Gynecology & Endogynecology

Laparoscopic Gynecology is the newest speciality in gynecology that deals with minimally invasive surgery for treating gynaecological conditions. Over the past few decades, laproscopy has evolved to such an extent that it is now the most common approach sought to in todays date. With advancement of technology and requisite training Laparoscopic Gynecology has come to the forefront. Laparoscopic Gynecology has many advantages like decreased pain, faster recovery, minimal or no scarring.

Common Disorders in Lap Gynecology

There are various types of prolase:

  • Fibroids of uterus: Fibroids are also known as uterine leimyoma or uterine myoma. They are a benign tumor of the uterus. This tumor arises from the smooth muscles of the uterus. Depending on the location of the fibroid, the symptoms vary. The symptoms range from abnormal bleeding, heavy bleeding, infertility etc.
  • Genital Prolapse- The protrusion of a portion of vaginal canal from the vaginal orifice is called as genital prolapse.
    1. Cystocele : It is a medical condition when the bladder protudes into vagina.
    2. Enterocele: It is a medical condition when the small intestine protudes into vagina
    3. Rectocele: The protrusion of rectal tissue in the vagina is called as rectocele.
    4. Urethrocele: The protrusion of the urethra into vagina is called as urethrocele
    5. Uterine prolapse: Prolapse of uterus into the vagina.
  • Menorrhagia- It is also known as abnormal uterine bleeding (AUB). It is a medical condition in which there is an abnormal menstrual period in terms of its quantity, timing, or duration of bleeding.
  • Dysfunctional uterine bleeding (DUB): A medical condition clinically presenting with abnormal bleeding due to an imbalance in hormones.
  • Uterine septum- It is a medical condition that is present since birth. The uterine cavity is divided by a longitudinal septum from inside though the uterus from outside looks nromal.
  • Uterine/ endometrial cancer- Endometrial cancer occurs due to an abnormal growth of cells that invade or spread to others parts of the body from the uterus. Endometrial cancer is the cancer that arises from the inner lining of uterus. It mostly occurs in post-menopausal woman.
  • Cervical polyp: Abnormal looking reddish or purple red growth seen at the opening of cervix. It is an elongated tumor seen in cervix and is called as cervical polyp. They are usually non-cancerous and can be surgically excised.
  • Cervical Cancer: Abnormal growth of cell that invade into the cervix wall is cervical cancer.
  • Vaginal cancer: cancer asiring from vagina is called as vaginal cancers. They usually present with abnormal bleeding in post-menopausal woman.

Vaginal injuries

Endometriosis: It is a condition in which the tissue that lines the uterus and grows in the uterus tends to be displaced outside the uterus and grows elsewhere giving rise to various symptoms like irregularities in menstrual cycle, pelvic pain.

Polycystic Ovarian Disease (PCOD): It is a medical condition due to an imbalance in hormones oestrogen and progesterone that lead to formation of cysts in ovary.

Adolescent Gynaecology problems:

Hormonal replacement therapy at Menopause

Ovarian cyst: Fluid filled sacs seen in ovary are called as ovarian cyst. Usually asymptomatic but if it ruptures it can cause immense pain.

Ovarian cancer

Ovarian teratoma

Ectopic pregnancy: Pregnancy occurring outside of the uterus is called as ectopic pregnancy. It is the condition wherein the fertilised egg gets implanted else-where than the uterus and in most cases; fallopian tubes are the most common site of implantation in ectopic pregnancy.

Common symptoms of Gynaecological disorders:

Menstrual irregularities: It is a menstrual disorder manifesting as abnormal bleeding or irregular length of cycle. The normal and standard duration is mentioned below:

 

 

Bleeding days

Length of cycle

 

Puberty

-

-

For first 2 yrs after puberty - irregular cycles

Reproductive group

3-10  days 

70 ml

21- 35 dys

 

Menopause

At an Average 59 years

Cessation of menses

 

Anything besides this is considered abnormal and mandates a visit to the gynaecologist.

· Abdominal pain:

Abdominal pain is a frequent complain during menstrual cycle but if the pain is unbearable or has any variation to it, a gynaecological opinion is advised.

Some of the disorders in which one can experience abdominal pain are as follows:

1. Pelvic inflammatory disease. 2. Infection. 3. Ectopic pregnancy. 4. Torsion of ovaries. 5. Fibroids. 6. Tubo-ovarian abcess. 7. Chocolate cyst or endometriosis.

Lower back ache pain:

One of most common factor that gives rise to low back ache in woman is bad or poor posture. Usually encountered in lactating mothers and also in woman with poor calcium intake. Pelvic pathologies mainly of the reproductive system causes low back ache.

Some of them are :

A. Uterine prolapse. B. Fibroids. C. Ovarian Cyst D. Pelvic infections.

Urine leaks:

This can be seen in all age groups from prepubertal age group, adolescent girls to post-menopausal woman.

In pre-pubertal and adolescents age group a specialist opinion is compulsory to rule out the cause of urine leaks. While in reproductive age group and post-menopausal woman causes like trauma during vaginal delivery , surgical complication , enlarged uterus due to fibroid ,huge adnexal mass ,prolapse uterus ,overactive bladder are some of the common conditions which present with urinary leaks .

Something protruding or coming out of vagina:

In certain cases, sometimes an organ may be seen protruding outside the vagina which could either be the prolapsed uterus, descent of the bladder support that needs surgical correction.

Discharge from Vagina:

Some discharge in woman from vagina is normal physiological hormonal changes. But if the discharge has a foul odour to it or is stained then it’s of concern. Itching, vaginal irritation, staining of garments and infection to partners necessitates a gynaecological examination and PAP smear.

Common surgeries in Laparoscopic Gynecology

Hysterectomy: It is the process of removing the uterus from the body. Various approaches are employed today.

They are listed below:

  • Laparoscopic Hysterectomy
  • Laparoscopic Assisted Vaginal Hysterectomy
  • Vaginal Hysterectomy
  • Abdominal Hysterectomy.

Myomectomy : The procedure to remove fibroids is myomectomy. The technique used can be :

  • Laparoscopic myomectomy
  • Hysteroscopic myomectomy

Ovarian Cystectomy: It is the removal of cyst in ovaries.

Operative Hysteroscopy –

  • Polypectomy

MITR Hospital offers cutting edge “Laparoscopic Gynecology” treatments.

Laparoscopic Gynecology Department at MITR Hospital is managed by:

Dr Nandita Dubey

MBBS , MD (Gyn)

Diploma in Pelvic Endoscopy (Germany)

Special Clinics:

OPD Timings at MITR Hospital

Call +91-22-27743558/27744229 or 09324180553 for appointment

Fill up an Enquiry form

Endo-Gynaecology FAQ's

FAQs

Endometriosis

Q. What are the symptoms of endometriosis?

Endometriosis occurs at various sites and accordingly the symptoms are of severe dysmenorrhoea , pelvic pain ,abdominal pain in case of endometriotic cyst .Symptoms of endometriosis do not correlate well with the disease severity.

Q. What is the incidence of this disease?

Recent reports show the rate as high as 20 %- 50 % in infertile couple. The incidence increases with age from 12% in girls aged 11 -13 yrs upto 45% in females aged 20- 21 yrs. Exact incidence is unknown because disease diagnosis is based on biopsy or laparoscopic visualization of endometrial implants.

Q. Why did I get endometriosis?

There is no proven cause found for endometriosis though there are a lot of theories. Immunological ,G Genetic dysfunction are few leading theories which attempt to explain the cause of endometriosis although none of these theories have been proven.

Q. How is the disease diagnosed?

Diagnosis of the disease is confirmed by performing Diagnostic Laparoscopy and biopsy. Ultrasound is useful diagnostic tool in endometriotic cyst.

Q. Can medicines alone cure me of this disease?

Progesterone preparation gives promising results in treating endometriosis.Pain relief Is best achieved with anti inflammatory drugs. There is good disease control and pain management with medicines.

Q. What are the other treatment options?

Conservative surgery needs to be performed in cases of infertility , adolescent age grp and where reproductive functions needs to be preserved. Radical surgery is performed in extensive and deep endometriosis.

Q. Will it recur after treatment?

Recurrence rate of endometriosis is variable and only pregnancy and lactation is known to postpone the occurrence of disease.

Q. Will it affect my ovarian function?

Adhesion formation around the reproductive organs distorts the anatomy and all of this is collectively responsible for infertility.30 % _40 % of women will be subfertile. Fibroid

Q. How are fibroids formed?

Fibroids are excessive growth of the uterine musculature. According to their site fibroids can be Subserous (above the uterine surface ) , Submucous (within the uterine cavity) , Intramyometrial (within the musculature ).

Q.How do I know if I have fibroid?

Symptomatic Fibroids present with heavy menstrual flow ,pain , clots .Pressure symptoms are urine leak, swelling in the kidney , prolapsed uterus.

Q. Why do women get fibroids? Fibroids are formed due to excessive exposure to estrogen hormone.

Q. Will it affect my fertility?

Fibroid affect the shape of uterine cavity ,alter anatomical relationship of reproductive organs and give rise to infertility.

Q. What is the treatment for fibroids?

Asymptomatic fibroids are to be observed in reproductive age group. There are no medicines for cure of fibroids. Myomectomy is surgical treatment in ladies who wish to preserve reproductive function. Hysterectomy is definitive treatment for fibroid.

Q. Can I preserve my uterus?

In selective cases Uterine artery embolisitation (non invasive radiological intervention ) can be performed.

Q. Are they malignant?

Fibroids have poor malignant potential.

Q. Does it run in families?

Yes there is a familial tendency for the growth of fibroids.

Q. After treatment will I get it again?

There is risk of recurrence in fibroids which is person specific. Ovarian cyst

Q. What are cyst ?

Cyst are fluid filled sac within the ovarian tissue.

Q. Do all cysts need treatment?

Physiological cyst are only to be observed. Endometriotic cyst , Dermoid cyst ,Para ovarian cyst need to be managed surgically.

Q. Do cyst exists in young girls?

Yes cyst do occur in young girls.

About Dr. Nandita Dubey

She has done her residency training at Lokmanya Tilak Medical College located in Mumbai. It is one of the reputed medical colleges in state of Maharashtra with an Enormous workload from where she has learnt her skills as a gynaecologist.

After three years of residency she got the opportunity to work with Dr. C.N.Purandare in Grant Medical College located in Mumbai which also is her college of undergraduation. Dr.Nandita Dubey was invited to an underprivileged country in Carribeans called Guyana to establish Gynaecology center catering to population of 4 million. This experience and confidence brought her back to India to specialize in Gynaecologic endoscopy at BEAMS–Bombay Endoscopy Academy and Minimally Invasive Surgery which is the leading Endo-gynae centre in Mumbai. At BEAMS Dr. Nandita Dubey received training in Endogynaecology from a nationally recognized advanced Endo-gynae surgeon Dr. Rakesh Sinha.

Further training was with Dr. Neeta Warty who is specialist in pelvic floor reconstruction and onco-gynaecology. Dr. Nandita is fellowship trained in Minimally Invasive Endogynecologic surgery under Dr.Mettler from the Keil University School in Germany. A short stint at Royal Free Hospital London in minimally invasive training centre with Dr. Adam Maggos was a good learning experience.

Dr. Nandita dubey has practiced in both private practice settings, providing comprehensive care to her patients as well as at academic centres instructing resident physicians in minimally invasive surgery. Her desire is to explore and contribute to the future of women’s health care.

Dr. Nandita M Dubey

M.D (OB/GYN)

MITR HEALTHCARE HOSPITAL

74-77 Chaturbhuj, Sector-21, Kharghar ,

Navi Mumbai, Maharashtra, India -410210.

Tel (091)-00 -27743558.

Profile :

  • Fellowship trained in Laparoscopic and Endogynecological procedures
  • 10 years of experience in Gynecology.

Qualifications :

M.D (OBGYN)

Mumbai University, Lokmanya Tilak Municipal Medical College & General Hospital

M.B.B.S

Mumbai University, Grant Medical College & J.J.Hospital

Clinical Experience:

March 2002 :

Diplomate - The Keil School for Gynaecologic Endoscopy, Germany.

Aug2000-Jan2002 :

Clinical Research Fellow - BEAMS -Bombay Endoscopy Academy & centre for minimally invasive surgery.

7 Basic Laparoscopic & Hysteroscopic training course.

2 Advanced Hysterectomy Myomectomy course.

2 suturing course in collaboration with Ethicon Institute Of Surgical Endoscopy Assisted 4 workshops.

Aug 1999-March 2000 :

Consultant(Ob/Gyn)- Medical Diagnostic ant Therapeutic Center, New Amsterdam, Guyana, South America.

May 1998– May1999 :

Lecturer - J.J.Hospital Mumbai Training course for interns,students,residents and nursing staff Chief family planning officer for a period of one year.

Publications :

International

"Laparoscopic Excision of very large Myoma" : Journal Of American Association of Gynaecologic Laparoendoscopist. 2003; Vol 10;4:461-468.

Presentation :

"Should Size Site & Number be a limitation for Laparoscopic myomectomy"

March 2001-29th Annual Conference of MOGS & at YUVA FOGSI West Zone at Goa Sep 2001.

"Role of Operative Laparoscopy in Ovarian cyst" Jan 2002 All India Congress of OBGYN,Orissa.

Workshops :

"Focus on Fibroids" workshop-Bombay Hospital. Post graduate training workshop-Bombay Hospital. Scientific rationale of Endoscopic Surgery-Bhatia Hospital. Video Endoscopy Workshop-Loni. Endoscopic Surgery and Infertility Management Beyond 2000-Jaslok Hospital. Conditions treated at MITR in Gynaecology(Alphabetical order)

  • Cystocele
  • Endometriosis
  • Female Prolapse
  • Female Urology
  • Fibroids Surgery
  • Genital Prolapse
  • Ovarian cysts

Specialized Gynecology surgeries available at the Center:

  • Laparoscopic Management of Endometriosis.
  • Total Laparoscopic Hysterectomy
  • Laparoscopic Myomectomy
  • Laparoscopic fertility promoting surgery
  • Laparoscopic ovarian cystectomy


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