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Ad Astra Per Aspera | To the Stars through Difficulties

Ad Astra Per Aspera | To the Stars through Difficulties

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Minimally Invasive Gynecological Surgery Unit

Astra Minimally Invasive Gynecological Surgery Unit (MIGS)

The Astra Minimally Invasive Surgery Unit is a center of excellence for advanced laparoscopic and hysteroscopic reproductive surgery in Ontario. We are currently the only out-of-hospital facility licensed to do a large range and complexity of procedures. We handle some of the most complicated and difficult cases with unparalleled success and patient satisfaction. Patients endure no cost for these procedures since all the procedures are covered under the provincial insurance plan (OHIP).


The Astra Minimally Invasive Surgery (MIS) unit is currently the one and only independent health facility in Ontario offering a full range of expert minimally invasive gynecological procedures. The Astra MIS unit has been a successful model that provides OHIP funded ambulatory surgical care to women out of the hospital environment, ultimately shortening wait times, lowering health costs, providing quality patient care, and importantly, achieving high patient satisfaction.

The Staff

All nursing staff have years of experience and are registered nurses (RNs and RPNs), certified to work in Ontario community hospitals. The entire medical device processing and sterilization staff is highly skilled and certified. Our surgeons are certified gynaecologists with vast experience in gynecologic endoscopic procedures and in reproductive surgery.

Scope of Services

All gynecological surgeries that are performed in the hospital as outpatient surgery fall under the Astra MIS scope of surgery. These include all laparoscopic and advanced hysteroscopic procedures that manage a full range of gynecological conditions and pathologies including tubal disease, endometriosis, uterine fibroids and pelvic adhesions. We also perform standard gynecological procedures not related to reproduction.

We also specialize in advanced hysteroscopic procedures involving fibroids, uterine anomalies and cases involving significant uterine pathology. We have vast experience successfully treating uterine anomalies and severe and recurrent synechiae (Asherman’s syndrome).

Tubal Microsurgery

Tubal microsurgery refers to repair of damaged fallopian tubes.

Tubal reversal is a common tubal microsurgery procedure. Tubal reversal is a microsurgical procedure that unblocks the fallopian tubes to reverse the effects of sterilization surgery. A successful tubal reversal operation allows women to conceive naturally and experience the joys of giving birth.

We offer laparoscopic tubal re-anastomosis surgery at our surgical unit with excellent success rates, minimal postoperative discomfort, the ability to go home on the same day of surgery, and resumption of normal activities within a few days. We also offer very experienced performing hysteroscopic tubal cannulation to open tubes blocked proximally (at their origin from the uterine corners).

We also offer laparoscopic surgery for distal tubal disease (the end of the tube facing the ovary to pick up the eggs). That type of surgery includes lysis of adhesions and salpingostomy or open distally blocked tubes. Tubal surgery, when indicated, offers a good alternative to IVF achieving a pregnancy.

When Is Tubal Reversal Recommended?

Women who have undergone a tubal ligation procedure and would like the ability to become pregnant naturally can benefit from tubal reversal. It also applies to women who had previous segmental resection for ectopic pregnancy treatment. Those women should have a good ovarian reserve, a normal uterus and the male partner should have normal semen parameters. It can be an alternative to IVF.

Endoscopic Surgeries

Endoscopic surgery is a type of surgical procedure performed through very small incisions in the abdomen or other body cavities, using specialized instruments. Laparoscopy refers to surgery in the abdomen and pelvis, while hysteroscopy refers to surgery in the uterine cavity. Minimal scarring surgery is another term to describe these types of procedures.

What is Laparoscopy?

In laparoscopy, a thin instrument (only a few millimeters in diameter!) is used to give the surgeon an exceptionally clear view of the abdominal and pelvic cavity on a TV monitor. The abdominal cavity is entered through an incision in the navel. The abdomen is then inflated with CO2 gas to allow space to operate and manipulate organs and tissues. Usually, other tiny incisions are needed to insert various instruments to assist the surgeon with operating. Various pathologies like endometriosis and peritubal adhesions (scarring) that are often not visible by ultrasound imaging can be diagnosed and treated by laparoscopy.

What is Hysteroscopy?

With hysteroscopy, a much thinner telescope (hysteroscope) is used to visualize the uterine cavity. A Normal Saline solution (similar to water) is used to distend the uterine cavity for visualization. The benefit of hysteroscopy is that subtle lesions missed frequently on ultrasound and/or X ray can be clearly diagnosed and readily treated with a hysteroscope. “Advanced Hysteroscopy” is a term reserved for expert complex hysteroscopic procedures that may be beyond the skill set of the generalist. Astra is a regional referral unit for such complex challenging cases.

What is Transvaginal Endoscopy (TVE)?

Transvaginal Endoscopy (TVE), a combination of hysteroscopy and transvaginal hydro-laparoscopy, is a revolutionary technique used for direct visualization and assessment of the entire female reproductive system. The procedure is done under light sedation with only one needle puncture to enter the abdomen through the vagina and behind the uterus. A Normal Saline solution, instead of CO2 gas, is used to visualize the entire female pelvis directly. Post-operative recovery is quick, with most patients feeling back to normal within hours.

It is important to note that subtle uterine and pelvic pathology can only be diagnosed under direct visualization. This novel procedure allows for the accurate diagnosis of infertility causes when other basic tests fail to reach a diagnosis, leading to the frequently inaccurate diagnosis of “unexplained infertility” (basically, a diagnosis that is reached when physicians run out of answers to explain the real cause of infertility). Remember, having a real diagnosis is the most important step in managing fertility patients.

Benefits of endoscopic procedures compared to conventional open surgery include:

– Less invasive: it does not require opening of the abdomen
– Better visualization of pelvic structures
– Smaller incisions and therefore, smaller scars
– Less internal and external scarring
– Decreased post-operative discomfort
– Quicker recovery time
– Earlier return to full activities