Firm Hospitals’ Laparoscopic centre is committed to providing excellent and compassionate health care ranging from simple to advanced laparoscopic surgeries. It is well equipped with state of the art technology gadgets to make the procedure simple and safe. Even the complex surgeries like Laparoscopic Surgery for Myomectomy and Laparoscopic Surgery for Fibroid are simplified with the skill and expertise of Dr. Mala Raj. It is to be mentioned that Laparoscopic surgery for myomectomy and the removal of fibroids with laparoscopic surgery for fibroid are the best treatment option for fibroids. The patient can be discharged the very next day even after major surgeries like removal of uterus and removal of fibroids laparoscopically.
Laparoscopy is the term used for surgery in the abdominal cavity using thin, long tubular rod like instruments called Telescope, which are introduced via tiny incisions on the abdomen.
To the end of the Telescope, A camera is attached which allows us to view, magnify and record the image on the monitor. This is called minimally invasive otherwise known as Band-Aid surgery, where very small incisions are made.
For minimally invasive operations on the abdomen, Incisions may be only a half inch long, Compared to four to six inches for Traditional “open abdominal surgery”, which is termed as Laparotomy.
Laparoscopy is a type of surgical procedure that allows a doctor to observe a woman’s uterus, ovaries and a fallopian tube. It is often used to detect ovarian cysts, fibroids, scar tissue, and diagnose pelvic or abdominal pain, endometriosis, ectopic pregnancy or blocked fallopian tubes.
Laparoscopic surgeries are usually done as a day care procedure under general anaesthesia. The viewing tube (called the laparoscope) is equipped with a small camera on the eyepiece and is inserted through a small incision in the naval. The doctor can then examine the abdominal and pelvic organs on a video monitor connected to the tube. Other small incisions can be made to insert instruments to perform a variety of procedures. Laparoscopy is less invasive than regular open abdominal surgery (laparotomy).
Laparoscopy was first used by gynaecologists to diagnose and treat conditions relating to the female reproductive organs: uterus, fallopian tubes and ovaries. It is now used for a wider range of procedures, including operations that in the past required open surgery, such as removal of fibroids, cysts, uterus, tubal pregnancy and to find out the cause of Infertility. Laparoscopy can also be used to examine the appendix, gallbladder or liver.
Dr. Mala is an expert in Total Laparoscopic Hysterectomy which requires great skill and expertise as entire uterus is removed laparoscopically along with suturing which is also done laparoscopically. There are tremendous benefits to the patient by doing an entire surgery laparoscopically compared to hybrid surgery, laparoscopic assisted vaginal hysterectomy where half the surgery is done laparoscopically and remaining half is done vaginally.
During Total Laparoscopic Hysterectomy, we believe in not removing the ovary unless it is diseased, as the ovary produces a hormone called ‘androgen’, even after Hysterectomy, which is important for a normal sexual functioning and for the well being of the woman.
Diagnostic Hystero laparoscopy is a small operation (Procedure) done under anesthesia ( GA ). It is a day care procedure and patients are discharged on the same day. In this operation a laparoscope is introduced into the abdomen, the uterus, tubes, ovaries, pouch of douglas and bowel is visualized. Tubal patency is confirmed by injection of dye. Small corrective operations are also done through laparoscope such as ovarian drilling, adhesiolysis excision of myomas, endometriomas, cauterisation etc. Through hysteroscope the uterine cavity is visualised. Polyps, fibroids, septum etc are diagnosed & treated. Tubal Ostia can be visualized and cornual block can be removed if needed. At the end of hysteroslaparoscopy ,the diagnosis of Infertility is definitely established and a treatment plan is made. It is better to do a hystero laparoscopy in all cases of Infertility before starting any strong treatment.
A Good Diagnostic Hysteroslaparoscopy is the golden standard for basic investigation and treatment in fertility, as it not only helps identify the cause of infertility but also provides a solution to the problem in the same sitting.
Polycystic ovary syndrome (PCOS) is a health problem that can affect a woman’s menstrual cycle, ability to have children, hormones, heart, blood vessels, and appearance. With PCOS, women typically have: 1. High levels of androgens. These are sometimes called male hormones, although females also make them. 2. Missed or irregular periods. 3. Many small cysts in their ovaries and they are fluid-filled sacs. One of the ways of treating this disease is Laparoscopic Ovarian Drilling. “Ovarian drilling” is a surgery that brings on ovulation. It is done when a woman does not respond to fertility medicines. Patients of PCOD are taken up for surgery after strict pre-operative diagnostic work-ups that include ultrasound, blood test for FSH, LH, TSH, PRL and DHEAS. When a patient satisfies all the above investigation, the first line of management is diet advice, weight reduction, increase physical activity. For medical management, clomiphene citrate is used. Insulin sensitizers, metformin etc are used as basic outlay. In PCOS hyper insulinemia occurs as a result of insulin insensitivity which is treated with metformin. After a fair trial of medical management and if the patient still does not become pregnant, patients are then taken up for laparoscopic ovarian drilling. Most of the women will ovulate the very next month after PCOD drilling and are able to achieve pregnancy within 3-6 months of the surgery.
Myomectomy is the surgical removal of fibroids from the uterus. It allows the uterus to be left in place and for some women makes pregnancy more likely than before. Myomas (Fibroids) are one of the most common benign tumors. 25% of women over the age of 35 have myomas. Majority of myomas (Fibroids) are asymptomatic. The most common indicators for treatment are
1) Menorrhagia (Heavy bleeding)
2) Pelvic pain
3) Pressure on adjacent organs
5) Habitual Abortion.
Researches indicate that Laparoscopic surgery for myomectomy is the best treatment option for fibroids. Majority of these fibroids can be removed by our exclusive laparoscopic surgery for fibroid. Even in women above 40 years of age, who desire to keep their uterus – laparoscopic myomectomy surgery can be performed and uterus can be retained from removal.
Ovarian cyst can be removed by laparoscopic cystecomy. Before performing the procedure, the nature of the cyst is to be evaluated by doing an ultrasound of the abdomen,pelvis and blood test for CA125. During the procedure whatever is the size of cyst they can be removed laparoscopically by placing the cyst in an endobag. The patient can go home on the same day. Even huge cysts like Dermoid Cyst can be removed laparoscopically without spilling the content by placing in the Endo bag thereby saving the ovary.
For women who have already undergone permanent sterilization by cutting the tubes. Laparoscopic Tubal Recanalisation (Tuboplasty) can be done by joining the tubes back and the woman can still achieve pregnancy. But there are a small percentage of women developing ectopic pregnancy after tuboplasty which need to be kept in mind
In women who have weak Pelvic Floor or who develop vault prolapse after open Hysterectomy. They can be treated laparoscopically by placing a mesh and by fixing the vault to the sacral promontory (bony pelvis)