Performed for pain in lower abdomen or for something coming out Per vaginum or passing of urine on straining (coughing, weight lifting etc. or sometimes in-patient with Infertility and when all other causes of infertility are rule out.
Incidence of 2nd and 3rd degree uterine prolapse is now found frequently with specific operation for prolapse and preserving her child bearing potential in future. Many patient discloses the fact that she passing urine on coughing or laughing in patients along with prolapse and she wants relief for this distressing and long standing symptom since many years.
2nd or 3rd degree uterine prolapse is found to be associated with multiple pelvic floor defects and this can be better identified laparoscopically and addressed appropriately & anatomically. Addressing anterior. Mid and posterior compartments defects repair from below may be inadequate and may leads to recurrent prolapse after vaginal repair. Today concept of identifying defects in pelvic endo-pelvic fascia and offering mesh support for adequate repair has become popular for better results. These multiple pelvic defects are identified and Anterior or mid or Posterior compartment defects repair are done systemically to prevent reoccurrence. Vaginal wall or isthmus can be fixed with one end of mesh and then another end of the mesh with sacral promontory with tacker. This surgery requires lot of experience & expertise.
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.
- Special advantages of laparoscopic repair are
- Better pain relief after operation,
- Less chances of redo surgery for prolapse again,
- Comprehensive and anatomical repair of multiple pelvic floor defects repair better
- Finally better sexual quality because of good vaginal depth after laparoscopic repair.
- Normal delivery can also be tried after laparoscopic repair.
Pre-operative Check Lists:
- Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S)Pelvic Trance vaginal USG report
- Specific Investigations for associated problems.
- Two days of liquid diet before operation and Special Peglac / Colo-wash (Powder dissolved in one liter of drinking water and patient is asked to drink every 10 minutes till the same colored fluid comes out instead of stool) six hours prior to operation & preparation/shaving of local parts.
No. Of Cuts on Abdomen:
Three cuts: all of 5 mm size.
Average Stay in Hospital:
12-24 hours. (DAY CARE SURGERY)
Average Duration of Surgery:
Average Blood loss during Surgery:
Average time after operation to resume normal activities/work:
Within 24 hours.
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. With previous midline scar on abdomen, we generally introduce verres needle through palmer’s point and then first 5 mm port is introduced through Palmer’s point. . 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. With help of palmer’s point port, second 5 mm port is kept supra umbilically on vision above the midline intra abdominal midline adhesions. Third port is kept on Rt side near anterior superior iliac spine on vision. Adhesiolysis is done with Bipolar & scissor and adhesions are stretched from one side simultaneously
Uterus is manipulated anteriorly and posterior vaginal mucosa is cut near isthmus and long artery forcep is introduced from below under laparoscopic guidance and medial to Rt. Uterosacral ligament till it reaches to window near sacral promontory. Peritoneum is opened on pelvic brim and peritoneum is dissected down, medial to Rt. Uterosacral ligament, away to RT Ureter. Lower end of the mesh is sutured with isthmus vaginally with prolene No.1 stitches. Proximal mesh end is fixed with sacral promontory with tacker (small screw fixes with sacral promontory) Peritoneal closure done near sacral peritoneum with No. 1 Vicryl by continuous closure and mesh totally covered with peritoneum.
Most of the time many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 15 to 35 minutes only. For more complicated case it may take 1-2 hour. Most begin feeling much better within one day.
- 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 12hours after the laparoscopy.
- Folly’s catheter is removed on next day. 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.
- 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.