GYNE ENDOSCOPY & LAPAROSCOPIC SURGERY

Dr. Geeta Kinra
Senior Consultant
Gynecology
Dr. B.B Dash
Senior Consultant
Gynecology
Dr. Sukanya Patra
Senior Consultant
Gynecology
Dr. Meenakshi Sahu
Senior Consultant
Gynecology
MD, DNB, MRCOG(UK)
Dr. Neeta Jain
Senior Consultant
Gynecology
MS, DNB, MNAMS
       
Dr. Sula Ray Prasad
Senior Consultant
Gynecology
MBBS(CAL) DGO(CAL)
Dr. Shelly Singh
Senior Consultant
Gynecology
MBBS MD OBS & GYNAE
Dr Gurmeet Bansal
Senior Consultant
Gynecology
Dr Indra Kaul Hangloo
Senior Consultant
Gynecology
Dr. Renuka Sinha
Senior Consultant
Gynecology
MD OBS & GYNAE SICOG,FICMCH
Dr Richa Katiyar
Senior Consultant
Gynecology
Dr Smita Sanyal
Senior Consultant
Gynecology
Dr Suman Lal
Senior Consultant
Gynecology
       
Dr Seema Mehrotra
Senior Consultant
Gynecology
Dr Garima Goel
Consultant Gynecologist
ms(Obs & Gyne),Gold Medalist,Ex RO (AIIMS)
Dr. Shelly Singh,Book Appointment With Dr. Shelly Singh,OBG,Gynaecologist Dr. Meenakshi Sahu,Book Appointment With Dr. Meenakshi Sahu,Gynaecologist Dr. Renuka Sinha,Book Appointment With Dr. Renuka Sinha,Gynaecologist

WHAT IS GYNE ENDOSCOPY? WHEN IS IT DONE AND WHAT ARE THE PROBLEMS THAT CAN BE TREATED WITH THIS TECHNIQUE?

During the last 35 years, gynecologic laparoscopy has evolved from a limited surgical procedure used only for diagnosis and tubal ligations to a major surgical tool used to treat a multitude of gynecologic indications. Today, laparoscopy is one of the most common surgical procedures performed by gynecologists. Gynae Endoscopy is a minimally invasive gynaecological surgery in women. You would be happy to know that now all normal gynaecological surgeries can be done through smaller cuts and without large, unsightly and traumatic cuts. It is also loosely called key hole surgery or pin hole surgery or laser surgery.

For many procedures, such as abnormal bleeding during periods, painful periods, heavy periods, less flow during periods and any menstrual problems, for sterilization without cuts, in Patients who cannot bear children (Infertility), Uterine Fibroids/Tumors, Ovarian Cysts and Tumors, Cancer in women, Blocked fallopian tubes, Ectopic Pregnancy, treatment of endometriosis, laparoscopy has become the treatment of choice. Almost all gynaecological problems can be diagnosed and treated through Gynae endoscopy. As a matter of fact all traditional surgeries can be done by this technique.

INFERTILITY

Laparoscopy is a procedure that involves insertion of a narrow telescope-like instrument through a small incision in the belly button. This allows visualization of the abdominal and pelvic organs including the area of the uterus, fallopian tubes and ovaries.This procedure allows us to determine whether there are any defects such as scar tissue, endometriosis, fibroid tumors and other abnormalities of the uterus, fallopian tubes and ovaries. If any defects are found then they can often be corrected with operative laparoscopy which involves placing instruments through ports in the scope and through additional, narrow (5 mm) ports which are usually inserted at the top of the pubic hair line in the lower abdomen.

Because of the cost and invasive nature of laparoscopy it should not be the first procedure or diagnostic test performed as part of the couples infertility diagnostic evaluation. In general, semen analysis, hysterosalpingogram and documentation of ovulation should be assessed prior to consideration of laparoscopy. For example, if the woman has a clear ovulation problem or her male partner has a severe sperm defect then it is unlikely that laparoscopy will provide additional useful information that will help them to conceive.Laparoscopy traditionally used to be part of the female infertility work-up. However, this tradition has recently been challenged as potentially being a questionable procedure when assessed by its cost-effectiveness and invasiveness.

The procedure usually takes between 20 minutes to 2 hours depending upon how much operative corrective work is required. A complicated case could take up to 4 hours or more. The woman is generally discharged home from the hospital approximately two hours after completion of the surgery. The woman will usually need to take off an additional 1-2 days from work following the procedure. Mild to moderate pain should be expected to last for up to 7 days or so after the procedure.

EXPERTS SPEAK ON SIMPLE BUT SIGNIFICANT FACTS OF INFERTILITY

Infertility should not be treated as a social stigma. It is no one’s fault. Society should be kind and supportive. Couples with known problems like low sperm count, polycystic ovaries, fibroid, endometriosis should see a doctor as soon as possible.

WHAT IS INFERTILITY?
When a couple is living a Conjugal life without practicing any form of contraceptive for 1 year and still has not conceived, then the couple is clinically known as Infertile couple.

IS INFERTILITY ONLY A FEMALE PROBLEM?
Infertility has both male and female factors, although male factor is 25%, whereas female factor is 75%, but still male factor if detected should be treated by Uroandrologist. The female partner should be treated by Gynaecologist. Both man and woman should equally participate in the treatment

DOES INFERTILITY TREATMENT ONLY MEAN ASSISTED REPRODUCTIVE TECHNIQUE?
Assisted reproductive technique is the last resort. The couple should be thoroughly evaluated on the basis of history taking, clinical examination and investigations. IVF i.e. in – vitro – fertilization signifies fertilization of egg and sperm outside the body. Not all couples with infertility need IVF, but some cannot get pregnant without it, like the men with low sperm count and women with blocked tubes. These procedures are expensive. Results are not absolute.

ARE THERE SURGICAL WAYS OF TREATING INFERTILITY?
There are many pathological conditions which leads to female infertility like uterine polyp, fallopian tube blockage, submucous fibroids, uterus having two cavities, uterine synachae. These conditions have to be corrected surgically, otherwise even assisted reproductive technique will not yield any results.

DOES MALE INFERTILITY REQUIRE SURGICAL MANAGEMENT?
Common causes of male infertility are varicocele, undescended testis, testicular atrophy. These conditions have to be tackled surgically to improve the quality and quantity of sperms.

DOES LIFE STYLE OF MALE AFFECT FERTILITY?
Yes definitely male factors like obesity, tobacco use, smoking, alcohol use, heavy exercise, tight undergarments, exposure to hot environmental conditions, use of too many mobile phones can adversely affect fertility. Hence alleviation of these factors drastically improves fertility. Sometimes results are obtained with proper counseling and without further intervention.

DOES LIFE STYLE OF A FEMALE AFFECT FERTILITY?
Yes. Obesity, sedentary life style, exposure to radiation leads to infertility. Correction of these factors improve fertility significantly.

ECTOPIC PREGNANCY

If an ectopic is discovered, the surgeon can use laparoscopy (keyhole surgery) to cut the tube and remove the pregnancy, leaving the tube intact if it can be repaired. Laparoscopy has advantages over open abdominal surgery, because the operation is quicker, less blood is lost during surgery, you don't need to stay in hospital for as long, and less analgesia (pain killing medicine) is needed.

Whether the tube and pregnancy are removed altogether, or the pregnancy is removed and the tube repaired depends on how damaged the tube is, the health of your other fallopian tube and your desire for future pregnancy.If the tube has ruptured, doctors usually recommend abdominal surgery, because it is the quickest way to reduce blood loss. In some cases a blood transfusion may be needed to replace lost blood.

In a small percentage of women, usually in cases where the tube has been saved (about 4 per cent with keyhole surgery and 8 per cent with open surgery) the pregnancy continues to grow and needs treatment with the drug methotrexate, which terminates pregnancy, or further surgery to remove it.

HYSTERECTOMY

The most common medical reasons for performing hysterectomies include uterine fibroids (30 percent of cases), abnormal uterine bleeding (20 percent), endometriosis (20 percent), genital prolapse (15 percent), and chronic pelvic pain (about 10 percent). Laparoscopically Assisted Vaginal Hysterectomy (LAVH) is a procedure using laparoscopic surgical techniques and instruments to remove the uterus (womb) and/or tubes and ovaries through the vagina (birth canal).

Its greatest benefit is the potential to convert what would have been an abdominal hysterectomy into a vaginal hysterectomy. An abdominal hysterectomy requires both a vaginal incision and a four to six inch long incision in the abdomen, which is associated with greater post-operative discomfort and a longer recovery period than for a vaginal procedure. Another advantage of the LAVH may be the removal of the tubes and ovaries which on occasion may not be easily removed with a vaginal hysterectomy.

TYPES OF HYSTERECTOMY
There are various types of hysterectomy. The type you have depends on why you need the operation and how much of your womb and surrounding reproductive system can safely be left in place.

The main types of hysterectomy are:
• Total hysterectomy – the womb and cervix (neck of the womb) are removed; this is the most commonly performed operation
• Subtotal hysterectomy – the main body of the womb is removed, leaving the cervix in place
• Total hysterectomy with bilateral salpingo-oophorectomy – the womb, cervix, fallopian tubes (salpingectomy) and the ovaries (oophorectomy) are removed
• Radical hysterectomy – the womb and surrounding tissues are removed, including the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue

There are three ways to carry out a hysterectomy:
• Vaginal hysterectomy – where the womb is removed through a cut in the top of the vagina
• Abdominal hysterectomy – where the womb is removed through a cut in the lower abdomen
• Laparoscopic hysterectomy (keyhole surgery) – where the womb is removed through several small cuts in the abdomen

EXPERTS SPEAK ABOUT THE PROCEDURE - HYSTERECTOMY

A hysterectomy is a surgical procedure to remove the womb (uterus). You will no longer be able to get pregnant after the operation. If you haven't already gone through the menopause, you will also no longer have periods, regardless of your age. The menopause is when a woman's monthly periods stop, usually at around the age of 52.

WHY DO I NEED A HYSTERECTOMY?
Hysterectomies are carried out to treat conditions that affect the female reproductive system, including:
• heavy periods (menorrhagia)
• long-term pelvic pain
• non-cancerous tumours (fibroids)
• ovarian cancer, uterine cancer, cervical cancer or cancer of the fallopian tube

A hysterectomy is a major operation with a long recovery time and is only considered after alternative, less invasive, treatments have been tried

THINGS TO CONSIDER
1. If you have a hysterectomy, as well as having your womb removed, you may have to decide whether to also have your cervix or ovaries removed.
2. Your decision will usually be based on your personal feelings, medical history and any recommendations your doctor may have.
3. You should be aware of the different types of hysterectomy and their implications.

The main types of hysterectomy are:
• Total hysterectomy – the womb and cervix (neck of the womb) are removed; this is the most commonly performed operation
• Subtotal hysterectomy – the main body of the womb is removed, leaving the cervix in place
• Total hysterectomy with bilateral salpingo-oophorectomy – the womb, cervix, fallopian tubes (salpingectomy) and the ovaries (oophorectomy) are removed
• Radical hysterectomy – the womb and surrounding tissues are removed, including the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue

There are three ways to carry out a hysterectomy:
• Vaginal hysterectomy – where the womb is removed through a cut in the top of the vagina
• Abdominal hysterectomy – where the womb is removed through a cut in the lower abdomen
• Laparoscopic hysterectomy (keyhole surgery) – where the womb is removed through several small cuts in the abdomen

RECOVERING FROM A HYSTERECTOMY
A hysterectomy is a major operation. You can be in hospital for up to five days following surgery, and it takes about six to eight weeks to fully recover. Recovery times can also vary depending on the type of hysterectomy.

Rest as much as possible during this time and don't lift anything heavy, such as bags of shopping. You need time for your abdominal muscles and tissues to heal.

SURGICAL MENOPAUSE
If your ovaries are removed during a hysterectomy, you will go through the menopause immediately after the operation, regardless of your age. This is known as a surgical menopause.

If one or both of your ovaries are left intact, there's a chance you will experience the menopause within five years of having your operation.

HYSTEROSCOPIC SURGERY

Hysteroscopic surgery involves placing a small telescope instrument within the uterine cavity and examining the cavity. Scar tissues, polyps or small fibroid tumors can be removed without difficulty. This procedure has fewer surgical risks than a hysterectomy and provides an option to hysterectomy for stopping or reducing menstrual flow or for removing small fibroids or polyps while preserving a young woman's fertility.

Following the procedure, patients note a brownish to slightly bloody discharge, which occurs shortly after the procedure, and last up to 6 weeks. Patients are advised to refrain from any kind of exercise for at least 3-4 weeks because there have been reports of heavy bleeding following strenuous exercises (i.e., moving furniture, cutting wood, jogging). Half the patients will experience no side effects with the cautery technique, and are back to normal activity within 2-3 days: the other half will notice a cramp-like sensation, and are tired for several days. Over 90 percent of the patients are back to normal activity within 4-5 days after surgery. Most patients take 4-5 days off work following their surgery, although some individuals have returned to work within 24 hours.A new procedure called a Uterine Balloon Ablation was approved by the FDA in December, 1997. Both procedures are now offered by Dr. Dott.akes it possible to destroy the uterine lining when a women suffers from excessive menstrual flow. This is an advance over a hysteroscopic endometrial ablation or "roller ball surgery". Patients who have had this procedure have been followed for up to 10 years. During this period of time, they have enjoyed either complete, or almost complete, cessation of menses in over 90 percent of the cases. The "Roller ball" is done under general anesthesia or regional block (spinal or epidural). This is the outpatient procedure. Hospitalization is not necessary, except in rare instances.

OVARIAN CYSTS

Cysts are a common cause of concern among women. But, it is important to know that the vast majority of ovarian cysts are not cancer. However, some benign cysts will require treatment in that they do not go away by themselves, and in quite rare cases, others may be cancerous.

An ovarian cyst, which looks like a small balloon filled with water, grows from within the ovary and stretches the normal ovarian tissue over it. Removing the cyst, called a cystectomy, is like taking a clam out of the shell. The thinned out ovarian tissue is cut open, and the cyst is gently peeled away from inside the ovary. The cyst fluid is then removed with a suction device. The cyst now looks like a deflated balloon and can easily be removed through the small laparoscopy incision. If a cyst has destroyed all the normal ovarian tissue, it may be necessary to remove the entire ovary. A number of ways have been developed to allow the removal of the entire ovary with the laparoscope. Using either special sutures or surgical staples, the blood vessels going to the ovary can be tied, and the ovary cut away and removed. In most situations, the operating time for laparoscopic surgery takes no longer than standard surgery. However, the benefit of laparoscopic surgery is that you may leave the hospital the same day and return to normal activity within a week or two.

BREAST DISEASES

When many people think of breast disease, they think of breast cancer. However, there are many diseases and conditions of the breast that are benign (non-cancerous). Benign breast diseases include fibrocystic disease, fibroadenoma, papilloma, mammary dysplasia, and breast infections. Most women experience breast changes at some time. Men also have breast tissue and can develop breast disease. A breast lump, pain, discharge or skin irritation needs to be evaluated by a health care provider. A breast tumor can be benign or malignant. Benign tumors are not considered breast cancer. Breast cancer is a malignant tumor that has developed from cells in the breast.

Family history, age or genetic inheritance can put some women at a higher risk of developing breast cancer. Yet the majority of women and men who develop breast cancer have no known risk factors. To protect your breast health perform regular monthly breast self-examinations, see your doctor once a year for a clinical breast exam, and schedule an annual digital mammogram, as appropriate based on age and family history.

There are many signs and symptoms of breast disease including swelling of all or any part of the breast, skin irritation or dimpling, breast pain, nipple pain, nipple discharge, redness, scaling or thickening of the nipple or breast skin, and a lump in the underarm area. It is important to have anything unusual checked by your doctor.

The treatment is determined by the type of breast disease. Surgery is usually the first line of attack against breast cancer. There are multiple surgical options for breast cancer including lumpectomy, simple mastectomy, modified radical mastectomy and lymph node removal. The decision about surgery will depend on many factors. The different treatment options should be discussed with all the physicians involved in the patient’s care.

STRESS INCONTINENCE

Stress Incontinence Stress incontinence is the most common form of urinary incontinence. The main treatment which often works well is to do exercises to strengthen the pelvic floor muscles (pelvic floor exercises). In some cases medication may help in addition to exercises if exercises alone do not work. A treatment option in some cases is surgery to 'tighten' or support the bladder outlet.

UTERINE MYOMAS

When a benign (not recurring or progressive) tumor grows in the muscles of the uterus, it is known as uterine Myoma. These tumors can grow very large, sometimes growing as large as a melon. The typical Myoma, however, is around the size of an egg. When the Myoma penetrates the entire wall of the uterus, it is referred to as uterus myomatosus. In certain very rare cases (less than 1/2 of 1% of the time) the tumors can become malignant. When this happens, it is known as sarcoma.

Laparoscopic-assisted myomectomy is as effective as myomectomy by laparotomy, but it is associated with a smaller abdominal incision and shorter hospital stay.

HOW IS GYNAE ENDOSCOPY BETTER THAN OTHER SURGERIES?

This novel surgical technique is done using a hi-tech imported specialized equipment. Gynecological Surgeons who are specialized and trained in these advanced techniques of surgery and equipment do this surgery.

Gynae Endoscopy is better than other surgeries in many ways:
• Safer
• Less Expensive
• Pain is much Less
• It is a Day Care Surgery, and thus less/shoter duration of hospitalization
• Shorter Recovery Time
• Back to work and normal life much earlier
• No Big Scars and also cosmetically better
• Less Bleeding ( Blood Generally Not required)

Doctors Available