Ultrasound guidance in reproductive surgery has the potential to reduce operating time and to lower the potential morbidity.To guide uterine surgeries, position the US probe to visualise cervical canal, endometrial cavity and myometrial depth.Infertility surgery is dead: only the obituary remains. There is a continuing debate about the utility of reproductive surgery, which has evolved over the decades. Initially this involved interventions through an open approach, with improved reproductive outcomes but longer recovery times and increased risk of adhesions. In the 1970s, reproductive surgery revolved around the implementation of laparoscopy, enabling the reproductive surgeon to achieve similar outcomes through a minimally invasive approach, with careful attention to techniques that decreased the risk of adhesion formationHysteroscopy then allowed for visualization and treatment of intrauterine pathology . Reproductive surgeons had in their armamentarium an array of techniques to improve a patient's reproductive outcomes. More recently, assisted reproductive technologies (ART) have provided the reproductive endocrinologist the means to overcome many structural obstacles to conceiving. Hysteroscopy is another modality that meets little resistance. Intrauterine pathology could easily be identified and treated through a minimally invasive transcervical approach. Removal of a uterine septum was found to increase fecundity and live birth rates. Perez-Medina et al. found that pregnancy rates doubled after polypectomy. Similarly, Casini et al. showed that hysteroscopic myomectomy increased pregnancy rates from 27% to 43% and decreased miscarriage rates by more than 10%.

Treatment of fibroids because of their association with pregnancy wastage and infertility is another procedure that reproductive endocrinologists are responsibleOver the past few decades, there have been numerous paradigm shifts in male reproductive surgery, resulting from a combination of technologic advancements in both the operating room and the laboratory. The operating microscope transformed the field of male reproductive surgery, enabling novel techniques and higher precision for the treatment of male-factor subfertility. The subsequent widespread adoption of microsurgical approaches was largely responsible for the emergence of a cadre of highly specialized male infertility microsurgeons. The advent and evolution of in vitro fertilization/intracytoplasmic sperm injection was a concurrent story that further revolutionized the field. The ability to achieve fertilization and pregnancy with just a single sperm changed the ways in which male reproductive surgeons could approach a wide range of pathologies from obstructive to nonobstructive causes, culminating in the microdissection testicular sperm extraction procedure for the treatment of nonobstructive azoospermia. Here we review the recent advancements in fertility-enhancing male reproductive surgery for the treatment of four disease processes: varicocele, obstruction of the excurrent ductal system, ejaculatory duct obstruction, and nonobstructive azoospermia. While examining the great strides of the past, we look forward to exciting developments on the horizon.

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Mishita
Jornal co-ordinator
Journal of General Surgery Reports