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LAPAROSCOPIC SURGERY / KEY HOLE SURGERY / MINIMAL ACCESS SURGERY (MAS)

Laparoscopy is a procedure whereby a thin lighted tube (laparoscope) is inserted into any human cavity and the surgeon can look into your body organs and see if these organs have any abnormality.

The main advantage of laparoscopic surgery ( Key hole ) is the minimal acess associated with this surgery. A conventional surgery consists of three stages, cutting the patient open, repairing / removing the diseased organ and lastly closing up the patient. In Minimal Access Surgery, the impact of first and the last is of these is reduced as far as possible as this surgery is carried out through very small holes (5-15 mm) cut into the body.

The advancement in surgical tools, fibre optic cables, High definition HD cameras and Vessel sealing instruments and specially designed ( grasping / cutting ) tools have vastly helped surgeons perform complex surgeries with great ease and expertise.

Advantages of Minimal Access Surgery over open surgery Include.

  • Shorter hospital stay of 1-2 days in MAS vs 5-7 days in open surgery.
  • Post operative healings of 5-7 days in MAS vs 4-6 wks in open surgery.
  • Lesser pain and discomfort in MAS vs open surgeon
  • Minimal scars in MAS vs long cuts and long scars in open surgeon.
  • Fewer post-op infections and lesser chances of haemorrhage (blood loss) in MAS vs open surgery.

Laproscopic surgery is a modern surgical technique whereby surgery in the abdomen are performed by 3 or 4 tiny cuts (5-10 mm) on your abdomen unlike in open surgery where larger cuts (3-5 inches) are required. In laparoscopy a telescope with a high definition camera is inserted into the abdomen and these images are displayed on high resolution monitors and surgery is carried out by looking at these monitors.

Laproscopic Surgery's performed at Dr. Rama Sofat`s Hospital

  1. Fertillity evaluation and tubal testing, PCOD drilling, removing of endometriotic implants etc.
  2. Laparoscopy for removing ovarian cysts (endometriotic cyst / dermoid cyst / ovarian cysts.)
  3. Laproscopic removal of ectopic pregnancy.
  4. Laproscopic tubal sterilization.
  5. Laproscopic/keywhole Surgery for removing fibroid uterus (Laparoscopic Myomectomy.)
  6. Laproscopic removal of uterus (Total laparoscopic hystrectomy.)

1. Laparoscopy for fertillity evaluation

This procedure allows us to determine the abnormalities of uterus, fallopian tubes & ovaries.This helps us to diagnose endometriosis, fibroids, ovarian cysts, congenital abnormalities of uterus , polycystic ovaries etc.

During this procedure tubal testing is done by injecting a blue dye through the Cervix (mouth of womb) to diagnosis if tubes are open or blocked.

If ovaries are found to be polycystic and enlarged and medical management has failed, ovarian drilling improves the chances of egg formation / ovulation in 70-80% women.

All these procedures improove the success rate of achieving a pregnancy. Laparoscopy is also considered a gold standard in diagnosing endometriosis (where by the uterus lining spreads into the pelvic cavity leading to infertility and chronic pelvic pain. Endometriotic spots are coagulated and fulgurated with bipolar cautery during laproscopic surgery.

2. Laparoscopy for removal of ovarian cysts / endometriomas.

Ovarian cysts are small fluid filled sacs that develop in woman's ovaries. These cysts can be simple as most will disappear & require observation. Other type is benign where one needs close monitoring and sometimes surgery is required due to its large size.

Other type is cancerous cyst which requires surgery. Usual symptoms include fullnes in abdomen, painful periods, irregular periods, pain with fever / vomiting. Laparoscopic surgery can be done for most of these ovarian cysts except in advanced cancer cysts. Usually these cysts can be removed laparoscopically provided the surgeon meticulously removes / ablates the cysts lining to prevent any recurrences later.

3. Laparosopic surgery for removing ectopic pregnancy.

Ectopic pregnancy is a pregnancy that develops outside the uterus either in the fallopian tubes, ovaries or the abdomen. Its main symptom is pain / bleeding. If not recognized can lead to internal bleeding and massive bloods loss.

Usual symptoms include pain in lower abdomen and lower back

  1. Feeling of dizziness, vomiting
  2. Occasional vaginal bleeding and pain during passing urine / stools
  3. Treatment options include observation / laparoscopy / laprotomy

Laparoscopy is the preferred treatment option for many surgeons and patients due to small incisions, lesser trauma, and faster recovery.

4. Laparoscopic tubal ligation

Laparoscopic tubal ligations is a surgery to prevent a woman's ability to reproduce. It is also called tying of the tubes. The fallopian tube are on either side of uterus and transport the eggs from the ovary to the uterus. Once the tubes are closed the mans sperm and the womans egg can never unite and thereby a pregnancy is permanantly avoided. Laparoscopic tubal ligation can be due via a small cut under the navel. The fallopian tubes are cut during the procedure and patient sent home after 4-6 hours.

5. Laparoscopy Myomectomy for removal of uterus fibroids (Laparoscopic Myomectomy)

Fibroids are bening tumours of uterus. There incidence ranges from 20-40% in women in reproductive age group. The usual symptoms include painful and heavy periods, pain abdomen, lower backache , difficulty in passing urine. Key hole surgery for removal of fibroids is a wonderful n safe procedure for patients. Firstly the fibroids are separated from the uterus, the uterus is sutured and bleeding controlled and fibroids are removed from the abdomen by morcellation.

The whole procedure translates into smaller cuts, lesser pain, lesser trauma, lesser bleeding, lesser chances of infections and in short a fabulously early recovery , patients are discharged in 1-2 days.

Laparoscopic removal of a diseased uterus (Laparoscopic Hystrectomy).

Hystrectomy is the surgical removal of uterus and results when a women has health related problems after her child bearing is complete.The main reasons being fibroids, heavy periods, ovarian tumours, premalignant conditions of uterus / ovaries, endometrosis, cancer of uterus, ovaries, cervix.

In most of the cases this surgery is done through key hole surgery except when the size of the uterus is very large and it is not possible to introduce instruments into the abdomen. During Total Laproscopic Hystrectomy, the uterus is separated from its supports using latest vessel sealers and harmonic scalpel, thereafter a normal sized uterus is removed from the birth canal. However, total laproscopic hysterectomy is also done in women with large sized uterus upto 22-28 weeks.

Whereby the uterus is firstly separated using high end vessel sealing machines and later removed from the abdomen by an instrument called morcellator. At our hospital Laproscopic removal of uterus is also done in cases of previous caesarian sections.

Patients are discharged from the hospital within 36-48 hours & believe us most patients do their routine work within a weeks time.