TVUSG showing adnexal mass in Infertility patient or for pain in abdomen
Young patient (14-20 yrs) presents to us for pain or torsion and pain. Sometimes diagnosis is suspected from USG findings during infertility evaluation. Dermoid Cystectomy can be tackled by various dissection techniques very easily with preserving normal ovarian tissue after Cystectomy. Dremoid cyst can be retrieved in Endobag without spillage or with minimal spillage through posterior pouch of Douglas. In cases of post-hysterectomy dermoid cyst bilateral salpingo-oopherectomy can be done if her child bearing function is over. USG with color & power Doppler studies and tumor markers should be done pre-operatively to rule out the possibilities of cancer of the ovary. In doubtful case frozen facility should be kept available during laparoscopy & patient is counseled for Laparotomy for omentectomy & Para-aortic lymph node dissection if frozen biopsy report comes positive for malignancy during Laparoscopy. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.
Benefits of Laparoscopy Surgery:
- Shorter Hospital stay,
- Earlier return to your routine work,
- Cosmetically vary small scar,
- Less pain after operation,
- Best fertility enhancement & Fertility results following Laparoscopy,
- Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
- The possibility of post-operative adhesion formation will be less, and the possibility of pain because of post-operative adhesions will also be less. Laparoscopic surgery offers the benefit of preserving ovarian tissue after cystectomy for future child bearing potentiality.
Pre-operative Check Lists:
- Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.etc.); Pelvic USG with Color Doppler study, Blood tests for Tumor markers.
- Specific Investigations for Infertility (Endocrine, Blood, Genetic, Husband’s Semen report etc.) If the couple is infertile.
- Operation planned from 4th to 10th day of Menstrual Cycle if Laparoscopy is done for Infertility.
- Enema & preparation/shaving of local parts.
No. Of Cuts on Abdomen:
Three cuts: Two of 5 mm size & one of 10mm size for retrieval.
Average Stay in Hospital:
4 to 6 hours. (DAY CARE SURGERY)
Average Duration of Surgery:
For normal laparoscopy procedure takes about 15 to 35 minutes only. For more complicated case it may take 1-2 hours based on the size of dermoid cyst.
Average Blood loss during Surgery:
Average time after operation to resume normal activities/work:
Within 24 hours. Many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. She can do her routine normal activity within 6-8 hours. Most begin feeling much better within one day.
General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery)
Inside the Umbilicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.
Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made inside the navel, and another two are usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen, which helps to keep intestines & omentum up and away from pelvic organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.
Dremoid cyst is dissected with monopolar hook or scissor or claw forcep & suction irrigation cannula. In doubtful case dissection should be done in Endobag to prevent spillage. During dissection normal ovarian tissue is saved for future. Ovarian cysts removed with help of Endobag and send for HPE.
- Patient remains drowsy/sedated for 2-3 hours after laparoscopy but conscious & pain free.
- Patient can take fluids 3-4 hours after laparoscopy & light food after 4-6 hours. She may feel little abdominal & shoulder pain after laparoscopy for 24 hours but it cam be relived with pain killer tabs.
- Most of the patients can walk normally without support and can take normal diet 6-8 hours after the laparoscopy.
- She can be discharged on the same day of the operation.
- Few patients may feel nausea & vomiting after laparoscopy, which can be very well controlled with injection in post-operative room.
- Patient can do her normal activity within 24 hours after laparoscopy.
- Patient is advised to take antibiotics & analgesic tabs. for 5 days following laparoscopy.
- Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately.
- Patient is advised to come for follow up 7 days after the Laparoscopy for dressing.