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Different Surgeries in Gynecology

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Vaginal- NO CUT NO HOLE GYNE SURGERIES

Many gynecological surgeries can be done through vaginal route. It is a perfect natural hole surgery. As there is no skin cut in these surgeries, harmful impact (stress reaction) of operation is minimal. (even less than laparoscopic gyne surgery). As vagina is made by nature to withstand some trauma during childbirth, healing is perfect. No chance of hernia at all as there is no weak point is created.( risk of hernia is maximum in abdominal surgery, less in laparoscopic surgery, but it is complete zero in case of vaginal surgery. No need of stitch & it’s agony of stitch removal does not arise. Patient can walk & even climb stairs after 24 hours of surgery. Dr.Pallab Gangopadhyay is the pioneer gynecologist who has revolutionized the gynecological surgery practice by using this method.

NDVH –non descend vaginal hysterectomy
Non Descend Vaginal hysterectomy is a NO HOLE NO CUT hysterectomy. This has simplified the major surgery like hysterectomy to such an extent that only 24 hours of rest is required. After that walking, regular exercise and even climbing stairs are allowed.
Problems like bulky uterus with one or more than one fibroid, uterus with adenomyosis, pelvic pain, ovarian cyst all can be treated by this way of hysterectomy. Both ovaries and tubes can also be removed at the same time. It can be done in patients with more than one previous caesarean section or pelvic surgery.
Repair for genital prolapse – Repair of genital prolapse is basically repair of weakened pelvic floor and should always be undertaken by a properly trained gynecologist or urogynecologist. It is also a vaginal surgery but need multiple stitch on the vaginal wall & pelvic floor. Different type of meshs have been used with mixed result for this type of repair.

Cystocele :
Repair of cystocele (bladder coming down) basically is the repair of anterior pelvic floor also called anterior colpopexy.
Rectocele :
Repair of posterior pelvic floor is called posterior repair or posterior colpopexy. This is done for putting the rectum at proper position
Complete prolapse :
when whole of the pelvic floor weaken and uterus also comes down it is called complete prolapse. Most of the cases of complete prolapse occurs in aged women and is treated by hysterectomy with repair of both anterior & posterior pelvic floor fascia. Sometimes some anchoring procedure like sacro spinous fixation should also be employed together with pelvic floor repair. In younger patients hysterectomy may be avoided and other repair procedure can be employed.
Vault prolapse ( something coming down after hysterectomy)
Vault prolapse is not common but it is a condition which is difficult to treat by many gynecologists. This is infamous for recurrence even after surgery. Simple pelvic floor repair is not sufficient treatment of vault Prolapse. There are three types of surgery available for this.
sacro-colpo suspension ( abdominal or laparoscopic approach)
Sacrospinous fixation (Vaginal or NO CUT NO HOLE surgery)
Prolift mesh repair (repair with synthetic mesh)
TransVaginal Tape operation (TVT/TOT)
for stress urinary incontinence These operations are to place a polypropelene tape below the mid urethra to aim to restore the bladder neck anatomy necessary to prevent urine leak during caughing, laughing, and sneezing. TVT and TOT/TVT-O are almost the same surgery but the tape is in slightly different position. (please see the image) in case of TVT risk of injury to bladder is slightly higher than TOT/TVT-o and to be accompanied by cystoscopy.
Hysteroscopic surgeries
This is a instrument through which a gynecologist looks inside the cavity of uterus. Like G.I. endoscopy, a proper assessment of uterine cavity can only be done through this. This invaluable in some gynecological cases like infertility, post menopausal bleeding etc. A properly trained gynecologist can undertake some surgical procedures (which are great in relieving patients like pelvic pain, heavy menstrual bleedingetc.) through this method. This is also a NO CUT NO HOLE surgery and patient can go home after few hours. The following are example of hysteroscopic surgeries.
Diagnostic hysteroscopy
Hysteroscopic myomectomy
Hysteroscopic polypectomy,
synechie reduction

Laparoscopy- surgery through only small holes
Laparoscopy is an instrument to visualize the abdominal content inside. In case of Gynecological laparoscopy there are four holes (ports) are made on the abdominal skin through which laparoscopic instruments are put inside the abdominal cavity as shown in the picture. Laparoscopy is much less invasive than the abdominal operation and patient get cured after much less time than the abdominal surgeries. And now, almost all gynecological operations can be done through laparoscopy. However, Vaginal route is preferred in terms of safety according to the international database Cochrane review. The followings are the common gyne. Laparoscopic surgery.
Laparoscopic Hysterectomy
Laparoscopic myomectomy
Laparoscopic ovarian cystectomy
Laparoscopic treatment of endometriosis
Diagnostic laparoscopy / Lap Dye test (in infertility)

Abdominal surgery- the traditional approach
This is the traditional way of doing a gynecological surgery. And in some cases this is the only way to take for a gynecologist. Cesarean section is an great example of abdominal surgery which all of the gynecologist specialist do to ensure the safety of the mother and the baby. Apart from cesarean section, abdominal approach is needed if a problem arise during laparoscopic or vaginal gynecological surgeries. Abdominal approach is still preferred in cases of gynecological cancer surgeries or where there is alteration of pelvic anatomy due to dense adhesion.

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