Introduction:
Fortis FLT. LT. Rajan Dhall Hospital has a super specialized department of Minimal and Natural Access Gynae Surgery & Gynae Cancer Surgery (MNAGCS) and Gynae Robotic Surgery (GRS). This advanced tertiary level referral department has dedicated well trained specialists capable of handling routine and complex cases using state-of-the-art equipment. The inhouse team specialists perform almost all emergency and planned gynaecological procedures by the minimal access route via key hole incisions and/or by the natural access route via the vagina. The healing and recovery after using these routes of surgery, instead of the traditional route is quick and least stressful for patients and has excellent outcomes.
Services and Treatments offered
Scope of minimal & natural access surgery
As examples the following gynaecological conditions have been treated with good outcome by either laparoscopy (key hole surgery), hysteroscopy (scarless surgery inside the uterus), vaginal surgery (scarless surgery through the natural orifice vagina) or traditional open surgery as best and appropriate to each patient and the medical circumstances.
- 1. Management of Fibroid uterus
Treatment is tailored to the individual medical circumstances, recommendations and personal preference of the patient to one of the following:
(A) Myomectomy (removal of the fibroid only) in patients who can have their uterus conserved . Myomectomy can be performed by the following routes:
- a. Laparoscopic myomectomy by Key- hole surgery.
- b. Hysteroscopic myomectomy to remove sub mucous fibroids or fibroid polyps.
- c. Vaginal myomectomy to remove fibroids scarlessly through the natural orifice- the vagina.
(B) Hysterectomy is the removal of the uterus along with the fibroids. The ovaries are generally preserved in younger women. This can be performed in either of the following ways:
- a. Total laparoscopic or vaginally assisted laparoscopic hysterectomy - through Key-hole surgery
- b. Vaginal hysterectomy- through the vagina like having a normal delivery or birth. The healing and recovery is best by this method.
- c. Traditional hysterectomy- by the open method.
(C) Uterine artery embolozation: This is a radiological, non-surgical procedure which occludes the blood supplying the fibroids and results in the fibroid shrinking over a period of time.
- 2. Management of Abnormal uterine bleeding
Management options for this include:
(A) Hysteroscopy
- a. Hysteroscopic assessment to diagnose the cause for the abnormal bleeding.
- b. Operative Hysteroscopy to remove uterine polyps or fibroids, which cause bleeding problems.
(B) Mirena insertion- An intrauterine device loaded with hormones that are locally released into the uterine cavity . This may help control excessive blood loss during periods.
- 3. Management of Infertility & Bad Obstetric History-
Surgically treatable causes of infertility are diagnosed and treated using the minimal access route with optimum results which are improved even more with robotic assistance. Common examples of some of these conditions are as follows:
(A) Uterine causes: These can be picked by doing a diagnostic hysteroscopy and thereafter be treated at the same sitting by an operative hysteroscopic procedure as follows:
- a. Hysteroscopic Polypectomy- Removal of uterine polyps
- b. Hysteroscopic Myomectomy- Removal of fibroids projecting inside the cavity
- c. Hysteroscopic Resection of a septum within the uterine cavity.
- d. Hysteroscopic Adhesiolysis in Ashermans syndrome to enlarge the available space in the uterus by dividing the areas and membranes which have resulted in the walls of the uterus getting stuck to each other
- e. Hysteroscopic Lateral metroplasy in a narrowed uterine cavity if the lateral walls are unduly thickened. The cavity is enlarged by opening up the space.
- f. Laproscopic correction of congenital malformations of the uterus.
(B) Tubal causes: Surgical procedures for treating the tubal factor responsible for infertility include:-
- a. Repair of the blocked tubes by laparoscopic tuboplasty - A block in the mid-segment of the tube is excised and the freshened edges on either side joined to each other.
- b. Laparoscopic neosalpingostomy- unblocks the tubes at the outer ends.
- c. Hysteroscopic tubal canulation- unblocks the tubes at the inner end.
- d. Laparoscopic reversal of sterilization or tuboplasty - The block in the tube from a previous sterilization is corrected and patency restored.
- e. Laparoscopic adhesiolysis- All membranes and areas which have distorted the internal anatomy and structures by being stuck to each other are released by the process, thus freeing the ovaries and tubes to facilitate fertilization and pregnancy.
(C) Ovarian causes: Ovarian cystectomy with preservation of ovaries for all kinds of cysts including dermoids, benign & malignant cystic tumours, endometriomas and solid ovaries and tumours etc.
(D) Peritoneal factors: Infections, adhesions, endometriosis or previous surgery can result in distorted anatomy, which can be corrected laparoscopically to as near normal as possible in order to maximize the chances of conception.
(E) Endometriosis: This common condition that may be in a mild or severe form, can be managed and surgically cleared using the advantage of magnification on the video monitor, by the laparoscopic approach.
(F) Genital tuberculosis: This is a common chronic infection, which can result in infertility and usually, difficult to confirm unless laparoscopy & hysteroscopy are done. Once diagnosed, treatment is initiated & thereafter chances of future fertility improved.
- 4. Urinary stress incontinence-
(A) TOT and TVT-: are surgical procedures, which are performed from the natural access route or vagina to correct urinary stress incontinence.
(B) Laparoscopic Surgery for urinary stress incontinence: can relieve patients of the problem by keyhole surgery & results in early recovery.
- 5. Prolapse-
(A) Conventional vaginal surgery- Repair of the relevant pelvic compartment, which is weak with or without concomitant hysterectomy (uterus removal), can be performed using the natural access scarless approach.
(B) Laparoscopic sling surgery- Using the minimal access technique of keyhole surgery, the weak and deficient areas of the pelvic floor can be hitched up and repaired.
(C) Vaginal vault repair with sacrococcygeopexy- can be performed by either the vaginal (natural access route) or laparoscope route as judged best for the patient.
Scope of Gynae Cancer Surgery
- 6. Gynae cancers and precancers-
(A) Colposcopy: Diagnosis and management of abnormal pap smears and precancerous lesions (CIN) of the cervix. Examination of the cervix is carried out under magnification to detect and treat early precancerous or cancerous changes.
Advantages & Scope of Robotic Surgery
Robotic surgery is a cutting edge technology, which enables laparoscopic surgery to be performed with even better precision and dexterity. It avoids general side-effects associated with open surgery and minimizes some of the challenges of laparoscopic procedures.
The scope of robotic surgery:-
- (A) Surgical laparoscopic procedures for infertility and bad obstetric history
- a. Repair of the blocked tubes by robotic laparoscopic tuboplasty.
- b. Robotic laparoscopic neosalpingostomy- unblocks the tubes at the outer ends.
- c. Robotic laparoscopic adhesiolysis- All membranes and areas which have distorted the internal anatomy and structures by being stuck to each other are released by the process freeing the relavant organs.
- d. Robotic laparoscopic treatment of endometriosis in its mild or severe form, can be managed and surgically cleared using the advantage of magnification & precision using the robot
- (B) Gynae cancers and precancers-
Robotic laparoscopic surgery is particularly beneficial for cancer patients because of the advantage of the 3D vision wherein, removal of all lymph nodes and tumour tissues becomes easier and complete. This can be used to robotically perform radical surgery in patients with cancer of the cervix, uterus, and ovary.
Complicated surgery is made simpler.Our medical faculty of leading gynaecologists is supported by modern facilities, enabling them to provide quality medical care. Our Operation Theatres (OTs) are equipped with HEPA filters ensuring an infection free environment.
Our support services, laboratory, radiological and blood bank amongst interspeciality references & support go a long way in providing comprehensive and efficient patient care under one roof.
Specialities 
