General & Laparoscopy

Laparoscopy means:

When an operation is done for viewing inside the abdomen
through a telescope, is called “Laparoscopy”. When Laparoscope is attached with CCD camera and connected with Monitor – is called as Video laparoscopy.
When it is done for diagnosis is called “Diagnostic Laparoscopy” and
When it is done for therapeutic purpose it is called as “Operative Laparoscopy”
Surgeries Performed with Laparoscopy:

• (1) Diagnostic Laparoscopy & Hysteroscopy :

  » Performed for Primary & secondary Infertility & B.O.H.

  » Diagnostic Laparoscopy & Hysteroscopy is the commonest type of work up in the entire Infertility patient. Single puncture Laparoscopy was replaced by double puncture Laparoscopy in most of the centers of the world. We must record both Laparoscopy & Hysteroscopy for future important record in Infertility patient, for second opinion & for deciding future treatment protocol. Observing free spill with methyline blue from both fallopian tubes is not enough/complete work up during laparoscopy. We must see on both ovarian fosses after lifting the tubes for the possibilities of Endometriosis. We must see for Tuberculosis, Endometriosis & PID in all the cases. Hysteroscopy requires dilatation of the cervix and flushes both fallopian tubes with high pressure fluid helps in achieving very good fertility enhancing results following Endoscopy in infertility patients. Addressing all the infertility related lesions like PCOD, Endometriosis, Adhesiolysis, Fibroid etc. helps us in treating infertility patients in the same sitting.

  » Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

  » Performing laparoscopy usually only requires two tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

  » Many patients undergo laparoscopy as an outpatient procedure, returning home within 4 to 6 hours of surgery. For normal laparoscopy procedure takes about 5 to 10 minutes only. Most begin feeling much better within one day.

• (2) PCOD Drilling & Hysteroscopy:

  » Performed for Primary & secondary Infertility & B.O.H.

  » Patient present to us with Obesity, hirsutisium, irregular/delayed cycles, anovulation & Infertility. TVUSG shows peripherally placed multiple follicles with hyperthicosis of stroma & large ovaries. PCOD drilling is indicated in Clomiphen resistant PCOD, where weight reduction & metformin had been tried sufficiently (for six months) in the past. As compared to Gonadotrophin (pure FSH), PCOD drilling had following advantages : 60-70% Ovulation rate, 40-50% Pregnancy rate, reduced abortion & OHSS following drilling, reduced requirement of CC.HMG/FSH/hCG following drilling. Effect of drilling lasts for nine months. According to the size of ovary 4 to 8 punctures should be made on both ovaries. One must understand the difference between Cystic ovary & PCOD.

  » Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

  » Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

  » Many patients undergo laparoscopy as an outpatient procedure, returning home within 4 to 6 hours of surgery. For normal laparoscopy procedure takes about 10 to 15 minutes only. Most begin feeling much better within one day.

• (3) Endometriosis- Bilateral Chocolate cyst

  » Performed for Infertility or pain in lower abdomen during menstrual period and painful sexual relations.

  » Dysmenorrohea, Dysparenunia & pelvic pain & Infertility are the presenting symptoms. Endometriosis is the commonest cause of Infertility during Laparoscopy. Pigmented & white fibrotic lesions are the two different varieties of lesions. Endometriosis is poorly detected during laparoscopy leads to more than 2-3 laparoscopy of infertility patient without result. Endometriosis needs to better address during laparoscopy, as residual diseases leads to recurrence & Infertility. Lot of awareness needs to be generated among Gynecologists for its identification during Laparoscopy, right treatment & documentation during surgery, proper post operative aggressive fertility treatment within nine months as it may reoccur after nine months & follow up. Most rewarding results were achieved following laparoscopic surgery with pregnancy rate from 50 to 70% in different series in mild, moderate to severe Endometriosis.Cystectomy should be preffered over simple drainage for preventing reoccurrence. But if we feel that cystectomy dissection is too difficult & likely to destroy many normal ovarian follicles, we should do drainage & bipolar fulguration of internal surface of chocolate cyst. Rectovaginal endometriosis is not touched most of the time during laparoscopy. We need to learn, identify the right cleavage & proper dissection of recto-vaginal nodule for her pain relief. With increased awareness will find out more & more incidences of Endometriosis during Diagnostic laparoscopy.

  » Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

  » Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

  » Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 25 to 75 minutes only. For advanced Endometriosis it may take 1-2 hours. Most begin feeling much better within one day.

• (4) Endometriosis – Rectovaginal diseases

  » Performed for Infertility or severe pain in lower abdomen during menstrual period and painful sexual relations or pain during defecation during period.

  » Dysmenorrohea, Dysparenunia & pelvic pain & Pain during defecation and Infertility are the presenting symptoms. Endometriosis is the commonest cause of Infertility during Laparoscopy. Pigmented & white fibrotic lesions are the two different varieties of lesions. Endometriosis is poorly detected during laparoscopy leads to more than 2-3 laparoscopy of infertility patient without result. Endometriosis needs to better address during laparoscopy, as residual diseases leads to recurrence & Infertility. Lot of awareness needs to be generated among Gynecologists for its identification during Laparoscopy, right treatment & documentation during surgery, proper post operative aggressive fertility treatment within nine months as it may reoccur after nine months & follow up. Most rewarding results were achieved following laparoscopic surgery with pregnancy rate from 50 to 70% in different series in mild, moderate to severe Endometriosis.Cystectomy should be preffered over simple drainage for preventing reoccurrence. But if we feel that cystotomy dissection is too difficult & likely to destroy many normal ovarian follicles, we should do drainage & bipolar fulguration of internal surface of chocolate cyst. Rectovaginal endometriosis is not touched most of the time during laparoscopy. We need to learn, identify the right cleavage & proper dissection of recto-vaginal nodule for her pain relief. With increased awareness will find out more & more incidences of Endometriosis during Diagnostic laparoscopy.

  » Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

  » Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

  » Many patients undergo laparoscopy as Day care procedure, returning home within 24-48 hours of surgery. For normal laparoscopy procedure takes about 25 to 75 minutes only. For advanced Endometriosis it may take 1-2 hours. Most begin feeling much better within one day.

• (5) Ectopic Pregnancy

  » Performed for pain in lower abdomen with H/o amenorrhea and Bleeding P/v and TVUSG showing tender adnexal mass.

  » More than 90% cases of Ectopic pregnancy cases are now treated by Laparoscopy all over the world. Important pre-requisite for laparoscopic management is – Patient should be haemodynamically stable. Ruptured Ectopic should be treated by salpingectomy as in subsequent pregnancy chances of repeat Ectopic will be more. Goal should be diagnosing Ectopic pregnancy in its asymptomatic/ enraptured stage so we can offer medical treatment with Methotraxate or Salpingostomy or Tubal milking for preservation of affected tube. Copious irrigation is necessary to prevent post-operative adhesions. Recording the surgery helps another consultant for the decision of Salpingostomy/Salpingectomy during past surgery. Procedure takes hardly 30 minutes & patient can be discharged on the same day like Lap.T.L.

  » Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

  » Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

  » Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 15 to 35 minutes only. For chronic ectopic it may take 1-2 hours. Most begin feeling much better within one day.

• (6) Dremoid Cyst :

  » Performed for pain in lower abdomen in P/v examination and TVUSG showing adnexal mass or in Infertility patient.

  » Young patient (14-20 yrs) presents to us for pain or torsion and pain. Diagnosis suspected from USG findings. Dremoid Cystectomy can be tackled by various dissection techniques very easily with preserving normal ovarian tissue after Cystectomy. Dremoid cyst can be retrieved in Endobag without spillage or with minimal spillage through posterior pouch. In cases of post-hysterectomy bilateral salpingo-oopherectomy is done.

  » Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

  » Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

  » Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 15 to 35 minutes only. For more complicated case it may take 1-2 hours. Most begin feeling much better within one day.

• (7) Lap. Mymectomy (Fibroid) :

  » Performed for Infertility, Menorrhagia, pain in lower abdomen, in P/v examination and TVUSG showing adnexal mass.

  » Fibroid less than 5 cms may be asymptomatic, may not be required to be removed. Fibroid with Menorrhagia, Dysmenorrohea, pressure symptoms, Infertility required to be removed. Expert TVUSG with Color Doppler should be done to exclude Adenomyosis.Patient must be counseled for the possibility of adenomyosis before fibroid surgery. Fibroid mapping should be done before surgery to access during them during surgery. Sub mucus fibroid is approached hysteroscopically. Video helps in conveying the quality of Mymectomy we have done, especially adequate laparoscopic suturing helps us about scar integrity and safety in next pregnancy after Mymectomy. Adequate homeostasis & copious irrigation with ringer lactate helps in preventing post-operative adhesions. This surgery requires lot of experience & expertise. Patient can be discharged on the same day.

  » Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

  » Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

  » Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 35 to 55 minutes only. For more complicated case it may take 1-2 hours. Most begin feeling much better within one day.

• (8) Laparoscopic Tubal Reversal (Anastomosis) :

  » In event of accidental death of child in family seeks for this operation.

  » This surgery requires lot of experience & expertise. Three chip camera & very good set up like special Needle holders and specially designed micro-instruments are must to achieve good results. Reversal of Laparoscopic Tubal Ligation gives better results compared to Abdominal Tubal Ligation operation. Patient can be discharged within 24 hours with excellent results.

  » Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

  » Performing laparoscopy usually only requires 3-5 tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

  » Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 2-3 hours. For more complicated case it may take 3-4 hours. Most begin feeling much better within one day.

• (9) Laparoscopic Burch’s for S.U.I.

  » Patient presents to us for distressing symptom - passing of urine on coughing or straining/laughing/weight lifting. Pre-operative assessment should be done to understand hyper mobility of mid-urethra & U-V junction and Detrusal instability should be excluded before operation.

  » Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

  » Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed.

  » Space of Retzius is dissected easily till both cooper’s ligament is seen well. Mid-urethra & U-V junction dissected after elevating from below by assistant. Non-absorbable suture stitch is taken from mid-urethra & from U-V junction to Cooper’s ligament. Preoperative counseling is necessary for entire procedure & possible post-operative results. Laparoscopic approach has advantage of treating posterior & mid compartment defects repair simultaneously. This surgery requires lot of experience & expertise. Burch’s procedure gives better result than Kelly’s plication & needle suspension procedures. Cystoscopy is necessary to rule out possible bladder injury. Patient can be offered TVT or TOT as optional treatment as it is very easy and effective.

  » Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

  » Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 55 to 75 minutes only. For more complicated case it may take 1-2 hours. Most begin feeling much better within 2-3 days.

• (10) Laparoscopic T.O.Mass

  » Performed for pain in lower abdomen, in P/v examination and TVUSG showing adnexal mass or sometimes in Infertility patient.

  » T.O.Mass present to us for pain or as mass in abdomen or chance finding during USG. All ovarian cyst cases must be evaluated for benign & malignancy by clinical means, USG with color & power Doppler and tumor markers. In doubt frozen facility should be kept available during laparoscopy & patient is counseled for omentectomy & Para-aortic lymph node dissection if frozen shows positive malignancy. Cystectomy for simple cyst, para-ovarian cyst.

  » Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

  » Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

  » Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 15 to 35 minutes only. For more complicated case it may take 1 hour. Most begin feeling much better within one day.

• (11) Laparoscopic Adhesiolysis

  » Performed for pain in lower abdomen.

  » PID, Tuberculosis, Endometriosis & past surgeries are the commonest causes of adhesions around pelvic genital organs. Tubercles with intestinal adhesions & adhesions all over abdomen & around liver- one should suspect Abdominal Tuberculosis. Here we must give adequate AKT before attempting Adhesiolysis. Aim of Adhesiolysis during diagnostic laparoscopy is to establish tubo-ovarian relationship. Post laparotomy adhesions are found in 20-70% of cases following various Gynecological surgeries leading to subsequent abdominal wall adhesions & posy operative pain requiring laparoscopic Adhesiolysis. Fact may inspire all patients to ask primary surgeon for not offering initial Gynaec surgery by Laparoscopic approach. Adhesiolysis is the most rewarding surgery in pain relief.

  » Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

  » Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

  » Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 15 to 35 minutes only. For more complicated case it may take 1-2 hour. Most begin feeling much better within one day.

• (12) Laparoscopic Vaginoplasty

  » Patient’s parents visits to us when their daughter does not menstruate after the age of 15-17 years of age for her fertility concern before marriage. In patient with absent uterus is evaluated for associated renal malformations.

  » As compared to usual method (skin graft from thigh) patient’s on peritoneum is utilized for Vaginoplasty. Vaginal space is dissected in usual way after putting Folly’s catheter in urethra and rectal probe in rectum. Laparoscopic light & pnumo helps during dissection. Peritoneum is cathched with artery forcep, opened from below under laparoscopic guidance and circumferentially mobilized down till we can take tension free stitch with labia minora. Then vagina is closed with mop to prevent leakage of pneumoperitoneum and at the level of pelvic brim purse string stitches are taken to close vaginal upper end with No-1 vicryl stitch & approximating with extra corporeal stitch. This technique gives two cms wide vagina & 8-10 cms long vagina and good quality of sexual function and patient discharged on the next day & with minimum requirement of postoperative care. This surgery requires lot of experience & expertise.

  » Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

  » Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

  » Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 15 to 35 minutes only. For more complicated case it may take 1 hour. Most begin feeling much better within one day.

• (13) Laparoscopic Vault (prolapse) Repair

  » Performed for pain in lower abdomen or Patient presents to us for something coming per vaginum after the removal of uterus being done in the past along with urinary problem or problem in passing stool now.

  » These multiple pelvic defects are identified and Anterior or Mid or Posterior compartment defects repair are done systemically to prevent reoccurrence. Vaginal vault can be fixed with mesh and then mesh with sacral promontory with tacker. This surgery requires lot of experience & expertise.

  » Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

  » Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

  » Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 15 to 35 minutes only. For more complicated case it may take 1-2 hour. Most begin feeling much better within one day.

• (14) Laparoscopic Vault (prolapse) Repair

  » Performed for Menorrhagia, pain in lower abdomen or for any of the indication for removal of the uterus. In P/v examination and TVUSG showing positive findings.

  » Laparoscopic approach is especially helpful with previous abdominal adhesions, previous 1/2/3/.4 LSCS, with adnexal mass & for very large uterus, Endometriosis, PID. Total laparoscopic hysterectomy is going to become popular, as we have understood pelvic floor support better. Good Bipolar cautery performance is must during LH. We believe that we can do NDVH up to 12-14 wks size uterus easily, along with laparoscopic McCall’s culdoplasty- Both utero-sacral ligaments are attached with anterior & posterior vaginal vault with non absorbable suture material after NDVH is very easy procedure & ideal way of vault support. Total Laparoscopic Hysterectomy (TLH) gives better sexual quality after operation compared to other methods. Even removal of both ovaries is safer with Laparoscopic approach. Removal of ovaries must be discussed with patient to understand menopausal protocols in future. Chances of post operative vault prolapse are less with Laparoscopic hysterectomy compared to NDVH.

  » Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

  » Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

  » Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 35 to 55 minutes only. For more complicated case it may take 1-2 hours. Most begin feeling much better within one day.

• (15) Laparoscopic Tubal Ligation

  » Performed for family planning purpose permanently. In event of future death of child reversal of Lap TL will give better chances of successful reversal operation as minimum length of tube is compromised in Lap. T.L.

  » Laparoscopic Tubal ligation was the simplest operation from very beginning. In government set up it was done under local anesthesia & sedation. In private set up it was always done under general anesthesia & intubation. Severe obesity & previous scars over the abdomen were considered to be relative contraindication for laparoscopic approach in the past. With advancement and better understanding the advantages of laparoscopic surgeries, now severe obesity & previous scars over the abdomen are the most common indications for laparoscopic approach, where in we can remove omental & intestinal adhesions with abdominal wall during laparoscopic Tubal ligation operation, which may help her from relief of occasional pain due to adhesions of previous scar. Palmer’s point is the choice of site for primary 10/5 mm port, in cases of previous scar over abdomen. Through Umblicus will be the choice of primary 10 mm port, in case of severe obesity. Recording also helps in conveying the quality of loop made during laparoscopy of both fallopian tubes. In young patient with children’s age less than/around 5 years, Laparoscopic T.L. has better success rate following tubal reversal compared to abdominal T.L. in event of death of her children in future.

  » Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

  » Performing laparoscopy usually only requires two tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

  » Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 15 to 35 minutes only. For more complicated case it may take 1 hour. Most begin feeling much better within one day.

• (16) Laparoscopic Sling operation (prolapse)

  » Performed for Infertility or pain in lower abdomen or Patient presents to us for something coming per vaginum along with urinary problem or problem in passing stool now.

  » When all other causes of infertility are ruled out prolapse correction can be offered as treatment for selective infertility case. Young patient presents to us with something coming out per vaginum with or without urinary complaint and she wants to preserve her child bearing function (preserve her uterus) and desires to treat prolapse. Here Polypropylene mesh is fixed from posterior side of cervix to sacral promontory Laproscopically through tunnel created medial to Rt. Uterosacral Ligament and under laparoscopic guidance. Results are very good. This surgery requires lot of experience & expertise. Results are most rewarding after operation.

  » These multiple pelvic defects are identified and Anterior or mid or Posterior compartment defects repair are done systemically to prevent reoccurrence. Vaginal vault can be fixed with mesh and then mesh with sacral promontory with tacker. This surgery requires lot of experience & expertise.

  » Just below Umblicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

  » Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made just below the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

  » Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 15 to 35 minutes only. For more complicated case it may take 1-2 hour. Most begin feeling much better within one day.