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Endoscopic Surgery

(Diagnostic - Operative Laparoscopy & Hysteroscopy)

This is routinely carried out on the woman partner, if she fails to conceive within one to two years of standard treatment. The procedure is an OPD based procedure, which is carried out under general anesthesia. Most patients can be discharged within 6 to 8 hours of the procedure.

In this, the wife is given general anesthesia. A small 1 cm cut is made on the skin at the navel and a telescope called the laparoscope is inserted inside the abdomen. This procedure is done using a carbon dioxide gas to distend the abdomen, so that the organs can be well visualized. Normally the uterus, the fallopian tubes on both sides, the ovaries on both sides and the region surrounding these organs is visualized. If there is any abnormality noticed, it is corrected at the same sitting, if possible. For example a uterine fibroid can be removed if it is thought that it is hampering fertility. This operation is called Myomectomy. We have been able to remove fibroids as large as 10 cm in diameter with the aid of laparoscope, without opening the abdomen. If the ovaries are enlarged and polycystic multiple small holes are burnt in the ovarian surface, a procedure called ovarian drilling. If there is a endomeriotic or a fuctional cyst it is removed. Endometrial deposits on the peritoneal surface are burnt or fulgurated using cautery or laser. Recently we are using a new machine called Harmonic Scalpel to operate many of these pathologies. In all cases where operative laparoscopy is performed two to three additional half to onecentimeter cuts have to be made, to pass other instruments into the abdomen. However these cuts are very small, and heal very well.

During laparoscopy we also conduct a Dye test or Chromopertubation to find out whether the tube are patent. In this a blue coloured dye called methylene blue is pushed into the womb from the vaginal route. In case of patent or open tubes, one can see the blue coloured dye coming out of the tubes, with the aid of laparoscope.

In hysteroscopy a small telescope is inserted into the womb to look at the inside of the womb. If there are any fibroids they are removed by an instrument called a Resectoscope. Alternatively recently one can also use the latest instrument which is called the VersaPoint.

In cases of blocked tubes one can also pass a guide wire into the tubal opening with the aid of the hysteroscope and try to clear the block.

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