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News Letters

Endoscopy Operations | Laparoscopic Tubal Ligation

Indication:

Performed for family planning purpose permanently. Laparoscopic Tubal Ligation gives better chances of successful reversal operation as minimum length of tube is compromised in Lap. T.L. as compared to Abdominal Tubal Ligation.

Objective:

Laparoscopic Tubal Ligation was the simplest operation from very beginning. In government set up it was done under local anesthesia & sedation. In private set up it is always done under general anesthesia & endotrachial intubation.

Severe obesity & previous scars over the abdomen were considered to be relative contraindication for laparoscopic approach in the past. With advancement and better understanding the advantages of laparoscopic surgeries, now severe obesity & previous scars over the abdomen are the most common indications for laparoscopic approach, where in we can remove omental & intestinal adhesions with abdominal wall during laparoscopic Tubal Ligation operation, which may help her from relief of occasional pain due to adhesions of previous scar.

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.
Special advantages of laparoscopic Tubal Ligation are better reversal rate in future and performing associated surgeries during laparoscopic Tubal Ligation.

Pre-operative Check Lists:

Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.) Pelvic Trance vaginal USG report
Specific Investigations for associated problems.
Nil by mouth from previous day at around 10 p.m. onwards.
Preparation of local parts.

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

Average Stay in Hospital:
2-3 hours. (DAY CARE SURGERY)

Average Duration of Surgery:
2-5 minutes

Average Blood loss during Surgery:
0-10 cc.

Average time after operation to resume normal activities/work:
Within 8 hours.

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. Palmer’s point is the choice of site for primary 10/5 mm port, in cases of previous scar over abdomen

Performing laparoscopy usually only requires two tiny incisions less than one half inch, (about 5-7 millimeters) in length. Second port is kept on Lt side near anterior superior iliac spine on vision.

Falop ring applied on both tubes with taking special care that slit is seen beyond ring clearly.

Most of the time many patients undergo laparoscopy as Day care procedure, returning home within 2-4 hours of surgery. For normal laparoscopy procedure takes about 2 to 5 minutes only. For more complicated case it may take 10-20 minutes with previous scars on abdomen. Most begin feeling much better within one day.

Post-operative Course:

Patient remains drowsy/sedated for 1-2 hours after laparoscopy but conscious & pain free.
Patient can take fluids 2-4 hours after laparoscopy & light food after 6-8 hours.
She may feel little abdominal & shoulder pain after laparoscopy for 12 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 same 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.

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