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Laparoscopic surgery in females

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Ovarian cyst surgery

Ovrian Cyst Surgery

An ovarian cyst is collection of fluid within the ovary causing it become larger in size. There are different causes and types of ovarian cysts.

  1. Simple cyst – is one which is filled with clear water like fluid. It usually doesn’t cause any symptoms unless it becomes very large in size.
  2. Hemorrhagic cyst- This usually forms at the time when follicles rupture in the ovary to release the egg. They can be painful but usually self limiting and do not require treatment unless they cause persistent pain.
  3. Endometriotic cysts- are associated with the condition of endometriosis. They may require hormonal therapy or surgery.
  4. Complex cysts/ Cystic tumors – are the ones which have some solid component along with fluid inside. They may represent benign tumors or cancers. The treatment of these cysts is usually surgical removal.

Many times ovarian cysts don’t have any symptoms and are detected incidentally during an ultrasound or CT scan of the abdomen. Larger cysts including hemorrhagic and endometriotic cysts cause pain. Severe pain can occur because of torsion or twisting of the ovarian cyst. Cystic tumors can cause fluid accumulation in the abdomen and can cause weakness and weight loss

1 . Medicines – may be useful for functional cysts or PCOD

  1. Medicines – may be useful for functional cysts or PCOD
  2. Percutaneous drainsge- This involves taking out the fluid from a simple cyst with a needle using ultrasound or CT scan for guidance. This may lead to recurrence in some cases.
  3. Surgery – is required for large cysts, torsion, cystic tumors and cancers.

These cysts are most commonly detected during imaging of the abdomen by ultrasound or CT scan.

The complications include-

  1. Bleeding- can occur inside the ovarian cyst. This will cause pain and increase in size of the cyst.
  2. Infection- can rarely occur inside the cyst
  3. Cyst twisting or torsion- can occur in larger cysts which cuts of the blood supply and causes sudden onset of severe unbearable pain. This may require emergency surgery.
  4. Cancer- This can occur in certain cystic tumors. They may start off as benign lesions but may transform into cancer.
  1. Laparoscopic deroofing- This means decompressing the cyst by removing part of its wall . This is useful for simple cysts.
  2. Laparoscopic cyst removal- This involves removal of the entire cyst by laparoscopy.
  3. Laparoscopic ovarian removal – This is indicated in case of complex cysts or cystic tumors where the cyst along with the same side ovary is removed laparoscopically.
  4. Open surgery- May be required for very large cysts or tumors where the chances of cancer are high.

Uterine fibroid surgery

Dr. Anirudh Vij Uterine Fibroid Surgery

Uterine Fibroids are benign tumours which form in the uterus particularly in the reproductive age group. These can small or large and can be located anywhere – within the cavity , within the wall or protruding outside.

  1. Bleeding – This is the most common symptom. Patients present with heavy bleeding during cycles, prolonged cycles or passage of clots. If excessive, this can cause deficiency of blood known as anaemia.
  2. Pain- sometimes, fibroids can present with pain or heaviness in the abdomen.
  3. Infertility – large fibroids within the cavity of the uterus can be the cause of recurrent miscarriages or infertility
  4. Cancer- large and long standing fibroids may turn into cancer and can present with weakness and weight loss.

Fibroids are detected most commonly on abdominal imaging usually an ultrasound or CT scan.

The different treatment options for fibroids are-

  1. Medical treatment- Small Fibroids may be treated with medicines which regulate the female hormones and suppress their growth.
  2. Hysteroscopic/ Endoscopic removal – may be possible for fibroids which are mainly located inside the uterine cavity.
  3. Laparoscopic Myomectomy- is a highly successful treatment for upto moderately large fibroids.
  4. Open Myomectomy- is considered for huge fibroids which may be difficult to remove laparoscopically.
  5. Laparoscopic or open hysterectomy- is considered in ladies with large or multiple fibroids particularly in the menopausal age group or those whose family is complete. It is also indicated for fibroids which have suspected or confirmed cancer.

Laparoscopic Uterus removal / Hysterectomy

Hysterectomy means removal of the uterus by surgery. It is commonly indicated in the following conditions-

  1. Multiple/ Large uterine fibroids
  2. Cancer of uterus / cervix
  3. Uterine descent/ prolapse
  4. Severe dysmenorrhea or PID
  5. Grade 4 endometriosis

Laparoscopic hysterectomy involves complete removal of uterus and closure of vault by laparoscopy. It has numerous advantages over open surgery such as

  1. Less blood loss
  2. Less pain
  3. Faster recovery
  4. Less chances of infection
  5. More precise procedure

Laparoscopic surgery in infertility

Laparoscopy In Infertility

Laparoscopic surgery can also be used in infertile women and has the following applications-

  1. Diagnostic laparoscopy for detecting the fibroids, ovarian cysts, endometriosis, etc.
  2. Laparoscopic chromopertubation to detect the patency of Fallopian tubes
  3. Laparoscopic ovarian drilling for PCOD
  4. Laparoscopic ovarian cyst removal for simple/ hemorrhagic/ endometriotic cysts
  5. Diagnostic as well therapeutic Hysteroscopy for tubal patency, septal resection and adhesiolysis