What do you mean by Laparoscopy?

Laparoscopy also called as keyhole surgery, is a specialized kind of surgery, using very fine instruments and through small incisions (0.3-1.2 cm). Originally started in Germany, it has evolved rapidly over the last 3 decades, superseding convention surgery and ultimately is the preferred mode of operation for all types of Gynecological procedures and surgeries. The various advantages of Gynecological laparoscopic procedures include less hospitalization duration, quicker patient recovery, lesser scaring, overall less operative time reducing

complications.  

Procedures done by Laparoscopy /Hysteroscopy:

  • Laparoscopic Myomectomy
  • Laparoscopic hysterectomy
  • Laparoscopic Ovarian Cystectomy
  • Laparoscopic tubal evaluation and repairs
  • Laparoscopy & Hysteroscopy for Infertility
  • Laparoscopic Adhesiolysis
  • Hysteroscopic Polypectomy
  • Hysteroscopic Myomectomy
  • Hysteroscopic septal resection
  • Hysteroscopic D&C

Advantages of laparoscopic surgery:

  • Faster healing
  • Lesser scarring
  • Better recovery
  • Lesser hospital stay
  • Lesser intra operative complications

Complications of laparoscopy:

Same as of any other conventional open surgery.

The use of energy devices has risk of thermal injury to visceral organs, namely bowel injury and ureter injuries.

What all you need to know before your laparoscopy?

It is important to understand the benefits and risks of your procedure before undergoing any surgery.

In cases of difficulty, Laparoscopy may need to be converted into open laparotomy. Huge fibroids, adhesions and difficultly in visualisation can make laparoscopy a challenge for operating surgeon.

Laparoscopy Treatment:

Laparoscopy is being done in all the leading hospitals in South Delhi. Dr Ruchi Tandon has received extensive training in laparoscopy from best hospitals in Delhi and Mumbai, such as moolchand hospital, leelavati hospital. Dr Ruchi Tandon is one of the best gynecologists, based in greater Kailash and doing all sorts of daycare and operative laparoscopic procedures. Infertility surgeries, Myomectomy, hysterectomy, Hysteroscopy are some of the procedures to name a few.

She is doing these procedures at Max smart super specialty hospital, Saket, Apollo Cradle Royale and Apollo Spectra. In lieu of her experience and contribution to this field, she was conferred with the “best budding endoscopic surgeon “(National) award by the Economic Times at a grand event on 4th October, recently in Delhi.

Management of abnormal uterine bleeding

abnormal uterine bleeding

Abnormal uterine bleeding may be acute or chronic, and is defined as bleeding from the uterus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy. Acute AUB refers to an episode of heavy bleeding that is of sufficient quantity to require immediate intervention to prevent further blood loss. Acute AUB may occur spontaneously or in association with chronic AUB. Initial screening for an underlying disorder of hemostasis in patients with excessive menstrual bleeding should be structured by the medical history.

Basic workup of abnormal bleeding includes CBC (complete blood count), blood group, Thyroid function tests(TSH), UPT( Urine pregnancy test), coagulation parameters(PT,PTT,INR) and LFT( liver function test). Hormonal management is considered the first line of medical therapy for patients with acute AUB without suspected bleeding disorders.

Antifibrinolytic drugs, such as tranexamic acid, work by preventing fibrin degradation and are effective treatment for patients with recurrent AUB. Surgical options include dilation and curettage, endometrial ablation, uterine artery embolization, and hysterectomy.

The etiologies of acute AUB should be classified based on the PALM–COEIN system: Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, and Not otherwise classified.

Dr. Ruchi Tandon is a famous gynecologist who specializes in cases of AUB (Abnormal uterine bleeding).She has performed about 1000 hystroscopies and procedures related to AUB.

Endometriosis and its controversies

Endometriosis is defined as the presence of endometrial tissue at any area other than the normal situation; if it is seen in myometrial tissue it leads to a condition called as adenomyosis.

Endometriosis  commonly involves your ovaries, fallopian tubes and the tissue lining of pelvis. Rarely, endometrial tissue may spread beyond pelvic organs like intestines,liver and retroperitoneal spaces.

With endometriosis, displaced endometrial tissue continues to act as it normal tissue , it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped and bleeds monthly. When endometriosis involves the ovaries, cysts called endometriomas or chocolate cysts may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions ,abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other.

Endometriosis can cause pain , sometimes severe —,especially during  periods. Fertility problems also may develop in younger females. Fortunately, effective treatments are available for both.

Symptoms

The primary symptom of endometriosis is pelvic pain associated with  menstrual period.

Common signs and symptoms of endometriosis may include:

  • Painful periods (dysmenorrhea).Pelvic pain and cramping may begin before  period and extend several days into the period.
  • Pain with intercourse.Pain during or after sex is common with endometriosis.
  • Pain with bowel movements or urination. most likely to experience these symptoms during  
  • Excessive bleeding. occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
  • Endometriosis is first diagnosed in  women who are seeking treatment for infertility.
  • Other symptoms. may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during the menstrual periods.

The severity of  pain isn’t necessarily a reliable indicator of the extent of the condition.  Women with mild endometriosis have intense pain, while others with advanced endometriosis may have little pain or even no pain at all.

Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts or appendicitis. It may be confused with irritable bowel syndrome (IBS), a condition that causes alternate bouts of diarrhea, constipation and abdominal cramping.

When to see a doctor

See your doctor if you have signs and symptoms that may indicate endometriosis.

Endometriosis can be a challenging condition to manage. An early diagnosis, a multidisciplinary medical team and an understanding of your diagnosis may result in better management of your symptoms.

Causes

Although the exact cause of endometriosis is not certain, possible explanations include:

  • Retrograde menstruation.In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
  • Transformation of peritoneal cells.In what’s known as the “induction theory,” experts propose that hormones or immune factors promote transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial cells.
  • Embryonic cell transformation.Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial cell implants during puberty.
  • Surgical scar implantation.After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
  • Endometrial cells transport.The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
  • Immune system disorder.It’s possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that’s growing outside the uterus.

Risk factors

Several factors place you at greater risk of developing endometriosis, such as:

  • Never giving birth
  • Starting your period at an early age
  • Going through menopause at an older age
  • Short menstrual cycles — for instance, less than 27 days
  • Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces
  • Low body mass index
  • Alcohol consumption
  • One or more relatives (mother, aunt or sister) with endometriosis
  • Any medical condition that prevents the normal passage of menstrual flow out of the body
  • Uterine abnormalities

Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis end temporarily with pregnancy and end permanently with menopause, unless you’re taking estrogen.

Complications

Fertilization and implantation

Infertility

The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant.

For pregnancy to occur, an egg must be released from an ovary, travel through the neighboring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting. But the condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.

Even so, many women with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise women with endometriosis not to delay having children because the condition may worsen with time.

Ovarian cancer

Ovarian cancer does occur at higher than expected rates in women with endometriosis. But the overall lifetime risk of ovarian cancer is low to begin with. Some studies suggest that endometriosis increases that risk, but it’s still relatively low. Although rare, another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in women who have had endometriosis.

Cervical cancer vaccination and awareness

Cervical cancer vaccination and awareness

Human papilloma virus also known as the cervical cancer virus or HPV accounts for upto 75% of all cervical cancers. Cervical cancer is the fifth most prevalent cancer and is caused by sexual transmission of HPV virus. The incidence is maximum in reproductive age group , namely between 30-40 years of age group and peaks by 50 years of age. India has a population of about 300 million women above the age group of 15 years. HPV 16 & 18 account for maximum number of cases of cervical cancer. HPV infection causes CIN1, CIN2,CIN3,CIS,invasive cancers.

The recent most vaccination programme in recommended in age groups 9-44 years and is preventive against 4 HPV’s i.e.HPV 6, 11,16,18. Prolonged use of contraceptives, increased parity, early age of sexual activity, multiple sex partners, tobacco smoking and co-infection with STD’s have been identified as established cofactors for cervical and precervical cancers. 70% of all adults are likely to be infected with at least one HPV type. Vast majority of the infections resolve spontaneously and only a few of the HPV infections progress to cancer.

The lifetime risk for genital HPV is 60–80% and genital warts is approximately 3-5%. Large scale screening programmes like pap smears are practically to implement in developing countries , hence cervical cancer screening should be carried out more effectively. The only effective way is to reach out to schools and encourage adolescent girls into cervical cancer vaccination.

Dr. Ruchi Tandon has visited numschools ands  and corporate organizations in Delhi -NCR to help the cervical cancer vaccination drive. She firmly believes that effective immunization can significantly help in reducing prevalence of cervical cancer.