Patient presents to us for distressing symptom - passing of urine on coughing or straining/laughing/weight lifting.
Performed for Infertility, Menorrhagia, pain in lower abdomen & in P/v examination and TVUSG showing adnexal mass.
Pre-operative assessment should be done to understand hyper mobility of mid-urethra & U-V junction and Detrusal instability is evaluated by clinical examinations and urodynamic study carefully before operation. Patient is also counseled about TOT & TVT tension free tap for its advantages and results. This surgery requires lot of experience & expertise. Burch’s procedure gives better result than Kelly’s plication & needle suspension procedures.
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. Associate intra abdominal lesions found during laparoscopy can also helps be treated them simultaneously.
- As compared to TOT/TVT Laparoscopic approach also helps in identifying mid & posterior compartment pelvic defects & simultaneously offering her the treatment for it.
Pre-operative Check Lists:
- Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.), Pelvic Trance vaginal USG report, Urine R & M and C/S with Uro-dynamic study to rule out the possibility of detrusor Instability.
- Enema & preparation/shaving of local parts.
No. Of Cuts on Abdomen:
Four cuts: four of 5 mm size.
Average Stay in Hospital:
24 to 36 hours. (DAY CARE SURGERY)
Average Duration of Surgery:
30-40 minutes depending upon associated surgeries.
Average Blood loss during Surgery:
Average time after operation to resume normal activities/work:
Within 24 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. First 5mm port/incision is made through umbilicus. Another three ports/incisions are made inside the navel near Lt. & Rt. Anterior superior iliac spine another at midline suprapubically, usually made near the bikini line. The first incision allows a Varies needle to be introduced 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.
Bladder is identified & pulled towards cavity with atraumatic grasper from one of the lateral port and Bipolar & scissor were used from lateral & midline port for desiccation & cut. Bladder was dissected from anterior abdominal wall and incision laterally extended to open up the space of reitzeius till urethra in midline seen and cooper’s ligaments were seen laterally on both pelvic walls. Space of Reitzeius was dissected easily till both cooper’s ligament were seen well. Mid-urethra & U-V junction dissected after elevating from below by assistant. Non-absorbable suture stitches were taken from mid-urethra near the U-V junction to Cooper’s ligament. Prolene no1 suture material used for taking stitches at midurethra and on Para urethral level after lifting the space vaginally by assistant from below. Same stitch is fixed with same side cooper’s ligament and tied and hammock is formed. Cystoscopy is necessary to rule out possible bladder injury. Same procedure is done on another side. Peritoneum is closed with No.1 Vicryl suture and continuous locking stitches.
- Patient remains drowsy/sedated for 2-3 hours after laparoscopy but conscious & pain free.
- Patient can take fluids 6-8 hours after laparoscopy & light food after 8-10 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 12 hours after the laparoscopy.
- She can be discharged on the next day of the operation.
- Few patients may feel nausea & vomiting after laparoscopy, which can be very well controlled with injection in post-operative room.
- Folly’s catheter was removed on next day.
- Patient can do her normal activity within 24 hours after laparoscopy. Patient was advised to take antibiotics & analgesic tabs.
- For 5 days following laparoscopy.
- Patient is advised to report to doctor for severe pain (suprapubic pain may be because of bladder distention due to retention of urine) 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.