A new option for the surgical treatment of Gynecological disorders.

INDICATIONS OF GYNECOLOGICAL LAPAROSCOPY


Diagnostic:

1) Investigation of infertility and chronic pelvic pain.

Operative:

1) Ovarian cystectomy – Benign or chocolate cyst.

2) To achieve female sterilization.

3) To surgically treat endometriosis.

4) To release pelvic adhesions.

5) For myomectomy.

6) Laparoscopic Hysterectomy or LAVH – due to fibroid uterus, DUB, endometriosis.

7) Tubal surgery – Recanalization, Salpingostomy, Neosalpingostomy.

8) To enhance fertility eg : Assisted reproductive techniques.

9) Correction of stress incontinence.

10) Miscellaneous condition.

Removal of IUD.

Ventrosuspension of retroverted uterus.

Burch – procedure.

Pre – sacral nurectomy.

Correction of congenital anomalies of reproductive system.

ADVANTAGES OF LAPAROSCOPIC SURGERY OVER CONVENTIONAL SURGERY :

1) Less tissue trauma and handling, less post – operative pain.

2) Less blood loss and wound infection.

3) Hospital stay is usually 1-3 days.

4) Short recovery time 1-2 weeks.

5) For infertile patient’s – less adhesion formation so pregnancy rate more than the
conventional surgery.

6) Small incisions are much more cosmetic value.

Disadvantages :

1) Total expenditure is more.

2) Not preformed all operation.


Complications :

1) Anaesthetic complications.

2) Haemorrhagic complications.

- Bleeding from the inferior epigastric vessels.

- Bleeding from perforated uterus, Mesosalpingeal tear. Retroperitoneal bleeding
from umbilicus.

3) Bowel injury.

4) Ureter injury.

5) Infection ( less common ).

Analysis of 40 cases of Gynecological lap – operation in Khulna city.

( from November 2000 – April 2001 )

A. Infertility – (16) 40%
- Primary – (6)
- Secondary – (10)

B. Primary amenorrhoea – (2) 5%

C. Simple ovarian cyst – (5) 12.5%

D. Chocolate cyst with pelvic endometriosis – (7) 17.5%

E. Chronic lower abdominal pain after Hysterectomy – (7) 17.5%

F. Chronic ectopic pregnancy – (1) 2.5%

G. Tubal sterilization – (1) 2.5%

Mode of operation :

A. Infertility cases – 40%

Ploy cystic ovary drilling – (6)
Fimbriolysis – (2)
Rt. Sided salpingectory due to Hydrosalpinx – (1)
Adhesiolysis with Myomectomy– (1)
Simple adhesiolysis – (2)
Adhesiolysis with endomelriotic deposit ablation –(2)
Normal findings – (2)

B. Ovarian cystectomy – (5)

Cyst measurement within 9cm x 5cm
Histopathological findings:

- Serous cyst adenoma – (4)
- Mucinous cyst adenoma – (1)

C. Chocolate cyst with penvic endometriosis – 12.5%

Cystectomy with endomelrial tissue ablation and separation of adhesion – (5)
Unilateral salpingo – ophorectomy – (2)

D. Lap-Surgery after Hysterectomy :

Chocolate cystectomy – (2)
Simple ovarian cystectomy – (2)
Pelvic haematoma drainage – (2)
Tubo-ovarian abscess drainage after appendicectomy – (1)

E. Salpingostomy for ectopic pregnancy

F. Tubal sterilization :

Bipolar coagulation with cutting of the Fallopian tube .


Result :

Within 16 cases of infertile patient we ensure pregnancy 6 cases within this short period.

Complications :

No major complication except post-operative vomiting – (11)

Generalized muscle ache – (2)

Umbilical wound infection – (3)