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

Ovarian cysts and fertility: Is there a connection?

Having a child is one of the most profound experiences in a woman s life. The joy of being a mother and welcoming a new life is unparalleled. In the midst of such expectation, an inability to conceive can take a serious toll on any woman s health. The mental scars from such an event can never be obliterated.

This does not mean you should give up. Consult a doctor to find the cause and rectify it. With advances in medical science and technologies like IVF in the market, no fertility challenge is insurmountable.

One of the most common cause of infertility is ovarian cysts. According to research conducted by the American Society For Reproductive Medicine, ovarian cysts resulting in ovulation abnormality and infertility has been recorded among 25% of women.

There are two types of cysts that are produced as byproducts of ovulation-

1. Follicular Cysts which does not break open to release the eggs. Rather the follicle stays as a whole while the cyst continues to grow.

2. Corpus Cysts or luteal cysts is a condition when after the egg has bronek free, the follicles seal itself rather than shrinking and the fluid builds up inside.

Causes-

Ovarian cysts are mainly caused due to hormonal imbalance, abnormal cell growth where the cells overgrow and develop into cysts, pelvic infections that spread to the ovaries and fallopian tubes and causes severe harm to them, and endometriosis when the tissue attaches to an ovary and forms cell growth.

Which ovarian cyst affects fertility?

Ovarian cysts that generate complications during pregnancy include-

1. Endometriomas - This is the condition when the tissues lining your uterus or endometrium grows outside the uterus or the fallopian tubes and is largely associated with fertility problems. Endometriomas can differ in sizes from the range of less than an inch to over 6 inches. They are filled with dark coloured blood.

Some studies have demonstrated that women suffering from mild endometriosis develop a lower (2%-4%) chance of getting pregnant each month when compared to women who are healthy and have a 15%-20% chance. Another research states that 40% of unexplained infertility results from endometriosis through anatomical distortion or inflammation.

2. Polycystic Ovary Syndrome - PCOS is the condition where small cysts form inside your ovaries which prompts irregular periods, excessive stomach cramps and large hormonal imbalance. Connected to immature ovaries, they do not assist in ovulation and thus produces complications infertility. The immature follicles with an immature egg cause the ovary to be politic.

This chronic lack of ovulation also alters the hormonal levels in your body that assists in ovulation. Women with PCOS develop high levels of androgen or male hormones in your body, which gets converted to estrogen. As a result, they do not ovulate.

Does the treatment of ovarian cysts also affect fertility?

This usually depends on the kind of treatment you receive. Hormonal birth control doesn t have a long-term effect on fertility. Although surgeries can invariably damage some healthy eggs inside your body, the doctors recommend that the ovaries be removed before you have more complications. However, in both the situations, the egg count in your body decreases significantly.

Ovarian Cysts & Fertility - Is There A Connection?

Feeling acidic after eating a heavy meal can often make you regret those last few morsels. This acidic sensation is known as acid reflux or Gastroesophageal reflux disease, better known as GERD. GERD occurs when the functioning of the lower oesophagus muscles is restricted. This makes the undigested food in the stomach and stomach acids leak back into the oesophagus. 

Thankfully, this is not something you have to live with and a few simple lifestyle changes can help resolve the situation.

Do not lie down after eating: When your body is in a horizontal position, there are higher chances of food being regurgitated into the oesophagus. To avoid this, finish your meals at least 3 hours before going to bed. Sit upright while eating and do not lie down or slouch immediately after eating. This gives the food time to be digested and move out of the stomach.
Limit your food intake: Overeating is one of the most common triggers of GERD. Cutting down your portion sizes can instantly reduce the number of GERD occurrences. Instead of eating large, heavy meals, shorten the duration between meals and have more frequent small meals.
Avoid foods that trigger acidity: With time, you will soon realise which types of foods trigger an acidic reaction. Some common triggers are onions, peppermint, caffeine, citrus fruits etc. Keeping a diary can help identify such foods and ease your problem.
Quit Smoking: Nicotine not only harms your lungs, but can affect your digestive system as well. It is responsible for weakening the muscles that control the opening between the stomach and oesophagus. This allows stomach acids and food from the stomach to re-enter the oesophagus. Alcohol can also worsen GERD symptoms and hence it is better to avoid alcohol is you suffer from frequent bouts of acid reflux.
Lose weight: Overeating, obesity and acid reflux go hand in hand. Being overweight can put extra pressure on your stomach and abdomen, thus pushing food and gastric juices into the oesophagus. Losing this extra weight should effectively resolve your acid reflux problem if you are overweight.
Look at your medications: Some types of medication too can cause acid reflux by interfering with the digestive system and irritating the oesophagus. These types of medication include blood pressure medication, asthma medication, Non-steroidal anti-inflammatory drugs, bisphosphonates, sedatives and painkillers. Do not simply stop taking these medications, but talk to your doctor about replacing them with something else.

GERD - 6 Ways You Can Manage It!

What menstrual problems are to women, prostate problems are to men. The prostate is a gland in the lower abdomen that aids in the production of semen. The prostate is walnut sized in a young man, but can get enlarged with age. As it grows bigger, it can cause a number of problems. These are commonly seen after a man celebrates his 50th birthday.

There are three common prostate problems faced by men. Some of the symptoms that can tell if a man has a prostate problem are:

1. Difficulty faced while urinating
2. The urge to urinate frequently at night
3. Constant feeling of a full bladder
4. Pain while urinating
5. Blood in the urine

Prostatitis

This can be defined as inflammation of the prostate gland. In most cases the cause of this inflammation is unknown. However, there are two types of prostatitis; bacterial and nonbacterial. While the former reacts well to antibiotics, the latter is more difficult to control. Symptoms of this disease vary from one person to the next. Some of the factors that could trigger this disease are:

1. Chemical irritants
2. Past bacterial infection
3. Dysfunctional pelvic floor muscles
4. Sexual abuse
5. Chronic anxiety

Enlarged prostate

As mentioned earlier, as men get older, the prostate gland tends to grow in size. This growth is benign, but can block the bladder neck and prostatic urethra. This can cause problems urinating and lead to acute urinary retention. This can be very painful. Inserting a catheter can provide temporary relief and help release stored urine. Chronic retention is much less common and is associated with high bladder pressure and can damage the kidneys.

Prostate cancer

Advancing age and family genetic history are said to be the main triggers of prostate cancer. This type of cancer can remain restricted to the prostate gland in its early stages but may spread to the other glands as the cancer advances. This can also cause the growth of secondary tumors in the bones.

The only way to correctly diagnose a prostate problem is with a thorough physical examination. This includes a digital rectal exam where the doctor will insert a gloved finger into your rectum to check the size of your prostate, a blood test, mid stream urine tests and ultrasounds. In some cases a biopsy of the prostate may also be required. Depending on the diagnosis, your doctor may prescribe antibiotics, surgery, radiotherapy or hormone therapy to manage your prostate.

Are You at Risk of a Prostate Disease?

Ovarian cysts are common and most women will have at least one during their life. In most cases they do not display any symptoms and are discovered only during routine physical exams and ultrasounds. In most cases, it is nothing to worry about but in rare cases it can lead to complications and hence it is best to get an ovarian cysts checked out by a doctor.

Ovarian cysts usually affect women in their child bearing years. They can be described as fluid-filled sacs that develop in either of the ovaries. In an ultrasound image, these can look like small bubbles. Problems usually arise when these cysts grow larger or rupture. 

In such cases, you may experience symptoms that include:

Pain in the lower abdomen
Painful intercourse
Irregular menstruation
Painful urination and bowel movement
Pelvic pain after exercising
Nausea and vomiting
Bloating
Spotting between periods
Heartburn and indigestion
If the doctor suspects ovarian cysts, an ultrasound is usually used to confirm the diagnosis. A pelvic ultrasound or a sonograph as it is also known is a non-invasive imaging technique that uses high-frequency sound waves to produce images of the body s internal structure. In some cases, an endovaginal ultrasound may also be required. This involves inserting a covered wand or probe into the vagina through which a clearer image of the ovaries can be seen.

If the cyst does not trigger any of the above symptoms, it usually does not require treatment. Instead a pelvic ultrasound may be scheduled after a month to check on the size of the cyst. In most cases, these cysts resolve themselves within a month or two. In the case of larger cysts, a biopsy may be required to rule out the chances of the cysts being cancerous. Birth control pills may be prescribed to address the pain associated with this condition. These pills are also used to stop ovulation and reduce the risk of developing further cysts.

Surgery is considered only if the cyst grows in size or continues to pain. In such cases, surgery can be of two kinds: laparoscopy or laparotomy. Laparoscopy involves the removal of cysts through a telescope like an instrument that is inserted through a small incision made in the abdomen. This is usually used to remove small cysts. Larger cysts and ovarian tumours are treated with a laparotomy. This involves making a bigger incision in the stomach and may also involve the removal of the ovaries, fallopian tubes and uterus depending on the tumour. 

Ovarian Cysts - 9 Symptoms About It!

Gall bladder is a very important digestive gland, which is located on the right side of your abdomen, just beneath your liver. Its main function is to collect, store and release bile, a digestive fluid produced in your liver, essential for metabolizing fats, into your small intestine.

Sometimes, small hard stones comprising of cholesterol, bile pigments and calcium salts in the shape of a pebble, can form in your gall bladder. Gallstones may cause no symptoms but when the gallstone lodges in ducts and blocks the flow of bile, it can cause persistent high-intensity pain which requires gallstone surgery.

Surgery is then prescribed to remove the gall bladder. This surgery is called cholecystectomy. It s done when there are

Gallstones in the gallbladder
Gallstones in the bile duct
Gallbladder inflammation
Inflammation in pancreas
Gallstone surgery or cholecystectomy is a common surgery, and it comes with only a small risk of complications and you can walk out of the hospital on the day of the surgery itself.

Procedure

Minimally invasive or laparoscopic cholecystectomy
During this procedure, the surgeon makes 4 tiny incisions in your abdomen and inserts a tube with a tiny video camera inside it.
Through a video monitor, the surgeon watches while he inserts surgical tools through the other 3 incisions to remove your gallbladder.
After the surgery, the surgeon confirms that there are no gallstones left. Once this is done, he sutures your incisions and you are taken to the recovery area. A laparoscopic cholecystectomy takes just 2 hours or so.
But the problem with this procedure is that it  not appropriate for everyone. Sometimes, what happens is that, the surgeon may start with a laparoscopic surgery and then may decide to go for an open gallstone surgery because of scar tissue or complications.
Traditional or open cholecystectomy
This procedure requires a bigger incision of about 6-inches in your abdomen, below your ribs on the right side. The liver and gallbladder are exposed and the surgeon removes the gallbladder.
An open cholecystectomy takes one or two hours.
Single-incision Laparoscopy Surgery

Traditional laparoscopic surgeries use a telescopic rod attached to a video camera called a laparoscope, which is inserted through a small incision. Apart from this, 3 to 5 additional small cuts are made to insert the other surgical instruments to perform the surgery.

However, single-incision laparoscopy surgery (SILS) is a revolutionary minimally invasive surgical procedure conducted through a single incision. It provides a better cosmetic outcome, as a small incision is made through the patient s navel or belly button, resulting in an almost scarless outcome.

Indications

Most patients who are good candidates for laparoscopic surgery are eligible for single-port procedures. Some of the surgeries that single incision laparoscopy is indicated for include cholecystectomy (removal of gall bladder), appendectomy (removal of appendix), splenectomy (removal of spleen), hepatectomy (removal of liver) and adrenalectomy (removal of adrenal glands). SILS can also be used for diagnostic purposes.

However, patients who have previously undergone multiple major surgeries to the abdominal region and those who are morbidly obese are not considered for SILS.

Procedure

Single Incision Laparoscopy is usually performed as day surgery either in the hospital or outpatient surgery center under general, regional, or occasionally local anesthesia depending on the type of procedure performed and the surgeon s preference.

The patient is made to lie down in a tilted position so that the feet are placed higher than the head. The surgeon makes a single incision of about 3/4th of an inch at the belly button and injects a harmless gas to expand the area and obtain a clear view of the operative site. A tube called a trocar or port is placed through the incision, through which the laparoscope (a narrow telescope having a light source and camera) and tiny surgical instruments are inserted. The laparoscope guides your surgeon with images of the abdominal contents that can be viewed on a large screen. Once the diseased organ is excised, your surgeon removes the instruments, releases the gas, and closes the incision with a small bandage.

Recovery

Common post-operative guidelines following Single Incision laparoscopy include the following:

You will need someone to drive you home after you are released as the anesthesia may make you feel groggy and tired
Do not remove the dressing over the incision for the first two days and keep the area clean and dry.  No showering or bathing during this time.  The incision usually heals in about 5 days
Your surgeon may give you activity restrictions such as no heavy lifting. It is very important that you follow your surgeon s instructions for a successful recovery
You may feel soreness around the incision area. Your surgeon may give you a prescription pain medicine or recommend NSAID s (non-steroidal anti-inflammatory drugs) for the first few days to keep you comfortable
If the abdomen was distended with gas, you may experience discomfort in the abdomen, chest, or shoulder area for a couple days while the excess gas is being absorbed
Diet

You must be very careful with your diet after gallstone removal as your body will not be able to digest fats well. You will of course be sticking to a liquid diet for a week or two and then introduce solids back into your diet. When you do so, you have to stick to a low fat diet. Stay off fried foods and gas-forming foods. Also make sure that you consume no more than 60 gm of fats per meal to avoid discomfort. Stay off spicy foods to avoid bloats and abdominal pains.

Gallbladder Surgery - Aftercare Tips To Help You Recover Better!

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