in performing the whole OB/GYN surgeries using laparroscopy and hysteroscopy
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Laparoscopy is a minimal invasive surgery that uses a thin, lighted tube put through an incision in the belly to look at the abdominal organs or the female pelvic organs....More
News and updates on gynecology, infertility and Cosmetic Surgery for Women
Laparoscopic surgery is usually performed as out-patient surgery under general anesthesia and has absolutely revolutionized gynecologic surgery because of the short hospital stay and quick recovery. The laparoscope is a slender telescope that is inserted through the navel to view the pelvic and abdominal organs. Two or three small, half-inch incisions are made below the pubic hairline and instruments are passed through these small incisions to perform the surgery. Because the incisions are smaller, patients can enjoy faster recovery times and smaller scars.
Laparoscopic surgery differs from traditional surgery in a few key ways: For laparoscopic myomectomy, a small scissors-like instrument is used to open the thin covering of the uterus. The fibroid is found underneath this covering, grasped, and freed from its attachments to the normal uterine muscle.
After the fibroid is removed from the uterus, it must be brought out of abdominal cavity. The fibroid is cut into small pieces with a special instrument called a morcellator, and the pieces are removed through one of the small incisions. New morcellators allow the easy removal of even large fibroids. The openings in the uterus are then sutured closed using specially designed laparoscopic suture holders and grasping instruments. Laparoscopic suturing with small instruments, in particular, requires special training and expertise. The entire procedure can take one to three hours, depending on the number, size, and position of the fibroids.
Myomectomy should be performed only if appropriate indications exist. And since it is a technically difficult surgery, your physician should have the extra training and experience that it requires. When talking to your doctor or interviewing a gynecologic surgeon, it is your right to ask about qualifications:
Many gynecologists have not been trained to suture with laparoscopic instruments, and some may even say that laparoscopic surgery is not possible. It is often a good idea to get a second opinion from a gynecologist who performs laparoscopic myomectomies on a regular basis to see if this procedure is feasible for you.
Following laparoscopic myomectomy, most women are able to leave the hospital the same day as surgery. For more extensive surgery, a one-day stay may be a good idea. Because the incisions are small, recuperation is usually associated with minimal discomfort. Since the abdominal cavity is not opened to air, bacteria are less likely to reach the area of surgery, and the risk of infection is very low. The intestines are not exposed to the drying effect of air, or the irritating effects of the sterile gauze sponges used to hold the bowel out of the way during abdominal surgery. As a result, the intestines usually begin to work normally again immediately after laparoscopic surgery. This avoids the one- or two-day delay before a person is able to eat following regular abdominal surgery. After laparoscopic myomectomy, women usually can walk the day of surgery, drive in about 1 week and return to normal activity, work, and exercise within two weeks.
How Can We Remove a Big Fibroid Through a Small Laparoscopic Incision?
Less than a decade ago, removing fibroids after laparoscopic myomectomy was a difficult and time-consuming task. However, a few years ago an electrically powered device, called a morcellator, was invented and now allows us to quickly cut up the fibroid and easily remove it from the abdomen. The device is a hollow tube with a sharp circular blade at the end that rotates quickly and takes small slices off the fibroid in a few seconds. A large fibroid can now be removed in about fifteen minutes. Therefore, we are now able to perform laparoscopic myomectomy on women with even large fibroids. This device has allowed a major advance in our laparoscopic technique.
Which Fibroids Can Be Removed Laparoscopically?
The limits to laparoscopic myomectomy depend on a number of factors – the size(s), number and position of the fibroids, whether future fertility is desired, and the experience of the surgeon. Some of the issues are:
Size: Many experienced laparoscopic surgeons are comfortable removing fibroids less than 8 cm (3.5 inches) in diameter. Depending on the position of the fibroid, I have removed fibroids as large as 15 cm, and the largest reported in the literature is 16 cm.
Number: It is actually easier to remove 1 large fibroid than 10 small ones, because each fibroid may require a separate incision which then needs to be sutured. Suturing laparoscopically is more tedious than through an abdominal incision and is a skill that takes many years to perfect. Many experienced laparoscopic surgeons are comfortable removing up to 5 fibroids, but more may be reasonable in some situations.
Position: The easiest fibroids to remove are those that are outside the uterus on a stalk (subserosal pedunculated). Once the stalk is cut, the fibroid can be cut up into small pieces with a specially designed instrument called a morcellator and brought out of the abdomen through a small incision. The deeper the fibroid is into the uterine muscle wall, the more difficult it is to remove, and the more suturing needs to be done to repair the muscle wall. Other considerations regarding position include how close the fibroids are to the fallopian tubes (if fertility is desired) or to the uterine blood vessels, and whether there is any risk of damage to these areas. Skill, experience and judgment of the surgeon all come together here.
Fertility: If future fertility is desired, then the strength of the uterine wall repair is important. Therefore, the doctor must be able to suture the uterine wall with laparoscopic skill and care that is equivalent to the technique they would use for an abdominal surgery. If future fertility is not desired, then laparoscopic surgery can almost always be performed, again dependent on the sizes, number and position of the fibroids. MRI is a very helpful test that allows me to see the exact size, number and position of all the fibroids, so I always get an MRI before laparoscopic surgery. I like to show the MRI to the patient so that she can appreciate what the issues are and so we can discuss what is in her best interest.
These are the reasons why different gynecologists will give different opinions about whether laparoscopic myomectomy is feasible and appropriate – it is complicated. And, to a large degree, opinions will be based on the surgeon’s experience, skill and comfort doing laparoscopic myomectomy.
Laparoscopy is a surgical procedure that allows a fertility doctor to see inside of the abdomen. In a female, the uterus, fallopian tubes and ovaries are located in the pelvis which is at the very bottom of the abdomen. Laparoscopy allows the fertility doctor to see abnormalities that might interfere with a woman’s ability to conceive a pregnancy. The most common problems are endometriosis, pelvic adhesions, ovarian cysts and uterine fibroids.
What is a laparoscope?
A laparoscope is a thin fiber optic telescope that is inserted into the abdomen usually through the belly button. The fiber optics allow a light to use to see inside the abdomen. Carbon dioxide (CO2) gas is placed into the abdomen prior to inserting the laparoscope. This lifts the abdominal wall and allows for some separation of the organs inside the abdomen making it easier for the fertility doctor to see the reproductive organs during the surgery. If abnormalities are found during the laparoscopy, additional instruments can be placed into the abdomen through tiny incisions. The incisions are usually made at the pubic hair line on the left and/or right side. Together with the laparoscope in the belly button, this forms a triangle that allows the fertility doctor to perform virtually any surgical procedure that can be performed by using a more traditional “open” surgery where a large incision is made. Laparoscopy is performed using general anesthesia. This means that the patient is completely asleep during the entire procedure.
What are the advantages of laparoscopy for infertility?
Laparoscopy will allow the diagnosis of infertility problems that would otherwise be missed. For example, a woman who has severe endometriosis can be identified by using ultrasound. A woman with mild endometriosis can only be identified using surgery such as laparoscopy. Another problem that can only be identified through surgery are pelvic adhesions. Also known as scar tissue, adhesions cannot be seen with ultrasound, x-rays or CT scans. Adhesions can interfere with the ability to conceive if they make it more difficult for the egg to get into the fallopian tube at the time of ovulation. Many people view laparoscopy as a less invasive surgery that traditional surgery. Traditional surgery requires making an incision in the abdomen which is several centimeters long. This in turn means that the patient has to spend two to three nights in the hospital. Laparoscopy utilizes one to three smaller incisions. Each incision may be one half a centimeter to a full centimeter in length. Most often, patients who have had a laparoscopy will be able to go home the same day as the surgery. In other words, a hospital stay is not usually required. Some people believed that laparoscopy would result in less adhesions being formed after reproductive surgery. However, this does not appear to be true.
What are the disadvantages of laparoscopy for infertility?
Laparoscopy requires a different set of skills compared to traditional surgery. In many cases, it can be more challenging to complete a procedure. For example, removing one superficial medium sized fibroid can be accomplished equally well through laparoscopy or traditional surgery. However, a woman that has dozen of fibroids, large and small with some occupying the deep layers of the uterus is much better served with a traditional surgery. A good fertility doctor will know when laparoscopy is an advantage and when it is a liability.
Which infertile patients should have laparoscopy?
Generally, laparoscopy should be reserved for couples who have already completed a more basic infertility evaluation including assessing for ovulation, ovarian reserve, ultrasound and hysterosalpingogram for the female and semen analysis for the male. Some couples may elect to skip laparoscopy in favor of proceeding to other fertility treatments such as superovulation with fertility medications combined with intrauterine insemination or in vitro fertilization. There may be instances in which the fertility doctor may have a high suspicion for finding problems with laparoscopy. For instance, if a woman had a history of a severe pelvic infection or a ruptured appendix, this would increase the likelihood that she may have pelvic adhesions and therefore more likely to benefit from laparoscopy.
Laparoscopy versus IVF
Two commonly encountered problems during a laparoscopy, pelvic adhesions and endometriosis, can also be effectively treated using IVF. Since IVF is less invasive than laparoscopy and has a very high success rate, some couples will opt to skip laparoscopy and proceed directly to IVF. Even if a woman has severe adhesions that are not treated, this would not impact on her ability to conceive a pregnancy with IVF.
What to expect after laparoscopy
The incisions will be covered with bandages that can be removed after twenty four hours. The fertility doctor will give prescriptions for postoperative pain and for nausea. The pain medicine will almost always be needed, the nausea medicine may or may not be needed. The length of time needed for recovery will depend on the type of procedure that was done, the length of time the surgery took, the number of incisions that were made, whether the patient has had surgery previously, the state of health the patient was in before the surgery, whether any complications occurred and what the tolerance of the patient is naturally. The patient can eat or drink whatever she feels up to having after an uncomplicated laparoscopy for infertility problems. Due to the anesthesia, she should rest for twenty four hours. Generally thereafter, she may resume normal activities as soon as she feels well enough. Depending on the type of procedure, some women may be able to return to work in a few days. Other women may require a few weeks.
Premature ovarian failure is sometimes referred to as premature menopause, but the two conditions aren’t the same? Women with premature ovarian failure can have irregular or occasional periods for years and might even become pregnant. Women with premature menopause stop having periods and can’t become pregnant.
Premature ovarian failure — also known as primary ovarian insufficiency — is a loss of normal function of your ovaries before age 40. If your ovaries fail, they don’t produce normal amounts of the hormone estrogen or release eggs regularly. Infertility is a common result.
Signs and symptoms of premature ovarian failure are similar to those of going through menopause and are typical of estrogen deficiency. They include:
- Irregular periods (amenorrhea)
- Difficulty conceiving
- Night sweats
- Vaginal dryness
- Irritability or difficulty concentrating
- Decreased sexual desire
When to see a doctor
If you’ve missed your period for three months or more, see your doctor to help determine the cause. You can miss your period for a number of reasons — including pregnancy, stress, or a change in diet or exercise habits — but it’s best to get evaluated whenever your menstrual cycle changes.
Even if you don’t mind not having periods, it’s advisable to see your doctor to find out what’s causing the change. Low estrogen levels can lead to bone loss.
- Chromosomal defects.
- An immune system response to ovarian tissue (autoimmune disease).
- Unknown factors.
Factors that increase your risk of developing premature ovarian failure include:
- Risk rises between the ages of 35 and 40, although younger women and adolescents can develop the condition.
- Family history.Having a family history of premature ovarian failure increases your risk of developing this disorder.
- Multiple ovarian surgeries. Ovarian endometriosis or other conditions requiring repeated surgeries on the ovaries increases the risk of premature ovarian failure.
Complications of premature ovarian failure include:
- Inability to get pregnant may be the most troubling complication of premature ovarian failure, although in rare cases, pregnancy is possible until the eggs are depleted.
- The hormone estrogen helps maintain strong bones. Women with low levels of estrogen have an increased risk of developing weak and brittle bones (osteoporosis), which are more likely to break than healthy bones.
- Depression or anxiety.The risk of infertility and other complications arising from low estrogen levels causes some women to become depressed or anxious.
- Heart disease.Early loss of estrogen might increase your risk.
- Lack of estrogen can contribute to this in some people.