• These fibroids unfortunately cannot be treated with medicines but have to be removed surgically if they are causing problems. Laparoscopic surgery can remove even large fibroids with minimal cuts on the stomach wall. The entire surgery is done by watching the procedure on a television screen and operating with a camera in the abdomen. The large fibroids are made into small pieces by means of a special machine called the morcellator and so can be removed through a small opening.

• Patients who are older and have fibroids or problem of heavy bleeding during periods or some other reason to remove the womb can also be treated by laparoscopic surgery. The womb (uterus) can be removed by this procedure. The patient’s hospitalization is less and recovery is very fast. Prolonged rest and absence from work is not needed.

• Ovarian cysts are common and can occur in any age group. They may be simple cysts, endometriosis or dermoid cysts where water, blood or thick pus like material can fill in the ovary. These cysts are best treated by laparoscopic surgery.

• Endometriosis is a major problem in young women where dark, thick blood accumulates in the ovary or around the womb and causes pain and often inability to conceive. It damages the tubes and ovaries and can cause the intestines to stick together. This problem can also be treated by keyhole surgery.

• Infertility (inability to become pregnant) is on the rise and often one of the necessary investigations is to put a camera through the belly button into the pelvis and check to see if the tubes are open and if the uterus and ovaries are normal. If any problem is detected it can be treated at the same time.

• Keyhole surgery is here to stay. More and more operations are now being done by this method though there is still a role for traditional open surgery in certain cases.

FAQ

Q.1.   I am 28 yrs. old and was diagnosed as having a large fibroid when I did a sonography recently. Are there any medicines that will treat this fibroid or do I have to undergo surgery?

Ans:   Fibroids are non-cancerous tumours which if large and placed deep inside the uterus (womb) can cause heavy menstrual bleeding, pain, infertility and abortions. There is no permanent cure with medicines and removal of fibroids is the only option in a young woman like you. This can be done by Keyhole surgery (laparoscopy) in which even large fibroids can be removed through a 1-2 cm cut on the stomach (abdominal wall). If the fibroid is on the inner side of the womb, it can be shaved off with the help of a hysteroscope and this can be done without any cuts or stitches. The recovery from these surgeries is very good and hospitalization is for 1-2 days only. Some cases may require an open surgery with a 3-4 inch cut on the abdomen.

Q.2.   I have been married for 4 years and have not become pregnant yet. I am very keen to have a baby soon. My gynaecologist has told me to have a laparoscopy. What exactly is it and is it a painful procedure?

Ans: If a couple is unable to conceive after one year of trying, basic tests of both should be done. The most important is semen test of the husband and checking to see if the tubes are open, in the woman. This checking of the tubes is done by laparoscopy. Laparoscopy is a simple short procedure in which a thin tube with a camera is introduced into the stomach through a 1 cm cut near the belly button (umbilicus). The entire womb and tubes can be checked by this. If there is any problem such as fibroid, cyst, endometriosis etc, it can be operated at the same time. The Diagnostic laparoscopy takes 20 minutes to perform and the patient can go home from hospital in a few hours. There is not much pain as the procedure is done under general anaesthesia.

Q.3. My sister has been advised to undergo a hysterectomy. She is 42-years-old and has been suffering from severe menstural bleeding. What is the procedure involved and how risky is it? Post hysterectomy what are the medications to be taken? Are there any side effects?

Ans: What is the reason for the heavy bleeding? Does she have large fibroids or ovarian tumour etc., in which case hysterectomy may be necessary. Hysterectomy can be done either vaginally or by laproscopy (Key Hole Surgery) or by open abdominal surgery. It is a major surgery and though quite safe, there is a slight risk of bleeding, infection or injury to the internal organs. Recovery takes a few weeks. However for heavy bleeding without any large tumours, there are now simpler, safer and quick methods for permanent treatment such as Uterine Ballon Ablation, Microwave ablation, or use of Hormonal IUCD. All of these can be done within 15 minutes, require no hospitalization and permanently cure the bleeding problem. However the suitability of each patient for a particular procedure has to be determined by the gynecologist.

Office Hysteroscopy

• Hysteroscopy uses a hysteroscope, which is a thin telescope that is inserted through the cervix into the uterus. Modern hysteroscopes are so thin that they can fit through the cervix with minimal or no dilation. Although hysteroscopy dates back to 1869, gynecologists were slow to adopt hysteroscopy. Because the inside of the uterus is a potential cavity, like a collapsed airdome, it is necessary to fill (distend) it with either a liquid or a gas (carbon dioxide) in order to see. Diagnostic hysteroscopy and simple operative hysteroscopy can usually be done in an office setting. More complex operative hysteroscopy procedures are done in an operating room setting.

Operative Hysteroscopy

• Operative Hysteroscopy is performed under general anesthesia. This will allow the physician to both diagnose and treat most findings, which are encountered at the time of the procedure.
• The Operative Hysteroscope has ports, which allow the physician to insert operating tools, such as, scissors, cautery devices or a laser fiber. These may be used to resect or cauterize specific abnormalities under direct visualization. The Hysteroscope is also valuable in treating some forms of tubal occlusion. Many patients with a blockage in the fallopian tube may have an obstruction at the junction between the uterus and fallopian tube. The Hysteroscope is used to pass a small catheter through this contracted area under direct visualization. Occasionally, scar tissue can be disrupted and allow passage of sperm as the result of the procedure.
• A physician will be able to evaluate the cervical canal, the contour of the uterus, and the quality of the endometrial lining. The tubal ostia are the openings of the fallopian tube into the uterine cavity. They should be easily seen with the hysteroscope

Diagnostic Laparoscopy

• A diagnostic laparoscopy is a technique used by surgeons to obtain information about the inside of your abdomen without making a large incision. Through a few small incisions, the surgeon inflates the abdomen with gas (carbon dioxide) to enlarge the size of the viewing area. He or she then inserts a laparoscope or small camera which projects images of the abdomen onto a high resolution television screen. By mobilizing the camera, the surgeon can have a very thorough look through your abdomen without the pain and recovery of a larger incision. In most cases, this procedure provides the surgeon with more information about your condition than if routine tests were used.

Operative Laparoscopy

• Operative laparoscopy is performed for many different conditions. These may include Infertility treatment-used to remove endometriosis, cut adhesions (scar tissue) or open closed fallopian tubes

• Pelvic Pain.

• Ovarian Cysts–Remove the cysts, or drain them.

• Remove small fibroid tumors.

• Sterilization procedures–tubal ligation (getting your tubes tied)

• Treating ectopic pregnancies–pregnancy in the fallopian tube

• Sometimes a Laser is attached to the laparoscope to help in the removal of endometriosis or to remove adhesions or cut tissue. We use the latest laser technology (Coherent 5000L laser) which was specially designed for this purpose. Sometimes, however the laser does not work as well as other techniques, so ask your doctor.