Jyoti Hospital & Minimum Invasive Surgery Center

Pregnancy in the abnormal place like Fallopian tube is defined as Tubal Ectopic Pregnancy.

Indication: 
Performed for pain in lower abdomen with H/o amenorrhea and Bleeding P/v and TVUSG showing tender adnexal mass or when medical treatment fails for ectopic.

Objective:
More than 90% cases of Ectopic pregnancy cases are now treated by Laparoscopy all over the world. Important pre-requisite for Laparoscopic management is – Patient should be haemodynamically stable. Ruptured Ectopic pregnancy should be treated by salpingectomy, as in subsequent pregnancy chances of repeat Ectopic will be more with Salpingostomy. Goal should be diagnosing Ectopic pregnancy in its asymptomatic -unruptured stage so that we can offer medical treatment with Methotraxate or Laparoscopic Salpingostomy or Tubal milking for preservation of affected tube. Recording the surgery helps another doctor for the decision of Salpingostomy/Salpingectomy during past surgery. Procedure takes hardly 30 minutes & patient can be discharged on the same day like Lap.T.L. 

Benefits of Laparoscopy Surgery:

1. Shorter Hospital stay.
2. Earlier return to your routine work.
3. Cosmetically vary small scar.
4. Less pain after operation.
5. Best fertility enhancement & Fertility results following Laparoscopy.
6. Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
7. The possibility of post-operative adhesion formation will be less, and the possibility of pain because of post-operative adhesions will also be less.  

Pre-operative Check Lists:

1. Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.); Pelvic Trance vaginal USG report, UPT OR S.B-hCG
2. Operation planned before vital data deteriorates.
3. Preparation/shaving of local parts.

No. Of Cuts on Abdomen:
Three cuts: all of 5 mm size.

Average Stay in Hospital:
4 to 6 hours. (DAY CARE SURGERY)

Average Duration of Surgery:
20-30 minutes

Average Blood loss during Surgery:
Bloodless and 50 to 500 cc if ruptured Ectopic with free blood in the abdomen.

Average time after operation to resume normal activities/work:
Within 24 hours. Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal ectopic laparoscopy procedure takes about 15 to 30 minutes only. For chronic ectopic it may take 1-2 hours. Most begin feeling much better within one day. 

Anesthesia:
General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery) 

Operative Procedure:

Inside the Umbilicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside. 

Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made inside the navel, and another two are usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen, which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

Blood from the abdomen is suctioned with suction irrigation cannula. Affected Ectopic tube is desiccated with bipolar desiccation & cut & removed. For Salpingostomy anti-mesenteric border is cut after pitressin injection in mesosalpinx and ectopic sac delivered gently with suction & irrigation cannula. Haemostasis achieved by compression with atraumatic grasper. Copious irrigation is necessary to prevent post-operative adhesions.

Post-operative Course:

Patient remains drowsy/sedated for 4-5 hours after laparoscopy but conscious & pain free. Patient can take fluids 5-6 hours after laparoscopy & light food after 6-8 hours. She may feel little abdominal & shoulder pain after laparoscopy for 24 hours but it cam be relived with pain killer tabs. Most of the patients can walk normally without support and can take normal diet 6-8 hours after the laparoscopy. She can be discharged on the same day of the operation. Few patients may feel nausea & vomiting after laparoscopy, which can be very well controlled with injection in post-operative room. Patient can do her normal activity within 24 hours after laparoscopy. Patient is advised to take antibiotics & analgesic tabs. For 5 days following laparoscopy. Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately. Patient is advised to come for follow up 7 days after the Laparoscopy for dressing.

Patient’s parent’s visits to us when their daughter does not menstruate after the age of 15-17 years of age for her fertility concern & for planning surgery before her marriage. This operation is advised for Phenotype female i.e. normal secondary sexual characters & Genotype XX.

Objective:

In-patient with absent uterus is evaluated for associated renal malformations by USG & SOS IVP. As compared to commonly practiced method (skin graft from thigh & putting on neo vagina) patient’s on peritoneum is utilized for covering neo-vagina for Vaginoplasty. Vaginal space is dissected in usual way from below and laparoscopic access helps in avoiding injury to bladder & rectal injury.  This technique gives two cms wide vagina & 8-10 cms long vagina and good quality of sexual function and patient discharged on the next day with minimum postoperative care. This surgery requires lot of experience & expertise.

Benefits of Laparoscopy Surgery:

1. Shorter Hospital stay,
2. Earlier return to your routine work,
3. Cosmetically vary small scar,
4. Less pain after operation,
5. Best fertility enhancement & Fertility results following Laparoscopy,
6. Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
7. The possibility of post-operative adhesion formation will be less, and the possibility of pain because of post-operative adhesions will also be less.  

The special advantages with our technique are:

• • Next day discharge,
  • No plastic surgery for skin graft so no post-operative dressings,
  • User friendly post-operative care by patient by using vaginal stent every night following operation till she starts actual sexual relation with her husband 6 weeks after laparoscopic Vaginoplasty.

Pre-operative Check Lists:

• Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.); Pelvic Trance vaginal USG report for renal malformation.
• Operation planned at about 1.5 to 2 months prior to her proposed Marriage.
• Enema & preparation/shaving of local parts.

No. Of Cuts on Abdomen:
Three cuts: all of 5 mm size.

Average Stay in Hospital:
24 hours. 

Average Duration of Surgery:
40-60 minutes

Average Blood loss during Surgery:
10-30 cc

Average time after operation to resume normal activities/work:
Within 24 hours.

Anesthesia:
General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery)

Operative Procedure:

Inside the Umbilicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside. 

Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made inside the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen, which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

Vaginal space is dissected in usual way after putting Folly’s catheter in urethra and rectal probe in rectum by 3 cms long incision at labia minora.  Laparoscopic light & pnumo helps during vaginal dissection. Peritoneum is cathched with two artery forceps, opened from below under laparoscopic guidance and edges of the catched peritoneum is circumferentially mobilized down till we can take tension free stitch with dissected & pulled peritoneum & labia minora by few No1/0 Vicryl figure of ‘8” stiches. Then vagina is closed with mop to prevent leakage of pneumoperitoneum from below and laparoscopically neo fornices are created at the level of pelvic brim by purse string stitches taken to close vaginal upper end with No-1 Vicryl stitch & approximating with extra corporeal knot. This technique gives two cms wide vagina & 8-10 cms long vagina and good quality of sexual function and patient discharged on the next day & with minimum requirement of postoperative care.

Post-operative Course:

• Patient remains drowsy/sedated for 2-3 hours after laparoscopy but conscious & pain free.
• Patient can take fluids 3-4 hours after laparoscopy & light food after 4-6 hours.
• She may feel little abdominal & shoulder pain after laparoscopy for 24 hours but it cam be relived with pain killer tabs.
• Most of the patients can walk normally without support and can take normal diet 6-8 hours after the laparoscopy.
• She can be discharged on the same day of the operation.
• Few patients may feel nausea & vomiting after laparoscopy, which can be very well controlled with injection in post-operative room.
• Folly’s catheter is removed on next day.
• Patient is advised to prepare vaginal stent from 10/20 cc syringe with gauze pieces applied around it and then condom is applied on it and then xylocaine jelly with soframycin applied on stent –which is advised to put the same in vagina gently every night, till she starts actual sexual relation 45 days after operation.
• Patient can do her normal activity within 24 hours after laparoscopy. Patient is advised to take antibiotics & analgesic tabs. for 5 days following laparoscopy.
• Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately.
• Patient is advised to come for follow up 7 days after the Laparoscopy for dressing.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Indications:

1. Primary Infertility
2. Secondary Infertility
3. Investigating & treating a case of B.O.H.
4. Investigating & treating Abnormal bleeding P/V
5. Investigating & treating case of mass inside the uterine cavity

Objective:

Hysteroscopy is the commonest type of work up in the entire Infertility patient along with Diagnostic Laparoscopy. Only diagnostic hysteroscopy is the commonest work up recommended before IVF. We record Hysteroscopy diagnostic & operative procedure for future important record in Infertility patient, for second opinion & for deciding future treatment protocol. 

Benefits of Hysteroscopy Surgery:

1. Shorter Hospital stay.
2. Earlier return to your routine work.
3. Cosmetically no scar on abdomen.
4. Less pain after operation.
5. Best fertility enhancement & Fertility results following hysteroscopy
6. Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
7. Patient discharged within 2-4 hours after procedure.
8. Patient can resume to her normal routine work within 12-24 hours after the procedure.

Pre-operative Check Lists:

1. Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.Etc.); Pelvic Trance vaginal USG report.
2. Specific Investigations for Infertility (Endocrine, Blood, Genetic, Husband’s Semen report etc. If The couple is infertile)
3. Operation planned from 4th to 10th day of Menstrual Cycle.
4. Preparation of local parts.
5. No. Of Cuts on Abdomen: Nil 

Average Stay in Hospital:
2 to 4 hours. (DAY CARE SURGERY)

Average Duration of Surgery:
2 to 10 minutes

Average Blood loss during Surgery:
Negligible

Average time after operation to resume normal activities/work:
Within 12-24 hours.

Anesthesia:

General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery)Procedure:Patient is given general anesthesia. Patient is put on lithotomy position. Local parts cleaning & paintings with antiseptic solution & draping are done. After P/V examination cervix is checked with uterine sound. For Diagnostic hysteroscopy after removing the air, hysteroscopy (varsascope/1.9 mm/ 2.9 mm Hysteroscopy along with irrigation of Normal saline is introduced inside the cavity. Systemically both corneal openings, cavity, both lateral walls and anterior & posterior wall of the uterine wall is noticed for any lesions or normalcy. For operative/therapeutic hysteroscopy cervix is dilated up to 7mm / 10 mm for introduction of Operating hysteroscopic sheath or resectoscope for operative hysteroscopy. Hysteroscopy requires dilatation of the uterine cavity to create working space inside the uterine cavity and flushes both fallopian tubes with high pressure fluid helps in achieving very good fertility enhancing results following Hysteroscopy in infertility patients. Addressing all the infertility related lesions like broad septum from the fundus, intra-uterine adhesions, polyps or tubal cannulation helps us in treating infertility patients in the same sitting
                        
Post-operative Course:

Patient remains drowsy/sedated for 1-2 hours after hysteroscopy but conscious & pain free. Patient can take fluids 1-2 hours after hysteroscopy & light food after 2-4 hours. She may feel little discomfort after hysteroscopy for 6-8 hours but it can be relieved with pain killer tabs. Most of the patients can walk normally without support and can take normal diet 6-8 hours after the hysteroscopy. She can be discharged on the same day of the operation. Few patients may feel nausea & vomiting after hysteroscopy, which can be very well controlled with injection in post-operative room. Patient can do her normal activity within 12-24 hours after hysteroscopy. Patient is advised to take antibiotics & analgesic tabs for 5 days following hysteroscopy. Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately. Patient is advised to come for follow up 7 days after the next period or on the day for IVF protocol & preparation for IVF. In case you have a concern or query you can always consult an expert & get answers to your questions!