Chapter 62: What is Surgical NaProTECHNOLOGY?

Hilgers TW

Restorative Reproductive Medicine · NaProTechnology

Chapter 62: What is Surgical NaProTECHNOLOGY?

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 839-843, 2004

RRM Academy Synopsis

Surgical NaProTECHNOLOGY pursues near adhesion-free pelvic surgery

Surgical NaProTECHNOLOGY aims to remove disease and prevent pelvic adhesions, this textbook chapter explains. The chapter defines it as reconstructive surgery of the uterus, tubes and ovaries. It also describes the surgeon's training, the review visit before an operation, and the choice of incision.

Key Findings

After the first IVF birth in 1978, the chapter states, training in reproductive endocrinology shifted toward IVF, and many younger IVF doctors (reproductive endocrinologists) lack surgical skills for some reconstructive pelvic operations.
Adhesion prevention is the emphasis, and the chapter reports that open surgery allows direct handling and repair of tissue after the pathology is removed.
In surgical NaProTECHNOLOGY, the main goal of diagnostic laparoscopy is a good diagnosis, and the secondary goal is effective treatment at the time of the laparoscopy.
The chapter's review visit presents the laparoscopy video, selective hysterosalpingogram, CrMS chart, endocrine evaluation and seminal fluid analysis together so that a treatment strategy can be developed.
The chapter matches incision to disease: a small incision for anterior disease such as ovarian wedge resection, a larger Pfannenstiel incision for extensive endometriosis deep in the posterior cul-de-sac.

RRM Context

Restorative reproductive medicine treats the cause of disease and aims to keep the organs working. Surgery that spares tissue fits that aim. NaProTECHNOLOGY places the operation inside an evaluation built on CrMS charting, ovulation ultrasound and hormone testing, so the surgeon works from a diagnosis. The chapter adds the seminal fluid analysis to that review, so both partners are assessed. IVF bypasses the pelvic disease that surgery removes. Healthy tubes and ovaries support conception without technological help, and careful surgical repair works toward that outcome.

Our editorial summary of this paper, not the article's abstract.

Abstract

Hilgers defines surgical NaProTECHNOLOGY as a specialized form of gynecologic surgery that aims to reconstruct the uterus, fallopian tubes and ovaries so that pelvic adhesive disease is eliminated and is not caused by the surgery itself. The chapter uses ovarian wedge resection as an example of a procedure largely abandoned because it formed adhesions, which Hilgers reports can now be performed with high pregnancy rates and a very low incidence of pelvic adhesions. Hilgers describes physician qualifications, patient selection and surgical planning, and reports that approximately 60 percent of patients with endometriosis at the Pope Paul VI Institute can have a corrective laser procedure at the time of diagnostic laparoscopy. When laser laparoscopy cannot be done at the same time, the procedure is videotaped and reviewed with the patient at a laparoscopy review visit, together with the CREIGHTON MODEL chart, endocrine evaluation and other test results.

Topics

Restorative Reproductive Medicine › NaProTechnology › Protocols and Framework · Reproductive Surgery › Adhesion Prevention › Surgical Technique and Adhesions

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 62: What is Surgical NaProTECHNOLOGY?

Surgical NaProTECHNOLOGY pursues near adhesion-free pelvic surgery

Key Findings

RRM Context

Abstract

Topics

By this author

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