Endoscopy Surgeries

What is Endoscopic Surgery?

Endoscopic surgery is a surgery in which long telescope like instruments are used through small incisions or natural body openings in order to diagnose and treat disease.

Commonly performed endoscopic surgeries in infertility management are laparoscopy (instrument introduced through the abdomen to visualize the womb and its surroundings like the fallopian tube and ovaries from above) and hysteroscopy (instrument introduced through vagina and cervix to visualize the inside of the womb). Both of these can be either diagnostic (to diagnose the cause leading to infertility) or operative (to treat the condition leading to infertility ).

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What is Laparoscopy ?

Laparoscopy is a procedure that involves insertion of a narrow telescope-like instrument through a small incision in or near the belly button.

Laparoscopy is indicated whenever the history of the patient, clinical examination or other investigations such as Ultrasonography (USG) or Hysterosalpingography (HSG) indicate an abnormality in pelvic region. Hysteroscopy usually goes hand in hand with laparoscopy.

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What is Endometriosis ?

Endometriosis is a condition where tissue, similar to the one that normally grows inside the uterus (lining of uterus), also grows outside of the uterus.

The tissue inside the uterus is called “endometrium” and the tissue outside of the uterus is called “endometriosis”. The most common places where endometriosis occurs are the ovaries, the fallopian tubes, the bowel, and the areas in front, in back, and to the sides of the uterus.

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What are Fibroids?

Uterine fibroids are benign (not cancer) growths in the womb (uterus). They are made of muscle and other tissue. Fibroids almost never develop into cancer. They are also called leiomyomas or myomas.

Uterine fibroids are very common in women of childbearing age (20-45 years).
The size, shape, and location of fibroids can vary greatly. They may appear inside the uterus (submucous fibroids), on its outer surface (subserosal), within its wall (intramural), or attached to it by a stem like structure (pedunculated).

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What Is PCOS ?

PCOS or polycystic ovarian syndrome or polycystic ovarian disease is a name given to a hormonal imbalancewhich may present as following:

Menstrual irregularities: No menses, irregular menses, less bleeding during menses.
Abnormal (androgenic pattern) hair growth over chin, upper lip, cheeks etc or excessive hair growth on arms and legs.
Increase in weight.

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What are Pelvic Inflammatory Diseases (PID)?

Pelvic inflammatory disease is a general term used to describe infection of uterus (womb), fallopian tubes (tubes that carry egg, sperm, embryo between ovaries and uterus), ovaries and other reproductive organs.

The pelvic organs get infected commonly due to bacterial organisms. These organisms reach the uterus, tubes and ovaries through sexual route i.e. vagina. Gonorrhoea and chlamydia are two common bacterial organisms that cause PID. Tuberculosis can also cause PID. Tuberculosis can be transmitted via the sexual route or through blood when some other organ in body is infected.

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What is Hysteroscopy ?

Hysteroscopy is a procedure that allows Gynaecologist to see inside the womb by means of a fine telescope (Hysteroscope) that can be introduced through the (cervix) neck of the womb.

Hysteroscopy can be painless and can be done in an outpatient basis. More often it is done in an operation theatre under anaesthesia. Hysteroscopy usually follows investigations such as Hysterosalpingography or transvaginal ultrasound.

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What is a T-Shaped Uterus ?

The normal uterine or womb cavity is triangular in shape and spacious. Such a normal triangular cavity is a prerequisite for attachment of embryo and carrying the pregnancy for 9 months.

T shaped uterus this normal triangular cavity is replaced with a cavity resembling English alphabet ‘T’, i.e. the cavity is broader at the top and narrow tube like below. Such a cavity is not spacious enough and may lead to infertility, abortions and preterm delivery.

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What is a Uterine Polyp?

A uterine polyp, also known as endometrial polyp is an overgrowth of lining of the uterus. The concept is similar to that of a skin tag – basically normal tissue, but growing in an abnormal fashion.

They are soft, fleshy growths that form on the inside of the uterus. Polyps remain attached to the uterus by a large base (sessile) or thin stalks (pedunculated).

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What is Tubal Cannulation ?

Tubal cannulation is a procedure to open up tubal corneal blocks (origin of fallopian tubes near the uterus). It is done under hysteroscopic guidance (a procedure that allows the Gynaecologist to see inside the womb by means of a fine telescope called Hysteroscope, introduced through the neck of the womb).

It involves passage of a fine wire through the hysteroscope into the opening of fallopian tubes.
This part of the fallopian tube at the junction of uterus and tubes, it is as thin as a hair and such a procedure often removes blockage due to mucous plugs or debris, thus restoring tubal patency. Simultaneous Laparoscopy is needed to visualize the distal end of the fallopian tubes and confirmation of their normal status. Laparoscopy is also needed for the passage of guide wire through the tube followed by pushing a blue dye to check whether tube has opened (chromopertubation).

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What is Asherman’s Syndrome ?

Intrauterine Adhesions & Asherman’s Syndrome
Asherman’s syndrome or intrauterine adhesions, is an acquired uterine condition, characterized by formation of adhesions or scar tissue within the uterus.

In simple language these are thick bands of scar tissue which make the front and back wall of uterus stick to each other. (To naked eye they look like dried glue bands). The scar tissue may lead to obliteration of the cavity. They may occupy only a part of uterus or the entire cavity. Depending on the extent of adhesions we can classify the syndrome as mild, moderate or severe. These adhesions are generally avascular.

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What is a Uterine Septum?

Uterine septum is a deviation from normal shape of the uterus which is present congenitally (from birth). The uterine cavity is normal or slightly enlarged with a central septum.

It is like a curtain dividing the uterine cavity into two spaces. This curtain can be partial i.e. dividing only the upper part of the cavity into two or complete, in which case the curtain divides the entire uterine cavity into two.

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