The procedure step by step
View(s):After putting the patient to sleep with anaesthesia, the steps taken by the team performing the laparoscopic procedure, according to Dr. Silva are:
Initially carbon-dioxide (CO2) gas is pumped into the abdomen to expand it.Thereafter, three to four tiny five-mm incisions (cuts) are made on the abdomen including the belly-button and a thin medical telescope (the laparoscope) is inserted through the one on the belly-button.
The large expanded space (like a tent) created by the gas separates the organs and allows them to be seen clearly by the Gynaecologist. The camera sends pictures to a television screen and these pictures are magnified so that the organs are visible. The surgical instruments are inserted through the other tiny cuts.
Thereafter, the sigmoid colon or bowel is dissected (freed) off the womb and ovaries, which would usually be adhered to it.
This would be followed by dissecting the ovaries and the ovarian tubes off the ovarian bed, all the while clearing any chocolate cysts on the way. The ovaries and ovarian tubes would be suspended from the abdominal wall to keep the ‘field’ of the procedure visible to the team.
The bowel too would be strung up to get a good view of the Pouch of Douglas.
The ureters are completely dissected as these are the site of the commonest injuries in advanced endometriosis surgery.
Then the team would access the para-rectal spaces deep down near the rectum and also the recto-vaginal septum.
These dissections are made, says Dr. Silva, to identify each essential structure such as the ureters, the bowel and the ovaries and isolate them, to get a clear view of the field of the procedure. Then it is not a blind procedure, and one by one, the nodules, which are sometimes like “yakada guli” (balls of iron) can be cut off.
The nodules in the utero-sacral area, ureters and the womb are carefully cut away and those on the rectum are either shaved off or cut off, MediScene learns.