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Gynaecology

Procedures

Laparoscopic surgeries

Laparoscopic surgeries are all keyhole surgeries that are minimally invasive with quick recovery time. The tube which is provided with a camera and inserted into the body via incisions, is called a laparoscope.

Laparoscopic Ovarian Cystectomy

A keyhole surgery for removing cysts in the ovaries, it involves minimum incisions typically made in the lower part of the abdomen. Cysts are quite common and when they do not cause any pain or discomfort, they remain undetected. When pelvic pain manifests as a result of ovarian cysts, then surgery to remove the cysts may become a necessity.

Performed under anesthesia, small cuts will be made on the abdomen to insert a laparoscope. Small surgical instruments will also be inserted through the cuts to remove the cysts. Once removed, the cuts will be closed with stitches and covered by a bandage for protection. It is important to keep the surgical area dry. Patients are advised to get as much rest as possible for a week after surgery as they might feel tired. Pain after surgery is expected and normal and may be controlled by medication.

Diagnostic Laparoscopy and Hysteroscopy for Dye Test

Primarily done to diagnose infertility issues, this procedure focuses on ruling out any blockages in the fallopian tubes. Performed as a keyhole surgery with very few small incisions, it involves injecting a dye to check for obstructions in the fallopian tubes. Under anesthesia, an incision is made near the navel for inserting a laparoscope. Another incision is made in the lower abdomen for inserting instruments when treatment is possible at the same time as diagnosis. Other conditions like cysts, endometriosis, pelvic infections, etc. can also be diagnosed through this method. Patients can often go home on the same day but sometimes a night’s hospitalization may be needed. Usually, daily activities can be resumed 3 days after the procedure.

Laparoscopic Sterilization

A minimally invasive method of birth control, the procedure involves either blocking the fallopian tubes or removing them completely. Performed laparoscopically, an incision made near the naval allows insertion of the laparoscope. Another incision made lower down on the abdomen allows for the insertion of instruments to block or remove the fallopian tubes. Blocking is done either by means of electrocoagulation or by means of a clip or band placed on the fallopian tube that act as an obstruction. In the case of fallopian tube removal, the process cannot be reversed so women are advised to be absolutely sure before undergoing the procedure. Typically, no hospitalization is needed and normal activities can be resumed after 3 days.

Laparoscopic Myomectomy

This procedure is performed to remove fibroids from the uterus. Done through small incisions through which a laparoscope and other instruments for removing the fibroids are inserted, women who want to remove fibroids but retain their uterus opt for this procedure. Usually, fibroids are left untreated and just observed when they do not cause any problems. But if they interfere with pregnancy, cause heavy bleeding or pelvic pain then they can be removed. The procedure is performed under anesthesia and typically requires hospitalization of one day. Complete recovery may take around 3 weeks.

Total Laparoscopic Hysterectomy

This is a safe procedure for the removal of the uterus and cervix. Done through small incisions on the abdomen area, the advantages of removing the uterus through laparoscopy include lesser post-operative pain and faster recovery. Performed under general anaesthesia, incisions made on the stomach allow for the insertion of a laparoscope and other instruments to remove the uterus. The uterus is cut and removed through the vagina. Women are advised to avoid heavy lifting and strenuous work while recovering.

Laparoscopic Management for Ectopic Pregnancy

Ectopic pregnancy is also known as tubal pregnancy. This is because the fertilized egg stays in the fallopian tube instead of moving to the uterus. As eggs cannot survive in the fallopian tubes, the pregnancy will have to be terminated. Damaged fallopian tubes are thought to be a probable cause for this condition. Symptoms of an ectopic pregnancy include bleeding and pain in the pelvic area. Sometimes, when detected in the early stages, medication might be sufficient to treat the condition. Other times, surgery will be required. Surgery can be done through laparoscopy and is of two kinds: saplingostomy and salpingectomy. In saplingostomy, the pregnancy alone is removed while in salpingectomy, the pregnancy and the fallopian tube both are removed. The procedure opted for will depend on the patient’s condition. Both procedures done laparoscopically with few small sized incisions are minimally invasive. However, in case of emergency, laparoscopic management will not be possible and the surgeon will have to do an open surgery.

Hysteroscopic surgeries

Hysteroscope is an instrument used for both diagnostic and treatment purposes. It is a long tube with a camera at the end which is inserted through the vagina.

Hysteroscopic Polypectomy

A polyp is a growth on the wall of the uterus. They are usually non-cancerous in nature. A hysteroscopic polypectomy is a procedure by which the polyp alone is removed and the uterus is left intact. A Hysteroscope is used for examining the uterus. Small sized polyps can be removed with the scope itself. Surgery will be done under anaesthesia and one day’s hospitalization may be necessary. After surgery, bleeding is expected and will last for around a week. Pain after surgery is also normal and your doctor may manage it with pain killers. Normal activities can be resumed in a day or two.

Hysteroscopic Myomectomy

Submucous fibroids are growths that are not cancerous in nature found in the walls of the uterus or endometrium. These growths can cause a lot of bleeding. Hysteroscopic myomectomy is a procedure to remove these fibroids without making any incisions on the abdomen. The uterus is not removed and hence this procedure is a great option for women who plan on having children. Before the advent of hysteroscopy and laparoscopy, this procedure was carried out as an open surgery. Now it is greatly simplified and carried out as an outpatient procedure not requiring hospitalization. During surgery, the surgeon will insert a hysteroscope, into the vagina. This will allow examination of the uterus for fibroids. The patient can resume normal activities in 2 days.

Hysteroscopic Septal Resection

A septate uterus is one that appears normal externally but internally it is divided into two. Women with septate uterus might be able to conceive but after conception, as the space within the uterus is limited, the pregnancy might abort. This hysteroscopic septal resection is a procedure done under anaesthesia to rectify this defect in the uterus. During the procedure, the surgeon will insert a hysteroscope through the vagina. Sometimes, the uterus will be filled with a fluid to expand it for better visualization. Loop electrical excision will be used to remove the septum in the uterus. The surgery does not involve any incisions. Hence, there is no blood loss and recovery is also quicker.

Pap Smear

An important tool for cervical cancer screening, a Pap smear or Pap test involves examining the cells from the lower end of the uterus (cervix) to detect cervical cancer. A pap smear also helps in detecting changes that might lead to cervical cancer in the future. Early treatment is very important for successful treatment and hence undergoing a pap smear is very important for women in the age group of 21-65 years. The procedure is usually completed in a matter of minutes and is not painful. During the procedure, the patient will be required to lie down with legs bent at the knees. A speculum will be inserted to widen the vagina. Cervical cell samples will be taken with a soft brush and a spatula. These samples will be sent to the laboratory for testing. The patient can resume normal activities immediately. Many women shy away from undergoing a pap smear because they fear it will be painful. But pap smears are very important to detect the beginning of cervical cancer. Women are advised to talk to their gynaecologists about when and how often they need to undergo this test.

Colposcopy

If the results of a pap smear are not normal, the doctor might want to do a colposcopy for a more in-depth examination of the cervix, vagina and vulva. The instrument used for this purpose is called a colposcope. Changes that point to possible cancers of vagina, vulva or cervix can be detected with a colposcopy. Before the procedure, the use of tampons and vaginal medication should be avoided. The procedure cannot be done during menses (periods). Vaginal intercourse should also be avoided prior to the procedure. The patient can talk to the doctor and find out if any painkillers are necessary.

During the procedure, the patient will be made to lie down with knees bent. A speculum will be used to open the vagina. The doctor will use a colposcope (which will give a magnified view) near the vulva to check the vagina and the cervix. If any abnormalities are detected, a biopsy will be taken immediately. If the doctor feels the biopsy will cause pain or discomfort, a local anaesthetic will be applied. After biopsy, it is normal to feel slight pain and experience light bleeding. The doctor will advise the patient on management. The results of the biopsy will help in further treatment.

Many patients experience a lot of anxiety before a colposcopy. Music, meditation and yoga will help in controlling it. Talking to the doctor, knowing what to expect and being aware will also help control anxiety.

Hysterectomy

Open

An open hysterectomy involves incisions on the abdomen to remove the uterus and cervix. When the uterus and cervix are both removed, it is called total hysterectomy. Sometimes, the ovaries and fallopian tubes might also be removed. The exact procedure will depend on the patient’s condition. The size of the incision made on the abdomen varies from 10-15 cms. A hysterectomy is done in the following cases:

  • Cancer in the uterus or other related organs
  • Fibroids which cause a lot of discomfort
  • Abnormal and excessive vaginal bleeding
  • Long term pain in the pelvis
  • Endometriosis
  • Prolapse of the uterus

The doctor will guide the patient on pre-operative procedures. The surgery itself will last 1-2 hours and will be performed under general anaesthesia. Hospitalization of 1-2 days will be needed.

Laparoscopic

Here, the removal of the uterus and related organs is done through very small incisions. Advantages over an open hysterectomy include smaller cuts, faster healing and less post-operative pain. The surgeon will be the best person to determine which type of hysterectomy will suit the patient best.

During a laparoscopic hysterectomy, a few small sized incisions are made in the abdomen. Through the incisions, a laparoscope (a tube with a light and camera) and other instruments are inserted to remove the uterus. The surgeon views the output of the laparoscope on a monitor and is guided by it during surgery. As it is minimally invasive, this mode is preferred by surgeons when it is feasible.

Vaginal

As the name implies, in this procedure, the uterus is removed through the vagina. This overcomes the need for abdominal incisions. Reduced hospitalization time and cost along with quick recovery are the advantages of this procedure. However, not all women are candidates for this procedure and some may have conditions that may require an open hysterectomy.

During the procedure, the patient will be made to lie down with knees bent. A catheter may be used to empty the bladder. The surgical site will first be cleaned. An incision will be made on the vagina to access the uterus. Instruments will be inserted to clip the uterus and remove it. In some cases, the uterus may be cut into pieces and then removed. After removing the uterus, the incision will be stitched. These stitches will be absorbed with the course of time and will not need separate removal. Two days of hospitalization is usually needed. Pain is expected and medication to deal with the same will be given. Recovery will take 3-4 weeks. The patient will need help at home and should avoid carrying heavy objects.

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