Fibroids / Laparoscopy Clinic

Most gynaecological diseases can be diagnosed and rectified (treated) through key hole or natural orifice surgery i.e. laparoscopically or hysteroscopically. Most commonly handled cases are listed and described in brief viz frequently asked questions and surgically.

FIBROIDS/ MYOMA

What is HYSTERECTOMY?

Fibroids are the commonest pelvic tumours found in at least 20% of the females over 30yrs of age. There is a spectrum of presentations that a large proportion (1/4) are asymptomatic Surgical management include hysterectomy (removal of uterus), myomectomy (removal of myoma).

Commonest symptoms are:

  • Irregular Uterine bleeding
  • Excessive uterine bleeding
  • Lower abdomen pressure and pain (constipation, urinary, frequency / urgency, retention)
  • Recurrent pregnancy losses
  • Infertility



Diagnosis

Medical history, Physical exam that includes a pelvic exam. An abdominal, transvaginal or pelvic ultrasound can help identify the number, size, location and shape of most fibroids. In certain cases, MRI pelvis need to be done for exact sae/shape, location of fibroids.

Hysterosalpingography involves injection of dye into the uterus and fallopian tubes, which is then X-Rayed to identify the anatomy of these structures.

Hysteroscopy looks at the uterus by passing a small filberoptic telescope with camera through opening of the cervix to identify any fibroids protruding into the uterine cavity. This procedure is carried out in the operation theatre.

Laparoscopy is a surgical procedure. The surgeon inserts a fiberoptic telescope with camera into the abdomen through small abdominal incisions.


Laparoscopy

Surgery

Myomectomy is surgical removal of fibroids through hysteroscopy/ laparoscopy, or open procedure. The surgical approach depends on the size and location of the fibroid. Sometimes the approach is decided after putting in a laparoscope and visualizing the uterus and the fibroids.

Hysterectomy is the surgical removal of uterus. It is the most commonly performed surgical procedure in the treatment of fibroids and is considered a cure which can be done via laparoscopic / Vaginal / Abdominal Approach. In today’s scenario nearly all the big fibroids/uteruses seen can be removed laparoscopically, with the advances in the field of laparoscopy. Newer techniques now make it possible for carrying out Myomectomies & Hysterectomies in complicated cases also like in cases of severe endometriosis, in patients with repeated previous operation.

Advantages of Laparoscopic Myomectomy / Hysterectomy small incisions, less pan, quicker recovery, quicker return to work, less blood flow, less chances of infection Et less chance of adhesion formation later

 

HOW IS LAPAROSCOPIC MYOMECTOMY PERFORMED?

Three to four 5-10mm incisions are made on the abdomen depending on the site, size Et shape of myoma. After cannula placement telescope is inserted with camera attached which visualizes the entire abdomen. Once the myomas are identified they are separated from the uterus after decreasing the blood supply of the organ with medicine. The space created thus is then closed with sutures (surgical threads). A drain pipe is left in the operated area for removing secretions/ fluid from the wound for quicker recovery. The fibroid is removed from the body (piece meal) with a powered motor (MORCTLLATOR) and sent for biopsy examination to the pathologist.

Duration of the stay in the hospital is 2 – 3 days. Procedure is carried out under General Anaesthesia.

 

HOW IS HYSTEROSCOPIC MYOMECTOMY PERFORMED?

This is carried out by introducing an instrument called the Resectoscope (Operative Hysteroscope) by opening out the mouth of the womb (cervix) without a cut. The resectoscope has an electric loop which operates in a fluid media which distends the womb and shaves off the fibroid bit by bit.

Duration of stay in the hospital Day-care / 24hours. Procedure is carried out under General Anaesthesia.

 

WHAT HAPPENS AFTER ADMISSION FOR SURGERY?

Patients are admitted in the hospital on the day of surgery or a day prior to surgery. On admission, patients are examined and investigations reviewed by one of the team members. A member of the anaesthesia team conducts the pre-Anaesthetic check-up. Pre-operative investigations are performed if needed. Patients need to be fasting overnight before the surgery. Next morning, she will be shifted to the operation theatre half an hour prior to surgery. After surgery, they are shifted to the recovery room for 1 – 2hours under the care and supervision of our Anaesthesia Team for observation and then shifted back to the room.

It takes about 4 – 5 hours approach before the patient comes back to her room. Patient is given sips of water or-ally on returning to the room and progresses to drinking liquids on the same even ng as surgery. They may sit up, visit the toilet and move around for a few hours after surgery and are encouraged to do that early depending on the f tress retie s. Patients are given a normal breakfast next morning and discharged, from hospital after a visit by the doctor. Or discharge, a discharge summary with the advised medication is handed over to the patient.

 



Post-operative Instructions and information:

  1. After the operation you will be kept in the recovery room. This period may vary from few minutes to few hours. The anaesthetist decides about your shifting to room. The decision depends or many technical factors.
  2. You will be sleepy immediately after the operation due to sedation giver during anaesthesia and during the recovery period.
  3. You may have some discomfort when coming out of the effect of sedation. It gradually reduces to a tolerable level within a few minutes without any pain killer. However, if necessary you may ask for pain killer injections /tablets
  4. You may feel nauseated in the immediate post-operative period, and you may even vomit which should not cause any worry. This generally gets over after few hours.
  5. You are generally allowed to have sips of water immediately after the operation and liquids on day of operation. In case of vomiting the liquid intake may be stopped and restarted after 30 minutes. The liquids may include water/ cold drinks / tea / coffee juices or some clear soups.
  6. You are allowed to have normal home cooked meals of your choice from the next morning at breakfast.
  7. You should have small frequent meals for few days after operation following which you can resume your normal diet gradually. This is vital because you may fee` bloated and distended if the quantity of food is in large quantities at a time.
  8. You should try to move the limbs and can sit up immediately after operation. You should also go to the toilet on your own if you don’t have the catheter (pipe in the bladder). There are no restrictions whatsoever for the physical movement. In fact, majority of the patients will feel much better after they have started the movement. The pain also dramatically reduces once you start sitting up, moving and walking.
  9. There is no restriction on your physical activity. You are allowed to walk as soon as you recover from your sleep. There is no restriction on climbing of stairs.
  10. You will be discharged on the same day or next day of operation unless there is some associated medical / social problems. You are advised to visit again for follow up after 7 days when the dressings are removed. As the dressings are water proof you can have normal bath with soap and water.
  11. In very few cases there may be some bloody / whitish discharged from the wound in the post-operative period. This should not bother you because it is generally harmless. You can wipe the discharge and apply Neosporin powder so as to avoid staining the clothes. If it is more you should report to the surgeon during the next visit Pease feel free to ask any question that may come to you mind.

We wish you a speedy recovery…


Category
Speciality Clinics

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