Gynae Surgery

Difficult Hysterectomy

43 yearls old obese lady with heavy menstrual bleeding and severe pain during bleeding

Ultrasound revealed chocolate cysts in both ovaries

Injection Leuprolide was advised to relieve her symptoms

After 3 months of injection, the symptoms recurred and she opted for operation (Removal of the uterus and the ovaries) after explaining all the risks and benefits

The operation was EXTREMELY DIFFICULT, because of severe ADHESION (uterus, ovaries, bladder, ureters, intestines, rectum all were attached together)

Careful dissection was performed, removing the uterus first. Because of severe adhesion, subtotal hysterectomy was done (Leaving behind the cervix (lower part of the uterus), which has been explained to the patient

Then both ovaries containing chocolate cysts were removedPatient was transfused blood and her condition was closely monitoredShe was discharged in stable condition

She is absolutely OK in follow up period

Biopsy revealed ENDOMETRIOSIS

Dermoid Cysts in Both Ovaries

34 years old lady from Burdwan

Presented with HUGE TUMOURS in both OVARIES, confirmed by ultrasound and CT scan

CA-125 was normal and our presumption was Benign “Dermoid Cysts” of the ovaries

We removed cysts from both sides, preserving her ovaries and tubes in both sides and the uterus, as per her request.

Right sided cyst- 9 cm x 8 cm x 5.5 cm

Left sided cyst- 10 cm x 9 cm x 7 cm

Biopsy confirmed DERMOID CYSTS

Despite major surgery, she went home within 3 days!!!

She is now doing well and her normal menstruation again started after the operation

Challenging Case of Hysterectomy

55 years old lady presented with post-menopausal bleeding

She was found to have multiple FIBROIDS in the UTERUS, confirmed by ultrasound

IVP was done to ensure that the tumours had not affected urinary tract

She was having Diabetes and Hypertension, with Haemoglobin 7.2 g/dl- so at HIGH RISK from ANAESTHETIC and SURGICAL point of view

After discussion and obtaining patient’s informed CONSENT, we proceeded for this CHALLENGING SURGERY

10 KG TUMOUR was removed along with the uterus and the ovaries.

3 units of BLOOD was TRANSFUSED

Post-operative period was alright and SHE WENT HOME WITHIN 3 DAYS, despite major surgery!!!

Fallopian Tube Block, Successful Laparoscopy-Hysteroscopy

5 years long Infertility


All other Fertility Factors normal

Was offered 2 options 1.Directly IVF 2.Laparoscopy and Hysteroscopic guided Proximal tubal Cannulation (Attempt to open the tube surgically), failing which IVF would be required

Patient opted for option 2

We managed to open one tube during the operation

Conceived naturally within 3 months of the operation

Pregnancy was uncomplicated, except mild hypertension

Delivered a healthy baby at 37 weeks

Ruptured Ectopic Pregnancy

ECTOPIC PREGNANCY (Pregnancy outside the uterus, usually in the tubes or ovaries), is uncommon but LIFE-THREATENING condition, because of severe INTERNAL BLEEDING

Patient presented with severe pain abdomen and bleeding per vagina, after a missed period

Her pregnancy test was positive and so the diagnosis of ECTOPIC PREGNANCY was considered

She came to us without any tests, so we advised URGENT ULTRASOUND SCAN, which confirmed RUPTURED ECTOPIC PREGNANCY

After arranging BLOOD, starting intravenous SALINE, we decided for IMMEDIATE SURGERY to save her LIFE to stop the INTERNAL BLEEDING

In Surgery abdominal BLEEDING (Around 1 Litre !!!) Was found with Left FALLOPIAN TUBE RUPTURED, which contained the ECTOPIC PREGNANCY

Patient’s condition IMPROVED DRAMATICALLY after the surgery and she returned back to home within 3 DAYS !!!!!

Dermoid Cyst Surgery in a Very High Risk Patient

57 years old lady, having high blood pressure and heart disease (Angina), who was on multiple medicines for BP and angina, presented with swollen abdomen

She had Angiography 2 times before

Ultrasound scan and MRI revealed a large Tumour (17 x 12 cm) from Right Ovary, with normal CA 125 level

The diagnosis was Dermoid cyst

She opted for removal of both the ovaries (bilateral oophorectomy) and the uterus (hysterectomy)

After proper arrangement, Anaesthetic check up and Cardiologist review, the operation was done with ICU back up (though she did not require it)- removing the large tumour with the uterus and part of omentum (abdominal fat)

Despite Major Operation, she recovered well and was discharged from the hospital 4th day after the operation !!!

Biopsy came as DERMOID CYST (benign disease, NOT cancer) and she is now doing well

Removal Of Hydrosalpinx before IVF

If the Fallopian tube us swollen and filled by the fluid/ pus/ blood, the tube is not functioning. The tube can even damage the Embryo which is implanted after IVF.
Thus, the affected tube must be removed before IVF to improve the success rate of IVF. It can be done by Laparoscopy.
The picture shows Laparoscopic Tube Removal (Salpingectomy) in a patient who is planning for IVF.
Please pray for her.

Dermoid Cyst Removal, Laparoscopy, Natural Pregnancy

•Dermoid Cyst Removal and Preserving the healthy Ovary by Laparoscopy in a lady with Infertility.
It was 5 cm dermoid cyst in left ovary. After taking consent and explaining the risk, we proceeded for Laparoscopy and removed the cyst with all hair (!!!) and secretion. The right ovary was intact and not disturbed. The left ovary was preserved as much as possible so as not to compromise her Fertility much.
We also performed hysteroscopy to look inside the uterus in the same sitting (with her consent) to avoid the need of second operation.
We also checked whether the tubes are patent or not by inserting blue dye (Methylene blue- shown in the picture).
Dermoid cyst is a benign tumour of the ovary that may contain hair (seen in this picture), oil (like skin secretion), skin, teeth, bones, cartilages etc.
The chance of malignancy is very rare.
But if left untreated, it can undergo TORSION (twisting of the ovary, causing severe pain and may cause gangrene of the ovary if untreated, an ACUTE EMERGENCY) and also hemorrhage inside the cyst.
It was a CHALLENGE to remove the cyst (5 cm size) keeping the ovary (we took consent from the woman that she may require removal of the ovary, fortunately it did not happen).
The operation took long time but finally it was done.

•She got pregnant naturally within 3 months of surgery

Fibroid-Infertility, Lapaparoscopic Myomectomy, Low AMH, Advanced Age, Spontaneous Pregnancy

•40 year-old woman presented with Infertility of 5 years

•AMH was very low and she was advised IVF with Egg-Donation

•She had large fibroid (6 cm) with heavy menstrual bleeding, not relieved by any medicines

•We removed the fibroid by laparoscopy (Myomectomy) and she was discharged from the hospital next day

•Within 3 months after the operation, she conceived spontaneously (Without IVF) and delivered a healthy baby