Laparoscopic Surgery

Diagnostic Hystero Laparoscopy
Diagnostic Hystero laparoscopy is a small operation (Procedure) done under anesthesia ( GA ). It is a day care procedure and patients are discharged on the same day. In this operation a laparoscope is introduced into the abdomen, the uterus, tubes, ovaries, pouch of douglas and bowel is visualized. Tubal patency is confirmed by injection of dye. Small corrective operations are also done through laparoscope such as ovarian drilling, adhesiolysis excision of myomas, endometriomas, cauterisation etc. Through hysteroscope the uterine cavity is visualised. Polyps, fibroids, septum etc are diagnosed & treated. Tubal Ostia can be visualized and cornual block can be removed if needed. At the end of hysteroslaparoscopy ,the diagnosis of Infertility is definitely established and a treatment plan is made. It is better to do a hystero laparoscopy in all cases of Infertility before starting any strong treatment. A Good Diagnostic Hysteroslaparoscopy is the golden standard for basic investigation and treatment in fertility, as it not only helps identify the cause of infertility but also provides a solution to the problem in the same sitting.

Total Laparoscopic Hysterectomy
Laparoscopic hysterectomy involves removing the entire uterus with minimally-invasive techniques, using a narrow telescope-like instrument (laparoscope) to see the inside of the abdomen. Under complete general anesthesia, the abdomen is first inflated with carbon dioxide gas to create space for operating. Four or five incisions (1/4 to ½ inch each) are made in the navel and lower abdomen to allow insertion of both the laparoscope and long, narrow instruments through tubes called “ports.” (When using the robot, the incisions are higher up, at the level of the belly button and higher up towards the head.) A normal sized uterus, once it is detached from its supports, can be removed through the vagina. A large uterus can be reduced to smaller pieces using a laparoscopic morcellator. With our long experience and high volume, we are comfortable removing a uterus as large as a 30 week pregnancy. Once the uterus is removed, the inside edges of the vagina are brought together using suture, which is readily done laparoscopically

The advantages of Total Laparoscopic Hysterectomy are:
• Pain is less as the nerve fibres are not disturbed and the patient recovery is very fast
• The patient is out of the bed the very next day and gets back home
• The chances of urinary incontinence (leakage of urine), Vault prolapsed (hernia of intestine) occurring is less and the depth of the vagina is also maintained
• Maintaining its depth is very important for normal sexual activities
• The pelvic floor is not disturbed
• The patient returns to normal activities within a week and working women can get back to work in 2 weeks time
During Total Laparoscopic Hysterectomy, we believe in not removing the ovary unless it is diseased, as the ovary produces a hormone called ‘androgen’, even after Hysterectomy, which is important for a normal sexual functioning and for the well being of the woman.

Laparoscopic PCOD Drilling
Polycystic ovary syndrome (PCOS) is a health problem that can affect a woman’s menstrual cycle, ability to have children, hormones, heart, blood vessels, and appearance. With PCOS, women typically have: 1. High levels of androgens. These are sometimes called male hormones, although females also make them. 2. Missed or irregular periods. 3. Many small cysts in their ovaries and they are fluid-filled sacs. One of the ways of treating this disease is Laparoscopic Ovarian Drilling. “Ovarian drilling” is a surgery that brings on ovulation. It is done when a woman does not respond to fertility medicines. Patients of PCOD are taken up for surgery after strict pre-operative diagnostic work-ups that include ultrasound, blood test for FSH, LH, TSH, PRL and DHEAS. When a patient satisfies all the above investigation, the first line of management is diet advice, weight reduction, increase physical activity. For medical management, clomiphene citrate is used. Insulin sensitizers, metformin etc are used as basic outlay. In PCOS hyper insulinemia occurs as a result of insulin insensitivity which is treated with metformin. After a fair trial of medical management and if the patient still does not become pregnant, patients are then taken up for laparoscopic ovarian drilling. Most of the women will ovulate the very next month after PCOD drilling and are able to achieve pregnancy within 3-6 months of the surgery.

Laparoscopic Myomectomy
Myomectomy is the surgical removal of fibroids from the uterus. It allows the uterus to be left in place and for some women makes pregnancy more likely than before. Myomas (Fibroids) are one of the most common benign tumors. 25% of women over the age of 35 have myomas. Majority of myomas (Fibroids) are asymptomatic. The most common indicators for treatment are 1) Menorrhagia (Heavy bleeding) 2) Pelvic pain 3) Pressure on adjacent organs 4) Fertility 5) Habitual Abortion. The treatment options for fibroids are myomectomy. Majority of fibroids can be removed laparoscopically. Even in women above 40 years of age, who desire to keep their uterus – laparoscopic myomectomy can be performed and uterus can be retained from removal.

Laparoscopic Cystectomy
Ovarian cyst can be removed by laparoscopic cystecomy. Before performing the procedure, the nature of the cyst is to be evaluated by doing an ultrasound of the abdomen,pelvis and blood test for CA125. During the procedure whatever is the size of cyst they can be removed laparoscopically by placing the cyst in an endobag. The patient can go home on the same day. Even huge cysts like Dermoid Cyst can be removed laparoscopically without spilling the content by placing in the Endo bag thereby saving the ovary.

Laparoscopic Ectopic Pregancy Removal
Some women develop pregnancy in the tubes and this becomes an emergency situation when the tubes rupture. Laparoscopically the tubal pregnancy can be removed where we can save the patient. If there is a delay in the surgery, the patient can lose lots of blood and it is very dangerous.