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News Letters

Endoscopy Operations | Endometriosis- Bilateral Chocolate cyst

Indication:

Performed for Infertility or pain in lower abdomen during menstrual period and painful sexual relations.

Objective:

Dysmenorrohea, Dysparenunia & pelvic pain & Infertility are the presenting symptoms. Chocolate cysts may be found in Infertility patient during trance vaginal USG evaluation. Endometriosis is the commonest cause of Infertility during Laparoscopy. Pigmented & white fibrotic lesions are the two different varieties of lesions. Endometriosis is poorly detected during Laparoscopy leads to more than 2-3 Laparoscopy of infertility patient without result. Endometriosis needs to be better address during Laparoscopy, as residual diseases leads to recurrence & Infertility. Most rewarding results are achieved following Laparoscopic surgery with pregnancy rate from 50 to 70% in different series for chocolate cyst with Endometriosis.Cystectomy should be preferred over simple drainage for preventing reoccurrence. But if we feel that cystectomy dissection is too difficult & likely to destroy many normal ovarian follicles, we do drainage & bipolar fulguration of internal surface of chocolate cyst. Rectovaginal endometriosis is carefully evaluated during Laparoscopy. Right cleavage & proper dissection of recto-vaginal nodule for her pain relief is paramount importance.

Benefits of Laparoscopy Surgery:

Shorter Hospital stay.
Earlier return to your routine work.
Cosmetically vary small scar.
Less pain after operation.
Best fertility enhancement & Fertility results following Laparoscopy.
Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
The possibility of post-operative adhesion formation will be less, and the possibility of pain because of post-operative adhesions will also be less.

Pre-operative Check Lists:

Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.etc.); Pelvic Trance vaginal USG report. Tumor marker study.
Specific Investigations for Infertility (Endocrine, Blood, Genetic, Husband’s Semen report etc.),If the couple is infertile.
Operation planned from 4th to 10th day of Menstrual Cycle.
Enema & preparation of local parts.

No. Of Cuts on Abdomen:
Three cuts: all of 5 mm size.

Average Stay in Hospital:
14 to 26 hours. (DAY CARE SURGERY)

Average Duration of Surgery:
For normal Laparoscopy procedure takes about 25 to 75 minutes only. For advanced Endometriosis it may take 1-2 hours

Average Blood loss during Surgery:
50-100 cc

Average time after operation to resume normal activities/work:
Many patients undergo Laparoscopy as Day care procedure, returning home within 24 hours of surgery. Most begin feeling much better within one day.

Anaesthesia:
General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery)

Operative Procedure:

Inside the Umbilicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

Performing Laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made inside the navel, and another two are usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen, which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

Chocolate cyst is gradually separated from surrounding omentum & intestines & tubes. Chocolate cyst is separated from pelvic wall and uterosacral ligament and chocolate fluid is drained gradually to prevent spillage. Cystectomy is done without damaging normal ovarian tissue. Endometriotic lesions are excised if pain is the main complaint and fulgurated with bipolar desiccation if Infertility is the main complaint. Suction & irrigation done with Ringer lactate and Haemostasis is checked. Edges of the ovarian capsule are grasped with grasper for 2-3 minutes so ovary is restructured & Tubo-ovarian relationship established.

Post-operative Course:

Patient remains drowsy/sedated for 2-3 hours after laparoscopy but conscious & pain free. Patient can take fluids 3-4 hours after laparoscopy & light food after 6-8 hours. She may feel little abdominal & shoulder pain after laparoscopy for 24-48 hours but it cam be relived with pain killer tabs. Most of the patients can walk normally without support and can take normal diet 12 hours after the laparoscopy. She can be discharged on the next day of the operation. Few patients may feel nausea & vomiting after laparoscopy, which can be very well controlled with injection in post-operative room. Patient can do her normal activity within 24 hours after laparoscopy. Patient is advised to take antibiotics & analgesic tabs. For 5 days following laparoscopy. Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately. Patient is advised to come for follow up 7 days after the Laparoscopy for dressing.sss

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