Best Laparoscopic surgeon in Bangalore
- Is one of the leading surgeons in Bangalore .15 years of experience in eminent hospitals like Manipal Hospital, Apollo Hospitals and Narayana Hrudalaya in Bangalore.
- He has experience of treating numerous OVARIAN CYST patients successfully in Bangalore .
- He believes that patient safety comes first and strives to provide exceptional service to patients.
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INTRODUCTION FOR TREATMENT OF OVARIAN CYST
- The management of the reproductive-aged woman who presents with an ovarian cyst is often controversial. Despite the fact that the vast majority of ovarian cysts are benign in nature, surgical management is often quite radical for laparoscopic ovarian cyst surgery in Bangalore.
- Traditional management,based on recommendations by Spanos advocated a therapeutic trial of oral contraceptives .
- During this period of observation, radiographic imaging of the ovarian cyst might also be performed in an effort to distinguish further the actual
type of cyst. Persistent ovarian cysts were more often managed by laparotomy with either an ovarian cystectomy or even the more radical oophorectomy.
- Laparoscopic management of ovarian cysts has been explored as a conservative alternative to the more traditional and radical approach, primarily because of the reduced surgical morbidity, reduction in pelvic adhesions, shorter recovery period, and reduced cost.
- The potential benefits are especially appealing in the patient who has yet to finish childbearing or may in fact be dealing with infertility and is therefore highly
motivated to preserve her ovarian function. More conservative management of ovarian cysts demands an improvement in the ability to predict the benign nature of the cyst, however. We will review the differential diagnosis of ovarian cysts in women of reproductive age, discuss the ability of ultrasound to predict the benign or malignant nature of ovarian cysts, and the current literature regarding the laparoscopic management of ovari.
SYMPTOMS OF OVARIAN CYST
- Patients may present with a myriad of symptoms referable to a cystic ovarian mass
While many of these cysts are detected at the time of routine physical examination,presenting complaints may include either acute or chronic pelvic pain, dysfunctional uterine bleeding, and the presence of an abdominal/pelvic mass.
- In the acute setting, one must consider whether an ovarian cyst has ruptured, undergone torsion,or whether hemorrhage has occurred in the cyst. Abdominal pain, often with peritoneal signs, is a common feature of all acute events, yet each entity often has
- Torsion typically occurs in enlarged ovarian cysts, as the weight of the cyst creates a long pedicle that is prone to twist with a change of position.
- A patient with torsion of the ovary will relate intermittently severe pain that is often exacerbated or relieved with positional changes.
- Without treatment, occlusion of the ovarian pedicle will ultimately result in venous and arterial thrombosis,with ultimate necrosis of the ovary. These patients will often have fever and leukocytosis and will develop peritonitis with associated gastrointestinal symptoms.
- A patient with a ruptured ovarian cyst will similarly complain of acute onset of pain,yet symptoms are often less severe than those noted with torsion. In addition, an ultrasound scan of the pelvis will often demonstrate a significant amount of fluid in the cul-de-sac. A hemorrhagic ovarian cyst is often difficult to differentiate clinically from other ovarian pathology. While one may suspect hemorrhage into the ovary with the observation of a significant drop in the hematocrit, ultrasound is often more useful in securing the diagnosis
INVETIGATIONS FOR OVARIAN CYST
- Ultrasonography is the most useful adjunct to pre-operative management, as characterization may be made before any intervention.
- Cytology is less useful because of the variability between laboratories in performing cytologic examination.
DIFFERENTIAL DIAGNOSIS AND CLINICAL PRESENTATION
The differential diagnosis of benign ovarian cysts includes
- the follicular cyst; the active or persistent corpus luteum cyst; the hemorrhagic ovarian cyst; benign neoplasms of epithelial origin, including the endometriotic cyst; the serous and mucinous cystadenoma, and the benign cystic teratoma of germ cell origin.
- Other masses that might initially be considered in the differential diagnosis of an adnexal mass include the parovarian cyst, ectopic pregnancy, hydrosalpinx, and tubo-ovarian abscess; their management will not be included in this discussion.
- For women with a solid ovarian mass, post-menopausal women, and pre-pubertal girls with an ovarian mass, certain caveats regarding the management of ovarian mass are clear, and laparotomy remains the treatment of choice in these circumstances.
LAPAROSCOPIC OVARIAN CYSTECTOMY WHAT IS OVARIAN CYSTECTOMY?
- This procedure involves the removal of an ovarian cyst on the ovary with preservation of the ovary. Usually the cystic portion contains only a small amount of ovarian tissue. The aim is to preserve as much of the ovary as possible as a loss of ovarian tissue may affect future fertility. Even if the ovary looks damaged as in ovarian torsion there may be benefit in not removing the ovary as there may still be some viable tissue. The intended benefit of the procedure is usually to remove the cyst and the symptoms caused by it. Cysts may cause pain, twist on themselves and may affect fertility. Some cysts are produced by endometriosis and can cause period pain, pelvic pain or pain with intercourse. Laparoscopic cystectomy is not appropriate for large ovarian cysts (greater that 8-10cm) or cysts where cancer is suspected. This procedure would normally be carried out only in women who had not undergone menopause for laparoscopic ovarian cyst surgery in Bangalore
ADVANTAGES OF LAPAROSCOPIC MANAGEMENT OF OVARIAN CYSTS
With the continued evolution of laparoscopic surgery, there are certain advantages over traditional laparotomy.
- The laparoscope facilitates illumination and magnificationof the pelvis.
- Furthermore, one is able to obtain a panoramic view of the pelvis for an easier assessment of the extent of disease.
- With extension of atraumatic surgical principles to laparoscopic operative procedures, management of ovarian cysts has evolved from a practice of simple aspiration to ovarian cyst excision.
- Clinical assessment of the patient with a cystic ovarian mass plays an important role in the management of an ovarian cyst. Regardless of whether the presentation is acute or indolent, the approach to the cyst is likely to be via laparoscopy, barring any suggestion of malignancyfor laparoscopic ovarian cyst surgery in Bangalore.
- Diagnostic laparoscopy will then allow the physician to determine whether the management may proceed laparoscopically or whether laparotomy would be a preferable approach.
HOW IS IT DONE? laparoscopic ovarian cyst surgery in Bangalore
- Under general anaesthetic a laparoscope (a 5 or 10mm fibre-optic telescope) is inserted through an incision just below the umbilicus. 2 further ports are inserted lower in the pelvis, one in the midline and one to one side. Do not worry if the side incision is on the opposite side from the ovary you expected to be operated on. Sometimes the position of the ovary is such that an approach from the opposite side makes the operation technically easier.
- The ovary is identified and any adhesions around it divided to free up the ovary. The ovary is then opened over the cyst and the contents aspirated (sucked out). If the cyst contains solid material (usually called a dermoid cyst) then this step is not carried out.
- The cyst wall is then separated from the ovary. This is quite a slow process as it has to be peeled away from the ovary and any bleeding point cauterised to ensure there is no bleeding. It is divided from its attachment to the ovary and freed. It is then sealed in a bag that isolates it from your other tissues. The cyst wall is then removed through the port on that side of your abdomen still in its protective bag and sent for analysis. This is to avoid it toughing the incision in the abdominal wall. The pathological analysis takes about a week and confirms the nature of the cyst.
- A careful inspection of the abdomen is carried out to make sure there is no bleeding. An anti-adhesion fluid may be left in the abdomen. The instruments are then removed and the incisions closed. The abdomen feels somewhat bloated if this happens and you can get shoulder tip pain. Very rarely the ovary has to be removed.
- This might occur if the cyst had replaced so much of the ovary that there is no normal ovary left, if there is excessive bleeding from the ovary or if the ovarian appearance is different from that expected and malignancy is suspected. In the latter situation a biopsy would be taken if possible and the ovary left until the diagnosis is confirmed by the pathology laboratory rather than being dealt with there and then for laparoscopic ovarian cyst surgery in Bangalore.
- OPEN OPERATION It is occasionally not possible to complete the operation laparoscopically and an open operation
- Laparoscopic ovarian surgery is certainly evolving as a primary mode of management for ovarian cysts.
- Pelvic adhesive disease is a major contributing factor in infertility; thus attempts to decrease adhesion formation are important. From a reproductive endocrinologist’s perspective, approaching the ovary laparoscopically has some advantages. These include minimizing tissue trauma and maintaining the tissue moist, thus decreasing the likelihood for formation of pelvic adhesions. Second-look laparoscopy reports minimal adhesion formation in patients so treated . With either of the latter