Which Procedures can be carried out by Endoscopy (Hysteroscopy/ Laparoscopy) ?
Some procedures, which are routinely carried out are :
- Fertility evaluation and tubal testing ( Diagnostic Hysterolaparoscopy)
- Ovarian Pathology: Cyst, Tumour, PCO drilling, Endometrioma etc.
- Tubal Surgeries: Selective tubal cannulation for blocked tubes, Neosalpingotomy for dilated and blocked tubes, tubal surgery for ectopic pregnancy and tubotubal recanalisation.
- Uterine Pathology : Surgeries for Fibroid , Adenomyoma, Septum.
- Peritoneal diseases : Endometriosis and Adhesions
- Total Laparoscopic Hysterectomy for benign conditions and radical hysterectomies for early malignancies
Procedure Desciption
Diagnostic Hysteroscopy
Hysteroscopy is a procedure where a thin, lighted tube (Endoscope) is inserted inside the uterine cavity through a cervix.
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Endometrial Polyp
Polyps are abnormal growths and projections of endometrial or myometrial tissues inside the uterine cavity giving rise to abnormal bleeding patterns and infertility.
They can be removed under Hysteroscopic guidance with use of graspers or Energy Sources.
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Septum
Due
to defective or improper development of uterus a thick band (Septum)
divides the cavity in two parts. Giving rise to fertility problems or
recurrent pregnancy loss.
It can be corrected (Cut / Released) under Hysteroscopic guidance using electrocautery Energy.
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Diagnostic Laparoscopy
The
laparoscope is inserted through a tiny incision in or near the navel.
Other instruments may be inserted through one or more other tiny
incisions. A video camera is attached to the laparoscope to enlarge and
record the view.
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Ectopic Gestation
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Endometric Spot Fulguration
Pelvic
Endometriosis: It is a condition where there is deposit of endometrial
tissue [lining of the uterus] outside the uterus. It appears as small
black dots “powder burns” seen over the uterosacral ligament or the
pouch of Douglas. There is scarring of peritoneum surrounding the
implants, the peritoneum is puckered and adherent to the back of the
uterus and adenaxae causing painful menses, chronic pelvic pain and
Infertility.
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Chocolate Cyst of Ovary
Chocolate cyst of Ovaries (Ovarian Endometrioma) - It is Endometriosis of ovary leading to collection of chocolate coloured fluid in the ovarian tissue causing their fixity and adhesion formation to surrounding structures. It gives rise to symptoms of Dysmenorrhoea( painful Menses ), Menorrhagia ( Bleeding problems Infertility, Dyspareunia ( Painful Coitus ) and pelvic and abdominal pain.
Laparoscopic treatment for Chocolate cyst of Ovary:
- When the ovarian implant is < 2 cm they can be cauterized /laser ablated or excised.
- When > 2 cm complete Adhesiolysis is followed preferably by the cyst aspiration and cyst wall (capsule) removal to avoid recurrence.
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Pelvic Endometriosis
Endometriosis
may involve surrounding structures like rectum or bladder giving rise
to chronic pelvic pain and pain during urination or defecation or
Sexual intercourse.
These condition requires proper preoperative preparation and extensive dissection of disease under Laparoscopic Guidance.
No Video
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PCO Drilling
Polycystic Ovarian Disease: Condition associated with irregular scanty menses, subfertility, hirsutism and many a times obesity.
One of the treatment option includes Ovarian Drilling where multiple punctures are performed targeting on the ovarian stroma with unipolar coagulation.
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Ovarian Cyst
Ovarian Cyst is abnormal collection of fluid or material in ovarian substance.
Laparoscopy can be performed for drainage, removal or biopsy from such cyst. The material removed is normally sent for Histopathological examination.
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Adhesions
.
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Hydrosalpinx
Abnormal dilatation with clear fluid collection in cases of distal tubal block is known as Hydrosalpinx.
Linear / Cruciate incision Neosalpingostomy is surgical incision on this blocked distal part and creation of new healthy opening with dissection and monopolar energy under Laparoscopic guidance.
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Tubal Recanalisation
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Total / Subtotal Laparoscopic Hysterectomy
Indications :
Why Laparoscopic hysterectomy is better than Abdominal hysterectomy?
- Less blood loss.
- Shorter hospital stay.
- Speedier return to normal activitie.
- Fewer wound infections and febrile illness episodes.
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Genital Prolapse
Abnormal Descent of Genital organs from their usual position.
- Advantages of Laparoscopic Prolapse repair.
- Less blood loss, Shorter hospital stay
- Better tissue visualization and dissection.
- More physiological and compartmentwise repair possible.
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