India's one of the leading Laproscopy centre
and No.1 Laproscopy centre in Tamilnadu.

CARE & CURE & CONFIDENCE

About INH

Indira Nursing Home(INH), the brain work of Dr.P.shankar is one of the leading proctology Centers in Tamilnadu. This hospital has a benchmark in the field of Laser Proctology, Introducing the latest Innovation and advanced Surgical Procedures for Piles, Fissure, Fistula and PNS(Pilonidal Sinus) in India.

INH Ensures the excellent treatment & the latest laser facilities in proctology. Where the new invention of laser technology has been introduced over a period of 16 Years. INH has done more than 25,000 Surgeries. And is one among the largest wide speciality centre in proctology.

LAPAROSCOPIC SURGERIES



Laparoscopy is a low-risk, minimally invasive procedure that requires only small incisions (Key Hole Surgery)

An instrument called a laparoscope is used to look at the abdominal organs. A laparoscope is a long, thin tube with a high-intensity light and a high-resolution camera at the front. The instrument is inserted through an incision in the abdominal wall.

LAPAROSCOPIC APPENDISECTOMY

This is the procedure in which the appendix is removed laparoscopically. The commonest indication for laparoscopic appendisectomy is acute appendicitis.

LAPAROSCOPIC APPENDISECTOMY

SYMPTOMS:

1) Pain in the region of the umbilicus/ right lower abdomen
2) Nausea and/or vomiting
3) Fever

DIAGNOSIS:
1) Ultrasound
2) CT scan

OTHER TREATMENT OPTIONS:

1) Open appendisectomy
2) Interval appendisectomy

LAPAROSCOPIC CHOLECYSTECTOMY

It is the procedure in which the gall bladder is removed laparoscopically.

Indications:

1) Cholelithiasis – Gall stones

2) Calcified gallbladder
3) Acute cholecystitis- inflammation of the gall bladder
4) Gallstone pancreatitis

LAPAROSCOPIC CHOLECYSTECTOMY

Cholelithiasis

Cholelithiasis is defined as formation of stones in the gall bladder which is a small organ close to the liver, and is the most common indication for laparoscopic cholecystectomy.

They can be either Cholesterol stones or pigment stones.

Cholelithiasis

SYMPTOMS:
Pain over the right hypochondrium and the epigastrium.
Indigestion
Fever
Nausea / vomiting
Jaundice

INVESTIGATIONS:
1) Ultrasound
2) CT scan
3) MRCP

OTHER TREATMENT OPTION:
Open Cholecystectomy

LAPAROSCOPIC INGUINAL HERNIA REPAIR



TEP – Totally extraperitoneal repair – a key hole technique for inguinal hernia repair. Mesh left behind the abdominal wall

TAPP – Transabdominal pre peritoneal approach



Advantages :
1) Less post op pain
2) Quicker recovery
3) Less hospital stay

LAPAROSCOPIC HIATUS HERNIA REPAIR:

Hiatus hernia occurs when contents of the abdominal cavity protrude through the esophageal hiatus of the diaphragm.

CAUSES :

Enlargement of the esophageal hiatus due to developmental defects
Increased abdominal thoracic pressure gradient
Depletion of elastic fibers in the phrenoesophageal membrane with aging

TYPES OF HIATUS HERNIA:

Type I, also known as a sliding hernia,
Types II-IV are classified as paraesophageal hernias.

LAPAROSCOPIC HIATUS HERNIA REPAIR:

OPERATIVE STEPS at laparoscopic hiatus repair

1) Excision of the hernia sac
2) Mobilization of the oesophagus
3) Closure of the crura
4) Fundoplication

COMPLICATIONS:

1) Recurrent herniation,
2) Reflux
3) Dysphagia.

LAPAROSCOPIC OVARIAN CYSTECTOMY

If the follicle fails to rupture and release an egg, the fluid stays in the follicle and forms a cyst. This is called an ovarian cyst.

Cystectomy is a surgical excision of an ovarian cyst.

LAPAROSCOPIC OVARIAN CYSTECTOMY

SYMPTOMS:
Irregular menstruation
Pain in the pelvis
Pelvic pain during intercourse
Bloating, swelling, or heaviness in the abdomen.

COMPLICATIONS:
Torsion
Cancer

DIAGNOSIS:
1. Ultrasound
2. CT scan
3. Ca 125

OTHER TREATMENT OPTIONS: Open ovarian cystectomy

LAPAROSCOPIC MYOMECTOMY

Removing a fibroid from the uterus through a laparoscopy is called laparoscopic myomectomy.

TYPES OF FIBROID:
Submucosal fibroids
Intramural fibroids
Subserosal fibroids

LAPAROSCOPIC MYOMECTOMY

INDICATIONS
1) FIBROIDS AND INFERTILITY
2) Fibroids not responding to medical management in a young woman.

COMPLICATIONS:

Bladder, bowel, and ureteral injury
Intraoperative and postoperative hemorrhage requiring transfusion
Unintended conversion to open myomectomy / hysterectomy

LAPAROSCOPIC EXCISION OF ECTOPIC GESTATION:



Presence of a pregnancy outside the uterine cavity is called ectopic pregnancy.

LAPAROSCOPIC EXCISION OF ECTOPIC GESTATION:

Symptoms:
Nausea and vomiting with pain
Sharp abdominal cramps
Dizziness

DIAGNOSIS:
Urine Pregnancy test positive
Ultrasound:
Empty uterine cavity
Presence of adnexal mass

TREATMENT:

Stable patients - Emergency laparoscopic surgical removal of ectopic pregnancy in ruptured ectopics with peritoneal wash.
Unstable patients - Laparotomy proceed.

LAPAROSCOPIC EXCISION OF ECTOPIC GESTATION:


COMPLICATIONS OF ECTOPIC PREGNANCY:
1) Ruptured ectopic – Haemoperitoneum requiring massive transfusion
2) Hypovolemic shock

LAPAROSCOPIC STERILISATION

Sterilisation ( tubectomy) is the permanent method of contraception. It can be done laparoscopically.
INDICATIONS:
1) Desire for permanent sterilization
2) Completed childbearing

DISADVANTAGES:
1) Need for anesthesia
2) Cost of laparoscopic equipment

LAPAROSCOPY ASSISTED VAGINAL HYSTERECTOMY

INDICATION:
1) Benign tumors of the uterus- fibroid uterus, adenomyosis
2) Abnormal uterine bleeding
3) Endometriosis

Symptoms:
Symptoms depend on the indications
Eg. Heavy menstrual blood loss; dysmenorrhea etc

ADVANTAGES OF LAVH:
1) Relatively small incision (key hole)
2) Less blood loss
3) Less pain
4) Shorter hospitalization
5) Shorter recovery time