Laproscopic Surgery has more or less replaced the conventional surgery. Since the advent of Laproscopic Surgery, we have been able to decrease the cost of treatment, shorten the hospital stay, minimize the surgical trauma; it has definitely helped in diagnosing and treating the most difficult Gynae and Infertility cases with ease and confidence.


INDICATIONS OF LAPROSCOPY
1. IN Infertility 

• To break the adhesions in and around the uterus and the tubes.
• To remove Blockage of the fallopian tubes. These can be re-opened to a large extent by fine surgery using scissors, laser or cautery.
• To check the patency of the Tubes. As the patient is fully relaxed due to anaesthesia the test is 100% accurate unlike the tube patency test done with the X- ray.
• In cases of Unexplained Infertility, it enables us to study in detail, the reproductive organs and pick up some pathology or malpositioning of the tubes, ovaries, uterus or their congenital defects.

IN GYNAECOLOGY

LAPROSCOPIC HYSTERECTOMY-LAVH

Until recently, whenever a hysterectomy was indicated the choice was between abdominal or vaginal operation. The first case of Laproscopic Hysterectomy was done in 1989, and since then this method is fast gaining more acceptance.

The ADVANTAGES of the Laproscopic method over the Abdominal method are ?

1. Avoidance of a large painful skin incision
2. Short stay
3. Less hectic post operative period, tissue trauma, adhesions, blood loss and early mobilisation

INDICATIONS

Fibroid uterus, D.U.B.or excessive bleeding from the uterus, cysts and masses of the ovaries, if present late in the reproductive period are at times indicative of Hysterectomy

CONTRAINDICATIONS
Certain medical problems
If the uterus is very big with huge fibroids
If the ovarian masses are very big.

LAPROSCOPY IN GYNAE EMERGENCIES

Laproscopy has been used for the last 25 years to diagnose different causes of abdominal pain, ectopic pregnancy, and ovarian problems.
Now it is used for emergency operations for ectopic, tubal pregnancy, or torsion of an ovarian cyst.

A- TUBE PREGNANCY (ectopic pregnancy)
This can be identified, and simultaneously operated with the laproscope. Treatment may be conservative and the tube might be saved in a few cases. Patients who present in an acute stage with huge blood loss should ideally not be taken up for laproscopy .

B-PELVIC INFLAMMATORY DISEASE
This might present as adhesions around the uterus and the ovaries, which can be broken.

Drainage of pus from the dilated tube or aspiration of the contents of an ovarian cyst and removal of a cyst can be easily done laproscopically.

C-Treatment of Ovarian Cysts

Simple Ovarian Cysts-The exact size, position, texture and the nature of the content in the cyst can be diagnosed. These cysts can be aspirated thro the laproscope,the excess tissue can be excised and sent for biopsy.

Endometriotic Cysts ? these cysts can be very troublesome and can prevent pregnancy. These can be aspirated and the base cauterized and healthy ovary can be preserved.

Poly cystic ovaries ? These patients have large and thick coated ovaries which do not allow proper egg formation and rupture of the egg. Small punctures are made on the surface of the ovary to decrease the size and release the fluid in the ovary.

D. FOR VARIOUS BIOPSIES
To exclude cancer or tuberculosis, Biopsies from various suspicious sites and aspiration of the abdominal fluid can be taken

HYSTEROSCOPY
This is performed

• To evaluate the uterine cavity
• To break the adhesions in the uterus
• To remove displaced Copper ?T 
• To remove small polyps or growths in the uterus.
• To remove and Incise Uterine septa under vision.
• Biopsies from specific sites can be taken.