Myth Vs Truth
I have been diagnosed with fibroid. Do I need surgery?
Fibroids are very commonly seen in young women. Their presence do not necessarily mean that you need to have them removed.
The advice depends on factors such as your age, symptoms (due to fibroids), size, number and location of fibroids.
Can fibroids cause infertility?
In most women, fibroids do not cause infertility. All other relevant investigations should be done to rule out / identify any obvious cause.
In the absence of any other factor, fibroid could be responsible for infertility and it’s removal may be advisable. However, large fibroids are better removed prior to planning pregnancy to avoid complications of pregnancy in the presence of fibroids.
What are the surgical options?
Surgical options include myomectomy (removal of fibroids) and hysterectomy (removal of uterus). These are performed laparoscopically which has several advantages compared to traditional, open method
Are there any other methods of treating fibroids?
There are other methods of treating fibroids. You may discuss the various options at the time of consultation.
LAPAROSCOPIC CERVICAL CERCLAGE (LCC)
Who should have this procedure?
Those women who have repeated miscarriages (abortions) especially after 12 weeks of pregnancy are offered cerclage. This procedure involves inserting a stitch around the cervix (neck of the womb) to provide the required strength to the cervix so that the pregnancy progresses without miscarriage.
Is there any other approach to doing this procedure?
Yes. Traditionally, this procedure has been performed via vaginal route. However, the failure rate with this procedure is relatively high compared to laparoscopic approach.
When is this procedure done?
It can be done either during early pregnancy or before getting pregnant. Having the cerclage before getting pregnant is advisable.
TOTAL LAPAROSCOPIC HYSTERECOMY (TLH)
What are the advantages of having hysterectomy done laparoscopically?
More than 90% of women who have this surgery with us go home in under 24 hours. Women having TLH have less blood loss during the surgery, need less pain relieving medicines, recover quickly from the surgery and have less post-operative adhesions.
Can it be done if I had previous surgery including caesarean section?
Yes. It can be done in women who had previously undergone one or more caesarean section, although there may be slightly increased risk of inadvertent injury to the urinary bladder. However, the chance of this happening is less than 1% in our experience.
Does the size of uterus matter?
No. It can be done for large uterus including those who have multiple fibroids.
When is this procedure done?
It is done in those who have undergone family planning operation (tubectomy) and wish to have the reversal of the surgery. Laparoscopic approach is arguably the best way as it provides excellent view necessary to perform the operation. We do this procedure using microsurgical instruments which increases the success rate.
Does endoscopic surgery have a role in enhancing prospects of pregnancy in infertile couple?
Yes. There are several conditions causing infertility which can be addressed successfully using endoscopic approach. Amongst the common ones are Polycystic Ovarian Disease (PCOD), Endometriosis, Pelvic adhesions, Fibroids, Endometrial polyps, Uterine septa, Tubal block needing tubal cannulation etc.
LAPAROSCOPIC SURGERY DURING PREGNANCY
Is it safe to perform Laparoscopic surgery in pregnancy?
Laparoscopic surgery can be performed safely in pregnancy.
What are the conditions where it is performed?
Commonly performed procedures during pregnancy are removal of appendix and ovarian cysts. It can also be performed in women with heterotopic pregnancy with one pregnancy in the tube and the other one in the uterine cavity.
Do all ovarian cysts need surgery?
No. Not all cysts in the ovaries need surgical removal. The decision is based on the history and symptoms along with the findings of imaging studies such as ultrasound, MRI or CT scan.
Can all cysts be removed by laparoscopy?
Most cysts can be removed successfully via laparoscopic approach. However, based on your history and investigations, it will be offered if thought to be safe. There will be occasions where an open surgery may be offered especially in those with any suspicion of cancer of ovary.
What does this surgery involve?
Women who had abdominal or pelvic surgery may have adhesions (scarring in the tissues) which can be responsible for long-standing pelvic pain and also pain in abdomen, especially in the absence of any other obvious cause. Laparoscopic adhesiolysis involves breaking down these adhesions to help in relieving the symptoms of pain. Apart from surgical cause, the other common condition causing adhesions is endometriosis.
What is ectopic pregnancy?
This is a condition in which pregnancy is implanted outside the uterus, most commonly in the fallopian tube.
Is surgery essential for treating this condition?
Not all ectopic pregnancy need surgical treatment. Based on the your symptoms, ultrasound scan findings and a particular blood test, your doctor may be able to avoid surgery.
Is it necessary to remove the affected tube?
No. In some situations, based on certain factors, the tube can be conserved. However, the main risk of this procedure is persistent trophoblast (incomplete removal of pregnancy) which may necessitate further treatment in the form of either an injection (Methotrexate) or further laparoscopy at a later date to remove the affected tube.
RISKS OF LAPAROSCOPIC SURGERY?
How common are the risks of laparoscopic procedure?
Like any surgical procedure, there are inherent risks with laparoscopy as well. The incidence of complications depend on the indication and can range from 2-3 in a 1,000 to as high as 3%.
What are the possible complications?
Amongst the significant risks are injury to urinary bladder, bowel, ureter or major blood vessel leading to excessive bleeding. These complications can be identified at the time of surgery but on few occasions, they may present later which could be up to a week. Minor complications such as infection after the surgery can be treated with antibiotics.
Can these complications be treated?
Yes. On most occasions the complications can be treated laparoscopically. However, there may be a need to perform open surgery based on the nature and extent of the problem.
RISKS OF HYSTEROSCOPIC SURGERY?
How common are the risks of hysteroscopic procedure?
These could be in the range of 1%. The nature of complication depends on the type of procedure being performed. The incidence of complications during diagnostic procedures is even less than 1%.
What are the common complications?
Amongst the common complications are uterus perforation (hole in the uterus) and infection after the surgery. These can be treated effectively without any long-term implications. Certain procedures may carry specific risks which we discuss with all patients prior to performing the procedure.