In Well Woman Daycare Surgery or Ambulatory surgery, the patient is discharged on the same day from the hospital.
Our Daycare Surgical Unit is fully equipped to perform most of the gynaecological endoscopic procedures involving hysteroscopy and laparoscopy. Not only the advances in minimally invasive surgery have made it easier but also the anaesthetic drugs have become smoother with faster recovery; emergence of newer analgesics provide excellent pain relief post procedure.
Patient Selection: Exclusion criteria - (a) Obese and anxious patients, (b) The elderly and infirm, (c) Surgery involving excessive blood loss or postoperative pain (d) Operations exceeding one hour
Technology:
(a) Timings of the daycare ward complex are from 0700 h to 1700 h daily on working days or till the last patient recovers from the effects of anaesthesia or declared fit for discharge by the surgeon
(b) Pre-operative work-up includes investigations along with a detailed explanation of the day care surgery procedure, admission and discharge, post-operative care at home by the relative and possibility of admission due to complications, if any.
Advantages of Daycare Surgery
1. Short hospital stay
2. Early ambulation
3. Less painful
4. More affordable and more patient satisfaction
5. Faster return to the routine environment
6. No waiting lists due to pre booked dates
Day care surgery is a time-honoured modality of treatment for most patients requiring surgery and also for the healthcare center as a whole.
Gynaecological Daycare Surgery not only encompasses the following surgeries but also includes a list of laparoscopies and hysteroscopies.
1. Cervical biopsy and colposcopy, Cervical cryocautery
2. Endometrial aspiration (EA) ± Mirena insertion
3. Bartholin cyst excision
4. Excision of labial cyst, vaginal or vulval biopsy
5. Vaginal myomectomy, vaginal polypectomy
6. EA with polypectomy
7. Repair of perineal tear
6. Suction & evacuation for first trimester abortion
7. MTP with laparoscopic tubal ligation
8. Midtrimster abortion
Laparoscopy – what is it all about?
It is a surgical procedure that involves the use of a laparoscope
The laparoscope is inserted through a tiny incision in the patient’s navel
It provides a broad view of the uterus, tubes, ovaries and fallopian tubes on a video monitor in the operating room
It can be performed along with hysteroscopy in women with infertility
Laparoscopy
Indications
Diagnostic
1. Acute or chronic pelvic pain
2. Ectopic pregnancy
3. Pelvic inflammatory disease
4. Endometriosis
5. Adnexal torsion
6. Tubal and peritoneal factor evaluation - infertility
7. Anomalies of mullerian / wolffian ducts
Operative
All procedures performed through laparotomy
What are the alternatives?
1. Open surgery may be done for similar procedures (Laparotomy)
2. This procedure is much more invasive, involving a higher risk of complications, longer time in hospital and longer recovery after discharge
Laparotomy versus Laparoscopy
Our Daycare Surgical Unit is fully equipped to perform most of the gynaecological endoscopic procedures involving hysteroscopy and laparoscopy. Not only the advances in minimally invasive surgery have made it easier but also the anaesthetic drugs have become smoother with faster recovery; emergence of newer analgesics provide excellent pain relief post procedure.
Patient Selection: Exclusion criteria - (a) Obese and anxious patients, (b) The elderly and infirm, (c) Surgery involving excessive blood loss or postoperative pain (d) Operations exceeding one hour
Technology:
(a) Timings of the daycare ward complex are from 0700 h to 1700 h daily on working days or till the last patient recovers from the effects of anaesthesia or declared fit for discharge by the surgeon
(b) Pre-operative work-up includes investigations along with a detailed explanation of the day care surgery procedure, admission and discharge, post-operative care at home by the relative and possibility of admission due to complications, if any.
Advantages of Daycare Surgery
1. Short hospital stay
2. Early ambulation
3. Less painful
4. More affordable and more patient satisfaction
5. Faster return to the routine environment
6. No waiting lists due to pre booked dates
Day care surgery is a time-honoured modality of treatment for most patients requiring surgery and also for the healthcare center as a whole.
Gynaecological Daycare Surgery not only encompasses the following surgeries but also includes a list of laparoscopies and hysteroscopies.
1. Cervical biopsy and colposcopy, Cervical cryocautery
2. Endometrial aspiration (EA) ± Mirena insertion
3. Bartholin cyst excision
4. Excision of labial cyst, vaginal or vulval biopsy
5. Vaginal myomectomy, vaginal polypectomy
6. EA with polypectomy
7. Repair of perineal tear
6. Suction & evacuation for first trimester abortion
7. MTP with laparoscopic tubal ligation
8. Midtrimster abortion
Laparoscopy – what is it all about?
It is a surgical procedure that involves the use of a laparoscope
The laparoscope is inserted through a tiny incision in the patient’s navel
It provides a broad view of the uterus, tubes, ovaries and fallopian tubes on a video monitor in the operating room
It can be performed along with hysteroscopy in women with infertility
Laparoscopy
Indications
Diagnostic
1. Acute or chronic pelvic pain
2. Ectopic pregnancy
3. Pelvic inflammatory disease
4. Endometriosis
5. Adnexal torsion
6. Tubal and peritoneal factor evaluation - infertility
7. Anomalies of mullerian / wolffian ducts
Operative
All procedures performed through laparotomy
What are the alternatives?
1. Open surgery may be done for similar procedures (Laparotomy)
2. This procedure is much more invasive, involving a higher risk of complications, longer time in hospital and longer recovery after discharge
Laparotomy versus Laparoscopy
Laparotomy
|
Laparoscopy
|
•Technically Easy
|
•Reduced morbidity
|
•More invasive
|
•Faster recovery
|
•higher risk of complications
|
•Reduced hospital stay
|
•longer time in hospital
|
•Reduced cost
|
•longer recovery after discharge
|
•Immense potential
|
Laparoscopic ovarian surgery
• Ovarian cystectomy
• Ovariotomy
• Ovarian drilling in PCOS
• Ovarian biopsy in premature ovarian failure
• Fenestration / cystectomy
Operative laparoscopy for fertility enhancement
Laparoscopic adhesiolysis
Blunt /sharp /aqua /laser dissection
• Results comparable with laparotomy
• Duration of surgery 30 min to 2 hours
• Discharge on same day
• Minimal complications
• Early return to activity
Fimbrioplasty / salpingostomy
• pregnancy rate 0 to 44% with ectopic pregnancy 0-14%
• pregnancy rates comparable to laparotomy and microsurgery
How is laparoscopy performed?
• Laparoscopy is performed under general anaesthesia
• The abdomen is inflated with gas and a laparoscope is inserted to look at the internal organs. Further small cuts may be made in your abdomen if any abnormalities require treatment
• After the procedure, the instruments are removed, the gas released and the cuts are then closed, with stitches. The procedure itself takes 30 minutes or more, but you can expect to be in theatre and recovery for a number of hours
What are the risks of undergoing this procedure?
• You should be aware that every surgical procedure has some risk
• The procedure may not be able to be completed laparoscopically, and you may require an “open” operation with a larger cut and an increased hospital stay
• If duration of surgery is prolonged due to some reason or incase of bladder or bowel injury, it may mean a longer stay in hospital and longer recovery time
• In few women, wound healing may be abnormal and the wound thickened, red or painful
Preparation for your surgery
• It is necessary that you have nothing to eat or drink at least six hours before your operation. You should stop eating and drinking at the following times on the day of your surgery:
- at 12 midnight for a morning procedure
- at 6 am for an afternoon procedure
• It is important for you to shower and dress into clean clothes prior to coming into hospital. No skin products are to be used following your shower (e.g. deodorant, perfume, body lotion, powder)
- You need to bring with you:
- All X-rays, blood and ECG test results
- Any medications in their labelled containers
- your Insurance Card
- your completed registration form
What should I expect after the procedure?
• You will stay in the recovery room after the operation while you wake up from your anaesthesia. You will then be transferred in your bed to the Day Care Procedure Unit.
• During your recovery, your vital signs (eg temperature, pulse, blood pressure) will be monitored for several hours after the surgery.
• It is common to feel drowsy, have some abdominal discomfort or bloating, some mild nausea and experience pain on the tip of your shoulder
Instructions at discharge
• You will be provided with pain relief as needed.
• Your nurse will discuss your follow-up appointment and any discharge arrangements that have been made with you.
• You should be eating and drinking normally, and be mobilising.
• It is important that you stay in the company of a responsible adult for 24 hours and:
- do not consume alcohol for the remainder of the day
- do not drive a car, motorbike or ride a bicycle
- do not engage in heavy lifting
• It is normal to expect some pelvic discomfort. You will be given specific discharge medication if require
• It is important for you to use sanitary pads and not tampons
• What to avoid: Intercourse, taking a bath and swimming for 2 weeks
Contact
Please contact Dr Nupur Gupta IMMEDIATELY if you experience any of the following after discharge:
• a fever or are feeling unwell
• offensive vaginal discharge or heavy bleeding
• wound becomes hot, painful or has offensive fluid draining from it
• nausea and vomiting which does not settle
• unable to empty your bladder or bowel
• severe pain
Facilities Offered - Laparoscopy
• Diagnostic laparoscopy and hysteroscopy
• Laparoscopic adhesiolysis
• Laparoscopic ovarian drilling
• Laparoscopic ovarian cystectomy/oophorectomy
• Laparoscopic treatment of ectopic pregnancy
• Laparoscopic evaluation of pelvic pain
• Laparoscopic treatment of endometriosis
• Laparoscopic assisted vaginal hysterectomy (LAVH)
• Total Laparoscopic hysterectomy (TLH)
What is Hysteroscopy?
• It is the access of the uterine cavity via a natural orifice (vaginally through the cervix)
• Diagnostic hysteroscopy is a day care procedure with short admission, performed on an outpatient basis in the ambulatory surgery unit
• It is an invaluable tool for the diagnosis and treatment of intrauterine pathology
How does it work?
Through the use of fibreoptic technology, the hysteroscope transmits an image of the uterine canal and cavity to a TV monitor, allowing the gynaecologist to properly guide the instrument into the endometrial cavity
Types of hysteroscopy
• Diagnostic hysteroscopy is performed to visualise the uterus and rule out any abnormality
• Operative hysteroscopy involves the insertion of small instruments through a sheath covering the hysteroscope
• Both diagnostic and operative procedures can be performed together or as separate procedures
Indications for hysteroscopy
• Dysfunctional uterine bleeding
• Infertility
• Postmenopausal bleeding
• Recurrent pregnancy loss
• Abnormal findings at USG, HSG, MRI, blind biopsy
• Suspicion of uterine congenital anomalies
• Suspicion of intrauterine adhesions
• Misplaced foreign bodies (e.g. IUD)
• Follow-up of medical (e.g. tamoxifen) or surgical treatment (intrauterine surgery)
• Mock embryo transfer & embryo evaluation (embryoscopy)
About the procedure
• The patient may be given either local or general anaesthesia depending upon the medical history or the nature of the disorder
• No surgical incisons are made
• A long very thin rod with a video camera and a light attached to it are placed through the opening of the cervix and guided through the endocervical canal into the uterus
• Diagnostic hysteroscope is 4mm in diameter
• A liquid distension media is used for distending the uterine cavity
• If a biopsy is performed during hysteroscopy, histopathology results are evaluated and the possibilities discussed with the patient
• For one or two days following hysteroscopy, mild cramping and some bloody discharge is expected. Mild analgesics are prescribed to alleviate the discomfort
• Patient should contact the doctor if she experiences severe pain, bleeding, fever or chills
Facilities Offered - Hysteroscopy
• Diagnostic hysteroscopy
• Hysteroscopic and endometrial biopsy
• Hysteroscopic adhesiolysis
• Hysteroscopic septal resection
• Hysteroscopic polypectomy
• Hysteroscopic myomectomy
• Hysteroscopic intrauterine device removal
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