Aastha Health Care Hospital Center Mulund | Mumbai

Laparoscopy Surgery Treatment in India at Aastha Healthcare Hospital

2009-09-18T04:19:00.000-07:00

'Going under the scissors' has always been a fear lived by practically every human. Whenever we talk about an operation, the first thing that comes to mind is - "Oh God! They are going to cut me open…." Well, not anymore! Reducing the size of incisions has been a dream of surgeons for thousands of years and with Laparoscopy, they have been able to achieve just that.

Laparoscopy is a surgical procedure performed through very small incisions in the abdomen, using specialized instruments. This type of surgery is also called 'minimally invasive surgery' or 'keyhole surgery' because of the very small incisions used. Yet major procedures can now be performed using this technique. In this procedure, a pencil-thin instrument called a laparoscope is used. A laparoscope has lenses like a telescope to magnify body structures, a powerful light to illuminate them, and a miniature video camera. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. Specialized surgical instruments can be inserted through the laparoscope, and through small incisions nearby. These instruments serve as tiny hands within the abdomen and assist the surgeon. Laparoscopy is used either to treat the problem (laparoscopic surgery) or to diagnose it (diagnostic laparoscopy). With laparoscopy, the doctor can identify diseased organs, take tissue samples for biopsy, and remove abnormal growths.

Advantages of laparoscopy surgery :

Despite small holes, there is no compromise in the field of vision. Much more of the 'insides' can be seen than is possible at an open operation. Unlike the 'mini-incision' operations, here the entire abdomen can be visualised ensuring no abnormal anatomy or pathology is missed. In the case of diagnostic laparoscopy, quick information is gained and the entire procedure can be recorded on video and further opinion can be taken from other surgeons in case of a diagnostic dilemma.

For more information on Laparoscopy Surgery Treatment India, kindly visit : http://www.aasthahealthcare.com/Laparoscopic-Surgery-Surgical-Treatment.htm

------------------------------------

Bariatrics Surgery Treatment in India at Aastha Healthcare Hospital

2009-09-18T04:18:00.000-07:00

Obesity is a growing epidemic of global proportions. There are more than 1 billion adults overweight and at least 300 million of them clinically obese. And this is surely a major contributor to the global burden of chronic disease and disability. Obesity is not about being overweight anymore; it is considered a disease now!

For many, the routine diets and exercises are not enough. Years of dieting can result in a poor metabolism and the ability to lose only a small amount of weight without achieving or maintaining significant results. Serious health problems such as diabetes, arthritis, thyroid dysfunction, hypertension, and respiratory problems can also hinder weight loss. If you have been unsuccessful in losing weight after exhausting all weight loss methods, you may need to consider weight loss surgery or "Bariatric Surgery".

Aastha Health Care is proud to offer advanced laparoscopic surgical techniques to the patient, like gastric bypass surgery, Adjustable Gastric Band surgery, and sleeve gastrectomy. The centre is renowned for its dedication and passion towards its patients. When our patients come to Aastha Health Care for Bariatric Surgery, our role is not just limited at the operating table. Infact we go a step ahead than others, and become their advocate, guide, and support, throughout the journey.

For more information on Bariatrics Surgery Treatment, kindly visit :
http://www.aasthahealthcare.com/Bariatrics-Surgery-Surgical-Treatment.htm

------------------------------------

Fertility Center Clinics in India at Aastha Healthcare Hospital

2009-09-18T04:17:00.000-07:00

Becoming a parent is a dream of every couple. It gives extension to ones personality and also makes the bond between a couple stronger. It is often taken for granted as something attainable by all who want to have children. But the fact is not so. Failure to conceive or infertility can become a chronic condition, wherein people experience major disruptions in their lives and their relationships. Failure of a couple to conceive after trying to do so for at least one full year is called infertility. When the couple is not able to conceive even for the first time, it is called primary infertility. In secondary infertility, one or both members of the couple have previously conceived, but are unable to conceive again after a full year of trying. Pregnancy is the result of a complex chain of events.

Infertility can result from problems that interfere with any of the above steps. There are many couples that establish their central identity as 'infertile' and they begin to define themselves by their infertility. They see themselves as failures because of their inability to conceive. This sense of themselves as failures takes on overwhelming proportions in their lives. They are unable to separate treatment failure from personal failure. They push themselves to the periphery. Infertility often leads to isolation because individuals find it difficult to socialize in the "fertile world." In the first part of the 20th century, scientists believed infertility was often psychogenic i.e. resulting from psychological stress. Later in the century, more attention was focused on infertility as a stressor in people's lives. Today, we recognize that stress can affect fertility, and we also recognize infertility is a major stressor for people.

For more information, kindly visit :
http://www.aasthahealthcare.com/Fertility-Center.htm

------------------------------------

Urosurgery Treatment and Endourology Treatment

2009-09-18T04:15:00.000-07:00

Urology is a surgical specialty which deals with diseases of the male and female urinary tract and the male reproductive organs. The complexity of knowledge and rapid development of technologies used to assess and treat the conditions affecting the genito-urinary tract have prompted the development of subspecialties within urology.

Endourology involves the use of small fibre optic scopes which can be passed through the urethra to visualize internally the lining of the urinary tract from kidney to bladder. Thin, flexible instruments including lasers, graspers, miniature stone retrieval baskets, special scalpels, and cautery, can be advanced through working channels in the scopes in order to perform surgery without creating any incisions at all. The majority of endoscopic procedures can be done on an outpatient basis.

At Aastha Health Care, surgeons use state-of-the-art surgery procedures that use optic devices to view body cavities, providing a variety of diagnostic and corrective procedures that are less invasive than conventional procedures. The procedures, known as Endosurgery, also offer the benefit of reduced trauma to the patient.

For more information on Urosurgery Treatment and Endourology Treatment, kindly visit :
http://www.aasthahealthcare.com/Urosurgery-and-Endourology-Treatment.htm

------------------------------------

Obstetrics Treatment and Gynaecology Treatment in India at Aastha Healthcare Hospital

2009-09-18T04:13:00.000-07:00

A woman starts her journey as a daughter fulfilling the expectations of her family. She then becomes a wife, and supports the needs of her family. As a mother, then she becomes an epitome of sacrifice and surrenders completely for the needs of her child. In the old age, she plays an important role in holding her family together and providing guidance to the youngsters. She plays all these roles with dignity and grace and hence womanhood is ever saluted. During this entire phase, she also submits her body to numerous pains and tortures, physical abuse and more.

No branch of medicine has changed as radically in the past three decades, as has Obstetrics and Gynaecology. This specialty has expanded its horizons and interests.

At the same time, we cannot forget that this is an intensely human, emotion-laden process which must not lose its psychological character and force in a welter of scientific methodology. So Aastha has a special cell for Obstetrics and Gynaecology to recognize the problems of these amazing women and take care of them. This special cell offers the care of the pregnant woman, her unborn child and the management of diseases specific to women.

At Aastha, we have introduced the concept of 'painless delivery'. And not only this, we have combined clinical expertise along with latest technologies to meet the unique needs of infants by providing a comprehensive array of general, tertiary and specialty care. While keeping pace with the latest advances in medical science, we have also ensured that the human elements of caring and compassion have remained the same. This is the reason why Aastha has become the choice for those who desire a family-centred maternity experience with the added assurance of a highly specialized staff and the most advanced equipment for any special needs that may arise.

For more information on Obstetrics Treatment and Gynaecology Treatment, kindly visit :
http://www.aasthahealthcare.com/Obstetrics-and-Gynaecology-Treatment.htm

------------------------------------

Minimally Invasive Procedure for Haemorrhoid Treatment in India at Aastha Healthcare Hospital

2009-09-18T04:12:00.000-07:00

Haemorrhoids are one of the most commonly occurring ailments, affecting both men and women. One reason people do not talk about haemorrhoid problems with their doctors is because they anticipate a painful, traditional haemorrhoid surgery. But the fact is that better understanding of the disease process along with new technological improvements; have enabled more procedures to be performed as day care procedure.

Piles or Haemorrhoids can occur at any age. Many experts believe that they are caused by continuous high pressure in the veins of the body, which occurs because humans stand upright. The causes of haemorrhoids include constipation and excessive straining during bowel movements. Persistent diarrhoea and loose stool movements are also causes of haemorrhoids, and some people inherit a family tendency to develop piles. Women are more susceptible to haemorrhoids during pregnancy, as pressure from the growing uterus restricts blood flow in the pelvic area. Lifestyle factors can also contribute to haemorrhoid development.

Haemorrhoids may be internal or external. Both types of haemorrhoids can be present at the same time. Internal haemorrhoids are classified further based upon the degree to which they protrude from the anal canal. This grading system is important since the grade in part determines which type of treatment is best. But no widely used grading system exists for external haemorrhoids.

Itching and irritation probably occur because the lumpy piles stop acting as soft pads to keep the mucus in; instead, a little mucus leaks out and irritates the area around the anus. Pain and discomfort comes from swelling around the pile, and from scratching of the lining of the anal canal by faeces as they pass over the lumpy area. The scratching also causes bleeding, which is a fresh bright red colour and may be seen on faeces or toilet paper or dripping in the pan. A pile that has been pushed down (a second- or third-degree pile) may be felt as a lump at the anus. Internal haemorrhoids cannot cause cutaneous pain, but they can bleed and prolapse. Prolapse of internal haemorrhoids can cause perianal pain by causing a spasm of the sphincter complex. This spasm results in discomfort while the prolapsed haemorrhoids are exposed. The discomfort is relieved with reduction. Internal haemorrhoids can also cause acute pain when incarcerated and strangulated. Again, the pain is related to the sphincter complex spasm.

For more information on Minimally Invasive Procedure for Haemorrhoid Treatment, kindly visit :
http://www.aasthahealthcare.com/Minimally-Invasive-procedure-for-Haemorrhoid-MIPH-Treatment.htm

------------------------------------

Laparoscopic Cholecystectomy Treatment in India at Aastha Healthcare Hospital

2009-09-18T04:11:00.000-07:00

The gallbladder is a pear-shaped organ that lies beneath the liver in the right-upper abdomen. The gallbladder is connected to the liver (which produces the bile) by the hepatic duct. Its function is to store bile. When food containing fat reaches the small intestine, a hormone called cholecystokinin is produced by cells in the intestinal wall and is carried to the gall bladder via the bloodstream. The hormone causes the gall bladder to contract, forcing bile into the common bile duct. A valve, which opens only when food is present in the intestine, allows bile to flow from the common bile duct into the duodenum (upper intestine) where it functions in the process of fat digestion.

What is cholecystitis?

Cholecystitis is an inflammation of the gallbladder wall and nearby abdominal lining. Cholecystitis can occur suddenly or gradually over many years. Acute cholecystitis is the sudden onset of inflammation of the gallbladder, resulting in severe, steady upper abdominal pain (biliary colic), which may occur repeatedly. Chronic cholecystitis is long-standing inflammation of the gallbladder characterized by repeated attacks of pain (gallbladder attacks) over a prolonged period.

At least 95% of people with acute cholecystitis have gallstones. Gallstones are stones which are formed in the gallbladder. The Gall Bladder stores and concentrates bile. Sometimes the substances contained in bile crystallize in the gall bladder, forming stones. These small, hard concretions are more common in persons over 40, especially in women and the obese. Rarely, acute cholecystitis occurs in a person without gallstones (acalculous cholecystitis). In these cases the cause can be any major injury, operation or burn, bacterial infection in the bile duct system, tumor of the pancreas or liver.

For more information on Laparoscopic Cholecystectomy Treatment, kindly visit :
http://www.aasthahealthcare.com/Laparoscopic-Cholecystectomy-Surgical-Treatment.htm

------------------------------------

Laparoscopic Hernioplasty Treatment in India at Aastha Healthcare Hospital

2009-09-18T04:09:00.000-07:00

What is Hernia?

A hernia is an abnormal protrusion, or bulging out, of part of an organ through the tissues that normally contain it. A hernia may develop in almost any part of the body; however, the muscles of the abdominal wall are most commonly affected. In this condition, a weak spot or opening in a body wall, often due to laxity of the muscles, allows part of the organ to protrude. Hernias by themselves usually are harmless, but nearly all have a potential risk of having their blood supply cut off (becoming strangulated). If the hernia sac contents have their blood supply cut off at the hernia opening in the abdominal wall, it becomes a medical and surgical emergency. There are many different types of abdominal wall hernias.

What are the symptoms?

The signs and symptoms of a hernia can range from noticing a painless lump to the painful, tender, swollen protrusion of tissue that one is unable to push back into the abdomen-possibly a strangulated hernia. A gap in the abdominal wall is not normally a problem in itself; it is the bulge of intestine that fills the gap that can potentially cause complications. Whether you feel severe pain or none whatsoever, it is important to have a hernia treated as quickly as possible. Every move you make puts more pressure on the internal tissues, forcing them further out of the gap. This enlarges both the gap and the bulge. If left untreated, a large part of the intestine can move inside the hernia.

In the case of an incarcerated hernia, the intestine gets trapped inside the hernia and is not able to come out. This causes a bowel obstruction, which results in severe groin pain, abdominal distension and vomiting. If it remains in the hernia too long, the blood supply can be cut off and the intestine can die, leading to a dangerous, sometimes fatal, strangulated hernia. Sometimes symptoms like nausea and vomiting may accompany pain. These are actually signs of bowel obstruction. Fortunately, with early treatment, the development of incarcerated and strangulated hernias is now quite rare.

Care at home

Once the patient is back at home, it is important to keep the incision clean and dry. The physician will give specific bathing instructions. If stitches or surgical staples are used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry and generally will fall off within a few days.

The incision and the abdominal muscles may ache, especially after long periods of standing. Pain relievers for soreness can be taken as recommended by the physician.

For more information on Laparoscopic Hernioplasty Treatment, kindly visit :
http://www.aasthahealthcare.com/Laparoscopic-Hernioplasty-Surgical-Treatment.htm

------------------------------------

Minimal Invasive Procedure For Varicose Veins Treatment in India at Aastha Healthcare Hospital

2009-09-18T04:08:00.000-07:00

The word "varicose" comes from the Latin root "varix," which means "twisted." Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That's because standing and walking upright increases the pressure in the veins in your lower body.

The veins of the legs are divided into two systems - the deep veins (which run deep to the leathery layer of fascia surrounding the muscles) and the superficial veins (which run in the layer of fat just beneath the skin). The superficial veins are the ones that you can see (for example, on your foot or around the ankle) and they are the ones that can become varicose. It is essential to keep in mind these two different systems - deep and superficial - in order to understand varicose veins and their treatment. In a number of places in the leg, the superficial and deep veins are linked by perforating veins (or 'perforators'). They are called perforators because they perforate the leathery fascial layer surrounding the muscles of the legs. Normally their valves should allow blood to flow only inwards - from the superficial veins to the deep veins. If the valves stop working properly, then blood is pushed out into the superficial veins when the muscles contract: this is one reason for high pressure in the superficial veins, and can be a cause of varicose veins.

The blood in your leg veins must work against gravity to return to your heart. To help move blood back to your heart, your leg muscles squeeze the deep veins of your legs and feet. One-way flaps called valves in your veins keep blood flowing in the right direction. When your leg muscles contract, the valves inside your veins open. When your legs relax, the valves close. This prevents blood from flowing backward. However, when these valves do not function properly, the blood pools, pressure builds up, and the veins become weakened, enlarged, and twisted. This causes varicose veins to develop. Varicose veins develop when one has faulty valves in the veins and weakened vein walls. These veins are twisted, enlarged veins close to the surface of the skin. They usually develop in the legs and ankles.

Varicose veins are a common condition, affecting up to 15 percent of men and up to 25 percent of women. Treatment may involve self-help measures or procedures by your doctor to close or remove veins.

What causes it?

Some people may be more likely than others to develop varicose veins and spider veins because of inherited characteristics (genetics), the aging process, or hormone changes. Varicose veins may also result from conditions that increase pressure on the leg veins, for example being overweight or pregnant. Though, the most contributing factor is Hereditary. Women are more likely to suffer from abnormal leg veins. Hormonal factors can affect the disease. It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume, which in turn cause veins to enlarge. In addition, the enlarged uterus causes increased pressure on the veins. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. Other predisposing factors include aging, standing occupations, obesity and leg injury. Varicose veins are present in 20-25% of adult females and 10-15% of men. This common condition represents a considerable surgical workload.

What are the symptoms?

In varicose veins, symptoms are often worse at the end of the day because more pooling has occurred. Other things which increase pooling and therefore symptoms also include prolonged standing and sitting, exposure to heat (summertime, hot baths) and hormonal factors (pregnancy, around the time of the menses).

Varicose veins may be associated with a sensation of heaviness and itching and, in the presence of deep and superficial reflux, cramps and aching. However, all too often generalised aches and pains in the leg may be attributed to visible varicosed veins. Left unchecked, they tend to increase in size and often lead to progressive skin and tissue damage resulting in eczema, lipodermatosclerosis and, in advanced cases, venous ulcers. Lipodermatosclerosis is the medical term that describes damage both to the skin and to the fatty layer beneath it '

Ulcers, when they occur, most often afflict the elderly, blighting their lives with frequent visits to their local surgeries or hospital out-patient departments. Many sufferers complain of aching of the legs, skin itching, ankle swelling, restless legs, night cramps and sleep disturbance.

For more information on Minimal Invasive Procedure For Varicose Veins Treatment, kindly visit :
http://www.aasthahealthcare.com/Minimal-Invasive-Procedure-For-Varicose-Veins-SEPS-Treatment.htm

------------------------------------

Laparoscopic Splenectomy Treatment in India at Aastha Healthcare Hospital

2009-09-18T04:06:00.000-07:00

Splenectomy means surgical removal of spleen. The spleen is a blood filled organ located in the upper left abdominal cavity. It is a storage organ for red blood cells and contains many specialized white blood cells called "macrophages" (disease fighting cells) which act to filter blood. The spleen is part of the immune system and also removes old and damaged blood particles from your system. The spleen helps the body identify and kill bacteria.

There are several reasons why a spleen might need to be removed, and the following list, though not all inclusive, includes the most common reasons.

How are these problems diagnosed?

An evaluation typically includes a complete blood count (CBC), a visual look at the blood cells placed on a glass slide called a 'smear', and often a bone marrow examination. Sometimes an ultrasound examination of your spleen, a computerized tomography (CT scan), magnetic resonance imaging (MRI) or nuclear scan is needed.

Complications

Complications following laparoscopic Splenectomy are infrequent, but you should consult your doctor regarding possible complications based on your specific case.

For more information on Laparoscopic Splenectomy Treatment, kindly visit : http://www.aasthahealthcare.com/Laparoscopic-Splenectomy-Treatment.htm

------------------------------------

Laparoscopic Adrenalectomy Treatment in India at Aastha Healthcare Hospital

2009-09-18T02:50:00.000-07:00

Adrenal glands are a part of our endocrine system. They are two small organs, located one above each kidney. They are triangular in shape and about the size of a thumb. These glands produce hormones which are involved in control of blood pressure, chemical levels in the blood, water use in the body, glucose usage, and the "fight or flight" reaction during times of stress. These adrenal-produced hormones include cortisol, aldosterone, the adrenaline hormones and a small fraction of the body's sex hormones (oestrogen and androgens).

What is Adrenalectomy?

The procedure of removal of an adrenal gland is called an Adrenalectomy. The adrenal gland may be removed on one side or both sides at the time of surgery depending on the nature of disease. An Adrenalectomy is the surgical removal and this procedure can be performed using an open incision or laparoscopic technique.

The adrenal glands are fed by numerous blood vessels, so surgeons need to be alert to extensive bleeding during surgery. In addition, the adrenal glands lie close to one of the body's major blood vessels (the vena cava), and to the spleen and the pancreas. The surgeon needs to remove the gland(s) without damaging any of these important and delicate organs.

What are the indications of Adrenalectomy?

Diseases of the adrenal gland are relatively rare. The most common reason that a patient may need to have the adrenal gland removed is because of tumour within adrenal gland. Most of these tumours are small and not cancers. They are known as benign growths that can usually be removed with surgery. Removal of the adrenal gland may also be required for certain tumours even if they aren't producing excess hormones, such as very large tumours or if there is a suspicion that the tumour could be a cancer, or sometimes referred to as malignant. Fortunately, malignant adrenal tumours are rare. An adrenal mass or tumour is sometimes found by chance when a patient gets an X-ray study to evaluate another problem. Occasionally, Adrenalectomy may be recommended when hormones produced by the adrenal glands aggravate another condition such as breast cancer.

How is it diagnosed?

If an adrenal tumour is suspected based on symptoms or has been identified by X-ray, the patients are advised to undergo blood and urine tests to determine if the tumour is over-producing hormones. CT scan, nuclear medicine scan, an MRI or selective venous sampling are commonly used to locate the suspected adrenal tumour. Surgical removal of the adrenal gland is the preferred treatment for patients with adrenal tumours that secrete excess hormones and for primary adrenal tutors that appear malignant.

Benefits and drawbacks

In the past, making a large 6 to 12 inch incision in the abdomen, flank, or back was necessary for removal of an adrenal gland tumour. Today, with the technique known as minimally invasive surgery, removal of the adrenal gland (also known as "laparoscopic Adrenalectomy") can be performed through three or four 1/4-1/2 inch incisions. Patients may leave the hospital in one or two days and return to work more quickly than patients recovering from open surgery.

Laparoscopic Adrenalectomy can de performed safely in a cost-effective manner. Given the benefits of this minimally invasive technique, the laparoscopic approach is quickly gaining popularity as the treatment of choice for Adrenalectomy. Results of surgery may vary depending on the type of procedure and the patients overall condition.

For more information on Laparoscopic Adrenalectomy Treatment, kindly visit :
http://www.aasthahealthcare.com/Laparoscopic-Adrenalectomy-Treatment.htm

------------------------------------

Laparoscopic Intestinal Surgery Treatment in India at Aastha Healthcare Hospital

2009-09-18T02:46:00.000-07:00

What is the intestine?

The intestine is the portion of the alimentary canal extending from the stomach to the anus. The intestine is a long, tubular organ consisting of two parts :

The large intestine is about 3.5 meters long. The large intestine is divided into 6 parts: caecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. The inner surface of large intestine is covered with mucous and is convoluted. The large intestine is responsible for absorption of water and excretion of solid waste material

The small intestine is about 6 meters long. It is divided into 3 sections: duodenum, jejunum, and ileum. This part is where the most extensive part of digestion occurs. Most food products are absorbed in the small intestine.

What is laparoscopic intestinal surgery?

The introduction of laparoscopic removal of the gall bladder (Laparoscopic Cholecystectomy) in the late 1980s revolutionized the surgical management of many abdominal operations. It offered less discomfort to the patient and faster recovery. But it was only the delay in the development of proper instruments that prevented Colon and Rectal Surgeons from performing laparoscopic intestinal surgery until 1991.

Today, laparoscopic surgery is an increasingly popular option for people with intestinal conditions, who may need sections of the bowel repaired or removed. Laparoscopy is a minimally invasive procedure in which the surgeons operate through very tiny holes (approximately 1/2-inch wide) instead of large incisions (8- to 12-inch wide). While recovery from open surgery for intestinal disease, takes an average of six weeks, people who have undergone laparoscopic surgery tend to feel back to normal in just three weeks.

Open surgery and laparoscopic surgery

Traditionally, abdominal surgery has been performed in an open manner and what that means is the patient has a reasonably large incision, which varies in size between four and 10 inches long. It's usually in the midline of the abdomen, so it runs from the pubis at the lower midline of the abdomen up to the navel. The length depends on the extent of surgery and the extent of bowel that one has to free up or take out. When the surgery's performed laparoscopically, three or four access ports are put, which are little plastic tubes that go into the abdomen that are positioned through incisions less than half-an-inch long. Then through these access ports we put in a camera, which is less than a half-inch in diameter, which is used to see what's going on inside the abdominal cavity. Through the other access ports we put in very fine little surgical instruments, about 5 millimeters in diameter. We use those instruments to free up the bowel and then we make an incision of four to six centimeters in size (around two inches) to remove the bowel.

How are less invasive procedures performed?

Laparoscopic surgery is a minimally invasive approach to common surgical problems in the abdomen. Many surgical problems that traditionally were performed through large incisions are now accomplished through small keyhole incisions that result in much less surgical trauma and postoperative pain. Aastha Healthcare has its expertise in Laparoscopic procedures. Our surgeons have the experience in performing many basic and advanced procedures with the Laparoscopic approach.

For more information on Laparoscopic Intestinal Surgery Treatment, kindly visit :
http://www.aasthahealthcare.com/Laparoscopic-Intestinal-Surgery-Surgical-Treatment.htm

-------------------------

Emergency Laparoscopy Treatment in India at Aastha Healthcare Hospital

2009-09-18T02:45:00.000-07:00

Laparoscopy was initially used for diagnostic and therapeutic purposes. But with the advancement of medical sciences, the role of laparoscopy was extended for emergency settings also. Emergency Laparoscopic treatment of acute abdomen was first proposed by Philippe Mouret in 1990 and since then it is being widely used for abdominal emergencies, especially- acute cholecystitis, appendicitis, perforated ulcers, Ectopic pregnancies,abdominal bleeding etc. Peptic ulcer perforation is the second most frequent abdominal perforation requiring surgery and accounts for 5% of abdominal emergencies.

Dr. Manish Motwani, an eminent laparoscopic surgeon and founder of Aastha healthcare, comments," When patients come to the emergency room, we prefer laparoscopy as it helps us to conduct an immediate diagnosis and can initiate treatment right there." Aastha is well equipped to handle any kind of emergencies. It is well equipped with all modern facilities and is supported by qualified and experienced surgeons. Laparoscopic surgery has improved our management of surgical emergencies and in certain conditions is now an essential part of our armamentarium. What is clear is that as surgical expertise and technology both continue to improve, so the remit for laparoscopic surgery will expand, to the benefit of our patients.

When emergency laparoscopy is performed, there can be two clinical scenarios :

In some emergency cases, diagnosis is done and a specific line of action is planned. Laparoscopic procedures are then performed.

In few cases, the abdominal pathology is uncertain or doubtful. In these cases, the primary aim of laparoscopy is diagnostic and then corrective.

How it is done?

The emergency laparoscopy is done in the same way as elective laparoscopy. The only thing is that the surgeon must be well qualified. Emergency Laparoscopy is generally performed under general anesthesia. Once the patient is under anesthesia, a urinary catheter is inserted to collect urine during the procedure. To begin the procedure, a small incision is made just below the navel and a cannula or trocar is inserted into the incision to accommodate the insertion of the laparoscope. Other incisions (one or two) may be made in other areas of the abdomen to allow for insertion of other laparoscopic instrumentation. A laparoscopic insufflation device is used to inflate the abdomen with carbon dioxide gas to create a space in which the laparoscopic surgeon can maneuver the instruments. Laparoscopes, which have integral cameras for transmitting images during the procedure, are available in various sizes depending upon the type of procedure being performed. The images from the laparoscope are transmitted to a viewing monitor, which the surgeon uses to visualize the internal anatomy and guide any surgical procedure. After laparoscopic treatment is completed, the laparoscope, cannula, and other instrumentation are removed, and the incision is sutured and bandaged.

Generally the patient recovers faster than he would in an open surgery. But Ofcourse it all depends upon on the diagnosis of the patient at the time of operation and what the surgeon did to treat the disease. In most of the cases, the patients are encouraged to move about after few hrs of surgery. They can resume their normal activities after 7-12 days after surgery, depending upon the condition.

For more information on Emergency Laparoscopy Treatment, kindly visit :
http://www.aasthahealthcare.com/Emergency-laparoscopy-Surgical-Treatment.htm

------------------------------------

Obesity - A Global Epidemic | Obesity Problems India | Overweight Issues India at Aastha Heathcare

2009-09-18T02:43:00.000-07:00

Though we all use the terms "fat" and "obese" casually in conversation, there is a medical definition of the condition and yes, obesity is considered a health "condition." It is a term used to describe body weight that is much greater than what is considered healthy. Measuring the exact amount of a person's body fat is not easy. The most accurate measures are to weigh a person underwater or in a chamber that uses air displacement to measure body volume, or to use an X-ray test called Dual Energy X-ray Absorptiometry, also known as DEXA. These methods are not practical for the average person, and are done only in research centers with special equipment.

There are also other ways to determine if a person is obese, but experts believe that a person's body mass index (BMI) is the most accurate measurement of body fat for children and adults. Adults with a BMI greater than 30 are considered obese. You will be surprised to know that nearly one-thirds of the world's population is overweight. Rates of obesity are climbing. The percentage of children who are overweight has doubled in the last 20 years. The percentage of adolescents who are obese has tripled in the last 20 years. Morbid obesity is typically defined as being 100 pounds or more over ideal body weight or having a BMI of 40 or higher. Obesity becomes "morbid" when it significantly increases the risk of one or more obesity-related health conditions or serious diseases (also known as co-morbidities). According to the NIH Consensus Report, morbid obesity is a serious chronic disease, meaning that its symptoms build slowly over an extended period of time. Today 97 million Americans, more than one-third of the adult population, are overweight or obese. An estimated 5-10 million of those are considered morbidly obese.

Overweight and obesity

Overweight and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height. For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the "body mass index" (BMI). BMI is used because, for most people, it correlates with their amount of body fat.

Effects of obesity

Severe obesity damages the body mechanically, metabolically, physiologically and has adverse effects on normal bodily function. This affects nearly every organ in the body in some way, and produce serious secondary illnesses, which may also be life-threatening. The cumulative effect of these co-morbidities can interfere with a normal and productive life, cause endless frustration and can seriously shorten life, as well.

For more information, kindly visit :
http://www.aasthahealthcare.com/Obesity-Global-Epidemic.htm

------------------------------------

Bariatric Surgery Benefits | Bariatric Surgery Information-Weight Loss Surgery at Aastha Healthcare

2009-09-18T02:42:00.000-07:00

As we have already seen in the previous sections, the health consequences of severe obesity. It is evident that almost every part of our body gets affected. In fact we can say that it affects all the three planes of human existence, i.e. physical, mental and spiritual.

The remarkable and wonderful fact is that most of these problems can be greatly improved, while some can be entirely resolved, with successful weight loss. Many have struggled with weight loss for years trying various diets, medications and professional weight loss services without long-term success. People have been adopting various dieting methods all over the world to loose weight. While some starve themselves to death while others go overboard with exercises to loose weight. And above all, those who do loose weight find the result very short lasting. Eventually they become even more disappointed and rejected. For these people, weight management is much more than carrying a few extra pounds. It can be a matter of life and death.

This weight loss surgery (Bariatric Surgery) has given many individuals a new lease on life. This surgery enables a person to loose weight in short time. The amount of weight one will lose will depend on the type of surgical procedure he has undergone and how committed they are to the required lifestyle changes, including exercise and eating habits. Results vary, but the average patient can expect to lose 50-90% of their excess weight 12-18 months after surgery. Even if the ideal weight is not reached, co-morbid medical problems are improved in most cases. Many patients find they no longer need medications for diabetes, hypertension, sleep apnoea, arthritis and back pain. Most patients report an increase in self-esteem and self-confidence and an improvement in their overall quality of life.

So Bariatrics is the branch of medicine that deals with the causes, prevention, and treatment of obesity. It is a highly specialized field of surgery, which requires exceptional surgical skills. Just like, a pilot cannot fly every aircraft. He has to be trained to fly different machines. Similarly not every laparoscopic surgeon can perform this gastric bypass surgery. So it is very important to consult a skilled surgeon. Bariatric surgery is a term derived from the Greek words: ''weight'' and ''treatment.''

For more information on Bariatric Surgery Benefits Details, kindly visit :
http://www.aasthahealthcare.com/All-about-Bariatric-Surgery.htm

------------------------------------

Bariatric Surgery Treatment Procedures in India at Aastha Healthcare Hospital

2009-09-18T02:41:00.000-07:00

There are several different types of Bariatric weight loss surgical procedures, but they are known collectively as 'Bariatric surgery'. To understand this, the procedures can be grouped in three main categories below). The three types are:

Malabsorptive procedures: This surgery does focus at reducing the stomach size but they mainly aim on creating malabsorption. i.e. Biliopancreatic Diversion (Scopinaro procedure - rare)

Restrictive procedures: This kind of surgery primarily reduces the stomach size. There are three ways of doing this:

Vertical Banded Gastroplasty (Mason procedure, stomach stapling)

Adjustable gastric band (or "Lap Band")

Sleeve gastrectomy

Hybrid procedures: In this type, both the techniques of restriction and malabsorption are applied simultaneously. i.e. Gastric bypass surgery, like Roux-en-Y gastric bypass
In this section, we will discuss all the procedures but only a surgeon can decide which one is suited the best for patient. Infact he is the only person who can tell whether the case could be handled laparoscopically or should be carried out as open surgery. This section is dedicated to providing you with the information to help you get familiar with Bariatric surgery

Malabsorptive procedures

This surgery focuses to reduce the stomach size but they mainly aim on creating malabsorption. So if the stomach pouch is smaller in size and if there is signifcant malabsorption, this will lead to impairment of nutrition absorption and assimilation. In other words Malabsorptive procedures alter digestion, thus causing the food to be poorly digested and incompletely absorbed so that it is eliminated in the stool.

Biliopancreatic Diversion: (BPD)

The original version of this procedure (without the duodenal switch) was developed by Dr. Scopinaro in Italy. This operation creates an impairment of nutrient absorption (called "malabsorption") as the primary factor in weight loss. This is done by removing about 2/3 of the stomach, and arranging the small intestine so that the section where food mixes with digestive juices is fairly short. This surgery is rare now because of problems with malnourishment. These operations may be more effective in achieving excellent weight loss in the extremely obese, but bring with them a higher rate of true malnutrition (malnutrition is very rare for those who undergo standard gastric bypass).

HYBRID PROCEDURES

There are several different types of Bariatric weight loss surgical procedures, but Hybrid procedures are most commonly performed. In this type, both the techniques of restriction and malabsorption are applied simultaneously. I.e. Gastric bypass surgery, like Roux-en-Y gastric bypass. Now let us see this procedure in details.

The third step in the procedure involves the reconnection of the bowel (the first 50-100 cm of the jejunum and the duodenum containing the juices from the stomach, pancreas, and liver and called the biliopancreatic limb) to the segment of small bowel that was connected to the gastric pouch (the Roux limb). It is the distance between the gastric pouch and the place where the biliopancreatic limb is connected that determines the length of the bypass and the degree of malabsorption created by the operation. This distance is selected based on the patients BMI. The average length of the small bowel before surgery is thought to be approximately 18 ft. with the jejunum accounting for the first 2/5 of the small bowel. The length of the Roux limb that is created ranges from 75 cm to 180 cm (3-6 ft). The average time it takes to complete the Laparoscopic Roux-en-Y Gastric Bypass is approximately 2 hours. If the patient has gallstones, the surgeon may choose to remove the gallbladder as a preventative measure since there is a high incidence of gallstone formation upon weight loss.

This surgery reduces the amount of food eaten as well as decreases absorption of the food and calories consumed. So one will feel full more quickly than when their stomach was its original size, which reduces the amount of food the person will eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed. This leads to weight loss. There is very little interference with normal absorption of food since the operation works by reducing food intake, and reducing the feeling of hunger. The result is a very early sense of fullness, followed by a very profound sense of satisfaction. Even though the portion size may be small, there is no hunger, and no feeling of having been deprived: when truly satisfied, you feel indifferent to even the choicest of foods. Patients continue to enjoy eating - but they enjoy eating a lot less. Ingestion of concentrated sugar is also essentially prohibited because doing so results in "dumping." Dumping is a group of unpleasant symptoms that resembles food poisoning (nausea, vomiting, diarrhea, abdominal cramps, flushing, and palpitations) that occurs when simple sugars enter the small intestine without first being properly digested by the stomach. Many people also report diminished appetite after Roux-en-Y gastric bypass, as well as a change in the taste of food. These are additional ways the gastric bypass causes weight loss. Following RNY surgery, patients are at risk for developing anemia because of poor absorption of iron and vitamin B12. Therefore, dietary supplementation of these nutrients is required. Poor absorption of calcium may also occur. Thus, calcium supplements must also be taken postoperatively.

For more information on Bariatric Surgery Treatment Procedures, kindly visit :
http://www.aasthahealthcare.com/Bariatric-Surgery-Procedures.htm

------------------------------------

Renal Calculi (Kidney Stones) Treatment in India at Aastha Healthcare Hospital

2009-09-18T02:40:00.000-07:00

The urinary tract, or system, consists of the kidneys, ureters, bladder, and urethra. The kidneys are two bean-shaped organs located below the ribs toward the middle of the back. They remove extra water and wastes from the blood, converting it to urine. They also keep a stable balance of salts and other substances in the blood. The kidneys produce hormones that help build strong bones and help form red blood cells. Narrow tubes called ureter carry urine from the kidneys to the bladder, an oval-shaped chamber in the lower abdomen. Like a balloon, the bladder's elastic walls stretch and expand to store urine. They flatten together when urine is emptied through the urethra to outside the body.

One in every 20 people develops a kidney stone at some point in their life. A kidney stone is a hard mineral and crystalline material formed within the kidney or urinary tract.

What is Renal Calculi (kidney stone)?

Kidney stones are one of the most common disorders of the urinary tract. In the year 2000, patients made 2.7 million visits to health care providers and more than 600,000 patients went to emergency rooms for kidney stone problems. Men tend to be affected more frequently than women. The function of the kidneys (Renal) is to remove waste products and unwanted water from the blood, in the form of urine. If there is too much of certain waste products in the urine, these substances form crystals. Crystals can then combine to form stones.

A kidney stone is a hard mass developed from crystals that separate from the urine and build up on the inner surfaces of the kidney. Normally, urine contains chemicals that prevent or inhibit the crystals from forming. These inhibitors do not seem to work for everyone, however, so some people form stones. If the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without being noticed. However, when they pass down the ureter on their way to the bladder, pain usually occurs with anything but the smallest stone. If a stone gets stuck on its way down the ureter, pain usually occurs in the form of renal colic. The pain comes and goes in waves. Blood may be passed as well, due to the irritation of the lining of the ureter by the sharp-edged stone.

Urolithiasis is the medical term used to describe stones occurring in the urinary tract. Other frequently used terms are urinary tract stone disease and nephrolithiasis. Doctors also use terms that describe the location of the stone in the urinary tract. For example, a ureteral stone (or ureterolithiasis) is a kidney stone found in the ureter. To keep things simple, however, the term "kidney stones" is used throughout this fact sheet.

For more information on Renal Calculi (Kidney Stones) Treatment, kindly visit :
http://www.aasthahealthcare.com/Renal-Calculi-stones-Treatment.htm

------------------------------------

Prostate Cancer Treatment in India at Aastha Healthcare Hospital

2009-09-18T02:39:00.000-07:00

The prostate is a glandular organ, about size of a walnut, present in males. The prostate is normally about 3 cm long and it lies at the neck of the bladder and in front of the rectum. The prostate gland produces fluid that makes up part of the semen.

Prostate cancer is found mainly in older men. As men age, the prostate may get bigger and block the urethra or bladder. This may cause difficulty in urination or can interfere with sexual function. The condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed to correct it. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms of prostate cancer. Prostate cancer is often a very slow-growing disease. It can take 10 years or more for a small tumor to spread beyond the gland and pose a serious threat to health.

For more information on Prostate Cancer Treatment, kindly visit :
http://www.aasthahealthcare.com/Prostate-Cancer-Treatment.htm

------------------------------------

Benign Prostatic Hyperplasia Treatment in India at Aastha Healthcare Hospital

2009-09-18T02:29:00.000-07:00

The prostate is a glandular organ, about size of a walnut, present in males. The prostate is normally about 3 cm long and it lies at the neck of the bladder and in front of the rectum. The prostate gland produces fluid that makes up part of the semen.

You will be surprised to know that Urinary obstruction from prostatic hypertrophy has been described for many centuries, starting with the ancient Egyptians in the 15th century BC. The word "prostate" comes from the Greek prostat, which means "one who stands before or in front of", which, in this case, means in front of the bladder.

What is Benign prostatic hyperplasia or BPH?

Benign prostate hyperplasia (BPH) is a condition that affects the prostate gland of the male reproductive system. The prostate gland enlarges in size though this may not cause problems until late in life. It is estimated that about 90% of men in the age group of 70-85 years have BPH. It is one of the most common problems experienced by men during the old age.

As the name suggests, there is hyperplasia or overgrowth of the prostatic tissue. This leads to enlargement of the prostate gland. Now since prostate surrounds the urethra. So any enlargement will definitely cause constriction of the urethra. So in BPH, the flow of urine is also reduced, making it increasingly difficult to empty the bladder. Similar symptoms may also be present when a person has prostate cancer. So it is very important for the physician to carefully rule out the possibility of the latter. To know more about prostate cancer,click here.

For more information on Benign Prostatic Hyperplasia Treatment, kindly visit :
http://www.aasthahealthcare.com/Benign-Prostatic-Hyperplasia-Treatment.htm

------------------------------------

Bladder Cancer Treatment in India at Aastha Healthcare Hospital

2009-09-18T02:26:00.000-07:00

A bladder is a muscular hollow organ that stores urine. It is located in the pelvic region. Urine from both the kidneys passes through ureter and reaches the bladder. When the bladder gets filled up to a certain level, the nerves send signal to the brain and we may feel the urge to urinate.

What is Bladder cancer?

Normally, cells grow and divide to form new cells as the body needs them. Cancer merely indicates towards a condition in which the cells start multiplying in an abnormal way. These extra cells can form a mass of tissue called a growth or tumor. Tumors can be benign or malignant: Bladder cancer refers to any of several types of malignant growths of the urinary bladder. The process of invading and spreading to other organs is called metastasis. Bladder cancers are most likely to spread to neighboring organs and lymph nodes prior to spreading through the blood stream to the lungs, liver, bones, or other organs. Bladder cancer affects 3 times as many men as women.

Types of bladder cancers :

Urolithiasis is the medical term used to describe stones occurring in the urinary tract. Other frequently used terms are urinary tract stone disease and nephrolithiasis. Doctors also use terms that describe the location of the stone in the urinary tract. For example, a ureteral stone (or ureterolithiasis) is a kidney stone found in the ureter. To keep things simple, however, the term "kidney stones" is used throughout this fact sheet.

Types of stones include :

The wall of the bladder is lined with cells called transitional cells and squamous cells. More than 90 percent of bladder cancers begin in the transitional cells. This type of bladder cancer is called transitional cell carcinoma. About 8 percent of bladder cancer patients have squamous cell carcinomas. All squamous cell carcinomas are invasive. This means that they gradually spread to deeper layers of the bladder wall if they are not treated. By the time these cancers are detected, they have usually already invaded the bladder wall. Many transitional cell carcinomas are not invasive. This means that they go no deeper than the transitional, or urothelial, layer.

Bladder cancers are classified or staged based on their aggressiveness and the degree that they are different from the surrounding bladder tissue. There are several different ways to stage tumors. Recently, the TNM staging system has become common. This staging system contains several sub stages, but it basically categorizes tumors using the following scale:

Stage 0 - This is a Non-invasive tumor limited to the bladder lining. Cancer that is only in cells in the lining of the bladder is called superficial bladder cancer. The doctor might call it carcinoma in situ. This type of bladder cancer often comes back after treatment. If this happens, the disease most often recurs as another superficial cancer in the bladder.

Stage I -- Tumor extends through the lining, but does not extend into the muscle layer. Cancer that begins as a superficial tumor may grow through the lining and into the muscular wall of the bladder. This is known as invasive cancer. Invasive cancer may extend through the bladder wall. It may grow into a nearby organ such as the uterus or vagina (in women) or the prostate gland (in men). It also may invade the wall of the abdomen.

Stage II - In this, the tumor invades the muscle layer of the bladder.

Stage III -- Tumor extends past the muscle layer into tissue surrounding the bladder.

Stage IV - In this, cancer has spread to regional lymph nodes or to distant sites (metastatic disease). When bladder cancer spreads outside the bladder, cancer cells are often found in nearby lymph nodes. If the cancer has reached these nodes, cancer cells may have spread to other lymph nodes or other organs, such as the lungs, liver, or bones.

When cancer spreads (metastasizes) from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if bladder cancer spreads to the lungs, the cancer cells in the lungs are actually bladder cancer cells. The disease is metastatic bladder cancer, not lung cancer. It is treated as bladder cancer, not as lung cancer.

What are the causes?

There is no particular cause that has been found out. But Studies have found the following risk factors for bladder cancer:

Age- The chance of getting bladder cancer goes up as people get older. People under 40 rarely get this disease.
Tobacco- The use of tobacco is a major risk factor. Cigarette smokers are two to three times more likely than nonsmokers to get bladder cancer. Pipe and cigar smokers are also at increased risk.
Occupation- Some workers have a higher risk of getting bladder cancer because of carcinogens in the workplace. Workers in the rubber, chemical, and leather industries are at risk. So are hairdressers, machinists, metal workers, printers, painters, textile workers, and truck drivers.
Infections-Being infected with certain parasites increases the risk of bladder cancer. These parasites are common in tropical areas.
Medications- cyclophosphamide or arsenic are used to treat cancer and some other conditions. They raise the risk of bladder cancer.

Approximately 20% of bladder cancers occur in patients without predisposing risk factors. Bladder cancer is not currently believed to be heritable (i.e., does not "run in families" as a consequence of a specific genetic abnormality).

What are the Symptoms?

The symptoms described below are not sure signs of bladder cancer. Infections, benign tumours, bladder stones, or other problems also can cause these symptoms. So incase of these symptoms, one must consult an urologist or correct diagnosis. Moreover most of the symptoms listed below can be associated with bladder cancer, but they can also be associated with non-cancerous conditions. Nevertheless, medical evaluation is critical.

Blood in the urine

increased Urinary frequency or Urinary incontinence

Painful urination

Urinary urgency

Additional symptoms that may be associated with this disease are Bone pain or tenderness, abdominal pain, Anaemia, Weight loss, Lethargy (tiredness).

Disadvantages of the surgery

Bladder cancer surgery may affect a person's sexual function. Because the surgeon removes the uterus and ovaries in a radical cystectomy, women are not able to get pregnant. Also, menopause occurs at once. If the surgeon removes part of the vagina during a radical cystectomy, sexual intercourse may be difficult. In the past, nearly all men were impotent after radical cystectomy, but improvements in surgery have made it possible for some men to avoid this problem. Men who have had their prostate gland and seminal vesicles removed no longer produce semen, so they have dry orgasms. Men who wish to father children may consider sperm banking before surgery or sperm retrieval later on.

For more information on Bladder Cancer Treatment, kindly visit :
http://www.aasthahealthcare.com/Bladder-Cancer-Treatment.htm

------------------------------------

Laparoscopic Hyesterctomy Treatment in India at Aastha Healthcare Hospital

2009-09-18T02:22:00.000-07:00

Uterus is a hollow, muscular, pear shaped organ often referred to as Womb since Biblical times. It has two tubes called fallopian tubes connected to it at one end and to the ovary at the other. When an egg cell is released from an Ovary it travels to the uterus via these fallopian tubes. It is a very remarkable organ capable of expanding to contain a full-grown baby and of shedding its lining up to 500 times during the life that is during the time of monthly period. The resultant stresses and strains on its supporting structures during pregnancies and the repeated shedding and re-growth of its lining may lead to problems.

What is hysterectomy?

Hysterectomy merely means surgical removal of uterus. It is the second most common major operation performed today. Hysterectomy involves removal of the uterus, and sometimes the ovaries too (oophorectomy). Often one or both ovaries and fallopian tubes are removed at the same time a hysterectomy is done.

Sub-total or partial hysterectomy
It involves the removal of Fallopian tubes and the upper two-thirds of the uterus only, preserving the cervix.

Hysterectomy with ovarian conservation
It involves the removal of the Fallopian tubes, uterus and the cervix, while preserving the ovaries.

Hysterectomy with oophorectomy
It involves the removal of the Fallopian tubes, uterus and cervix, together with one or both sets of ovaries.

Radical or Wertheim's hysterectomy
It involves the removal of the Fallopian tubes, uterus, cervix, ovaries as well as nearby lymph nodes and the upper portion of the vagina. This type of hysterectomy is used in the treatment of some gynaecological cancer cases.

Before having a hysterectomy, it is very important to discuss the implications you're your gynaecologist and partner. Your doctor may recommend a hysterectomy if none of the treatments for the various conditions have worked. Ofcourse in some cases, there is no other choice than hysterectomy.

Why should one go for hysterectomy?

Hysterectomy is used to treat :

Fibroids- This is the most common reason for which hysterectomies are done. For many women with fibroids, symptoms are minimal and require no treatment. Also, the fibroids often shrink after menopause. But in some cases, fibroids can cause heavy bleeding or pain in some women.

Endometriosis- This happens when the tissue lining the inside of your uterus grows outside the uterus on your ovaries, fallopian tubes, or other pelvic or abdominal organs. The surrounding tissue may become scarred, and often other organs such as the uterus, bladder or the rectum may become stuck down in these scars (adhesions). When medication and surgery do not cure endometriosis, a hysterectomy often is performed.

Uterine prolapse- This is when the uterus moves from its usual place down into the vagina. This can lead to urinary problems, pelvic pressure, or difficulty with bowel movements.

Cancer- Cancer of the uterus, cervix, or ovary, is another cause for hysterectomy.

Persistent vaginal bleeding- If menstrual flow is heavy, not regular, or last for many days and non-surgical methods have not helped to control bleeding, a hysterectomy may bring relief. But ofcourse the physician screens the candidate if she is suitable for the surgery.

Chronic pelvic pain- Surgery is a last resort for women who have chronic pelvic pain that clearly comes from the uterus.

Often a doctor will have a fairly good idea of the type of the problem after examining and listening to the patient's symptoms. The doctor will make detailed notes of medical history and the patient's concerns. The physician will then inform the patient about different types of hysterectomy procedures. It is important that women understand the full implications of the removal or certain reproductive organs so that they can be properly prepared for any resultant side effects.

Before the surgery

The doctor will once again examine the patient thoroughly. The blood will probably be tested for hormone levels and also a pelvic ultrasound scan may be recommended. If the scan shows any abnormalities or is unclear, the doctor may want to investigate further using hysteroscopy, a procedure in which a viewing device is inserted into the uterus. A sample of the lining of the womb (endometrium) may be taken. Endometrial sampling is done either as an outpatient procedure, or by D&C-dilatation and curettage, usually when under a general anaesthesia. In a D&C, the cervix is opened (dilatation) and the lining of uterus (the endometrium) will be systematically scraped (curettage) with a long, thin instrument. The strips of the lining will then be examined under a microscope.

Preparation for both vaginal and abdominal hysterectomy is similar. She will be given a suppository to empty the bowels the night before. She will be told not to eat or drink anything on the day of the surgery about 6 to 8 hours before the surgery. Anaesthesia is given. It can be general, epidural or spinal anaesthesia. A catheter (a narrow silicon tube) is inserted into the bladder to empty it. The operation area is cleaned thoroughly with antiseptic before the operation.

The surgery

The actual hysterectomy operation can be performed in several different ways. The method chosen will depend on the surgeon's skills, expertise and preference, the reason for the hysterectomy and the woman's characteristics (e.g. weight, previous pelvic surgery, if she has had children). There are presently following ways to perform a hysterectomy :

Abdominal hysterectomy

Vaginal hysterectomy

Laparoscopic method

After the surgery

The average hospital stay depends on the type of hysterectomy performed, but is usually from 2 to 3 days. Complete recovery may require 2 weeks to 2 months. Recovery from a vaginal or laparoscopic hysterectomy is faster than from an abdominal hysterectomy, and may include less pain. Removal of the ovaries along with the uterus in premenopausal women causes immediate menopause, and oestrogen replacement therapy may be recommended. Some patients report that the incisions feel a little sore and the residual gas in the belly hurts a bit. This gas often collects under the right diaphragm and causes the sensation of right shoulder pain.

Intravenous and oral medications are used after the surgery to relieve postoperative pain. A catheter may remain in place for 1 to 2 days to help the bladder pass urine. Moving about as soon as possible helps to avoid blood clots in the legs and other problems. Normal diet is encouraged as soon as possible after bowel function returns. The physician may advice to take some precautions like avoiding lifting heavy things etc. th epatient may also be recommended to take Hormone Replacement Therapy (HRT) which means replacing the missing female hormone oestrogen with tablets.

Benefits and drawbacks of laparoscopic hysterectomy

One advantage of laparoscopic hysterectomy is that the incisions are smaller (1/2 inch) and much less uncomfortable than that of abdominal hysterectomy. So people are able to resume normal activity in about 2 weeks. So Laparoscopic hysterectomy has many advantages like :

Less postoperative pain

May shorten hospital stay

May result in a quicker return to bowel function

Quicker return to normal activity

Better cosmetic results

However, the surgeon must be experienced in the procedure before these benefits can be seen or else complications may occur. Disadvantages include a possible longer operating time (depends on how much of the operation is performed laparoscopically), higher costs and an increased risk of damage to the urinary tract.

For more information on Laparoscopic Hyesterctomy Treatment, kindly visit :
http://www.aasthahealthcare.com/Laparoscopic-Hyesterctomy-Treatment.htm

------------------------------------

Laparoscopic Tubal Ligation Treatment in India at Aastha Healthcare Hospital

2009-09-18T02:21:00.000-07:00

Contraceptives are also called birth control methods which are used to deliberately prevent or reduce the likelihood of a woman becoming pregnant. They are devices or methods or procedures which reduces the likelihood of the fertilization of an ovum by a sperm. Nowadays, there is a vast number of different contraceptive methods. There are many different contraceptive methods available and different methods suit people at different times of their lives. It is very important for the woman and her partner to decide on the method of contraception most suited to them. There are barrier methods like condoms, cervical diaphragm. Then there are hormonal methods like pills which are very commonly used. Besides, devices like IUCD are placed in the uterus. But all these are temporary methods. That means they are reversible.

For more information on Laparoscopic Tubal Ligation Treatment, kindly visit :
http://www.aasthahealthcare.com/Laparoscopic-Tubal-Ligation-Treatment.htm

------------------------------------

Laparoscopic Ovarian Cystectomy Treatment in India at Aastha Healthcare Hospital

2009-09-18T02:20:00.000-07:00

A female has two walnut-sized ovaries. These are located on either side of the uterus, nestled under the fringed ends of the fallopian tubes. These tubes create a pathway for a released egg to reach the center of the uterus. During the menstrual cycle, one ovary will develop and mature an egg. The egg is encased in a sac called a follicle. About day 14 of the menstrual cycle, ovulation occurs and the egg is released from the ovary.

Ovarian cysts are small fluid-filled sacs that develop on a woman's ovaries. In an ultrasound image, ovarian cysts resemble bubbles. The cyst contains only fluid and is surrounded by a very thin wall. This kind of cyst is also called a functional cyst, or simple cyst. If a follicle fails to rupture and release the egg, the fluid remains and can form a cyst in the ovary.

Ovarian cysts are common among women of childbearing age. They are considered functional (or physiologic). Most often, cysts in women of this age group are not cancerous and many disappear on their own in a matter of weeks without treatment. But some may cause problems such as bleeding and pain and need medical intervention. Women who are past menopause (ages 50-70) with ovarian cysts have a higher risk of ovarian cancer. At any age, if you think you have a cyst, it's important to tell your doctor.

What are the causes?

Ovarian cysts form for numerous reasons. The most common type is a follicular cyst, which results from the growth of a follicle. A follicle is the normal fluid-filled sac that contains an egg. Follicular cysts form when the follicle grows larger than normal during the menstrual cycle and does not open to release the egg. Usually, follicular cysts resolve on their own over the course of days to months. Cysts can contain blood (hemorrhagic or endometrioid cysts) from injury or leakage of tiny blood vessels into the egg sac. Occasionally, the tissues of the ovary develop abnormally to form other body tissues such as hair or teeth. Cysts with these abnormal tissues are called dermoid cysts.

For more information on Laparoscopic Ovarian Cystectomy Treatment, kindly visit :
http://www.aasthahealthcare.com/Laparoscopic-Ovarian-Cystectomy-Treatment.htm

------------------------------------

Laparoscopic Ectopic Pregnancy Evacuation Treatment in India at Aastha Healthcare Hospital

2009-09-18T02:18:00.000-07:00

Once the egg gets fertilized, it travels down the fallopian tube to uterus. But when the tubes are damaged or blocked and fail to propel the egg toward the womb, the egg may become implanted in the tube and continue to develop there. Because almost all Ectopic pregnancies occur in one of the fallopian tubes, they are often called "tubal" pregnancies. Much less often, an egg implants in an ovary, in the cervix, directly in the abdomen, or even in a c-section scar. In rare cases, a woman has a normal pregnancy in her uterus and an Ectopic pregnancy at the same time. This is called a heterotopic pregnancy and it's more likely to happen if one has had fertility treatments, such as in-vitro fertilization.

There's no way to transplant an Ectopic (literally, "out of place") pregnancy into the uterus, so ending the pregnancy is the only option. In fact, if an Ectopic pregnancy is not recognized and treated, the embryo will grow until the fallopian tube ruptures, resulting in severe abdominal pain and bleeding. It can cause permanent damage to the tube or loss of the tube, and if it involves very heavy internal bleeding that's not treated promptly, it can even lead to death. Fortunately, the vast majority of Ectopic pregnancies are caught in time.

For more information on Laparoscopic Ectopic Pregnancy Evacuation Treatment, kindly visit :
http://www.aasthahealthcare.com/Laparoscopic-Ectopic-Pregnancy-evacuation-Treatment.htm

------------------------------------

Laparoscopic Myomectomy for Fibroids Treatment in India at Aastha Healthcare Hospital

2009-09-18T02:17:00.000-07:00

Fibroids are growths of tissue that are usually found in the wall of the uterus, or womb. They are made of a mixture of muscle tissue from the uterus and threadlike fibres of connective tissue. They are among the most common tumours in women. These growths aren't associated with cancer. The Medical names for a fibroid are leiomyoma, myoma, and fibromyoma.

They are one of the most common tumours found in women during their reproductive years. As many as three out of four women have fibroids, but most are unaware of them. Your doctor may discover them incidentally during a pelvic exam or prenatal ultrasound. Fibroids cause symptoms for about one in four women, most frequently during their 30s or 40s. But surprisingly they are the single most common cause for hysterectomy, being responsible for somewhere between 20% and 77% of all hysterectomies performed.

Uterine fibroids originate from the smooth muscle cells of the myometrium. A single cell reproduces repeatedly, eventually creating a pale, firm, rubbery mass distinct from neighboring tissue. Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. They can be single or multiple, in extreme cases expanding the uterus so much that it reaches the rib cage.

Types of Fibroids :

The names of fibroids reflect their orientation to the uterine wall. Basically, fibroids can be classified into four types. They are:

Intracavitary Myomas- These fibroids are present inside the cavity of the uterus. They usually cause bleeding between periods and often cause severe cramping.

Submucous Myomas- They are present partially in the cavity and partially in the wall of the uterus. They too can cause heavy menstrual periods as well as bleeding between periods.

Intramural Myomas- These fibroids are in the wall of the uterus, and can range in size from microscopic to larger than a grapefruit. Many of these do not cause problems unless they become quite large. There are a number of alternatives for treating these, but often they do not need any treatment at all.

Subserous Myomas- They are on the outside wall of the uterus. A fibroid may even be connected to the uterus by a stalk. These do not need treatment unless they grow large, but they can twist and cause pain

For more information on Laparoscopic Myomectomy for Fibroids Treatment, kindly visit :
http://www.aasthahealthcare.com/Laparoscopic-Myomectomy-Fibroids-Treatment.htm

------------------------------------

Diagnostic Laparoscopy Treatment in India only at Aastha Healthcare Hospital

2009-09-18T02:03:00.000-07:00

What is diagnostic laparoscopy?

Laparoscopy is a minimally invasive procedure which is used for both surgical and diagnostic purposes. When laparoscopy is used for diagnosis, it is called diagnostic laparoscopy. This is used when a diagnosis is in doubt and this procedure can provide the needed information to the surgeon.

Technological advances in equipment over the last decade have revolutionised the approach to traditional diagnostic ways for gynaecological problems. Today, at Aastha Health Care, Diagnostic Laparoscopy is one of the most commonly performed gynaecological procedures.

In this procedure, the surgeon makes small incisions and inflates the abdomen with gas (carbon dioxide) to enlarge the size of the viewing area. After this, a laparoscope or small camera is inserted. A laparoscope is a thin tube with a light and tiny camera and it projects images of the abdomen onto a high resolution television screen. By mobilizing the camera, the surgeon can have a very thorough look through the abdomen without the pain and recovery of a larger incision. During this, the surgeon can look directly at the outside of the uterus, ovaries, fallopian tubes, and nearby organs.

For more information on Diagnostic Laparoscopy Treatment India, kindly visit :
http://www.aasthahealthcare.com/Diagnostic-Laparoscopy-Treatment.htm

------------------------------------

Minimally Invasive Procedure for Haemorrhoid (MIPH) Treatment | Piles Treatment | Haemorrhoid Treatment | Aastha Healthcare | Super Speciality Center

2009-09-07T04:48:00.000-07:00

What are haemorrhoids?

Grade I haemorrhoids may bulge into the anal canal but do not protrude through the anus.
Grade II haemorrhoids protrude through the anus during straining and defecation, but return spontaneously.
Grade III haemorrhoids protrude through the anus with defecation or straining but do not return spontaneously, requiring the patient to gently push it back into its normal position with a finger.
Grade IV haemorrhoids cannot be manually returned to their normal position.

What are the symptoms of piles?

The symptoms of piles can come and go. There are five main symptoms:

Itching and irritation
Aching pain and discomfort
Bleeding
A lump, which may be tender
Soiling of pants or knickers with slime or faeces ('skid marks').

Itching and irritation probably occur because the lumpy piles stop acting as soft pads to keep the mucus in; instead, a little mucus leaks out and irritates the area around the anus. Pain and discomfort comes from swelling around the pile, and from scratching of the lining of the anal canal by faeces as they pass over the lumpy area. The scratching also causes bleeding, which is a fresh bright red colour and may be seen on faeces or toilet paper or dripping in the pan. A pile that has been pushed down (a second- or third-degree pile) may be felt as a lump at the anus. Internal haemorrhoids cannot cause cutaneous pain, but they can bleed and prolapse. Prolapse of internal haemorrhoids can cause perianal pain by causing a spasm of the sphincter complex. This spasm results in discomfort while the prolapsed haemorrhoids are exposed. The discomfort is relieved with reduction. Internal haemorrhoids can also cause acute pain when incarcerated and strangulated. Again, the pain is related to the sphincter complex spasm. See the table given below to know the symptoms of specific types of haemorrhoids:

Type	Symptoms
Internal haemorrhoid symptoms	May protrude Mucous discharge Rectal bleeding Rectal itching Feeling of incompletely emptying bowels.
External haemorrhoid symptoms	Rectal itching uncommon May protrude Rectal bleeding Interferes with anal hygiene.
Thrombosed haemorrhoid symptoms	Protrudes Rectal itching Rectal pain Rectal bleeding Tenderness Swelling.
Ulcerated haemorrhoid symptoms	Rectal itching Rectal bleeding Swelling Severe rectal pain.

Bulge of Internal Piles

Bleeding of Internal Piles

How is it diagnosed?

Haemorrhoids are diagnosed based upon a history, physical examination and visual inspection of the anal canal and rectum. When the patient reports to the physician with the symptoms of piles, the physician takes detailed case history.

To confirm presence of haemorrhoids, the doctor will do a rectal examination. The doctor will place a gloved and lubricated finger into the rectum to feel for abnormalities. External haemorrhoids can be diagnosed by a visual and/or rectal examination. To diagnose internal haemorrhoids, the doctor will insert a thin tube-like instrument (called an anoscope) into the lower few inches of the rectum. The anoscope has a light at the end and an eyepiece at the front for viewing into the anal canal. The procedure is painless but uncomfortable and lasts about 1 minute and is done in the OPD. Despite the fact that bleeding is common in patients with haemorrhoids, other potential causes of bleeding are excluded. To test for blood that may not be visible, the clinician obtains a small stool sample on a gloved finger. The stool is smeared onto a chemically coated paper and drops of another chemical are added. If blood is present, the colour of the paper will change to blue.

A more detailed look can be done by a procedure called sigmoidoscopy that is done under sedation or anaesthesia and a look upto 25 cm can be done to rule out any sinister disease that may be associated. Occasionally, a barium examination or colonoscopic examination of the large intestine may be required if other diseases are suspected.

What are the treatment options?

Several options are available for the treatment of haemorrhoids. For many, conservative or minimally invasive measures are effective in relieving symptoms. But in many cases, the physician may ask the patient to undergo the surgery.

Conservative Method

Increasing fibre in the diet is one of the best ways to soften and bulk the stool, which can help to reduce bleeding from haemorrhoids. The physician may also prescribe fibre supplementation. These products work by absorbing water and increasing stool bulk, which increases the frequency of bowel movement and softens stool. For grade II piles, Sitz bath will be recommended. The rectal area is immersed in warm water for 10 to 15 minutes two to three times daily. Pain-relieving creams and suppositories are also given to give temporary relief.

OPD / Alternate Procedure

Patients who have bothersome haemorrhoid symptoms, despite trying conservative measures, may consider a minimally invasive procedure. Most procedures are performed as a day surgery, allowing a patient to go home in the afternoon or evening. The following procedures are intended for treatment of internal haemorrhoids:

Rubber band ligation - Rubber band ligation is the most widely used procedure, and is best suited for grade I, grade II, and certain grade III internal haemorrhoids. Rubber bands or rings are placed around the base of an internal haemorrhoid. As the blood supply is restricted, the haemorrhoid shrinks and degenerates over several days. Many patients report a sense of "tightness" after the procedure, which may improve with warm sitz baths.

Laser, infrared, or bipolar coagulation - These methods involve the destruction of internal haemorrhoids with laser or infrared light or heat. Coagulation causes the haemorrhoidal tissue to harden and degenerate, and to form scar tissue as the area heals. Coagulation is generally effective for grade I and grade II internal haemorrhoids. In a technique called Haemorrhoidolysis, therapeutic galvanic waves are applied directly to the haemorrhoid, to shrink and dissolve the tissue.

Sclerotherapy - During sclerotherapy, a chemical solution is injected into haemorrhoidal tissue, causing inflammation, degeneration, and scar formation.

Cryosurgery- This freezes the pile to destroy it. It is not used much, because it causes a watery discharge afterwards.

Surgical Method

Patients who continue to experience symptoms despite conservative or minimally invasive therapies typically require surgical removal of haemorrhoids (haemorrhoidectomy). Surgery is the treatment of choice for patients with symptomatic grade IV internal haemorrhoids or strangulated internal haemorrhoids. Now under this, there are again two ways for doing it:

Conventional or open method
New method or MIPH method

Conventional method

Surgery to remove haemorrhoids is called haemorrhoidectomy. During this, the doctor makes incisions around the anus to cut away the haemorrhoids. It involves the surgical removal of excess haemorrhoidal tissue and anal canal lining. Most anal surgeries are being done under general or regional anaesthesia. Most patients experience some degree of pain following the surgery. It is painful for 7-10 days afterwards.

While surgery usually relieves the pain, swelling, bleeding, and itching caused by haemorrhoids, a drawback to this procedure is that the incisions are made in a highly sensitive area and might require stitches, which can cause the area to be tender and painful. In addition, patients might have some trouble urinating because the pain following surgery makes it difficult to relax and allow urine to flow.

New Method or stapler haemorrhoidectomy

In the past, open surgery was the only option available to surgeons when they needed to see inside a patient's body or remove or repair and organ. But today, minimally invasive technology is completely changing the way doctors approach patient care. While conventional surgical haemorrhoidectomy is a safe and reliable procedure, it is often associated with significant postoperative pain. A new procedure for removing large haemorrhoids, the stapler haemorrhoidectomy, is less painful and allows patients to return to work and other normal activities much earlier than with the conventional procedure. Stapled Piles Surgery is also known as PPH (procedure for prolapse and haemorrhoids) or MIPH (Minimally invasive procedure for haemorrhoids). The PPH procedure was first introduced in Italy in 1997 and in the last four years has become very popular all over the world.

This technique uses a stapling device and takes advantage of the fact that pain-sensing nerve fibres are absent higher in the anal canal. In this procedure, the mucosa above the dentate line, which contains part of the pile mass, is excised and stapled with the stapler gun, thus taking care of bleeding and prolapse - the two major components of piles. The pile masses are compressed into a cup like cavity inside the stapler. When fired, the titanium staples cut and seal simultaneously, thus causing minimal bleeding and as the cut line is above the nerves, there is reduction in post operative pain. Additionally there is no incision on the perianal skin or lower part of anal canal and the wound in the anal mucosa is also primarily closed with a stapler, thus, there is no need to do any post operative dressing. It can be done as an outpatient, using local anaesthesia with intravenous (IV) sedation. Routine preoperative workup for these techniques is required. Simple distal rectal evacuation is required for a clean operative field. Distal rectal evacuation is best achieved by small-volume saline enemas. But it should be done by a surgeon who is especially trained in doing stapler surgery. This is because there are few risks associated with the unskilled hands. The risks include: damage to the rectal wall, overstretching of sphincter muscles. etc.

Benefits and drawbacks

Studies suggest that Stapled Piles Surgery (also known as PPH - procedure for prolapse and haemorrhoids or MIPH - Minimally invasive procedure for haemorrhoids) is an effective treatment. This technique potentially provides a tool for reducing some of the problems associated with conventional surgery. It considerably reduces operative bleeding, postoperative pain, the length of hospital stay, and encourages a rapid return to normal activities when compared with conventional piles surgery. So the clear advantages of the modern methods for outpatient treatment of internal piles are that they are quick and relatively painless. Patients lose little if any time from work, the complications are minor, and the cure rates are high. So to summarise, given below are the advantages of MIPH in points:

Smaller incisions resulting in reduced pain and discomfort
Minimal scarring
Greater surgical precision
Fewer complications
Less blood loss and a decreased need for blood transfusions
Reduced risk of infection
Shorter hospital stays
Faster recoveries

Care to be taken at home

While no strategy completely removes the risk of haemorrhoids occurring again, following these suggestions can lower the risk:

Avoid straining during bowel movements.
Avoid constipation
Drink enough liquid for proper hydration.
Eat a diet high in fibre.
Exercise regularly.

For more information, kindly visit :
http://www.aasthahealthcare.com/Minimally-Invasive-procedure-for-Haemorrhoid-MIPH-Treatment.htm

------------------------------------

Laparoscopic Myomectomy Treatment for Fibroids | Obstetrics Surgical Treatment | Gynaecology Surgical Treatment | Aastha Healthcare | Super Speciality

2009-09-07T04:46:00.000-07:00

What are Fibroids?

Types of fibroids

The names of fibroids reflect their orientation to the uterine wall. Basically, fibroids can be classified into four types. They are:

What are the causes?

A fibroid starts as a single muscle cell in the uterus. For reasons that are not known, this cell changes into a fibroid tumor cell and starts to grow and multiply. Heredity may be a factor. After puberty, the ovaries produce more hormones, especially oestrogen. Higher levels of these hormones may help fibroids to grow, although exactly how this might happen is not understood.

What are the symptoms?

Surprisingly most fibroids up to the size of an orange cause no symptoms. Their mere presence is not a reason to treat them. Only about a quarter of women with fibroids will experience any symptom. These may include:

Heavy and painful periods- Periods may last more than seven days and menstrual flow may be very heavy.
Pain during sexual intercourse,
Infertility- Large intramural fibroids may be the cause of longstanding infertility if all other causes have been excluded.
Urinary or bowel symptoms caused by local pressure due to the fibroids.
Complications in pregnancy like miscarriage, premature labour
Pain in the pelvis-The pressure of large fibroids on other organs may cause pain in the pelvis. Pain may also occur if the stalk of a fibroid twists, cutting off blood supply to the fibroid. Rarely, a fibroid may become infected and cause pain.
Very rarely, a fibroid can undergo malignant change, particularly if the fibroid is very large or rapidly increases in size.

We have already discussed above the various types of fibroids that can arise. Let us see separately what kind of symptoms will be presented by each of them.

Intracavitary Myomas- These fibroids are present inside the cavity of the uterus. They usually cause bleeding between periods and often cause severe cramping.

Submucous: They protrude into the uterine cavity and cause menstrual cramps, heavy periods, infertility and repeated miscarriages. The diagnosis is often missed as the uterus is not enlarged and unnecessary hysterectomies have been performed for these. The diagnosis is made by hysterosonography or hysteroscopy.

Intramural: These fibroids are within the muscle of the uterus and can be very large. Because they enlarge the cavity of the uterus they can also cause heavy periods. The most common problem is 'pressure' symptoms on the bladder and rectum.

Subserous: These are external to the uterine muscle and are connected by a thin stalk. They are the least likely to be symptomatic and rarely need removal. Torsion (twisting) is a very rare complication.

How are they diagnosed?

One of the most common conditions confused with fibroids is adenomyosis. This can be a serious error, as the treatment may be quite different. In adenomyosis the lining of the uterus infiltrates the wall of the uterus, causing the wall to thicken and the uterus to enlarge. This can cause severe pain, and heavy bleeding. Since they present in the same way as fibroids, they often lead to wrong diagnosis. So after the gynaecologist takes the case history, the first step is to do a thorough pelvic examination. Fibroids may be felt during a pelvic exam, but many times myomas that are causing symptoms can be missed if the examiner relies just on the examination. So after this, the physician may ask the patient to undergo the following test:

Ultrasound

On ultrasound examination adenomyosis will often appear as diffuse thickening of the wall, while fibroids are seen as round areas with a discrete border.

Hysteroscopy

Hysteroscopy uses a hysteroscope, which is a thin telescope that is inserted through the cervix into the uterus. Modern hysteroscopes are so thin that they can fit through the cervix with minimal or no dilation. Because the inside of the uterus is a potential cavity, like a collapsed air dome, it is necessary to fill (distend) it with either a liquid or a gas (carbon dioxide) in order to see. During diagnostic hysteroscopy the hysteroscope is used just to observe the endometrial cavity (inside of the uterus.)

MRI scan

The above steps are usually all that is needed to make an accurate diagnosis and plan treatment. Sometimes, especially with very large fibroids, more information is needed. An MRI scan makes detailed images of the uterus. It can show the location of fibroids. An MRI can usually tell the difference between adenomyosis and fibroids.

What are the treatment options?

There's actually no single-best approach to treating fibroids. The option that's best for you depends on many factors. Your plans for childbearing, how close you are to menopause and your feelings about surgery may play a role in determining your options.

Watchful waiting

Fibroids that cause no symptoms may require only "watchful waiting". In this, your gynaecologist will monitor your condition through regular pelvic examinations. It is also a good option if one is approaching menopause.The reproductive hormones oestrogen and progesterone appears to stimulate fibroid growth. During menopause, the ovaries stop producing these hormones and fibroids shrink. Your gynaecologist may decide to take action if signs and symptoms such as heavy bleeding, pelvic discomfort and pressure on neighboring organs start intruding on your life. Treatment depends on the size and site of the fibroids. The options include:

Drug Therapy

Drug therapy is usually tried first. This might include:

The use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) or naproxen sodium (Naprosyn),
Birth-control pills, or
Hormone therapy.

In some patients, symptoms are controlled with these treatments and no other therapy is required. However, some hormone therapies can have risks and side effects (menopausal symptoms, erratic or no menstruation, bloating, moodiness) when used long-term, and generally are used temporarily. Hormonal therapy can be useful for women who are close to the menopause and wish to avoid surgery. But hormonal treatment is unlikely to be of any benefit in women who wish to conceive and causes unnecessary delays.

A newer group of drugs being used for fibroids are hormones known as GnRH analogues, which are administered by injection by the gynecologist. These synthetic (man-made) hormones act like the hormones that are naturally produced by the body and reduce the level of oestrogen. The result is reduced blood flow to the uterus and, therefore, to the fibroids, decreasing the size of both. Some physicians recommend these hormones prior to surgery to reduce the size of the fibroids and make them easier to remove. The effectiveness of the hormones is considered temporary as studies show that when the therapy is stopped, fibroids regrow to their original size in four to six months. The GnRH hormones also may cause side effects that mimic menopause, including hot flashes, vaginal dryness, mood swings and a decrease in bone density (osteoporosis).

Minimal invasive procedures

Myomectomy is a surgical procedure that removes visible fibroids from the uterine wall. Myomectomy is the removal of fibroids without removing the uterus. This operation preserves a woman's ability to bear children. There are several ways to perform myomectomy, including hysteroscopic myomectomy, laparoscopic myomectomy and abdominal myomectomy. While the first two are minimally invasive procedures, the latter one is a traditional method.

While myomectomy is successful in controlling symptoms about 80 percent of the time, the more fibroids there are in a patient's uterus, the less successful the surgery generally is. In addition, fibroids grow back several years after myomectomy in 10 percent to 30 percent of cases.

Laparoscopic myomectomy

The surgical removal of fibroids is called a myomectomy. Laparoscopic myomectomy may be used if the fibroid is on the outside of the uterus. Intramural and subserous fibroids up to 10 cm in diameter can be removed by laparoscopic myomectomy, through two small incisions 10 mm in length, one in the umbilicus (navel) and the other a little lower down in the midline of the abdomen. Two smaller incisions only 5mm in length are made, one on either side of the abdomen about three inches from the midline. Presently only a handful of surgeons in this country offer this procedure which takes much longer and is more challenging than conventional surgery. Aastha specializes in such kind of minimal invasive procedures. Fibroids that are deep in the wall of the uterus or submucous are most difficult to remove laparoscopically.

Hysteroscopic myomectomy

This procedure is used only for fibroids that are just under the lining of the uterus and that protrude into the uterine cavity. Hysteroscopic myomectomy is performed through the woman's cervical canal and does not involve any abdominal incisions. During operative hysteroscopy a type of hysteroscope is used that has channels in which it is possible to insert very thin instruments. These instruments can be used to remove polyps, to cut adhesions, and do other procedures. In many situations, operative hysteroscopy may offer an alternative to hysterectomy. A device called a resectoscope cuts away the fibroids or an electrical current "evaporates" the fibroids. The resectoscope has been used for male prostate surgery for over 50 years. It has been modified so it can be used inside the uterus. The resectoscope is a hysteroscope with a built in wire loop that uses high-frequency electrical current to cut or coagulate tissue. The resectoscope has revolutionized surgery inside the uterus. After a laparoscopic or hysteroscopic myomectomy, the patient goes home the same day. Most women are back to normal activities within 7-10 days.

Abdominal Myomectomy

This is a surgical procedure, in which an incision is made in the abdomen to access the uterus, and another incision is made in the uterus to remove the tumor. Once the fibroids are removed, the uterus is stitched closed. The patient is given general anesthesia and is not conscious for this procedure, which requires a several-day hospital stay. Typical recovery is four to six weeks.

Myolysis

Then, using techniques such as coagulation or electrosurgery, the fibroids are removed and the uterine wall repaired. We use a bipolar needle or laser to perform "myolysis" of the fibroids. This destroys the fibroids and shrinks the blood vessels that feed them. A similar procedure called cryomyolysis uses liquid nitrogen to "freeze" fibroids. So this does not involve surgically cutting into the uterus, but instead, it uses techniques to coagulate the fibroids, which shrink to about half the size after surgery.

Uterine artery embolization

Known medically as uterine artery embolization, this approach to the treatment of fibroids blocks the arteries that supply blood to the fibroids causing them to shrink. It is a minimally-invasive procedure, which means it requires only a tiny nick in the skin, and is performed while the patient is conscious but sedated and feels no pain. Fibroid embolization is performed by an interventional radiologist, a physician who is specially trained to perform this and other minimally-invasive procedures.

Uterine artery Embolization

The interventional radiologist makes a small nick in the skin (less than one-quarter of an inch) in the groin to access the femoral artery, and inserts a tiny tube into the artery. The catheter is guided through artery to the uterus while the interventional radiologist guides the process of the procedure using a moving X-ray (flouroscopy). The interventional radiologist injects tiny plastic particles the size of grains of sand into the artery that is supplying blood to the fibroid tumor. This cut off the blood flow and causes the tumor (or tumors) to shrink. The artery on the other side of the uterus is then treated. Fibroid embolization usually requires a hospital stay of one night. Pain-killing medications and drugs that control swelling typically are prescribed following the procedure to treat cramping and pain. Many women resume light activities in a few days and the majority of women are able to return to normal activities within one week.

MRI-guided focused ultrasound ablation

Magnetic resonance guided focused ultrasound (MRGFU) is a non-invasive outpatient, procedure that uses high intensity focused ultrasound waves to ablate the fibroid tissue. During the procedure, an interventional radiologist uses magnetic resonance imaging (MRI) to see inside the body to deliver the treatment directly to the fibroid. The procedure is FDA approved for treating uterine fibroids, but is under investigation for the treatment of breast, prostate, brain and bone cancer.

MRI scans identify the tissue in the body to treat and are used to plan each patient's procedure. MRI's provide a three-dimensional view of the targeted tissue, allowing for precise focusing and delivery of the ultrasound energy. MRI also enables the physician to monitor tissue temperature in real-time to ensure adequate but safe heating of the target. Immediate imaging of the treated area following MRGFU helps the physician determine if the treatment was successful. The ultrasound energy used in MRGFU can pass through skin, muscle, fat and other soft tissues. High-intensity ultrasound energy that is directed to the fibroid heats up the tissue and destroys it. This method of tissue destruction is called thermal ablation.

Hysterectomy

Hysterectomy is the surgical removal of the uterus (and usually of the cervix as well). It is the most common treatment for fibroids. In a hysterectomy, the uterus is removed either in an open surgical procedure or via laparoscopy. In case an open procedure is performed, it is considered major surgery and is performed while the patient is under general anesthesia. It requires an incision in abdominal wall to remove the uterus. It requires 3 to 4 days of hospitalization and the average recovery period is about six weeks. Hysterectomy can also be done laparoscopically provided the uterus is not too bulky because of fibroids. To know more about laparoscopic hysterectomy,

What are the Benefits and Drawbacks?

Today minimal invasive procedures have created a revolution in the world of surgery. The reason is that they cause less tissue-damage and scarring. So the recovery is also faster. Laparoscopy and hysteroscopy are two very common approaches for removing fibroids (myomectomy). Until recently, surgical removal of fibroids almost always involved a large abdominal incision (laparotomy) with a three-to-five day hospital stay and six-to-eight week recovery. The advantages of laparoscopic/hysteroscopic myomectomy are:

shorter hospital stay
reduced recovery time
reduced post-operative pain
smaller incisions
better cosmetic results

Side Effects or Complications

Fibroid embolization is considered to be very safe, however, there are some associated risks, as there are with almost any medical procedure. Most women experience moderate to severe pain and cramping in the first several hours following the procedure. Some experience nausea and fever. These symptoms can be controlled with appropriate medications. A small number of patients have experienced infection, which usually can be controlled with antibiotics. It also has been reported that there is a 1 percent chance of injury to the uterus, potentially leading to hysterectomy. These complication rates are lower than those of hysterectomy and myomectomy.

Myomectomy and hysterectomy also carry risks, including infection and bleeding leading to transfusion. Patients who undergo myomectomy may develop adhesions causing tissue and organs in the abdomen to fuse together, which can lead to infertility. In addition, the recovery time is much longer for abdominal myomectomy, generally one to two months.

For more information, kindly visit :
http://www.aasthahealthcare.com/Laparoscopic-Myomectomy-Fibroids-Treatment.htm

------------------------------------

Laparoscopic Ectopic Pregnancy Evacuation Treatment | Obstetrics Treatment | Gynaecology Treatment | Ectopic Pregnancy Treatment

2009-09-07T04:41:00.000-07:00

What is Ectopic pregnancy?

What are the causes?

Many factors are known to increase the risk of having an Ectopic pregnancy. Anything that alters the tubal function may affect further pregnancies. Fallopian tubes are not like a hollow pipe that sits there with the egg rolling down. They have little hairs on the inside (cilia) which move with a wave-like motion to encourage the egg toward the womb. If the tube becomes blocked or the cilia damaged then ectopic is more likely. Besides this, there are some risk factors, like:

Advancing age
Pelvic inflammatory disease - eg. previous Chlamydia or gonorrhoea. Infection causes scar tissue adhesions in the tube and may damage the cilia. PID is one of the main causes of the increase seen in Ectopic pregnancies in recent years. Risk of an Ectopic pregnancy increases about 7-fold after a woman suffers acute pelvic infection.
Tubal surgery - women who have had operations on their tubes are more at risk of Ectopic. This includes tubal ligation, reversal of sterilisation or tubal surgery for a previous Ectopic.
Previous Ectopic - about 10-20% of those attempting pregnancy after one Ectopic will have another.
DES exposure - this is a drug that was once used during pregnancy, until it was found that female babies of women who used it were at risk of developmental abnormalities of the genital system. Their tubes are more likely to be abnormal and predisposed to Ectopic pregnancy. This is a very rare problem.
Previous termination of pregnancy - the risk of ectopic increases among those who have had two or more terminations, particularly if there was infection afterwards.
IVF (test-tube baby) and ovulation induction - both these techniques of assisted reproduction are associated with increased chances of Ectopic pregnancy.

What are the symptoms?

Ectopic pregnancy can be difficult to diagnose because symptoms often mirror those of a normal early pregnancy. These can include missed periods, breast tenderness, nausea, vomiting, or frequent urination. Ectopic pregnancy can exhibit any of the following symptoms:

Abdominal or pelvic pain or tenderness. It can be sudden, persistent, and severe but may also be mild and intermittent early on. You may feel it only on one side, but the pain can be anywhere in the abdomen or pelvis and is sometimes accompanied by nausea and vomiting.
Vaginal spotting or bleeding. If you're not sure you're pregnant yet, you may think you're getting a light period at first. The blood may look red or brown like the colour of dried blood, and may be continuous or intermittent, heavy or light.
Pain that gets worse when you're active or while moving your bowels or coughing.

It's a medical emergency when:
There is severe shoulder pain. Cramping and bleeding can mean many things, but pain in the shoulder, particularly when one is lying down, is a red flag for a ruptured Ectopic pregnancy. The cause of the pain is internal bleeding, which irritates nerves that go to the shoulder area.
There are signs of shock, such as a weak, racing pulse; pale, clammy skin; and dizziness or fainting. This generally indicates that a fallopian tube has ruptured.

How is it diagnosed?

Ectopic pregnancy can be tricky to diagnose. If your symptoms suggest this type of pregnancy, your caregiver will do several tests to try to confirm the diagnosis:

A blood test- to check level of the pregnancy hormone human chorionic gonadotropin (hCG). If it's high enough to suggest pregnancy, but not as high as it should be at your stage, the pregnancy may be ectopic. If you're not in pain and there's still some question about the diagnosis, the test may be repeated in two to three days. If your hCG level doesn't increase as it's supposed to, this probably indicates either an Ectopic pregnancy or a miscarriage.

A vaginal exam- If the vaginal area is very tender or your caregiver detects a mass or an enlarged fallopian tube, an Ectopic is likely the cause.

An ultrasound- If the sonographer can see an embryo in the fallopian tube, you definitely have an Ectopic pregnancy. But in most cases, the embryo will have died early in the process and be too small for the sonographer to find. Instead, she may notice that a fallopian tube is swollen, and may see blood clots as well as tissue that remain from the embryo.

If the diagnosis remains unclear, your tubes may be examined more closely by using laparoscopic surgery, a procedure that may also be used to treat an Ectopic pregnancy and remove the embryo (see below).

What are the treatment options?

Once an Ectopic is diagnosed, there are several different treatments. It is not possible to take the pregnancy from the tube and put it into the womb. The options are as follows:

Expectant management

A proportion of all Ectopic will not progress to tubal rupture, but will regress spontaneously and be slowly absorbed. This may be appropriate if the level of hCG is falling and a woman is clinically well.

Medical treatment

This is done with a drug, which is given by injection. The drug is injected into a muscle and reaches the embryo through your bloodstream, where it ends the pregnancy by stopping the cells of the placenta from growing. Only a few Ectopic can be treated this way, which is the least invasive. Certain criteria must be fulfilled, such as small diameter of the Ectopic and low level of hCG. Close follow-up with further scans and blood tests is also necessary.

Open surgery or Laparotomy

This involves a 5cm incision at the top of the pubic hairline. The affected tube is brought out and either salpingotomy or salpingectomy performed. This is a major surgery and since the incisions are bigger compared to laparoscopic ones, it takes more time to heal.

Laparoscopic surgery

This is also called 'keyhole' surgery. Previously, salpingectomy by Laparotomy was the gold standard for the treatment of Ectopic pregnancy. The laparoscope has virtually eliminated the need for Laparotomy. Currently, Laparotomy is the preferred technique when the patient is hemodynamically unstable. Ofcourse it also depends on how clear the diagnosis is, how big the embryo is.

The surgeon will examine your tubes with a tiny camera inserted through a small cut in your navel and can often remove the embryo or remaining tissue while preserving your tube. (However, if there's extensive damage to the tube or you're bleeding profusely, the tube may need to be removed.) Laparoscopic surgery requires general anaesthesia, special equipment, and a surgeon experienced in the technique, and you'll need about a week to recuperate.

It may be possible to either open the tube and remove the pregnancy (salpingotomy), or remove the tube altogether (salpingectomy). The decision on which of these options is taken is very specific to each patient. In some cases - for example, if you have extensive scar tissue in the abdomen or heavy bleeding, or the embryo is too large - it may not be possible or expedient to use laparoscopic technology. If this is the case, you'll need major abdominal surgery.

By using a suction irrigator, the products of conception are flushed out

What is the prognosis?

The earlier you end an Ectopic pregnancy, the less damage you'll have in that tube and the greater your chances will be of carrying another baby to term. And even if you do lose one of your tubes, you can still have a normal pregnancy as long as your other tube is normal. If and when you do conceive again, call your health practitioner as soon as you suspect that you might be pregnant so that she can schedule you for an early sonogram and monitor you closely. Overall, your chances of having another Ectopic pregnancy are about 10 to 15 percent, depending on what caused the first one and what type of treatment you had. That means that your overall chances of having a normal pregnancy next time are still very high - about 85 to 90 percent.

If, on the other hand, you're unable to conceive because of Ectopic pregnancies or damaged tubes, the good news is that you're likely to be an excellent candidate for fertility treatments such as in vitro fertilization (IVF), in which your healthy embryos are implanted directly in your uterus.

Benefits and drawbacks

So Laparoscopic hysterectomy has many advantages like:

Less postoperative pain
May shorten hospital stay
May result in a quicker return to bowel function
Quicker return to normal activity
Better cosmetic results

So, if we were to compare an open surgery with a laparoscopic surgery, we can display it in a nutshell as under:

LAPAROSCOPIC	OPEN
Small Incisions (less than ½ an inch)	Large Incision
Hospital stay is 1 to 3 days	Hospital stay of about 5 days
Patients usually return to work in 5 to 10 days	Return to work in about 4 weeks
Lesser risk of Infection	Greater risk of infection
Less pain	More painful
Less chance of hernias	More chance of hernias

For more information, kindly visit :
http://www.aasthahealthcare.com/Laparoscopic-Ectopic-Pregnancy-evacuation-Treatment.htm

------------------------------------

Laparoscopic Ovarian Cystectomy Surgical Treatment | Obstetrics and Gynaecology Surgical Treatment | Aastha Healthcare | Super Speciality Center

2009-09-07T04:39:00.000-07:00

What are ovarian cysts?

Ovarian cysts are small fluid-filled sacs that develop on a woman's ovaries. In an ultrasound image, ovarian cysts resemble bubbles. The cyst contains only fluid and is surrounded by a very thin wall. This kind of cyst is also called a functional cyst, or simple cyst. If a follicle fails to rupture and release the egg, the fluid remains and can form a cyst in the ovary.

Ovarian cysts are common among women of childbearing age. They are considered functional (or physiologic). Most often, cysts in women of this age group are not cancerous and many disappear on their own in a matter of weeks without treatment. But some may cause problems such as bleeding and pain and need medical intervention. Women who are past menopause (ages 50-70) with ovarian cysts have a higher risk of ovarian cancer. At any age, if you think you have a cyst, it's important to tell your doctor.

What are the causes?

Ovarian cysts form for numerous reasons. The most common type is a follicular cyst, which results from the growth of a follicle. A follicle is the normal fluid-filled sac that contains an egg. Follicular cysts form when the follicle grows larger than normal during the menstrual cycle and does not open to release the egg. Usually, follicular cysts resolve on their own over the course of days to months. Cysts can contain blood (hemorrhagic or endometrioid cysts) from injury or leakage of tiny blood vessels into the egg sac. Occasionally, the tissues of the ovary develop abnormally to form other body tissues such as hair or teeth. Cysts with these abnormal tissues are called dermoid cysts.

The following are possible risk factors for developing ovarian cysts:

History of previous ovarian cysts
Irregular menstrual cycles
Hypothyroidism or hormonal imbalance
Tamoxifen therapy for breast cancer
Ovarian cancer and cancer that has spread to outside the ovary

What are the symptoms?

Many women have ovarian cysts without having any symptoms. But some may complain of:

Pressure, fullness, or pain in the lower abdomen or pelvic region
Dull ache in the lower back and thighs
Problems passing urine completely
Pain during sexual intercourse
Weight gain
Painful menstrual periods and abnormal bleeding
Nausea or vomiting
Breast tenderness
Weakness, dizziness, or faintness, especially from standing
Persistent fever

How Ovarian Cysts are diagnosed?

Pelvic Exam- Since ovarian cysts may not cause symptoms, they are usually found during a routine pelvic exam. During this exam, your doctor is able to feel the swelling of the cyst on your ovary. If a cyst is suspected, an ultrasound is usually the next step.

Pelvic Ultrasound- Once a cyst is found, the doctor may perform an endovaginal ultrasound which is a painless procedure resembling a pelvic exam. A thin, covered wand or probe is placed into the vagina, and the examiner directs the probe toward the uterus and ovaries. This type of ultrasound produces a better image than a scan through the abdominal wall can because the probe can be positioned closer to the ovaries. With an ultrasound, the doctor can see how the cyst is shaped; its size and location; and whether it's fluid-filled, solid, or mixed.

Diagnostic Laparoscopy- Laparoscopy is a surgical procedure performed when your doctor wants to see the cyst. A thin, lighted telescope, called a laparoscope, is inserted through a small incision into the abdomen. Laparoscopy may be used for treatment as well as diagnosis.

Other imaging- CT scan aids in assessing the extent of the condition. Though it is considered to be inferior to ultrasonography and MRI in defining ovarian cysts and pelvic masses. MRI is used to clarify results of an ultrasound.

Other tests- A pregnancy test is also done. Hormone levels (such as LH, FSH, estradiol, and testosterone) may also be checked. To find out if the cyst might be cancerous, your doctor may do a blood test to measure a substance in the blood called CA-125. The amount of this protein is higher if a woman has ovarian cancer. However, some ovarian cancers do not make enough CA-125 to be detected by the test. There are also non-cancerous diseases that increase the levels of CA-125, like uterine fibroids and endometriosis. These non-cancerous causes of increased CA-125 are more common in women under 35, while ovarian cancer is very uncommon in this age group. For this reason, the CA-125 test is recommended mostly for women over age 35, who are at high risk for the disease and have a cyst that is partially solid.

What are the treatment options?

Functional ovarian cysts are the most common type of ovarian cyst. They usually disappear by themselves and seldom require treatment. But some cysts may require medical or surgical intervention. So after the surgeon evaluates the complete case history, he decides on the appropriate line of action. Here are the three basic mode of action:

Watchful Waiting

If you have no symptoms and ultrasound shows a small, fluid-filled cyst, your doctor may simply schedule another pelvic exam and ultrasound in six weeks. The patient waits and gets re-examined in one to three months to see if the cyst has changed in size. It also might be an option for postmenopausal women.

The concept behind watchful waiting is to not actively treat the cyst until does not go away as your hormones change. An unchanging or growing cystic ovary needs further investigation.

Medications

Oral contraceptives: If you have a functional cyst that is larger in size and causing some symptoms, birth control pills may be prescribed. The purpose of birth control pills is to alter your hormone levels so the cyst will shrink. Birth control pills will reduce the probability of other cysts growing.

Pain relievers: Anti-inflammatories may help reduce pelvic pain. Narcotic pain medications by prescription may relieve severe pain caused by ovarian cysts.

Surgery

The cyst may be surgically removed if it is large, solid or filled with debris, persistently growing, irregularly shaped, or causing pain or other symptoms. If the cyst is not cancerous, it can be surgically removed without also removing the ovary. This is called a cystectomy. In some cases, the doctor may want to remove the affected ovary, while leaving the other intact in order to maintain your ability to have a normal hormone cycle. Sometimes an ovarian cyst may twist and cause severe abdominal pain as well as nausea and vomiting. This is an emergency, and an operation is necessary to correct it.

There are two main surgical procedures:

Laparoscopy-if the cyst is small and looks benign on the ultrasound, your doctor may perform a laparoscopy. This procedure is done under general anaesthesia. A very small incision is made above or below the navel, and a small instrument that acts like a telescope is inserted into the abdomen. If the cyst is small and looks benign, it can be removed.
Laparoscopy-if the cyst is large and looks suspicious, the doctor may perform a procedure called a Laparotomy. This procedure involves making bigger incisions in the stomach to remove the cyst. While you are under general anaesthesia, the doctor is able to have the cyst tested to find out if the tissue is cancerous. If it is cancerous, the doctor may need to remove the ovary and other tissues that may be affected, like the uterus or lymph nodes.

Whether performing a laparoscopy or Laparotomy, the goals are as follows:

To confirm the diagnosis of an ovarian cyst
To assess whether the cyst appears to be malignant
To obtain fluid from peritoneal washings for cytologic assessment
To remove the entire cyst intact for pathologic analysis, including frozen section, which may mean removing the entire ovary
To assess the other ovary and other abdominal organs

Benefits and drawbacks

One advantage of laparoscopic cystectomy is that the incisions are smaller (1/2 inch) and much less uncomfortable than that of Laparotomy. So people are able to resume normal activity in about 2 weeks. So Laparoscopic cystectomy has many advantages like:

Less postoperative pain
May shorten hospital stay
May result in a quicker return to bowel function
Quicker return to normal activity
Better cosmetic results

LAPAROSCOPIC	OPEN
Small Incisions (less than ½ an inch)	Large Incision
Hospital stay is 1 to 3 days	Hospital stay of about 5 days
Patients usually return to work in 5 to 10 days	Return to work in about 4 weeks
Lesser risk of Infection	Greater risk of infection
Less pain	More painful
Less chance of hernias	More chance of hernias

For more information, kindly visit :
http://www.aasthahealthcare.com/Laparoscopic-Ovarian-Cystectomy-Treatment.htm

------------------------------------

Laparoscopic Tubal Ligation Surgical Treatment | Laparoscopic Surgery | Surgical Contraception | Aastha Healthcare | Super Speciality Center Hospital

2009-09-07T04:37:00.000-07:00

What are contraceptives?

Nowadays, there is a vast number of different contraceptive methods. There are many different contraceptive methods available and different methods suit people at different times of their lives. It is very important for the woman and her partner to decide on the method of contraception most suited to them. There are barrier methods like condoms, cervical diaphragm. Then there are hormonal methods like pills which are very commonly used. Besides, devices like IUCD are placed in the uterus. But all these are temporary methods. That means they are reversible. But for few people, permanent birth control is a more reasonable option. This option is considered when the couple:

Does not want to have children in the future, no matter how the life may change.
Have a partner who also does not want children in the future but does not want to have a vasectomy
Have also considered other methods of birth control and do not want the side effects, risks, or costs of those methods.
Have health problems that would be made worse by pregnancy.
Have a hereditary condition that one does not want to pass on.

What is surgical contraception?

Permanent birth control methods are practically irreversible processes actually require surgical intervention. So they are also called surgical contraceptives. Sterilization is when a man or woman has an operation to prevent pregnancy. It safeguards individual health and rights, preserves our planet's resources, and improves the quality of life for individual women, their partners, and their children. For females there are two methods:

Tubal ligation

It is often referred to as "having the tubes tied," is a surgical procedure. The fallopian tubes, which carry the eggs from the ovaries to the uterus, are blocked or cut and sealed off so that the eggs can't reach the uterus and be fertilized by sperm. Instead, the eggs are reabsorbed by the body.

Tubal implants

They are small metal springs that are placed in each fallopian tube in a non-surgical procedure (no cutting is involved). Over time, scar tissue grows around each implant and permanently blocks the tubes.

Both these methods are considered to be permanent methods of birth control for women. Both procedure stops eggs from travelling from the ovaries into the fallopian tubes, where the egg is normally fertilized by a sperm. Reversing a tubal ligation is possible, but it is not highly successful.

How is it done?

Tubal ligation and tubal implants are considered to be permanent procedures. They come under surgical procedures. The female must make sure to talk to her gynaecologist openly to understand what is best for her. The choice of birth control depends on factors such as a person's health, frequency of sexual activity, number of sexual partners, and desire to have children in the future.

Before surgery

A pregnancy test is administered beforehand, because a pregnant woman can't undergo sterilization. After a detailed case history taking, the physician may advice for certain tests, depending upon the clinical indications. The patient will be advised to fast before the surgery. The doctor may choose to give either general anaesthesia or epidural.

The surgery

1. Tubal ligation method

There are several different ways of closing the fallopian tubes, including clipping or banding them, shut or cutting and stitching or burning them closed. The surgeon will probably prefer one of the following methods:

Laparoscopic tubal ligation

Laparoscopy involves inserting a viewing instrument and surgical tools through small incisions made in the abdomen. Laparoscopy can be done using local anaesthesia just at the site of the incision. However, they are usually done with a regional (epidural) or general anaesthetic.

The doctor injects a harmless gas (carbon dioxide) into the abdomen, which inflates the abdominal cavity, making it easier to see the internal organs. The doctor then makes a tiny incision near the navel and inserts a long, thin instrument (called a laparoscope) that contains a small lens and lighting system to magnify and illuminate the structures inside the lower abdomen. The physician may make a second incision just above the pubic hair to insert an instrument for grasping the fallopian tubes. The tubes are closed by one of the following means:

Tying and cutting (ligation)
Sealing by creating scar tissue
Removing a small piece of the tube
Applying plastic bands or spring-loaded clips

The tools are then removed and the openings closed with stitches. The procedure can be performed in outpatient surgical clinics. It takes 20 to 30 minutes. Very little scarring occurs. Women often go home the same day. They may have sexual intercourse as soon as they feel comfortable about it. Injury to the bowel or bleeding inside the abdomen occurs in five out of 1,000 cases. Major surgery may be required to resolve such complications.

The Fallopian tubes being tied using laparoscopic instrument

Mini-laparotomy ("mini-lap")

This is done through an incision that is less than 2 inches (5 cm) long. Postpartum tubal ligation is usually done by this method, following childbirth. The fallopian tubes are higher in the abdomen right after pregnancy, so the incision is made below the belly button (navel). The procedure is often done within 24 to 36 hours after the baby is delivered. Mini-laparotomy can be done using local anaesthetic just at the site of the incision. However, they are usually done with a regional (epidural) or general anaesthetic Laparoscopy can be done using local anaesthesia just at the site of the incision.

For this procedure, there is no gas or laparoscope. It is typically performed soon after childbirth. The doctor makes a small incision just above the pubic hair, or if done within 48 hours of childbirth, below the navel. The tubes are located, and the doctor uses a small tool to tie, clip, or seal off the tubes. Women usually recover in a few days. Doctors will advise as to when sexual intercourse can be resumed.

The mini-lap may be a good choice for women who cannot undergo laparoscopy due to prior
abdominal surgery or disease, and those for whom full laparotomy is too risky because of heart or respiratory conditions. It may not be appropriate for women who are obese or those with damaged fallopian tubes.

Laparotomy

This procedure is major surgery. It is less commonly used than mini-laparotomy and laparoscopy. The surgeon makes a two-to-five-inch incision in the abdomen. Laparotomy is usually done under general anaesthesia. This uses the same methods for closing or cutting the fallopian tubes, but the abdomen is opened with a larger incision to give the surgeon a clear view of all of the organs.

The surgeon locates and closes off the tubes. The operation requires general or spinal anaesthesia. A woman may need to be hospitalized for two to four days. It may take several weeks at home to completely recover. If the procedure is done after delivery, the woman's hospital stay may be extended by one or two days. When to resume sexual intercourse depends on the rate of recovery.

It may be preferable for women who need other abdominal procedures at the same time (such as caesarean delivery), and those who have had pelvic inflammatory disease, endometriosis, or prior abdominal surgery.

2. Tubal implant method

Implants are inserted in the fallopian tubes without surgery or general anaesthesia. The procedure is done in an outpatient surgery centre or hospital and does not require an overnight stay. The implant procedure usually takes about 30 minutes. A tubal implant can be difficult to insert. In about 15% of women, a second procedure is needed to completely block both tubes.

Before the procedure, the cervix is first opened (dilated) to reduce the risk of injury to the cervix. The health professional may place a slowly expanding tube or sponge (laminaria or synthetic dilator) in the cervix several hours beforehand. If not, a speculum and a dilating instrument is used to gradually open the cervix just before the procedure. The physician then passes a thin tube (catheter) through the vagina and cervix, into the uterus, and then into a fallopian tube. The catheter is used to place an implant into a fallopian tube. An implant is then placed in the other fallopian tube the same way. One may have some menstrual-like cramping afterwards. After the procedure, an X-ray is taken to make sure the implants are in place.

For the first 3 months after insertion, the patient is adviced to use another method of birth control. At 3 months, dye is injected into the uterus and an X-ray is taken (hysterosalpingography) to make sure that the implants are in place and the tubes are fully blocked by scar tissue. If they are, there is no longer use of another method of birth control.

After Surgery

After the surgery, the patient will be taken to the recovery room, where she will remain until she wake up or gets the feeling back in the numbed area. Depending upon the case, the physician may discharge the patient on the same day. After laparoscopy, the stomach may be swollen (distended) from the gas that was used to lift the skin and muscles away from the abdominal organs so the surgeon could see them better. This should go away within a day or so. One may also have some back or shoulder pain from the gas in abdomen. This will go away as the body absorbs the gas. A follow-up exam in 2 weeks is usually scheduled.

Care at home

She will be advised to take rest for a few days (or at least 24 hours) before beginning to resume normal activities. The patient has to take care as to avoid constipation because straining has to be avoided. The physician will also explain the patient as to when she can resume with her sexual life.

Benefits and drawbacks

Tubal ligation and tubal implants are permanent methods of birth control and allows the female to be sexually active without worrying about becoming pregnant. Although these methods are expensive but it is a one-time cost. These procedures are usually covered by medical insurance, and there are no costs after the surgery is done. The cost of other birth control methods, such as pills or condoms and spermicide, may be greater over time.

Above all, both these methods do not change the biological rhythm of the body. There is no change in monthly menstrual cycle. One will still release an egg each month (ovulate) and have menstrual periods. The female will go through menopause at the same time that she would have if she had not had the surgery. On the sexual front also there is no change. Infact women claim of feeling more relaxed about having sex because she doesn't have to worry about becoming pregnant.

The major disadvantage is that Tubal ligation and tubal implants do not protect against sexually transmitted diseases (STDs), including infection with the human immunodeficiency virus (HIV).

Risks and Complications

Major complications of tubal ligation are uncommon. Minor complications include infection and wound separation. They affect about 11% of women after mini-laparotomy, and 6% of women after laparoscopy. Major complications include heavy blood loss, general anesthesia problems, organ injury during surgery, and need for a larger laparotomy incision during surgery. They affect 1.5% of women after mini-laparotomy, and 0.9% of women after laparoscopy.

Although fewer complications occur with laparoscopy than with other kinds of tubal ligation surgery, these complications can be more serious. For example, on rare occasions, the bowel or bladder is injured when the laparoscope is inserted. But by choosing a skilled laparoscopic surgeon, these risks can be avoided.

The risk of pelvic infection is greater with tubal implants. There is a slight risk of becoming pregnant after tubal ligation. This happens to about 5 per 1,000 women after 1 year. After a total of 10 years following tubal ligation, about 18 per 1,000 women will have become pregnant. Pregnancy may occur if:

The tubes grow back together or a new passage forms (recanalization) that allows an egg to be fertilized by sperm. The health professional can discuss which method of ligation is more effective for preventing tubes from growing back together.
The surgery was not done correctly.
One was pregnant at the time of surgery.

If a tubal ligation or implant fails and the female becomes pregnant, she may run into the risk of having ectopic pregnancy. This means that the egg after getting fertilized implants itself into the fallopian tubes instead of uterus.

For more information, kindly visit :
http://www.aasthahealthcare.com/Laparoscopic-Tubal-Ligation-Treatment.htm

------------------------------------

Laparoscopic Hysterectomy Surgery Treatment | Uterus Treatment | Aastha Healthcare | Super Speciality Center Hospital | India

2009-09-07T04:33:00.000-07:00

What is uterus?

What is hysterectomy?

Hysterectomy merely means surgical removal of uterus. It is the second most common major operation performed today. Hysterectomy involves removal of the uterus, and sometimes the ovaries too (oophorectomy). Often one or both ovaries and fallopian tubes are removed at the same time a hysterectomy is done. So depending upon what is removed, hysterectomy can be classified as:

Sub-total or partial hysterectomy It involves the removal of Fallopian tubes and the upper two-thirds of the uterus only, preserving the cervix.
Hysterectomy with ovarian conservation It involves the removal of the Fallopian tubes, uterus and the cervix, while preserving the ovaries.
Hysterectomy with oophorectomy It involves the removal of the Fallopian tubes, uterus and cervix, together with one or both sets of ovaries.
Radical or Wertheim's hysterectomy It involves the removal of the Fallopian tubes, uterus, cervix, ovaries as well as nearby lymph nodes and the upper portion of the vagina. This type of hysterectomy is used in the treatment of some gynaecological cancer cases.

Before having a hysterectomy, it is very important to discuss the implications you're your gynaecologist and partner. Your doctor may recommend a hysterectomy if none of the treatments for the various conditions have worked. Ofcourse in some cases, there is no other choice than hysterectomy.

Why should one go for hysterectomy?

Hysterectomy is used to treat :

Fibroids- This is the most common reason for which hysterectomies are done. For many women with fibroids, symptoms are minimal and require no treatment. Also, the fibroids often shrink after menopause. But in some cases, fibroids can cause heavy bleeding or pain in some women.
Endometriosis- This happens when the tissue lining the inside of your uterus grows outside the uterus on your ovaries, fallopian tubes, or other pelvic or abdominal organs. The surrounding tissue may become scarred, and often other organs such as the uterus, bladder or the rectum may become stuck down in these scars (adhesions). When medication and surgery do not cure endometriosis, a hysterectomy often is performed.
Uterine prolapse- This is when the uterus moves from its usual place down into the vagina. This can lead to urinary problems, pelvic pressure, or difficulty with bowel movements.
Cancer- Cancer of the uterus, cervix, or ovary, is another cause for hysterectomy.
Persistent vaginal bleeding- If menstrual flow is heavy, not regular, or last for many days and non-surgical methods have not helped to control bleeding, a hysterectomy may bring relief. But ofcourse the physician screens the candidate if she is suitable for the surgery.
Chronic pelvic pain- Surgery is a last resort for women who have chronic pelvic pain that clearly comes from the uterus.

Often a doctor will have a fairly good idea of the type of the problem after examining and listening to the patient's symptoms. The doctor will make detailed notes of medical history and the patient's concerns. The physician will then inform the patient about different types of hysterectomy procedures. It is important that women understand the full implications of the removal or certain reproductive organs so that they can be properly prepared for any resultant side effects.

Before the surgery

The doctor will once again examine the patient thoroughly. The blood will probably be tested for hormone levels and also a pelvic ultrasound scan may be recommended. If the scan shows any abnormalities or is unclear, the doctor may want to investigate further using hysteroscopy, a procedure in which a viewing device is inserted into the uterus. A sample of the lining of the womb (endometrium) may be taken. Endometrial sampling is done either as an outpatient procedure, or by D&C-dilatation and curettage, usually when under a general anaesthesia. In a D&C, the cervix is opened (dilatation) and the lining of uterus (the endometrium) will be systematically scraped (curettage) with a long, thin instrument. The strips of the lining will then be examined under a microscope.

Preparation for both vaginal and abdominal hysterectomy is similar. She will be given a suppository to empty the bowels the night before. She will be told not to eat or drink anything on the day of the surgery about 6 to 8 hours before the surgery. Anaesthesia is given. It can be general, epidural or spinal anaesthesia. A catheter (a narrow silicon tube) is inserted into the bladder to empty it. The operation area is cleaned thoroughly with antiseptic before the operation.

The surgery

The actual hysterectomy operation can be performed in several different ways. The method chosen will depend on the surgeon's skills, expertise and preference, the reason for the hysterectomy and the woman's characteristics (e.g. weight, previous pelvic surgery, if she has had children). There are presently following ways to perform a hysterectomy:

Abdominal hysterectomy
Vaginal hysterectomy
Laparoscopic method

Abdominal hysterectomy

Initially this used to be the only method to remove the uterus. Ofcourse now options like laparoscopy have become the preferred choice of surgeons all over the world. But in some cases this method is still employed e.g. When there is a need for extensive exploration (in the case of cancer)or if the uterus is enlarged or if the woman has never had children or is obese. This surgery requires a four to eight inch abdominal incision to remove the uterus, and ovaries, if needed. An abdominal hysterectomy can be performed in two ways, with a vertical incision or a bikini line cut. A vertical incision generally involves a cut from the navel to the pubic hairline. The bikini line cut, as its name suggests, is done horizontally, directly above the pubic hairline. It leaves a less obvious scar and results in a shorter recovery time. The presences of large fibroids, extensive adhesions or endometriosis are other examples where this procedure is often preferred.

The advantages of an abdominal hysterectomy are lower incidence of damage to the urinary tract and blood vessels. It also allows the repair of a prolapse at the same time. But it is the least preferred route by patients because of the hospital stay, abdominal scar, pain, and disability; but it is sometimes the only route possible.

Vaginal hysterectomy

This is the next most frequently employed technique of hysterectomy. The surgeon operates entirely through the vagina, pulling the uterus down through the vagina into view, disconnecting the cervix and then the rest of the uterus. To use the vaginal route, a woman must usually have had a baby or two which widens the vagina and relaxes the connections of the uterus so it can be pulled down into the vagina to do the operation. There is no abdominal scar. It usually requires only two days in the hospital and about two weeks away from work. Vaginal hysterectomy is always preferred route if all the specific requirements are met-i.e. small uterus, no cancer, and vaginal laxity. It can not always be done for massive uterus. It is also not always possible to remove the ovaries because they are attached much higher in the pelvis than the uterus and cannot always be pulled down into the vagina for surgical removal.

The advantages of this method are less pain, a shorter hospital stay and recovery time and the absence of a visible scar. A review of different surgical approaches to hysterectomy for non-cancerous conditions concluded that a vaginal hysterectomy should be performed in preference to an abdominal hysterectomy where possible.

Laparoscopic hysterectomy

This merely means a hysterectomy in which any part of the operation is performed laparoscopically. Laparoscopy is a minimally invasive approach that involves specialized video equipment and instruments that allow a surgeon to remove the uterus through four tiny incisions, most of which are less than a half-centimetre in size. It allows the uterus to be detached from inside the body by laparoscopic instruments while the doctor is viewing the uterus, tubes, and ovaries through a camera attached to a telescope.

All laparoscopic surgery is performed under general anaesthesia with endotracheal intubation. The use of a naso-gastric tube avoids injury to the stomach and reduces bowel distension. The patient is placed in the dorso-lithotomy position, with the legs supported by stirrups and adjusted to permit mobilization of the uterus by the nurse or the assistant surgeon. Now in this case also, just like in conventional methods, uterus can be removed via abdomen or through vagina. But while performing laparoscopic surgery, if the surgeon at any time feels that it is not possible to remove the uterus laparoscopically, he can convert into an open procedure. This type of surgery involves passing from one to five small plastic tubes through half-inch incisions in the abdominal wall, providing a video picture of the inside of the abdominal cavity. Long slender surgical instruments can be used through these tiny "ports" to perform operations, such as removing the uterus, ovaries or performing biopsies. After the uterus is detached, it is removed through a small incision at the top of the vagina.

Laparoscopic surgeries have become the preferred choice for physicians all over the world. The first laparoscopic hysterectomy (LH) was performed in January 1988 by Harry Reich in Pennsylvania. This new procedure was designed to be an alternative to abdominal hysterectomy. Laparoscopic hysterectomy can be of two types:

Laparoscopic Assisted Vaginal Hysterectomy (LAVH):
Total Laparoscopic Hysterectomy

Laparoscopic Assisted Vaginal Hysterectomy (LAVH):

This also involves removal of the pelvic organs through the vagina but includes starting with cutting the ovarian attachments by working through the laparoscopes in the abdomen. This surgery is done under general anaesthesia. After the patient is "asleep," a retractor is placed through the vagina into the cervix. This helps to move the uterus around so that different areas of the uterus can be visualized. LAVH may be performed through 3 incisions: one 10-12 mm umbilical incision and two 5 mm lateral incisions. Carbon dioxide gas is used to fill the abdomen so that organs within the abdominal cavity are not injured when the instruments are placed inside. The laparoscope (which is similar to a periscope) is placed through the belly button incision. The instrument that grasps, coagulates, and cuts is placed through one of the other small incisions and the third incision is used for the retractor held by the assistant surgeon. The uterus with or without the tubes and ovaries are released from their blood supply and released from the cervix. The cervix is then supported by placing permanent sutures in the ligaments holding up the cervix to avoid falling later on. The canal in the centre of the cervix is also coagulated in order to avoid any monthly bleeding. Harmonic scalpel is the most preferred tool for coagulation. The uterus and tubes and ovaries (if they are being removed) are brought out in strips and sent to pathology to be evaluated for disease. After the abdomen is thoroughly checked for any bleeding, the instruments are removed and the gas that was used to fill the abdomen is emptied. The incisions are closed with sutures.

Usually two days in the hospital are needed with two weeks away from work. This is the next most preferred route for qualifying women. Most operating OB/GYN doctors can do this procedure, but not all. The doctor has to be especially trained in this procedure.

Total Laparoscopic Hysterectomy

This procedure involves disconnecting the uterus, and other structures as needed, by operating only through the laparoscopes in the abdomen, starting at the top of the uterus. The entire uterus is disconnected from its attachments using long thin instruments through the "ports." The early stages of total laparoscopic hysterectomy are performed in the same way as LAVH. When the broad ligament has been dissected the surgeon ties the uterine pedicle It is essential at all times to be aware of the position of the ureters and to ensure that all haemostatic procedures are carried out at a distance from them. Elevation of the uterus allows the ureters to separate further from the uterus. Then all tissue to be removed is passed through the vagina or through the tiny half-inch abdominal incisions. A massive ovarian cyst can be removed without rupturing it inside the abdominal cavity by placing it in a sturdy surgical-grade pouch and passing the pouch out the vagina or, after collapsing the cyst inside the pouch, passing it out through the "port" incision. If the uterus is massively enlarged it can be disconnected from its attachments, then cut into tiny pieces and passed down the vagina.

Abdominal scars consist of two to four tiny one-half inch incisions, one inside the belly-button, one in the top portion of the pubic hair just above the pubic bone, and one each just to the middle side of the front of the hip bone. Additionally hospitals with modern technology offer alternative methods of achieving haemostasis( stopping of blood). These include haemostatic clips. Automatic stapling is popular with some surgeons. These devices consist of two jaws each containing a triple row of micro-titanium staples which produce haemostasis.

TLH can thus be performed on women who have never had children, women with narrow or long vaginas, women with previous surgeries, women with cancer, and women with massive organs. This technique is the least painful and least debilitating route of surgery for women who need hysterectomy but do not qualify to have a vaginal hysterectomy. Laparoscopic hysterectomy has been shown to be associated with a shorter hospital stay and recovery than abdominal hysterectomy. Women having laparoscopic subtotal hysterectomy may have an even faster recovery.

Total Abdominal Hysterectomy (TAH)	Vaginal Hysterectomy (VH)

Large incision or "bikini cut" (4-6 inches) Tissues of the abdominal wall are stretched and uterus is removed Requires 3-5 day hospital stay; normal activity can usually resume in 6 weeks	Incision (approximately 1 inch) made at the top of the vagina Uterus and cervix are separated from the body and removed through the vagina Abdominal walls are not stretched Requires 1-3 day hospital stay; normal activity can usually resume in 4 weeks

Laparoscopically Assisted Vaginal Hysterectomy (LAVH)	Laparoscopic Supracervica l Hysterectomy (LSH) and Total Laparoscopic Hysterectomy (TLH)

Laparoscope (miniature camera) is inserted through a small incision to view the uterus and surrounding orhans Uterus isdetached under view of the laparaoscope using special tools inserted through small incisions Incision (approx. 1 inch) made at the top of the vagina Uterus and cervix are removed through the vaginal incision Requires 1-3 day hospital stay; normal activity can usually resume in 4 weeks	Using only laparoscopic tools, uterus is seperated from the body and removed through one of the abdominal incisions As LSH leaves the cervix in place; a TLH rem0oves both the uterus and the cervix Requires 1-3 day hospital stay; normal activity can usually resume in 4 weeks.

After the surgery

The average hospital stay depends on the type of hysterectomy performed, but is usually from 2 to 3 days. Complete recovery may require 2 weeks to 2 months. Recovery from a vaginal or laparoscopic hysterectomy is faster than from an abdominal hysterectomy, and may include less pain. Removal of the ovaries along with the uterus in premenopausal women causes immediate menopause, and oestrogen replacement therapy may be recommended. Some patients report that the incisions feel a little sore and the residual gas in the belly hurts a bit. This gas often collects under the right diaphragm and causes the sensation of right shoulder pain.

Intravenous and oral medications are used after the surgery to relieve postoperative pain. A catheter may remain in place for 1 to 2 days to help the bladder pass urine. Moving about as soon as possible helps to avoid blood clots in the legs and other problems. Normal diet is encouraged as soon as possible after bowel function returns. The physician may advice to take some precautions like avoiding lifting heavy things etc. th epatient may also be recommended to take Hormone Replacement Therapy (HRT) which means replacing the missing female hormone oestrogen with tablets.

Benefits and drawbacks of laparoscopic hysterectomy

One advantage of laparoscopic hysterectomy is that the incisions are smaller (1/2 inch) and much less uncomfortable than that of abdominal hysterectomy. So people are able to resume normal activity in about 2 weeks. So Laparoscopic hysterectomy has many advantages like:

Less postoperative pain
May shorten hospital stay
May result in a quicker return to bowel function
Quicker return to normal activity
Better cosmetic results

LAPAROSCOPIC	OPEN
Small Incisions (less than ½ an inch)	Large Incision
Hospital stay is 1 to 3 days	Hospital stay of about 5 days
Patients usually return to work in 5 to 10 days	Return to work in about 4 weeks
Lesser risk of Infection	Greater risk of infection
Less pain	More painful
Less chance of hernias	More chance of hernias

For more information, kindly visit :
http://www.aasthahealthcare.com/Laparoscopic-Hyesterctomy-Treatment.htm

------------------------------------

Obstetrics and Gynaecology Treatment Specialists

2009-09-07T04:32:00.000-07:00

No branch of medicine has changed as radically in the past three decades, as has Obstetrics and Gynaecology. This specialty has expanded its horizons and interests. The obstetrician and gynaecologist has assumed new roles and reverted to traditional relationships with the female patient:

As a primary physician for women from the menarche to the end of life;
As a protagonist for social awareness and change in women's rights, human sexuality, contraception and population dynamics;
As a biological scientist whose major focus is human reproduction in all of its physiologic and pathologic aspects.

Our specialty offers a wide range of sub-specialties areas, which include Maternal-foetal Medicine, Gynaecologic Oncology, Gynaecological Urology, Reproductive Medicine and Community Gynaecology. At Aastha, we encourage more of minimal invasive procedures to ensure speedy recovery of our patients. Laparoscopy is a minimally invasive approach that involves specialized video equipment and instruments that allows a surgeon to operate inside the body through tiny incisions, most of which are less than a half-centimetre in size. So the laparoscopy surgeries are more preferred because the healing rate is faster. This enables the patient to resume her normal activities much faster compared to the traditional 'open surgeries'. Continue below to learn more about our comprehensive obstetrical programs and gynaecological surgeries.

For more information, kindly visit :
http://www.aasthahealthcare.com/Obstetrics-and-Gynaecology-Treatment.htm

------------------------------------

Bladder Cancer Treatment | Bladder Cancer | Urinary Bladder Cancer | Aastha Healthcare | Super Speciality Center Hospital | Mulund | Mumbai | India

2009-09-07T04:29:00.000-07:00

What is bladder?

What is Bladder cancer?

Types of bladder cancers :

Urolithiasis is the medical term used to describe stones occurring in the urinary tract. Other frequently used terms are urinary tract stone disease and nephrolithiasis. Doctors also use terms that describe the location of the stone in the urinary tract. For example, a ureteral stone (or ureterolithiasis) is a kidney stone found in the ureter. To keep things simple, however, the term "kidney stones" is used throughout this fact sheet.

Types of stones include :

Stage II - In this, the tumor invades the muscle layer of the bladder.

Stage III -- Tumor extends past the muscle layer into tissue surrounding the bladder.

What are the causes?

There is no particular cause that has been found out. But Studies have found the following risk factors for bladder cancer:

What are the Symptoms?

The symptoms described below are not sure signs of bladder cancer. Infections, benign tumours, bladder stones, or other problems also can cause these symptoms. So incase of these symptoms, one must consult an urologist or correct diagnosis. Moreover most of the symptoms listed below can be associated with bladder cancer, but they can also be associated with non-cancerous conditions. Nevertheless, medical evaluation is critical.

Blood in the urine
increased Urinary frequency or Urinary incontinence
Painful urination
Urinary urgency

Additional symptoms that may be associated with this disease are Bone pain or tenderness, abdominal pain, Anaemia, Weight loss, Lethargy (tiredness).

How is it Diagnosed?

If a patient has symptoms that suggest bladder cancer, the doctor may check general signs of health and may order lab tests. The person may have one or more of the following procedures:

Physical examination
This includes a rectal and pelvic exam. The doctor may feel for the tumour by palpating.

Urinalysis
The laboratory checks the urine for blood, cancer cells, and other signs of disease. It is also screened for cancerous cells.

Cystoscopy
The doctor uses a thin, lighted tube (cystoscope) to look directly into the bladder. The doctor inserts the cystoscope into the bladder through the urethra to examine the lining of the bladder. The patient may need anesthesia for this procedure. Bladder biopsy (usually performed during cystoscopy)

Intravenous pyelogram - IVP
The doctor injects dye into a blood vessel. The dye collects in the urine, making the bladder show up on x-rays.

Blood Tests
This will give the doctor an indication of the general health of the patient and how well the kidneys are working.

A Chest-X-ray
This will examine the heart and lungs to check that they are healthy.

CT or CAT SCAN
This is a type of X-ray during which a large number of cross-section pictures of the body are taken to build up a three dimensional image of the issues and organs inside.

Radioactive Bone Scans
This may be performed to check if any cancer has spread from the bladder to the bones. A tiny amount of radioactive liquid is injected into a vein, and then the scan is done two to three hours later.

What are the Treatment options?

The choice of an appropriate treatment is based on the stage of the tumor, the severity of the symptoms, and the presence of other medical conditions. The treatment for patients with stage II and stage III disease is changing. While the accepted treatment has been removing the entire bladder but there is growing interest in conserving the bladder.

Conservative treatment

Some patients may be treated by removing only part of the bladder, and that procedure is followed by radiation and chemotherapy. However, many people with stage II and stage III tumors still require bladder removal. Most patients with stage IV tumors cannot be cured and surgery is not indicated. In these patients, chemotherapy is often considered.

Chemotherapy for bladder cancer can be administered through a vein or into the bladder. For early disease (stages 0 and I), it is usually given directly into the bladder. For more advanced stages (II-IV), treatment is usually given by vein. Chemotherapy may be given to patients with stage II and III disease either before or after surgery in an attempt to prevent the tumor from returning. It is given as a single drug or in different combinations of drugs.

Radiation therapy may also be given. Radiation is a high-energy ray that kills cancer cells. It can be either given externally or internally. External radiation is produced by a machine outside the body. The machine targets a concentrated beam of radiation directly at the tumor. Internal radiation is given by placing a small pellet of radioactive material inside the bladder. The pellet can be inserted through the urethra or by making a tiny incision in the lower abdominal wall.

Immunotherapy or biological therapy takes advantage of the body's natural ability to fight cancer. A fluid containing BCG, an attenuated vaccine (altered Mycobacterium), is introduced into the bladder through a thin catheter that has been passed through the urethra. The Mycobacterium in the fluid stimulates the immune system to produce cancer-fighting substances. The solution is held in the bladder for a few hours, and then drained. This treatment is repeated every week for 6 weeks.

Surgical methods

Trans Urethral Resection of Bladder Tumour (TURBT)

People with stage 0 or I bladder cancer are usually treated with Trans Urethral Resection of Bladder Tumour (TURBT). This surgical procedure is performed under general or spinal anesthesia. A cutting instrument is then inserted through the urethra. A small wire loop on the end of the instrument then removes the tumor by cutting it or burning it with electrical current (fulguration). Generally, stage 0 and I tumors are treated with this method. They sometimes may also be treated by administering chemotherapy or immunotherapy directly into the bladder. Because the risk of the cancer returning is so high, people with bladder cancer require constant follow-up for the rest of their lives.

Partial Cystectomy

In this operation, part of the bladder is removed. If the tumour is confined to the bladder wall, it may be possible to remove the tumour and just the section of the bladder involved. 'This may be done either as a telescopic procedure (Cystoscopic Resection) or as a cutting operation through the abdomen (Partial Cystectomy). After the operation the patient will be able to pass urine normally.

Complete Cystectomy or Bladder Removal

In this operation, the entire bladder is removed, as well as its surrounding lymph nodes and other structures that may contain cancer. This is usually performed for cancers that have invaded through the bladder wall or for superficial cancers that extend over much of the bladder. In women this involves the removal of the whole bladder, the urethra, and the lower end of the ureters, the front wall of the vagina, the womb (hysterectomy), fallopian tubes and ovaries. In younger women the ovaries may be preserved. As a result the vagina will be shorter and narrower following the operation. In men the whole of the bladder, the prostate gland, the lower ends of the ureters and sometimes the urethra is removed.

Many people with stage II or III bladder cancer may require bladder removal. This surgical procedure is also called complete or radical cystectomy. Radical cystectomy in men usually involves removal of the bladder, prostate, and seminal vesicles. In women, the urethra, uterus, and the front wall of the vagina are removed along with the bladder. Often, the pelvic lymph nodes are also removed during the surgery for examination in the laboratory. About half of the people treated with radical cystectomy will be completely cured; the other half shows signs of metastasis at the time of the surgery.

A urinary diversion surgery is usually performed with the radical cystectomy procedure. In this, an alternate method for urine storage is created. Three common types of urinary diversion are:

ileal conduit

An ileal conduit is a small urine reservoir that is surgically created from a small segment of bowel. The ureter that drain urine from the kidneys are attached to one end of the bowel segment and the other end is brought out through an opening in the skin (a stoma). The stoma allows the patient to drain the collected urine out of the reservoir. People who have had an ileal conduit will need to wear an external urine collection appliance at all times. Possible complications associated with ileal conduit surgery include: bowel obstruction, blood clots, urinary tract infection, pneumonia, skin breakdown around the stoma, and long-term damage to the upper urinary tract.

Continent urinary reservoir

A continent urinary reservoir is another method of creating a urinary diversion. In this method, a segment of colon is removed and used to create an internal pouch to store urine. This segment of bowel is specially prepared to prevent reflux of urine back up into the ureter and kidneys, and also to reduce the risk of involuntary loss of urine. Patients are able to insert a catheter periodically to drain the urine. A small stoma is placed flush to the skin. Possible complications include: bowel obstruction, blood clots, pneumonia, and urinary tract infection, skin breakdown around the stoma, ureteral reflux, and ureteral obstruction.

Partial bladder removal may be performed in some patients. Removal of part of the bladder is usually followed by radiation therapy and chemotherapy to help decrease the chances of the cancer returning. For those patients who undergo complete bladder removal, chemotherapy is also given after surgery to decrease the risk of a recurrence. . Some patients may be treated with chemotherapy before surgery, to try and shrink their tumor down, so that they might be able to avoid having the entire bladder removed.

Orthotopic Neobladder

This surgery is becoming more common in patients undergoing cystectomy. A segment of bowel is folded over to make a pouch (a neobladder or "new bladder"), then attached to the urethral stump, which is the beginning of where the urine normally empties from the bladder.

This procedure allows patients to maintain some degree of normal urinary control, although there are complications, and the urination is usually not the same as before surgery. For example, this procedure can be associated with leakage of urine at night, the need to perform manual catheterization periodically, and other complications listed above for the continent urinary reservoir.

Disadvantages of the surgery