Laparoscopic Gynae Colposcopy

Colposcopy is the close examination of the uterine cervix using a special instrument called colposcope. It is an ideal tool to diagnose female lower genital tract lesions ,by studying the surface epithelium and the underlying connective tissue stroma along with the vascular pattern.

Evaluation Of Lower Genital Tract

• Lugol Iodine
  Delineation of lesions becomes easy by using Lugol Iodine and green filter. Normal epithelium appears Mahogany brown while abnormal epithelium does not take any stain.
  
• Acetic Acid
  Application of 3-5% Acetic Acid turns metaplastic and dysplastic areas Aceto-white.
  
• Green filter
  It absorbs red color, therefore the blood vessels stand out as black streaks.
  
• Directed Biopsy
  A biopsy from a point within the most abnormal area can be taken under colposcopic guidance. This is the gold standard for diagnosing cervical pre-cancerous conditions.
  
• Cryocautery
  Destruction of abnormal tissue by the help of a Cryo-probe (cold probe) is called cryocautery. The tissue is frozen to -20 degrees C or lower which leads to intra and extra cellular crystallization and cryo-necrosis. The dead tissue is shed off and replaced with healthy tissue.
  
• LEEP- (Loop Electrosurgical Excision Procedure)
  It is used to excise deeper lesions. The tissue thus removed can be sent for histopathological examination. This is a both a diagnostic and therapeutic procedure.

Diagnostic Laparoscopy

A diagnostic laparoscopy is a procedure in which the laparoscopic surgeon uses a laparoscope, to look at the organs and tissues inside abdominal cavity.

1. Infertility
   Laparoscopy is an essential tool in the armamentarium of your Gynecologist by which he/she can evaluate the female genital tract for-
   • Tubal Patency Evaluation
   • Adhesion
   • Ovarian Drilling (in PCOS)
   • Tubal Reconstruction
   • Endometriosis
   • Hydrosxlpinx
   • Pyosalpinx
2. Unexplained Pelvic Pain
3. Suspected Ectopic Pregnancy
4. Suspected Endometriosis
5. Second Look & Follow Up in Cancer Ovary

Operative Laparoscopy

(A) Tubal Surgery (Surgery on fallopian tubes)

• Family Planning or sterilization operation
  In this operation the tubes are blocked to prevent passage of ovum thus preventing pregnancy. This is a permanent method of family planning
• Tubal reconstruction or re-canalization
  In this surgery the damaged tubes can be repaired , blocked tubes opened or re-implanted .
• Operative treatment of ectopic pregnancy
  Tubal ectopic pregnancy both ruptured or un-ruptured can be dealt with tubal excision or tubal conservation.
• TO mass, Peri- tubal Adhesions , Hydro-salpinx & pyo-salpinx
  Which are a sequel of pelvic inflammatory disease can all be dealt with in an appropriate manner by the laparoscopic technique.

(B) Uterus

• Myomectomy for fibroids in uterus
  In patients where fertility is to be preserved laparoscopic removal of fibroids (myomectomy) single or multiple is done laparoscopically. Size of the fibroid is not a limitation as large fibroids can be removed with morcellation.
• Removal of uterus
  TLH(Total Laparoscopic Hystrectomy)&LAVH(Lap. Assisted Vaginal Hystrectomy ) are both established procedures for removal of uterus and can be performed in almost all patients requiring hysterectomy, irrespective of whether the patient has undergone any caesarian or other pelvic surgery.
• Operation for cancer of uterus
  Laparoscopic extended hysterectomy for malignant conditions (Werthime’s extended Hystrectomy) is performed laparoscopically respecting all the principles of cancer surgery with no compromise in outcome.
• Congenital annamolies
  Metroplasty etc.

(C) Laparoscopic surgery for conditions of Ovary

• Tubo Ovarian Masses
  Laparoscopic removal of TO mass is the preferred modality of treatment.
• Ovarian Cyst Surgery
  Ovarian cysts can be safely removed with laparoscopic technique while conserving the ovarian tissue or the complete ovary can be removed along with the cyst if required ,as when fertility is not a concern or in cases of torsion when the ovary has become nonviable.

(D) Surgery for Endometriosis

• Early
  Small endometrial implants, red flame like, clear vesicles, blue – black or white opacified peritoneal defects- fulgration of these peritoneal lesions of endometrosis can be done in a better way under laparoscopic magnification.
• Severe
  Have varying degree of tubo-ovarian adhesions. Removal of endometrotic cysts, adhesiolysis and unilateral adenexectomy for large endometrioma is done laparoscopically.

(E) Biopsy suspected carcinoma or Tuberculosis of the genital tract

A biopsy of the genital tract helps diagnose suspected carcinoma or tuberculosis by examining tissue for abnormal growth or infection.

(F) Removal of misplaced IUCD or Copper- T

Removal of a misplaced IUCD or Copper-T involves extracting the device from the uterus to prevent complications like infection or injury.

(G) Sacro-colpopexy for vault prolapse

Laparoscopic repair of post hysterectomy prolapse of vaginal vault is done by attaching a mesh to the vaginal vault and anchoring it to the sacrum.