Akanksha Women's Clinic - Centre for Gynaec Laparoscopy

Hello,

Everyone, I’m Dr Sanket Pisat. I’m a consultant gynaecological laparoscopic surgeon, practising in Andheri in Mumbai and today we are going to talk about fibroids. Fibroids are among the communist non-cancerous tumours that grow in the reproductive tract of the female genital system. It is surprising to know that as many as 40% of women will have had an issue with fibroids in their entire lifetime. Some of these fibroids might actually be symptomatic in the sense that they may trouble the patient in terms of giving symptoms like excessive bleeding or inability to get pregnant or a sense of continues heaviness in the lower abdomen or symptoms like urinary symptoms or bowel symptoms where the patient cannot evacuate her bowels completely. Now a lot of these fibroids may actually be asymptomatic in the sense that they have no bearing on the women’s health at all, however most of these fibroids if they are symptomatic almost always require to be treated. Fibroids can be detected by a good ultrasound examination and it is worthwhile to remember that not all fibroids require treatment or require surgery.

A lot of this fibrosis can be left alone without any sequel and some of these fibroids can be managed very well with medicine without the need for surgery however in a select group of patients there are fibroids in the uterus which are causing problems like infertility the inability to get pregnant or heavy menstrual bleeding these are the fibroids that generally require surgery now previously this kind of surgery was done by opening up the abdomen and removing the fibroids. Not anymore now this surgery is done by what we call keyhole surgery or laparoscopy in which two or three small cuts are made on the abdomen and the entire fibroids can be removed these two or three cuts. It is a day care surgery in the scene the patients get admitted in the morning and is usually discharged in the same day or the next day for the removal of fibroids. Because of the advancement in fibroids removal this surgery has become extremely cost effective, painless and with a minimal hospital stay of maybe one or two days the other variant of fibroids is the fibroids that grow with in the uterine lining which are called submucouse fibroids and these can be managed virtually by a scar less called hysteroscopic fibroid removal in which the entire surgery is done through the vagina without having to take a single cut on the patients abdomen other treatment options for fibroids are also available called uterine artery embolization which is actually a small surgery to block the blood supply to the fibroids so that over time the fibroids shrinks and don’t grow anymore. The other option available for the treatment of fibroids is the use of a high-intensity beam much similar to the ultrasound we use for locating and seeing the fibroids but in much intensity in order to melt the fibroid so fibroid never comes back and gives you a pain-free life. Of course the whole decision of which treatment modality can be used in which patient and is suited best for whom has to be left to the doctor because there are several points to consider if you are planning of pregnancy as to how and where the fibroid should be removed and which fibroid should be left alone so that the pregnancy outcome or your future health is not affected. If you have any further questions in this regard please feel free to contact me through Lybrate. Thank you.

Hello Everyone,

This is Dr. Sanket Pisat. I am a consultant Gynecological Laparoscopic surgeon working in Adheri in Mumbai.

And today we are going to talk about endometriosis. Endometriosis, as you may have heard from newspapers or report, is a disease that effects the reproductive track of the females quite commonly. The incidence of endometriosis in the past few years, mainly attributed to a late age of marriage, a late age of pregnancy or sometime because of having no children at all. So what is actually endometriosis? Endometriosis is the abnormal growth of the uterine lining which should normally be growing within the uterus at places where it should not be growing like the other organs within the abdominal cavity for example on the ovaries. What happens that is this endometrial lining causes pockets of blood filled tissues on the other organs like the ovaries or the intestines and result in tremendously painful periods to the patient, also sometimes resulting in infertility. The diagnosis of endometriosis is largely clinical, in a sense that sequelae or a set of symptoms commonly suggest that you may be suggesting from endometriosis. These include very heavy periods, tremendously painful periods or an onset of pain just before the periods but going away as the period start or sometimes just plainly infertility. Other times in some patient it may be a difficulty in sexual intercourse or pain during sexual intercourse and all of these require intensive investigation. Sometimes endometriosis can be diagnosed by an ultrasound examination in which the cyst in the ovary show the presence of endometriosis and these are the patients who require surgery. Endometriosis surgery can nowadays be done by laparoscopy or minimally invasive surgery in which there are hardly three or four cuts take in the abdomen which are less than a centimetre in size and the entire disease of endometriosis can be removed by surgery through these three or four ports. Of course, some pockets of endometriosis which are attached to vital organs within the body may not be removed but these then can be managed by medicines alone. In other patients, endometriosis is not as wide spread, the entire disease can be controlled by medicines alone and the patient can be given long term therapy for about three months or six months to make sure that the endometriosis stays quist and does not grow again. A word of conscience for these patients with endometriosis who are also suffering from infertility is that it is essential to plan pregnancy and child birth early because endometriosis is a disease of recurrence and a disease of progression and as age advances an endometriosis increases in intensity. It becomes more and more to conceive either naturally or by any form of assistive reproductive techniques.

If you have any further question in regards please feel free to contact me via Lybrate. Thank you.

Hello Everyone,

This is Dr. Sanket Pisat. I am a consultant Gynecological Laparoscopic surgeon working in Adheri in Mumbai

And today we are going to discuss about ovarian cyst. Cyst in the ovary is a very common finding that you will found reported on several ultrasound studies done women who have presented varying complaints. Cyst may be the cause of infertility which is the inability to get pregnant. They may be the cause of heavy menstrual bleeding or they may be a cause for continuous dilating pain abdomen which the woman is experiencing before her periods or unrelated completely to her period. There can be several reasons for why there are cysts in the ovary and likewise these cysts may or may not dangerous and may or may not require treatment at all. Some of the commonest cyst that are seen in the ovary are poly cystic ovaries which are multiple small fluid filled balloons present inside the ovary itself which are a collection of follicles not ruptured which should have ruptured every month with every menstrual cycle. A lot of time these patients with these kind of polycystic ovaries have got menstrual disturbance find it difficult to get pregnant. This particular kind of variances can be manages wit medicine alone without the need for surgery or very rarely a small laparoscopy procedure called: polycystic ovarian drilling may be done. The other larger cyst seen in the ovary may or may not be cancerous in origin. Some of these are called simple ovarian cysts, which are just fluids filled vesicles formed in the ovary during the process of menstruation but get dissolved as the periods have gone by. Some of these cyst are in born, like dermoid cyst which is a collection of fat within the ovary itself and sometimes women endometriotic cyst which is the collection of blood filled pockets within the ovary which cause tremendous pain during periods and make it difficult for the patient to get pregnant. Rarely however these cyst can actually be cancerous in origin or may be preload to a cancer so it is so it is important that they be investigated fully. Most of the times cyst can be diagnosed by an ultrasound examination alone but sometimes these cyst may require T scan or an MRI for a diagnoses. As far as treatment is concerned some cyst can be managed by medicines alone but a lot of times these cysts needs to be removed. Earlier this kind of surgery need to be performed by open surgery or by opening the abdomen but now by laparoscopy or minimally invasive surgery it is possible only two or three cuts on the abdomen and remove the ovarian cyst with minimal damage to the ovarian tissue that means only the cystic part of the ovary which is abnormal can be removed and the rest of the ovary be left behind in order to continue its reproductive function, to continue its hormones secreting function and cause no symptoms to the patient later on.

If you have any further questions I this regard please feel free to contact me via Lybrate. Thank you.

Hello Everyone,

I am Dr. Sanket Pisat. I am a consultant Gynecological Laparoscopic surgeon practicing in Adheri in Mumbai.

And today we are going to talk about fertility enhancing Endoscopic Surgeries, no as you all may be appear infertility is a very common problem that is faced by a lot of couples these days which is basically inability to get pregnant. Now while there can be several problems as to why a couple cannot conceive children. One of the main causes is that in the light of more career option family and child bearing take a back seat until a very advance age. Sadly the body clock cannot be turned back and it does not really wait for us. There can be many causes as to a woman doesn’t get pregnant but in at least 50 % of the cases, actual cause can be found and located within the reproductive system of the woman itself. So after confirming that the male partner does not have any particular problem for which he should be treated, it is worthwhile to look into the defects of the female reproductive system and if thee defects can be corrected than pregnancy can be achieved rather simply. Now there can be a lot of defects ranging from a very small opening of the cervix which is the entry point of the uterus to poorly growing lining of the endometrial cavity which is the inside of the uterus to fibroids in the uterus or cyst in the ovary or even blocked tubes. All of these problems can be corrected by a procedure which is called diagnostic laparoscopy and hysteroscopy. Laparoscopy is basically the examining of the insides of the abdomen and reproductive organs using the camera system. Using this camera system we are able to examine every aspect of the female reproductive system and any correctable problems for example if there is a fibroid seen or if the tubes are blocked, those can be corrected at the same instant. It’s a very simple procedure, requires a single day of admission and the entire procedure is done through one or two small sized cuts on the abdomen so the patient is virtually painless after and can go immediately. Likewise there is another advance procedure called hysteroscopy, in which the inside of the uterine cavity where the baby actually grows can be examined using a camera system and a lot of defects namely, you may have defects that are congenital origin or they are since birth uterine septa or there may be am excessive band formation between the uterine cavity cynic or small growth within the uterine cavity called fibroid of polyps. Many of the times these small growth or small pathologies cannot be seen by diagnostic modalities like ultrasound, CT scan or MRI. Laparoscopy and hysteroscopy give us option of being able to diagnose these findings and treat these findings at the small instance which is almost one day procedure and the patient walks away with hardly any pain or hardly any sequelly. To summarize, fertility enhancing endoscopy surgery holds tremendous for the infertile couple in home. Small pathology which have not being diagnosed which have actually being the cause of their infertility and on surgical correction of these fertility in a single sitting it is possible for the couple to achieve pregnancy without really going for multiple or expensive treatment options like In Vito Fertilization and test tube babies.

If you have any further query regarding this matter lease fell free to contact me through Lybrate.