:: Dr. Bibek Mohan Rakshit ::

Laparoscopic surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5 1.5 cm) as compared to larger incisions needed in traditional surgical procedures.

Keyhole surgery uses images displayed on TV monitors for magnification of the surgical elements.
Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.

There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include reduced pain due to smaller incisions and hemorrhaging, and shorter recovery time.

The key element in laparoscopic surgery is the use of a laparoscope. There are two types: (1) a telescopic rod lens system, that is usually connected to a video camera (single chip or three chip), or (2) a digital laparoscope where the charge-coupled device is placed at the end of the laparoscope, eliminating the rod lens system. Also attached is a fiber optic cable system connected to a 'cold' light source (halogen or xenon), to illuminate the operative field, inserted through a 5 mm or 10 mm cannula or trocar to view the operative field. The abdomen is usually insufflated, or essentially blown up like a balloon, with carbon dioxide gas. This elevates the abdominal wall above the internal organs like a dome to create a working and viewing space. CO2 is used because it is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures.

What is Laparoscopy?
Laparoscopy is a process by which the inside of your tummy (abdomen) can been seen with the help of a telescope. Uterus, Ovary, Fallopian Tube, Appendix, Liver, Gall Bladder etc. are clearly visualized.

Method:
Mostly, in all cases, the patient is given general anesthesia. A needle is passed through the naval & the tummy is filled up with Carbon di Oxide gas. At the same place, a cut of about ½ “ broad is made to insert a telescope with a video camera which brings the picture of the organs on the television screen. If necessary a cut can be made at other place through which instruments can be inserted. At the end of the examination, the gas is let out from the abdomen & the cut is stitched from within.

In every case of infertility & women with bleeding problem, Hysteroscopy to see the inside of the womb (uterus) is also done at the same time.

Some Reasons why Laparoscopy is done:
Laparoscopy gives us a glorified & magnified picture of organs inside the tummy. We can therefore diagnose the diseases like tumors, Endometriosis, Adhesions, Infections & pregnancy in the tube etc. If necessary biopsy can also be taken. For childlessness, this test is superior to other investigating methods. The condition of the tubes, ovaries & uterus & ovulation can be detected as well. The cause of your infertility can be identified & therefore proper designing of the treatment can be chalked out.

Going Home:
You’ll go home after 8 hours of the operation. Rarely overnight stay is required. There is no need to cut the stitches. You can have bath removing the band aid after 48 hours.

Some post-operative problems:
Pain may occur in the shoulders or abdomen. Feeling of uneasiness due to left out gas in the abdomen & a little blood discharge below. These problems usually disappear within 2 – 3 days.

Back to activity:
You can go back to normal life & join work after 2 – 3 days. There is no restriction for any sort of household work. You can perform coitus after a week if no other difficulty arises.

Laparoscopy, a surgical technique where a small camera, usually between 5 and 10 mm (less than ½ inch), is inserted into a patient’s abdomen for the purpose of the visualization of the pelvic and abdominal anatomy, diagnosis of a disease condition, and treatment of such condition by a minimally invasive approach. Several small incisions (less than ¼ inch) are made in the bikini line for the introduction of laparoscopic instruments, such as laparoscopic scissors, scalpel, etc.

Multiple gynecologic procedures and surgeries that are routinely done by an open technique can be potentially done by laparoscope, including:

There are a number of advantages to the patient with laparoscopic surgery versus an open procedure:

Laparoscopic and minimally invasive surgery has become the mainstream in operating rooms across India. The field of gynecologic surgery is clearly not an exception, as minimally invasive gynecology has gained enormous momentum within the specialty.
Advances in computer technology and laparoscopic instruments have allowed us to offer a minimally invasive approach to a much broader range of patients. The field of gynecologic surgery is proudly included in this medical and surgical marvel.
As of today, many procedures can be successfully done by a minimally invasive approach in most patients including:

Treatment of abnormal uterine bleeding and hysteroscopy (the visualization of the inside of the uterus), myomectomy (removal of uterine myomas), cervical stenosis, and sacrocolpopexy (treatment of the prolapse of the vagina) and treatment of pelvic pain are among his areas of expertise.

• LAPAROSCOPIC HYSTERECTOMY:
Hysterectomy, the surgical removal of the uterus, is a recommended intervention in variety of gynecologic conditions, including:

These are just a few of many conditions that might require a hysterectomy.

Typically, depending on whether the condition is benign (such as fibroids or pain) or malignant (such as cancer), either a total hysterectomy with the removal of the body of the uterus together with the cervix, or subtotal/partial hysterectomy (the cervix is left behind) is performed. Removal of the ovaries at the time of hysterectomy is very controversial topic and should be discussed individually in every case.
In the past, the only available option for hysterectomy was an open abdominal surgery.

The incision would be made in either “bikini” or up-and-down fashion, the uterus would be removed, and abdomen closed in multiple layers with sutures and staples.

Typically, a woman would spend 5 to 7 days in the hospital with several months of recovery at home. In addition, the surgery would leave a large scar on the abdomen.

With the advent of better optics and laparoscopic instruments, the era of laparoscopic hysterectomy came to age. Utilizing magnified surgical field and available electrosurgical and ultrasonic instruments, the removal of the uterus is achieved through several (usually 3 to 4) ½ to ¼ inch incisions. Minimal blood loss and fast recovery time are the major advantages of laparoscopic hysterectomy, not to mention excellent cosmetic results. Most women go home either the same or next day and fully on their feet within a week or two.

Laparoscopic adnexal surgery is a minimally invasive procedure done on the ovary, fallopian tube, or ovarian cysts.

Reasons for the procedure:
Different circumstances sometimes make it necessary remove one or both ovaries or the fallopian tube such as:

Presacral Neurectomy is the surgical removal of the presacral plexus – the group of nerves that conducts the pain signal from the uterus to the brain. Indicated for the treatment of central pelvic pain including severe dysmennorrhea

Laparoscopic Presacral Neurectomy (LPSN) is the same procedure done by a minimally invasive method. It is a surgical approach in patients with central dysmenorrheal (painful periods), adenomyosis, and endometriosis.

• How the procedure is done
Done through a small umbilical and bikini line incisions, LPSN is carried out by removing the nerve fibers that innervate the uterus, thus blocking the pathways for pain impulses to the brain. LPSN does not cure the pelvic pain that is lateral, which is related to the ovarian or other pelvic sidewall structures.
When performed correctly and in the appropriately chosen patient, the complications PSN are minimal and sometimes include constipation, urinary symptoms, or painless labor.

• About Central Pelvic Pain
Central pelvic pain (CPP) is reported in about 20 percent of menstruating females. Chronic pelvic pain refers to menstrual or non-menstrual pain of at least six months’ duration.
Dysmenorrhea, one of the most frequently reported gynecological problems, is characterized by sharp, intermittent spasms. Symptoms of headache, nausea, vomiting, diarrhea and fatigue are also present. Pain typically begins before or at the onset of menses.
The prevalence of the disorder is highest in adolescents with estimates ranging from 20–90 percent.
Risk factors for the disorder include nulliparity, heavy menstrual flow, smoking, and depression. Medical therapy for dysmenorrhea includes NSAIDs (such as Motrin) and/or oral contraceptives. Approximately 10–25% of women with dysmenorrhea do not respond to medical management and may require surgical intervention, such as presacral neurectomy.
Strict selection of patients and adherence to the established protocol are the requirements for the successful presacral neurectomy (PSN), leading to the reported cure rates between 65 and 80 percent.