Dr. Sanket Pisat

Laparoscopic surgery

DIAGNOSTIC LAPAROSCOPY Diagnostic laparoscopy is the procedure of choice for patients suffering from:

Infertility without any detectable cause
Long term pain in lower abdomen (chronic pelvic pain)
Pelvic mass of unknown origin

OPERATIVE LAPAROSCOPY

Hysterectomy (removal of uterus)
Myomectomy (removal of fibroids)
Ovarian Cysts
Endometriosis
Adhesiolysis
Tubal Sterilization for family plannings
Tubal recanalization for opening blocked tubes
Surgery for uterine proplapse (descent of organs into vagina)
Surgery for vault prolapse (descent of vagina after prior removal of uterus/ hysterectomy)
Pelvic floor repair
Laparoscopic unification of double uterus (Laparoscopic Strassman’s Metroplasty)

WHAT IS LAPAROSCOPIC SURGERY?

Laparoscopic surgery is performed using 2 or 3 small cuts on the abdomen, followed by inserting microsurgical instruments to perform surgery. Even major operations like removal of uterus, removal of fibroids, removal of ovarian cysts and many other surgeries can be easily performed by this route. This has almost completely replaced the older “Conventional” surgery, which used a large cut on the abdomen to see and operate on the internal organs.

SMALL SCARS OF LAPAROSCOPIC SURGERY

SCARS OF OPEN SURGERY

Why is laparoscopic surgery better than older conventional surgery?

There are a number of obvious advantages.

As the scars are very small compared to open surgery, pain after surgery is much lesser
Smaller scars mean better cosmetic results. You need not have a large ugly scar on the tummy
Laparoscopy offers the surgeon a magnified view of the organs, up to 20 times or more. This obviously means more precise surgery
Significantly less blood loss during surgery due to use of advanced blood vessel sealing equipment.
Early discharge from hospital. Typically, any patient undergoing open surgery will have to wait in the hospital for at least 4 to 5 days. In laparoscopic surgery, most patients can be sent home the very next day after surgery.
Early return to normal activity and work. In conventional surgery, rest at home is recommended for about 15 days. In laparoscopic surgery, the patient can resume work in about 4 to 5 days comfortably in most cases.

LAPAROSCOPIC SURGERY	CONVENTIONAL (OPEN) SURGERY
Very small scars (2 or 3 scars of 0.5cm)	Large scar (about 10 cm)
Less pain after surgery	More pain after surgery
Early return to normal activity. Patient is usually walking the day after surgery, and can be discharged 2 days later	Patient is bedridden for at least 2 or 3 days. About 5 days until discharge from hospital
Less blood loss during surgery due to magnification, micro surgical equipment and advanced blood vessel sealing technology	More blood loss during surgery
Early return to work. Even after advanced laparoscopic uterus removal surgery, patients resume work in about one week	At least 15 to 20 days rest before resuming work

1. Fertility enhancing endoscopic surgery: In many women, infertility is because of correctable problems with the reproductive organs i.e the uterus, fallopian tubes and ovaries. These problems can both be identified and corrected in the same surgery, like a one step fertility treatment procedure. Results of some of these treatments, like opening up blocked tubes are almost immediate, and the patient may get pregnant in the next few months without any treatment at all

Other examples of fertility enhancing laparoscopic surgery include

Opening of blocked tubes (tubal cannulation)

Laparoscopic fibroid removal (laparoscopic myomectomy)

Laparoscopic endometriosis/ chocolate cyst removal

What is fertility enhancing endoscopic surgery?

2. Laparoscopic Myomectomy:

Fibroids may not just cause difficulty in getting pregnant. Many times, they also cause heavy menstrual bleeding, pain and difficulty in passing urine or stools. These fibroids, even the ones as large as 10 to 12 cm, can be safely removed by the laparoscopic route.

What to expect in a myomectomy surgery? Laparoscopic myomectomy surgical procedure

3. Laparoscopic Ovarian Cystectomy : Cysts are fluid filled collections within the ovary. These may cause pain, sometimes requiring emergency surgery. They may also interfere with the normal working of the ovary and cause difficulty in getting pregnant. While these cysts are sometimes treatable with medicines alone, some may turn out to be cancerous in the long run and require immediate attention.

Normal uterus with normal ovary

Uterus with ovarian cyst

What to expect in a cystectomy surgery? Ovarian cystectomy surgical procedure

4. Laparoscopic Uterus Removal Surgery (Hysterectomy): The uterus, or womb may be affected by several problems that require you to take a decision of removing the uterus. These problems may be multiple fibroid growths, repeat fibroid growth after surgery, painful growth of uterine tissue (adenomyosis), cancerous or pre- cancerous changes in the uterine lining, and many more. Laparoscopic hysterectomy ensures a fast and less painful recovery compared to the older conventional route.

Normal Uterus

Deformed uterus due to multiple fibroids

5. Laparoscopic surgery for endometriosis: Endometriosis is a disease causing blood to accumulate within the organs of the abdomen and reproductive system. In the ovaries, collected pools of blood give rise to ovarian cysts which are commonly called chocolate cysts or endometriomas. This disease can be a very important cause of undiagnosed infertility, because it disturbs the capacity of the ovaries and tubes to function normally. Surgery involves ovarian cystectomy (removal of the cyst) and adhesiolysis (separation of the stuck organs from each other) to restore fertility potential.

6. Laparoscopic surgery for uterine descent (Prolapse): Shifting of the uterus down into the vagina is a common problem that is not reported by many women for social reasons. This problem causes constant uneasiness, disturbance in passing urine and stools, and difficulty in sexual intercourse. Using laparoscopy, the uterus can be pulled up back to its correct position and the lady can resume both her work and sexual life comfortably.

7. Laparoscopic Tubal Ligation (Family planning surgery):

In patients who do not want any more children, permanent blocking of the tubes can be performed to ensure that the lady does not ever get pregnant in the future. This avoids the need to take regular contraceptive tablets or use any other contraceptive method like condoms.

8. Some of the other procedures that can be done laparoscopically include: a. Surgery for cancer of cervix b. Surgery for cancer of endometrium c. Reversal of tubal ligation (family planning) operation

LAPAROSCOPIC SURGERY

Laparoscopic surgery

WHAT IS LAPAROSCOPIC SURGERY?

SMALL SCARS OF LAPAROSCOPIC SURGERY

SCARS OF OPEN SURGERY

Why is laparoscopic surgery better than older conventional surgery?

Other examples of fertility enhancing laparoscopic surgery include

What is fertility enhancing endoscopic surgery?

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