Q1. What exactly is Laparoscopy?
Laparoscopy is an alternative to 'Open' surgery wherein the abdomen is opened by tiny 'key hole' incisions and surgery is done. 'Scopy' means the use of an endoscope or telescope to see inside the abdomen. This is attached to a camera and a light source and the inside of the abdomen is projected on to a monitor. The surgeon performs surgery looking at this screen. The surgeon makes a total of 2-4 small cuts on the abdomen ranging from half to 1 cm through which the telescope and other thin surgical instruments are passed into the abdomen. When the uterus is removed , known as hysterectomy, there is also a cut at the top of the vagina where the uterus is attached.
Q2. What kind of gynaecological surgeries can be performed by Laparoscopy?
Most surgeries done in gynaecology can now be performed by Laparoscopy and do not require the large incision as for open surgery. Laparoscopy can be done sometimes only for diagnosis and is called Diagnostic Laparoscopy, as in checking whether the tubes are open or not and to look for any causes of infertility or pain outside the uterus. In women who are unable to conceive, Diagnostic Laparoscopy is often combined with Hysteroscopy (endoscope inside the uterus, inserted from below, via the vagina). When laparoscopy is done to perform some surgical procedure inside the abdomen it is called Operative Laparoscopy. This may be for simple procedures like sterilization, minor adhesions, drilling ovaries; or for intermediate or major reasons like fibroids, endometriosis, removal of ovaries or tubes or both or removal of uterus, for staging of cancers or radical surgeries for cancer. However, about 5% of all surgeries including those for cancer or very large tumours may benefit from open surgery.
Q3. Why does an expert surgeon recommend Laparoscopy over Open Surgery?
Laparoscopic surgery has many advantages above open surgery: the incisions are much smaller (open surgery incisions are 8-10 cms long), therefore pain is much less; requirement for pain killers (which can have side-effects like sleepiness, impaired judgement) is lesser; hospital stay is shorter; complications fewer; requirement for blood transfusions infrequent; recovery in terms of physical, emotional and mental state is much better and quicker; return to work is faster with consequent lesser loss of working and earning days. Surgery with laparoscope is more precise because it is magnified view. Further vision is much better because it's like having your eye behind the structure because you can see with the telescope at places where the surgeon's eye cannot reach.
Q4. If the cuts on the abdomen are so small in Laparoscopic surgery, how do you remove the uterus or a large tumour from inside the abdomen?
Quite often if the tumour is not malignant and contains fluid, it is punctured to collapse it into a smaller size. If it is solid, it can be cut into smaller pieces inside the abdomen using a special instrument. The collapsed or cut structures can be removed gently through the 1 cm cut on the abdomen which may be increased a bit if required. After hysterectomy, the uterus can be removed easily from below, through the vagina.
Q5. Will there be much pain or discomfort after Laparoscopic Surgery?
There may be some pain and discomfort in lower abdomen for one day to few days after Laparoscopic surgery but this is much less as compared to open surgery because the incisions on the abdomen are much smaller and there is much less tissue handling inside the abdomen by fine instruments instead of rough, big, gloved hands which can cause tissue injury in open surgery. There may be some pain in the shoulder following laparoscopy. This is not serious and is due to the gas used in the surgery to make space for instruments.
Q6. When can I be discharged from hospital?
Following Diagnostic Laparoscopy or with simple Operative Laparoscopy you can expect to be discharged from hospital latest by the morning after surgery. In most other cases of intermediate or even major surgery, discharge is generally 1-2 days following the surgery unless there is some health issues prior to the surgery or any complication during the surgery. The complication rates for Laparoscopic surgery are not more than for open surgery and depend upon patient factors like anaemia, diabetes, obesity and skill of the surgeon.
Q7. When can I perform routine household activities or return to work after Laparoscopic Surgery?
Recovery after surgery depends upon many factors: presence of health problems before surgery; why the surgery is required; what surgery is being done; problems or complications of surgery, anaesthesia or blood transfusions. If all is well, one can perform routine household activities by 1 week, provided one doesn't feel tired. Although there may not be any harm, it may be unwise to be normally active within 48 hours of procedure. Following Diagnostic Laparoscopy or Operative Laparoscopy for simple procedures, one can return to work in 1 week. For other procedures, a 2-3 week off from work is reasonable. It depends on the type of work you are returning to. Avoid too rapid return to work if it is manually hard or requires standing for long durations of time. Sometimes a surgical procedure brings on a well needed rest and break from a lifetime of work. Mostly, when you return to work depends upon your own body and its signals of tiredness. You need to listen to those signals.


Know All About Gynae Laparoscopy Surgery

Polycystic ovarian syndrome or PCOS is a condition in which a woman experiences fluctuation of hormone levels, estrogen, and progesterone which causes cysts in her ovaries, dysfunctional menstrual cycle, cardiac problem, fertility and changes in appearance. Hormones are chemical messengers that can trigger a number of issues in the body. Long term problems due to PCOS can be avoided with an early diagnosis and a proper treatment.

Causes
- Genetics and hormonal imbalance have been identified as the main causes of PCOS although the exact reason has not been discovered.
- Overproduction of androgen, a male hormone in a woman can cause small lumps in the ovaries, irregular development of eggs and abnormal insulin level.

Symptoms
The severity of the symptoms depends on the constitution of the person but the most common one is irregular periods. PCOS occurs when there is a decrease in sex hormones which can lead to the development of certain male features like:

- Deeper voice
- Growth of hair on face, toes, stomach, chest and back
- Reduction in breast size
- Loss and thinning of hair

There are other symptoms as well which can help one to determine the syndrome including:
- Oily skin leading to acne
- Irregular egg formation causing fertility problems and miscarriages
- Depression, anxiety and mood swings
- Hyperinsulinemia, that refers to the presence of too much insulin in the body which can cause obesity
- Difficulty in breathing while sleeping

The severity of the symptoms varies but if you are experiencing any of these problems, it is advisable to seek a professional consultation. A healthy lifestyle, regular exercise, nutritious diets are some of the preventive measures you can take. There are hormone regulating medicines and treatments that attempt to curb the condition but there is no permanent cure.

What is Polycystic Ovarian Syndrome?

What is the ovary and what are ovarian cysts?  

Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary. Women have two ovaries - each about the size and shape of an almond - located on each side of the uterus. Eggs (ova) develop and mature in the ovaries and are released in monthly cycles during your childbearing years.

Many women have ovarian cysts at some time during their lives. Most ovarian cysts present little or no discomfort and are harmless. The majority of ovarian cysts disappear without treatment within a few months.

However, ovarian cysts - especially those that have ruptured - sometimes produce serious symptoms. The best ways to protect your health are to know the symptoms that may signal a more significant problem, and to schedule regular pelvic examinations.

What causes ovarian cysts?
Most ovarian cysts start during the normal function of your menstrual cycle. These are known as functional cysts. Other types of cysts are much less common.

Functional cysts

Your ovaries normally grow cyst-like structures called follicles each month. Follicles produce the hormones estrogen and progesterone and release an egg when you ovulate. Sometimes a normal monthly follicle just keeps growing. When that happens, it becomes known as a functional cyst. There are two types of functional cysts:

Follicular cyst. Around the midpoint of your menstrual cycle, an egg bursts out of its follicle and begins its journey down the fallopian tube in search of sperm and fertilization. A follicular cyst begins when something goes wrong and the follicle doesn't rupture or release its egg. Instead it grows and turns into a cyst.
Corpus luteum cyst. When a follicle does release its egg, the ruptured follicle begins producing large quantities of estrogen and progesterone in preparation for conception. This changed follicle is now called the corpus luteum. Sometimes, however, the escape opening of the egg seals off and fluid accumulates inside the follicle, causing the corpus luteum to expand into a cyst.
The fertility drug clomiphene (Clomid, Serophene), which is used to induce ovulation, increases the risk of a corpus luteum cyst developing after ovulation. These cysts don't prevent or threaten a resulting pregnancy.

Functional cysts are usually harmless, rarely cause pain, and often disappear on their own within two or three menstrual cycles.

Other cysts

Some types of cysts are not related to the normal function of your menstrual cycle. These cysts include:

Dermoid cysts. These cysts may contain tissue such as hair, skin or teeth because they form from cells that produce human eggs. They are rarely cancerous.
Cystadenomas. These cysts develop from ovarian tissue and may be filled with a watery liquid or a mucous material.
Endometriomas. These cysts develop as a result of endometriosis, a condition in which uterine endometrial cells grow outside your uterus. Some of that tissue may attach to your ovary and form a growth.
Dermoid cysts and cystadenomas can become large, causing the ovary to move out of its usual position in the pelvis. This increases the chance of painful twisting of your ovary, called ovarian torsion.

 SYMPTOMS:

Menstrual irregularities
Pelvic pain - a constant or intermittent dull ache that may radiate to your lower back and thighs
Pelvic pain shortly before your period begins or just before it ends
Pelvic pain during intercourse (dyspareunia)
Pain during bowel movements or pressure on your bowels
Nausea, vomiting or breast tenderness similar to that experienced during pregnancy
Fullness or heaviness in your abdomen
Pressure on your rectum or bladder that causes a need to urinate more frequently or difficulty emptying your bladder completely.

Ovarian Cysts - Knowing The Types & Symptoms!

Why do you get PCOS?

Polycystic ovarian syndrome is the condition when a woman's sex hormone levels get imbalanced. This can cause women to have irregular periods and may also have an impact on their fertility. Women suffering from PCOS also tend to grow small cysts in their ovaries which can also lead to severe health problems like diabetes and heart disease, if left untreated.

What causes PCOS?

The exact cause of PCOS is not known. However, the condition may be triggered by hormonal imbalances and genetic factors. Women are more susceptible to developing this condition if their mother or a female family member also has the condition. Excessive production of androgen, which is a male sex hormone, may also lead to this condition. Women suffering from PCOS tend to have high levels of androgen. The formation of eggs and their release during ovulation can be delayed by high levels of androgen. High androgen levels may result from excess insulin present in the blood. Poor lifestyle and irregular eating habits contribute to obesity which intern leads to increased insulin resistance and hence delayed ovulation and irregular cycles leading to infertility.

What are the symptoms of PCOS?


The type of symptom in case of PCOS varies from person to person. Since PCOS is characterized by low levels of sex hormones, this condition may lead to symptoms such as:

- Excessive hair growth on stomach, face, chest, toes and thumbs
- The breast size starts to shrink
- There is a change in voice, making it deeper
- There is excessive loss of hair from your scalp
- Sometimes the face is filled with acne and the skin turns oily
- There are fertility problems like having trouble in ovulating or recurring miscarriages
- Frequent depression or mood swings
- Facing breathings problems while sleeping
- Obesity

Why do you get PCOS?

Why every 1 in 5 Women in India suffers from PCOS? (And what they need to know)

Polycystic ovarian syndrome (PCOS) is a medical condition related to a woman’s endocrine system. Generally, this disorder is characterised by an imbalance of the sex hormones (oestrogen and progesterone), which leads to the development of multiple small cysts in the ovaries. Symptoms of PCOS include acne, irregular menstrual cycle and depression to name a few.
The causes of PCOS have not been accurately identified so far, but researchers suggest that the following factors might contribute to the onset of the condition.

1. Increased amount of insulin secretion- Women suffering from insulin resistance may get PCOS as their body is not able to effectively use this insulin, which results in increased insulin secretion by the pancreas. This, in turn, triggers more androgen (male sex hormone) production in the ovaries, making it difficult for the ovaries to ovulate.

2. Lower inflammation levels- The white blood cells present in your body form resistance against infections through a response termed as inflammation. Women with lower inflammation levels are likelier to get PCOS as the decreased levels stimulate polycystic ovaries, thereby producing more androgens.

3. Genetic factor-  If you have a family history of PCOS, it’s highly probable that you may also get it as the disease is linked with your genes.

How To  Live with PCOS

PCOS comes with numerous side effects like acne, obesity, infertility, excessive facial or body hair among others. There are certain lifestyle changes, which you may consider to manage PCOS and minimise its side effects.

1. Change your diet - Opt for a low carbohydrate, low sugar diet to keep your insulin levels in control, as insulin is responsible for increasing the severity of PCOS symptoms. 

2. Try to maintain an ideal body weight - Obesity is known for worsening insulin resistance, and you can prevent this by regularly keeping your weight in check. You can practice some easy at-home exercise to reduce weight besides having a balanced diet.

3. Get yourself checked regularly - Visit a doctor and get yourself checked regularly for potential health risks as PCOS is often associated with increased chances of diabetes, heart diseases, certain forms of cancer, hypertension, and high LDL (bad) cholesterol levels.

4. Join a support group - Joining a PCOS support group will help you cope with your emotional difficulties, while helping you to live a better life by cultivating an optimistic outlook.

If you would like to consult with me privately, please click on 'Consult'.

Every 1 in 5 Women in India suffers from PCOS! Why? (And what they need to know)

Ovarian cancer takes place when the cells in either of your ovaries have an abnormal growth. The ovaries are two small organs, situated on either side of your uterus. They deliver female sex hormones and store and discharge eggs (ova) that help a woman reproduce. Ovarian cancer is a serious disease that emerges from various sorts of cells and growths inside the ovary.

Specialists do not know precisely what causes ovarian cancer. Hereditary qualities, for example and other DNA changes, are a danger element for few ladies. Around 10 out of 100 ovarian cancers are thought to be brought about by quality transformations in the BRCA1 or BRCA2 genes. Women who go through changes due to these carrier genes are more at risk of contracting ovarian cancer.

The earliest symptoms of ovarian cancer are as follows

    Frequent bloating in the uterus or stomach area.
    Pain in your pelvis or belly.
    Inconvenience while eating, or feeling full quickly.
    Urinary issues, for example, a critical need to urinate or urinating more frequently than expected.


Treatment options for ovarian cancer

The decision of treatment and the long-term result for ladies who have ovarian cancer relies upon the sort and phase of cancer they are in. Your age, general wellbeing, personal satisfaction, and wish to get pregnant should be considered. The primary treatment methods for ovarian cancer are:

    Surgery to see whether you have cancer or not and to treat it. This may include taking an ultrasound and biopsies to check for the spread of cancer.
    Chemotherapy, which uses medications to kill the cancerous cells. It is suggested after surgery for most phases of ovarian cancer.
    Women who are in a more progressive stage of ovarian cancer may have a portion of their chemotherapy before surgery and whatever is left of it after surgery. This can make the surgery more secure for these women.
    Radiation treatment might be utilized to pulverize the cancer cells with the help of high-measurement X-ray beams or other high-vitality beams.

Side Effects of Treatment Methods:

Most medications for ovarian cancer cause reactions. They may vary, depending upon the kind of treatment, your age and general well-being. Reactions of surgery rely on the degree of your surgery and spread of the disease. In case your specialist removes your ovaries, you lose the capacity to bear children or get pregnant. Furthermore, in case you were all the while bleeding before your surgery, you will begin with your menopause.

Symptoms of chemotherapy may incorporate loss of appetite and weight, queasiness, fatigue, vomiting, nausea and hair loss. There is also a possibility of getting a very serious infection. One should get regular or annual check-ups done to see if there are anomalies in either parts of the bodies since natural symptoms of cancer are only visible after a certain stage. 

Ovarian Cancer - 4 Highly Effective Treatment Options Available

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