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Controversial Fertility Topics

The Art of Surgery

By Gina Caiazza RN,CNOR,RNFA
Arizona Center for Fertility Studies Program Coordinator

"Having been a long-standing member of the Association of Operating Room Nurses (ARON), an OR nurse since 1983 and an RNFA (RN First Assistant) since 1987, I have had the privilege of working with numerous surgeons over the past 26 years. I feel it is a fair assessment to say that not all surgeons are equal in skills and ability. There are major differences in technique, experience and the objective of the surgeon performing a surgical procedure. Sure, all physicians go through the mandatory surgical training during their residencies and/or fellowships, but not everyone excels at the given task at hand or gets the same surgical experience. The primary goal of surgery should be to remove the diseased tissue or pathology and avoid the potential long-term side affects such as scar tissue and loss of normal anatomy. In reproductive surgery, I believe that the primary goal should be to preserve future child bearing potential; and secondarily, to remove the pathology.

In the field of reproductive medicine, the consequences of surgery can be monumental and although it may correct the underlying pathology, it could result in subsequent damage to surrounding tissue or even impair a woman's ability to have a baby. Therefore, it is important for a patient to seek out an "expert" in the field of reproductive surgery who has specialized training in microsurgical techniques and proven results. A surgeon who operates not only to restore or remove, but someone who is preservation minded, aware of what the consequences of each of their actions can be. A surgeon who realizes that all the "small things" add up, and can make a difference in optimizing the surgical outcome. A surgeon who does not compromise the patient in performing a particular procedure if another would give better results. Sometimes an open procedure, although more invasive, gives a much better outcome than one performed by laparoscopy.

If your doctor has advised you that surgery is necessary and you are planning to have a baby now or in the future, be sure to ask a lot of questions. This includes the way they plan to perform the surgery. How many of these surgeries have they done? What is their complication and success rates? Are they the best qualified to perform this type of surgery? And most importantly, if this particular surgery can affect your future fertility. In my experience, sometimes gynecologic surgeries performed by excellent surgeons can unknowingly result in future difficulties with conception.

In many cases, when fertility preservation is important, it may well be worth seeking a second opinion. Unfortunately, not all insurance companies cover the costs of a fertility specialist, but that should not deter you from speaking with one. It could prove to make a profound difference in your outcome, and although it could be a bit more expensive, it could result in whether or not you will be successful in conceiving.

I look at surgery as an art form. Would you rather have a painting done by the superb skills of Michelangelo where each brush stroke is deliberately done using only the finest technique to create a "masterpiece", or by an artist that just completes a painting? The choice is yours; and you owe it to yourself to make it the best one."

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