Synergy Clinic

Hello everybody, I'm dr. Pulkit Nandwani. I'm a consultant gynaecologist & laparoscopic surgeon at Saroj Medical Institute, Rohini. So if you are about to undergo any operation especially total laparoscopy hysterectomy for whatever the indication might be, this video would be very useful for you. Once an operation has been decided, the patient gets really scared because of the unknown factor. What will happen once you admitted in the hospital? What will happen after the operation? How will you go through it? Just knowing the basic details of the hospital and treatment will put you a lot at ease. So on the day when you're supposed to undergo total laparoscopy hysterectomy, you would be asked to come to the hospital for admission usually early morning with empty stomach. We might even ask you to have just a light diet the previous day or even liquid diet the previous day and then not take anything after that from twelve o'clock in the night and come stomach to the hospital in the morning with all your records, all the blood tests, the ultrasound reports, that would have been done previously when the operation would have been decided. Once you admitted in the hospital, a sister will be an incharge of you. You will be given a bed, you will be asked to change your dress, the area where we have to operate would be prepared by doing shaving of hair of that area and then and IV saline IV cannula will be inserted.

Following all the medications, all the glucose, all the IV fluids would be given through this cannula and you will not have any other pain except the cannula pain. After that, an anesthetist will come and have a word with you and have a pre-Anesthesia checkup will be done. Then at the scheduled time you will be shifted in the operation theatre. Once you're in the operation theatre, again through that IV cannula line itself medicines in the form of injections would be given. A mask would be put on your nose and you will be put to sleep. The whole operation which would be undertaken by a team of doctors along with a multitude of workers along with us technician, nurses and anesthetist. The whole procedure will take around one and a half hours to two hours and then post operations once we find that you're stable you would be shifted to the postoperative room where you would be kept there for another three to four hours just for extra monitoring.

Later you'll be shipped out to the room. After the operation, once you wake up you will just have little grogginess, heaviness of the head which would be for the after-effects of the anesthesia. You would not be allowed to eat at that time. All the nutrients for the body will be given By the IV fluids in the form of glucose. All the medicines in the form of injections would be given. There would be a catheter inside the urinary bladder to allow drainage of urine. This catheter we will remove most probably the next day morning itself. So we will start giving you food either in the evening or the next day morning. Liquids will also be started first and gradually the food will be started. You might be asked to get off the bed on that evening.

This is the advantage of a total laparoscopy hysterectomy. The next day you will be kept inside the hospital, but you would be eating properly you would be walking around the hospital just for observation and the amount of injectable antibiotics. You would be kept inside the hospital. The next to next day you will be discharged. We put the dissolvable sutures over that, we put waterproof dressing. So the very next day of the operation and throughout after that you are allowed to take bath, just the vaginal hygiene has to be maintained at home. Heavy weightlifting or bending a lot would be just advisable not to do but other than that routine procedures and home routine activity at home is allowed. For a checkup you will have to come after a week. I hope the video was informative for you and would put you at ease.

I'm Dr. Pulkit Dhanwani and gynecologist and laparoscopic surgeon here at Saroj Medical Institute and if you want to contact me you can contact me by Lybrate or take an appointment at the hospital at Saroj Medical Institute. Thank you.

Hello everybody. I'm Dr Pulkit Nandwani. I'm a consultant gynaecologist and laparoscopic surgeon here at Saroj Medical Institute Rohini. Today, I would like to share some information with you about fibroids.

Fibroids are becoming increasingly common these days. They usually occur in the age group of 30 to 40 years of women but can occur at any age group usually at the age group of 30 to 40years.

Now what are fibroids?

Fibroids are usually noncancerous just an overgrowth of the muscle tissue of the uterus. Fibroids are also called myomas or leiomyomas. Now these fibroids can be located anywhere in the uterus. They can be either in the muscle tissue of the uterus or even in the ovaries or from a stem hanging inside the uterus or out of the wall of the uterus by hanging by a stem. The size and location number of fibroids vary a lot and according to them the symptoms depend.

Now what are the symptoms of fibroids?

The symptoms of fibroids depend on where the situation where the fibroid is located, how big it is and how many numbers of fibroids are located. The symptoms can be they usually cause the change in menstruation. The patient usually experiences heavy bleeding with painful cramping and now instead of monthly bleeds. The bleed may come at irregular intervals and at least twice or thrice in a month. There can be pain during bleeding. Other than the painful bleeding, the fibroid can also result in various symptoms. Because of the size and the weight of the fibroid, it might press on the urinary bladder and the patient might experience frequency of urination even pain during urination. Same if it's at the back of the uterus, it might press on the anus and cause painful deification obtained while passing motions. Because of the heavy bleeding patient might land up with low hemoglobin and having anemia and generalized symptoms of anemia like the fatigue, the weakness, loss of strength, loss of stamina, all these are the  symptoms of fibroids. Just a pain in the lower abdomen can also be the manifestation of fibroid.

Fibroid can also cause infertility. Patient might find difficulty in conceiving or there are chances if the patient conceives if the fibroid is located inside the lining of the uterus it might cause increased chances of miscarriages. There might be abortions then but the good thing is that fibroids rarely cause cancer. It might twist on itself, cause severe pain and but it rarely causes cancer and grows over a period of time. It slowly grows over a period of time, sudden growth is a matter of danger sign.

Now, what are the treatments available for fibroid?

Fibroid if it is asymptomatic the patient is comfortable it was just the routine diagnosis, need not require any treatment at all but usually fibroids cause bleeding problems. So the most common treatment that we employ is starting the patient on medical treatment, a number of hormonal pills come which regulate the hormones inside the body of the uterus and limits the blood flow of the patient and the patient remains comfortable. If medical treatment is either not successful or by the location of the fibroid we already know that medical treatment will not work as in case if the fibroid is coming inside the lining of the uterus. In those cases the fibroid has to be removed surgically for the fibroid is usually done. If it is coming inside the lining of the uterus even if it is very small or a big fibroid is obstructing, the uterus lining causing pressure symptoms. In that case surgery has to be done. Now for surgery also there are two to three types of surgery which can be done.

• If so patient is young, she has to conceive again and family is not completed, we try to remove only the fibroid. It is known as myomectomy.
• If the patient is elderly age family is completed, it caues a lot of problproblemshere are multiple fibroids, in that case, the modality of treatment is a one-stop treatment in which we prefer to remove the whole uterus in which case it is known as hysterectomy.
• Regularly total laparoscopic hysterectomy fully by laparoscopy is done routinely at the hospital at Saroj Medical Institute for fibroids.

So this is much for fibroid for today. If you have any query you can contact me at lybrate. I am Dr. Pulkit Nandwani or you can even take a consultation appointment at Saroj Medical Institute Rohini, Delhi.

Thank you.

Hello everyone, I'm Dr. Pulkit Nandwani. I'm a gynecologist and a laparoscopic surgeon practicing in Rohini Delhi. Today I want to share some information with you about Polycystic Ovary Syndrome.

What is polycystic ovaries?    

These days polycystic ovary syndrome is becoming extremely common. It is increasing in incidence. Nowadays every 2 in 10 women will be having this syndrome. Polycystic ovaries are nothing but ovaries slightly larger in size than the normal looking ovaries. The small cysts form in these ovaries which cause some hormonal disturbances. So having a diagnosis of polycystic ovaries on ultrasound does not mean that you have polycystic ovary in ovarian syndrome. Polycystic ovarian syndrome occurs only when a patient is experiencing symptoms along with an ultrasound diagnosis of polycystic ovaries.

Now what can be the symptoms that occur in polycystic ovarian syndrome?

The symptoms are usually due to the hormonal changes, means that you can either have irregular periods, heavy bleeding or their can be on period at all, then may be increase in body hair increase in facial hair specially and loss of hair on the head. Then their can be weight gain. Patient can become overweight. It can affect the fertility difficulty in conceiving as well as oily skin acne under and also because the polycystic ovarian syndrome. Then their can also be some psychological disturbances. Your patient can experience mood swings and depression. All because of the hormonal changes or polycystic ovaries.

What are the causes of polycystic ovary syndrome?

Cause of polycystic ovarian syndrome is as such not yet known. It is just seen to run in a hereditary fashion. If your mother or elder sister experience problems of this kind you are also likely to have polycystic ovarian syndrome. Now other than these syndrome discussed earlier, you can also experience a lot of long-term consequences on health because of polycystic ovarian syndrome. These patients are more likely for having heart diseases later on in life, very high chances diabetes and blood pressure is there and even higher chances of uterine cancers, developing cancer of the lining of the uterus.

Now how can we reduce the effects of polycystic ovarian syndrome. As such there is no cure for the polycystic ovarian syndrome. We have medical treatment but better than that is to have a healthy lifestyle. Polycystic ovaries respond a lot to just having a healthy lifestyle which includes losing weight. If a patient is overweight, the first advice that we give to the patient is to lose a weight even a minimum weight loss of 3 to 5 kgs makes a drastic decrease in the even appearance of polycystic ovaries and betterment of hormones. So having a healthy lifestyle means eating lots of fruits and vegetables, cutting down on junk food. Losing weight in the form of activity having exercised makes a difference in the treatment itself. Along with that any other medical requirement is that then we have some hormonal tablets which can be started to cure the bleeding problems as well as we start them to help the patient to try to conceive. For the long term effects, just having a healthy lifestyle and having a control on weight having regular checkups with a general practitioner. Having the regular checkups of sugar to rule out diabetes or blood pressure and then annual screening for cancer can reduce the effects of polycystic ovarian syndrome.

Thank you I hope the information was useful for you.

If you have any queries regarding that you can always contact me on lybrate.

Here are symptoms,types and treatment of Hysterectomy

Good morning everybody. I’m Dr. Pulkit Nandwani. I’m a gynecologist and a laparoscopic surgeon I would like to explain to you regarding Hysterectomy. If you have been decided to undergo a hysterectomy by a doctor for whatever reason it can be due to heavy bleeding, if you are having fibroids or there’s any type of cancer. Hysterectomy is usually the mode of answer.

Now understanding the procedure and how to go about it would be less stressful. There are three types of hysterectomy that we usually do.

Three ways of doing a hysterectomy.

• One is the open method which is known as abdominal hysterectomy.
• Secondly it is Vaginal.
• Thirdly it is laparoscopic or the minimally invasive one.

Now in open abdominal hysterectomy we usually give 15 to 20 centimeter cut in the lower part of the abdomen and the bikini line. This cut is throughout inserted in the abdomen and via this cut the uterus is removed to the attachments and uterus is taken out by this cut only. Because of the big amount of cut they might be some pain after this hysterectomy.

Second form is Vaginal Hysterectomy in which there is no incision on the abdomen and usually the uterus is removed via only through the vagina. But this hysterectomy might have some limitations like all the patients cannot undergo a vaginal hysterectomy with very big size uterus, previous multiple surgical. In those patients, vaginal hysterectomy becomes a limitation.

The third is the laparoscopic or the minimally invasive hysterectomy. This hysterectomy is a minimally-invasive one in which the abdomen is not open only three to four small, 5 to 1 centimeter keyhole incisions are made in your abdomen below the navel. Through these small keyhole incisions specialized instruments are inserted and the uterus is dissected from all its attachment via these specialized instruments and throughout the procedure the surgeon is seeing a camera and which with visualizes your internal organs and the whole operation is done. This is known as the uterus is usually moved by the vagina, this is known as minimally invasive total laparoscopic hysterectomy.

There are many advantages of laparoscopic hysterectomy. Because of the small keyhole incisions throughout the surgery the bleeding is very less. The rate of infection is very less. We don’t have to close those incisions much. Postoperatively the pain you experience will be very light as compared to abdominal hysterectomy. Because of less discomfort in the abdomen you’re able to mobilize earlier. You able to walk early and recovery becomes faster. You will able to be discharged early from the hospital and you can even join your job back in a matter of one to two weeks.

Even for a next operation anytime, addition formation in which internal organs get stuck to each other after surgery is minimal following a laparoscopic surgery as compared to an open surgery because our hands do not touch the in organs anytime. There is no addition formation of the organs and they remain as such as if no surgery has been done.

If you want any further clarification on any laparoscopic surgery you can consult be on lybrate by audio or even video conferencing. Thank you.