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Anam
Thank you so much for your attention, time and consideration to my presented problem. It is so very nice of you to take your time to respond to those of us in need. I find it truly amazing that you give such individual attention.i was facing my problem of endometriosis since 2 yrs bt pragnesh sir give me right guideline and staff of this hospital is very good and good concern
Babita
I found the answers provided by the Dr. Pragnesh Shah to be very helpful. Sir My weight is 96 and height 5'4 . If i reduce weight. This problem will be cured sir. I m very tensed .
Ganga Patil
I found the answers provided by the Dr. Pragnesh Shah to be very helpful, helped me improve my health, inspiring, caring and knowledgeable. Dear Sir ,i really Thankful.
Hina Siddiqui
I found the answers provided by the Dr. Pragnesh Shah to be very helpful, knowledgeable, well-reasoned and helped me improve my health. Thanks a lot!
Anusha
I found the answers provided by the Dr. Pragnesh Shah to be very helpful and knowledgeable. Thank u
Urvashi Patel
Dr. Pragnesh Shah provides answers that are very helpful. need to know how it will get cured
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Diagnostic laparoscopy is a surgical process for examining different kinds of organs present in the abdomen. It is a low-risk and minimally invasive process in which just a small incision is made. This allows the doctor to evaluate the conditions of your abdominal organs without opting for an open surgery.
It is mostly performed when the patient complains of pain in the pelvic region and when other assessing methods have failed to detect the reason behind the pain and discomfort.
The laparoscope is a slim and well-lit telescope that allows your doctor to evaluate the conditions of various organs in your body. It can help in determining whether there is any instance of fibroid or endometriosis. It can help in performing a variety of surgeries like removal of ovarian cysts, hysterectomy and tubal ligation. This surgery involves much lesser healing time compared to other elaborate surgeries.
Why should you go for laparoscopy?
Your gynaecologist may recommend you to get a laparoscopy for a treatment or for diagnosis. It is mostly performed due to unexplained pelvic ache, infertility and a history of pelvic infection. Laparoscopy is also performed for the diagnosis of conditions such as uterine fibroids, ovarian cysts, endometriosis, pelvic pus or abscess, ectopic pregnancy, painful scar, inflammatory disease in the pelvic region and reproductive cancers.
How to prepare for gynaecological laparoscopy?
Your gynaecologist would ask you to prepare for the laparoscopy test on the basis of the type of surgery. Your doctor would ask you about the medication you take, which would include health supplements and over-the-counter medications and in certain cases you may have to stop certain medications. This process is performed under anaesthesia and you would be able to go home on the same day. The following process depends on the type of process.
The diagnosis process is completed faster than the surgical process in which an incision is required to be made. The instrument would be inserted through the incision and then the surgery is executed by inserting the laparoscope tool. Once the process is completed, all the tools are removed from the body and the incision would be closed with stitches and the affected area would be bandaged.
In recent times, the laparoscopic process has advanced to a great extent and robotic surgery is often used for performing the surgical process. This is because it has been proven that robotic hands are steadier than human hands and can perform fine manipulations effortlessly.
Laparoscopy is one of the most common procedures for diagnosing and removing endometriosis. Instead of giving a big incision, this procedure of surgery uses lightweight instrument through a small hole or incision. There could be one or more incisions based on the number of instruments that require access inside the body.
This procedure involves the use of a camera to ascertain endometriosis as well as treat it in the same sitting. This brings drastic improvement in infertility as well as pain associated with the endometriosis. If a cyst is found in the ovary, laparoscopic surgeon removes it very delicately without causing any harm to the normal ovary, as a part of the Laparoscopic Surgery for Endometriosis.
How does the procedure go?
Eating and drinking should be suspended before 8 hours of the laparoscopic surgery. The doctor takes a call on whether to give a general or local anesthesia. Mostly, General anaesthesia is given during such procedures. A person specialised in Gynecological Endoscopy ( Gynaec Laparoscopic Surgeon) is the best to perform such a procedure.
How is the procedure performed?
The abdomen is first inflated with gas with the help of a needle. It pushes the abdominal wall from the organs to give a clear visibility to a surgeon. The laparoscopic Camera is then pushed through an incision or a set of incisions to examine the internal organ. If the scar tissue or endometriosis needs to be removed, a doctor can use one of the several laparoscopic techniques such as electrocautery, excision etc. Post the surgery, the incision is closed with stitches. The whole procedure usually takes 30-60 minutes depending upon the severity of endometriosis.
Why is laparoscopy done?
- If the endometriosis pain has returned after a hormone therapy
- If there is a growing endometriotic cyst
- If the scar tissue found on the pelvic wall poses a threat on fertility
- If the endometriosis interferes with other organs such as the bladder etc.
- If the pain during menses ( dysmenorrhoea) refuses to subside
Duration of hospital stay:
Operations such as these are usually conducted at the outpatient facility owing to their less risky nature. A patient need not spent more than a day in the hospital. Rarely in severe cases of endometriosis overnight hospitalisation may also be required. One can successfully return to normal work within 1 week of the surgery.
Post-surgical recovery: Once the laparoscopy is done, the next steps of treatment are decided based on the patient's age and severity of endometriosis. Few hormonal medicines are advised according to the desire for fertility etc. If a patient is over and above 35 years of age, the risk of miscarriages double. Since the quality of egg declines by the year, it makes sense to undergo infertility treatment such as the in vitro fertilization (IVF), intake of fertility drugs, insemination etc.
If, however, the patient is below 35 years of age, makes sense to conceive naturally first and consult a doctor simultaneously. A routine check-up post-laparoscopic surgery on alternate six months for a year will keep any risks at bay.
It is very common for women to have heavy and painful periods or have a feeling of fullness in the lower abdomen. Although, it may not sound very alarming these could be the symptoms of uterine fibroids. These are the most common types of benign tumours found in women. The fibroids are basically some tissues and muscle cells that grow within the uterus, outside the uterus, or along the wall of the uterus. The fibroids are usually benign and asymptomatic and do not require any treatment unless they cause problems.
Know the causes
Though the exact cause of fibroid formation is not known, it is believed that the female hormones estrogen and progesterone have a role to play in their formation. Fibroids are formed only when a woman is producing these hormones and they are not seen in women in non-reproductive age i.e. before starting of menses or after stoppage of menses (menopause). If fibroids are persisting even after menopause or especially if increasing in size then it is an alarming sign. Such a fibroid needs to be taken care of immediately.
Fibroids often remain quiet for long periods of time. They cause nonspecific symptoms in the pelvis and abdomen including:
- Fullness in the abdomen
- Low back pain
- Irregular menstruation
- Cramping with menstruation
- Painful sex
- Increased urgency to urinate
- Anemia, leading to tiredness and weakness
- Infertility Diagnosing the fibroids
When these symptoms are recurrent, it is good to confirm the diagnosis. This can happen with a pelvic exam followed by ultrasound scanning to confirm the size and location of the fibroids. A blood test also may be done to confirm anemia, which is common due to heavy periods.
Treatment Options
Management of fibroids can range from doing nothing to periodic monitoring to surgical removal.
- If pain and heavy bleeding are the only symptoms, then pain killers like ibuprofen should suffice for symptomatic relief. Anemia, if severe, may require iron supplementation.
- Embolization is an option which shrinks the fibroid, at the same time preserving the uterus. The blood flow to the fibroid is cut off, thereby preventing its further growth. It takes about 1 to 3 hours and requires some bed rest after the procedure. There could be some pelvic pain and vaginal bleeding, which will gradually subside. The fibroids may grow back, but the benefits of keeping the uterus are definitely there. This is suitable in case of single fibroid with specific blood supply.
- The next surgical option is myomectomy, where the portion of the uterus which contains the fibroid alone is removed. This is done in women who still wish to get pregnant and in women who would like to retain the uterus. This can also be achieved laparoscopically( key hole surgery). In such cases, fibroids are cut into small pieces and then removed from the body. This procedure should be done by a doctor specialised in advanced gynecological endoscopy as all this cutting should be done in a bag to avoid any spillage of cells inside the abdominal cavity. This procedure is known as Laparoscopic Myomectomy with In-bag Moecellation.
- In women who have crossed their pregnancy phase, hysterectomy or complete removal of the uterus is advised. In these women, the bleeding and pain may not have subsided even after years of treatment with hormones. The growing fibroids could be pressing on the adjacent organs, causing pressure. This is the only definitive treatment and should be done in women have completed their family and don’t desire to be pregnant.
- Myomectomy and hysterectomy may be done laparoscopically or with an open method depending on the overall health, the size and location of the fibroids in the uterus.
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:
- Shorter Hospital stay.
- Earlier return to your routine work.
- Cosmetically vary small scar.
- Less pain after operation.
- Best fertility enhancement & Fertility results following Laparoscopy.
- Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
- 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:
- Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.); Pelvic Trance vaginal USG report, UPT OR S.B-hCG
- Operation planned before vital data deteriorates.
- 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:
- Shorter Hospital stay,
- Earlier return to your routine work,
- Cosmetically vary small scar,
- Less pain after operation,
- Best fertility enhancement & Fertility results following Laparoscopy,
- Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
- 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:
- Primary Infertility
- Secondary Infertility
- Investigating & treating a case of B.O.H.
- Investigating & treating Abnormal bleeding P/V
- 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:
- Shorter Hospital stay.
- Earlier return to your routine work.
- Cosmetically no scar on abdomen.
- Less pain after operation.
- Best fertility enhancement & Fertility results following hysteroscopy
- Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
- Patient discharged within 2-4 hours after procedure.
- Patient can resume to her normal routine work within 12-24 hours after the procedure.
Pre-operative Check Lists:
- Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.Etc.); Pelvic Trance vaginal USG report.
- Specific Investigations for Infertility (Endocrine, Blood, Genetic, Husband’s Semen report etc. If The couple is infertile)
- Operation planned from 4th to 10th day of Menstrual Cycle.
- Preparation of local parts.
- 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.
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!