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Diagnostic Hysteroscopy
The procedure is done under local or general anesthesia. A tiny telescope is inserted into the uterus to observe the cavity. It allows viewing of the inner lining of the uterus (endometrium), shape, size, and diagnose intrauterine problems such as adhesions, septum, polyps or fibroids. If an abnormal condition is detected during the diagnostic procedure, operative hysteroscopy can often be performed to correct it at the same time, avoiding the need for second surgery.

Polyp Removal
A Polyp is a benign growth from the endometrium. It causes menstrual irregularities, heavy bleeding or infertility. It can be removed by cutting the stalk with scissors or shaved into pieces using an electric instrument called the resectoscope which is introduced into the uterus through the cervix.

Hysteroscopic Adhesiolysis
Adhesions are fibrous or vascular strands that cause the uterine walls to stick to each other. In severe cases the cavity can be completely obliterated. They cause scanty menstruation, amenorrhoea (absent menses), recurrent miscarriage or infertility. Removal of the adhesions is called adhesiolysis. They can be cut using scissors or electric current through an operative hysteroscope.

Fibroids projecting in the uterine cavity (sub-mucous myomas) can cause heavy menses, pain, dysmenorrhoea, recurrent miscarriage or infertility. They can be removed using the resectoscope by shaving the myomas into small pieces and removing them through the cervix.

Alterations in the size, shape and capacity of the uterus can occur due to congenital (uterine septum, T-shaped, hypoplastic uterus) or acquired (previous infection, previous surgery) conditions. Metroplasty is a procedure where using operative techniques the uterus is restored to its normal size, shape or capacity.

Tubal cannulation
Tubal blocks can be due to mucous plugs, debris or thin membranes covering the tubal ostia. A fine catheter can be guided through the hysteroscope to open these blocks.

Foreign Body Removal
Misplaced or broken IUCD’s or fetal bones from previous abortions can be retained in the uterine cavity. They can cause irregular bleeding or infertility. A forceps or grasper can be used to remove these objects using an operative hysteroscope.

Diagnostic Laparoscopy
The procedure is done under general anesthesia. A thin telescope is inserted through the umbilicus (belly button) to look at the outside of the uterus, fallopian tubes, ovaries, and internal pelvic area. If an abnormal condition is detected during the diagnostic procedure, operative laparoscopy can often be performed to correct it at the same time, avoiding the need for second surgery.

Laparoscopic Adhesiolysis
Adhesions are fibrous or vascular strands that stick pelvic organs like uterus, tubes, ovaries and bowel. They result from previous infection or surgery. Although in most cases, adhesions are innocuous, they can cause pain, dyspareunia and infertility. Removal of the adhesions is called adhesiolysis. They can be cut using scissors, electric current or laser.

PCOD Drilling
A polycystic ovary is a condition in which the ovaries are bulky due to multiple (8 – 20) tiny follicles in the ovary, diagnosed by ultrasonography. They suffer from infrequent menses, irregular menses, obesity, hirsuitism (excessive facial and body hair), and infertility. In patients wishing to conceive, when medical treatment fails, laparoscopic drilling of ovaries is performed. A needle is used to drill multiple holes on the ovarian surface using high frequency current. The procedure leads to fall in hormone levels, normalization of menses and improved fertility.

Ovarian Cystectomy
Cysts in the ovary could be due to hormonal imbalance or tumor process. Majority of them are benign (non-malignant). In young women wishing to preserve fertility, the cysts can be treated laparoscopically by performing cystectomy (removal of the cyst lining). The normal ovarian tissue is preserved. The lining is put in a endobag and removed from the abdomen.

Ovarian cysts or tumors which involve the entire ovary or when they occur in elderly women (fertility preservation not required), are treated by oophorectomy (removal of the entire ovary).

Endometriosis Surgery
Laparoscopy is ideally suitable for endometrisis surgery as diagnosis, staging of the disease and treatment can be performed in a single setting. It causes pelvic pain, menstrual pain, painful intercourse or infertility. The surgery can be fertility preserving/ enhancing in younger women who wish to conceive or preserve fertility or radical in older women who do not wish to conceive. Read Endometriosis – treatment options

Fibroids are common tumors in the reproductive age group, occurring in 20 – 25% of women. Although they are asymptomatic in most women, they may cause pain, heavy menstruation, pressure symptoms, infertility or recurrent miscarriage. In symptomatic patients removal of the fibroids (myomectomy) can be performed laparoscopically. The surgery involves removal of the fibroid from the uterus, reconstruction (suturing the defect) and removal of the fibroid from the abdomen by morcellation (reducing the fibroid into small chunks using a special instrument).

Ectopic Pregnancy
Pregnancy occurring in any site other than in the uterus is called Ectopic. The commonest site for ectopic pregnancy is the fallopian tube. Tubal ectopic pregnancy can cause pain, and internal bleeding following tubal rupture leading to shock or even death. If diagnosed early, it can be treated by laparoscopy. Salpingotomy (incision of the tube to remove the pregnancy) or Salpingectomy (removal of the tube) can be performed.

Removal of the fallopian tube (Salpingectomy) may be required when it is diseased due to infection or a cause of pelvic pain.

Removal of the fallopian tube and the ovary may be required when they are diseased due to infection or tumor.

Removal of the appendix

Repair of Genital Prolapse
The pelvic organs can be displaced from its normal position due to injury during delivery or weakening of pelvic supports due to ageing or menopause. Genital prolapse can cause backache, discomfort, urinary and bowel symptoms. Pelvic reconstruction can be performed to repose these organs to their normal position.

Removal of the uterus may be required in patients suffering from menorrhagia (heavy menstruation), adenomyosis, fibroids, genital infection, malignancy or prolapse. Read Understanding Hysterectomy.

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