Laparoscopic (Minimally Invasive) Fibroids Treatment – Uterine Fibroids Surgery at World Class Hospitals in India

What are Uterine Fibroids?

images (1)Women with large fibroids, or an enlarged uterus often undergo robotic or open procedures at the recommendation of their general practitioner or OB/GYN because they don’t have extensive laparoscopic training. When a doctor tells you that you aren’t a candidate for minimally invasive surgery, it could very well be that it’s not you, but the doctor who isn’t the right fit for the surgery you require.

Large Fibroid Procedures: Myomectomy Or Hysterectomy

There are two surgical treatment options for fibroids:

• Myomectomy — removal of fibroids only
• Hysterectomy — removal of uterus and fibroids

MYOMECTOMY

If you are planning to have children and/or are willing to undergo additional surgeries in the future if the fibroids return, a myomectomy preserves the uterus while removing the fibroids.

The main reason a myomectomy is performed is to preserve the uterus for pregnancy, or to remove fibroids that are preventing the uterus from becoming pregnant. However, removal of fibroids and keeping the uterus will not prevent fibroids from recurring. If fibroids return to the uterus, it could require either another myomectomy or a hysterectomy.

MYOMECTOMY

A hysterectomy removes the uterus and the cervix, as well as the fibroids. This is the most definitive treatment for removing fibroids. While the thought of this can be overwhelming, it’s important for women to understand that the ovaries are responsible for making hormones, not the uterus. Removing the uterus will stop menstruation, but it will not begin menopause. If childbearing is not a consideration, a hysterectomy can be the most effective treatment.

Diagnosis

Uterine FibroidsFibroids are usually diagnosed during a gynecologic examination. The presence of fibroids is most often confirmed by a lower abdomen ultrasound. Fibroids can also be confirmed using MRI (magnetic resonance imaging). These imaging techniques serve as a baseline examination for follow-up after uterine fibroid embolization (UFE).

What Problems do Fibroids Cause?

  • No Symptoms : most fibroids up to the size of an orange (12 weeks pregnancy) cause any symptoms. Their mere presence is not a reason to treat them.
  • Submucus : They protrude into the uterine cavity and cause menstrual cramps, heavy periods, infertility and repeated miscarriages. The diagnosis is often missed as the uterus is not enlarged and unnecessary hysterectomies have been performed for these. The diagnosis is made by hysterosonography or hysteroscopy.
  • Intramural : These fibroids are within the muscle of the uterus and can be very large. Because they enlarge the cavity of the uterus they can also cause heavy periods. The most common problem is PRESSURE symptoms on the bladder and rectum.
  • Subserous : These are external to the uterine muscle and are connected by a thin stalk. They are the least likely to be symptomatic and rarely need removal. TORSION (twisting) is a very rare complication.
  • Degeneration : Rarely there is liquifaction and bleeding within the center causing pain and fever. Infection may also occur. The most common occurrence is during pregnancy. Treatment is never surgery but conservative with fluids, pain and antibiotics.

Fibroids and Infertility, Miscarriage

1.Usually, the submucus fibroids cause repeated miscarriages.

2.Large intramural fibroids may be the cause of longstanding infertility if all other causes have been excluded.

Laparoscopic (Minimally Invasive) Fibroids Treatment – Uterine Fibroids Surgery at World Class Hospitals in India

Surgical Treatment :

download (1)1) The treatment for removing the fibroids from the uterine muscle is known as MYOMECTOMY.
2) It is a specialized operation where the uterus is preserved for future fertility and only fibroids are removed.
3) This operation is traditionally done through a LAPAROTOMY via a ‘bikini’ or ‘up and down’ incision.
4) When the fibroids are less than 5 and less than 18 weeks size LAPAROSCOPIC myomectomy can be performed.

Laparoscopic Myomectomy (Keyhole, Minimally Invasive procedure to remove fibroids)

Myomectomy is the most suitable surgery option for women who have fibroids but wish to retain their uterus.

Laparoscopic Myomectomy :

The advantage of this is that patients can go home the same or next day and be back to work in 1-2 weeks.

We use laser, harmonic scalpel, knife or electro surgery to remove the fibroids. The skill of the surgeon is paramount to results.

Minilap Myomectomy :

This is another technique pioneered at our center where large multiple (up to 24 weeks) can be removed through a 2-inch bikini incision.

Patients can go home the next day after surgery.

Hysteroscopic Myomectomy :

Submucus fibroids are removed by inserting a hysteroscope (small camera passed through the Vagina) and an electrical loop is used to remove the protruding part. This is rapid and effective surgery without the need of laparoscopy.

Estrogen is used after surgery to promote uterine lining re growth.

Total Laparoscopic Hysterectomy :

When the family is complete and patient has a symptomatic fibroid, the whole Uterus is removed via only four small holes in the tummy using laparoscopic technique.

Laparoscopic Myomectomy has many advantages over the abdominal (open) approach :-

You can get several benefits  which has helped a large number of patients from all around the world to get high quality medical treatment in India at best value.

  • Minimal Pain.
  • Minimal Blood Loss.
  • Early Post Operative Recovery.
  • No Scar.
  • Faster Recovery.
  • A shorter hospital stay.
  • Decreased Adhesion formation.
  • Better chances of post surgery pregnancy.
Advertisements
Laparoscopic (Minimally Invasive) Fibroids Treatment – Uterine Fibroids Surgery at World Class Hospitals in India

Atrial Septal Defect Repair in India | Heart Hole Surgery in India

images

Atrial Septal Defect (ASD), more commonly known as ‘Hole in the Heart’ is a Congenital Heart Disease present at birth. Atrial Septal Defect is a hole in the wall (septum) that separates the upper chambers (atria) of the heart into right and left atrium. This hole (defect) can be between 0.5 – 2 cm in diameter. Some of the oxygenated blood flows from the left atrium to the right atrium which contains blood that is poor in oxygen. This mixing increases the volume of blood in the right atrium that will be carried to the lungs for oxygenation, thus increasing the burden on the lungs to perform it’s function. Atrial Septal Defect is a common Congenital Heart Disease that can sometimes be asymptomatic in children. Atrial Septal Defect is the second most common Congenital Heart Disease (about 6 – 8% of all Congenital Heart Disease) and is more common in girls.

What are the types of Atrial Septal Defect?

Depending on the location of hole in the atrial wall, Atrial Septal Defect can be of 3 types:

  • Ostium Secundum Atrial Septal Defect – In this type of Congenital Heart Disease, the Atrial Septal Defect is present in the center of the septum.
  • Ostium Primum Atrial Septal Defect – This type of defect is present in the lower portion of the atrial septum.
    • Slow Growth and Development – Your child might have slow mental and physical growth and development as the body’s increased demand for oxygenated blood is not met.
    • Reduced Activity level – Your child’s activity level will have to be monitored as symptoms like dizziness and breathlessness with increased activity may be a problem. However, after the surgery for the closure of Atrial Septal Defect, this is not a problem any more.
    • Enlargement of the right side of Heart – Due to shunting of blood from the left to the right side of the atrium, the right side of heart may enlarge over time due to increased workload.
    • Pulmonary hypertension – Due to increased flow and pressure of blood in the lungs and pulmonary blood vessels, the pulmonary arteries may get diseased resulting in pulmonary hypertension.
    • Tricuspid valve regurgitation – The tricuspid valve, which is the valve between the right atrium and the right ventricle stretches and does not close properly, allowing some of the blood to leak back from the ventricle to the atrium instead of allowing it to move forward.
    • Irregular heart beats – Also called arrhythmias, this is a very serious problem associated with untreated Atrial Septal Defect.
    • Risk of Stroke – In people with Atrial Septal Defect, a blood clot or air bubble may develop that may travel to the brain and cause stroke.Sinus Venosus Atrial Septal Defect – This type of Atrial Septal Defect is present in the upper portion of the septum.

      Why is surgery for the closure of Atrial Septal Defect necessary?

      Small Atrial Septal Defects usually close on their own as your child grows up and do not require any medical or surgical intervention as there are no symptoms. However, children who have a large Atrial Septal Defect need surgical intervention so that they can lead normal and healthy lives after the surgery. If the option of timely surgery for the closure of Atrial Septal Defect is not considered for some reason, then unfortunately your child might have to deal with some of the following consequences:

     

    What does the surgical repair for Atrial Septal Defect involve?

    Atrial Septal Defect is most commonly closed by Open Heart Surgery. Due to worsening of symptoms with age, children suffering from Atrial Septal Defect should be operated upon between 3 – 6 years of age. The term Open Heart Surgery is used for surgical procedures performed on the heart where the heart is stopped and is connected to a heart-lung machine which oxygenates the blood and circulates it throughout the body. The surgeon makes an incision in the middle of the chest through the breast bone (sternotomy) to expose the heart. The heart is stopped and it’s function is completely taken over by the heart-lung machine. The Atrial Septal Defect is either stitched (if small) or patched with a special mesh to close the hole. Once the procedure is complete, the heart is re-started and the chest incision is sutured. The Open Heart Surgery to correct Atrial Septal Defect is considered a major surgery and is performed under general anesthesia.

Atrial Septal Defect Repair in India | Heart Hole Surgery in India

Cervical Disectomy from Best Hospitals in India

Cervical Disectomy in India

Who may require Cervical Discectomy?

Those patients who suffer from:

  • Constant neck pain that worsens as the day progresses.
  • Neck pain that radiates to the head causing headache.
  • Pain, numbness tingling and weakness in one or both arms.
  • Loss of balance while standing or walking.
  • Loss of bowel and bladder control.
  • Neck pain not cured by conservative means like medications and physiotherapy.


In Cervical Discectomy, disc can be accessed via Anterior or Posterior approach.

22709-hospital2The Anterior approach is more popular with the surgeons as the access to disc is very easy with little muscle tissue on the way and complete disc removal is possible with no recurrence of disc herniation. This approach also provides a good exposure to all cervical vertebrae from C2 to cervicothoracic junction. The limited amount of muscle division or dissection helps to limit postoperative pain following the spine surgery. The main postoperative problem most patients face is difficulty swallowing for 2-5 days due to retraction of the esophagus.

Posterior approach is slightly complicated as too many tissues have to be traversed to reach the disc. There are chances of injury to spinal cord and nerve roots while accessing the disc. Also since complete removal of disc is not possible, re-herniation can occur. But the positive aspect of this approach is that spinal fusion is not required so natural spine movement is preserved.

  • Anterior Approach:The patient is made to lie down on his back under general anesthesia. A horizontal incision is made just 2 inches above the clavicle on either left or right side. The thin muscle layer is cut and the trachea and esophagus are shifted to one side along with the nerves and vessels. The surgeon has a clear view of the cervical vertebrae. An X-ray is done to confirm the involved disc. An operating microscope can also be used to get a better picture of the operating field. The anterior longitudinal ligament is gently removed to reach the osteophytes and the disc fragments. The osteophytes are scraped off and the intervertebral disc is dissected. Once the disc is removed the vertebral bodies are gently distracted to their original distance to fill the space with bone graft. This helps to relieve the compression from the nerves as the diameter of the intervertebral foramen is enlarged. Sometimes cervical discectomy is followed by spinal stabilization using screws and plates.
  • Posterior Approach:The patient is sedated under general anaesthesia and made to lie on his abdomen. The neck is slightly bent and head is supported on the head rest. An incision is made on the back of the neck in the midline. The skin, fascia and muscles are retraced to reach the vertebrae. An X-ray is done to confirm the level of affected disc. Edges of the lamina are shaved off to give a clearer vision. Incase of central herniation, both lamina may have to be removed in order to get full view of the fragmented disc. The posterior longitudinal ligament is incised and a small hole is made in the ligamentum flavum. The surgeon now uses a surgical microscope to magnify the operating area and the disc fragments and bony spurs are carefully removed. The muscles fascia and skin are stitched back together.

Outcome and Recovery

The patients report an immediate relief in their symptoms after the surgery. The patient is allowed to go home in 1-2 days and allowed to begin gradually with his normal activities. Gentle stretching and strengthening exercises for neck muscles are progressed gradually and general body endurance program is initiated.

Vigorous neck movements should be avoided to allow proper healing of the graft. The physical therapist will advise on how to perform various activities without straining the neck.

 

Cervical Disectomy from Best Hospitals in India