Gynaecologic Endoscopy in Jaipur

What gynaecologic endoscopy is

Gynaecologic endoscopy is a group of minimally invasive procedures that let a surgeon look inside the pelvis and uterus using a thin camera called a scope. The two main types are hysteroscopy, where the scope goes through the vagina and cervix into the uterus, and laparoscopy, where the scope goes through a small cut near the belly button.

Both can be diagnostic, meaning they are done to find the cause of a problem, or operative, meaning the surgeon treats the problem at the same time.

In a diagnostic hysteroscopy the surgeon checks the uterine cavity for:

• Polyps
• Fibroids
• A septum
• Scar tissue

In an operative hysteroscopy the same scope carries tiny instruments to:

• Remove a polyp
• Shave a fibroid
• Cut a septum
• Divide adhesions

Diagnostic laparoscopy is used to see the ovaries, fallopian tubes and the outside of the uterus, often for infertility, chronic pelvic pain or suspected endometriosis. Operative laparoscopy can remove an ovarian cyst, take out fibroids, excise endometriosis or repair a fallopian tube.

Minimally invasive surgery has become the standard of care for many gynaecological conditions because it uses small cuts instead of a large open incision. The camera gives a magnified view on a screen so the surgeon can work precisely.

Symptoms and when to seek urgent care

Common reasons women are referred for gynaecologic endoscopy include:

• Heavy or irregular periods
• Bleeding between periods
• Pelvic pain that does not settle with simple pain relief
• Difficulty getting pregnant
• A known ovarian cyst or fibroid that needs checking

After a laparoscopy or hysteroscopy you should contact the hospital or go to the emergency department the same day if you develop any of the following: a high temperature or feel hot, cold or shivery; increasing pain, swelling, bleeding, pus or redness around the wounds; a very fast heartbeat; chest pain; or severe difficulty breathing such as gasping, choking or not being able to get words out. These can be signs of infection, internal bleeding or a blood clot and need immediate assessment.

Causes and who is at higher risk

The conditions diagnosed and treated with gynaecologic endoscopy have different causes. Fibroids are non-cancerous growths in the muscle of the uterus; they are very common and tend to run in families. Endometriosis happens when tissue similar to the lining of the uterus grows outside it, causing pain and sometimes infertility.

Ovarian cysts are fluid-filled sacs that can form during the menstrual cycle; most are harmless and go away on their own, but some persist or cause symptoms. Adenomyosis, polyps and scar tissue inside the uterus can also lead to bleeding or pain.

Women in their 30s and 40s are more likely to develop fibroids and endometriosis. A family history of these conditions increases the risk. Previous pelvic surgery or infection can cause adhesions that make organs stick together. Obesity and never having been pregnant are also linked to a higher chance of some of these problems.

How gynaecologic endoscopy is diagnosed: examination and tests

Before any scope procedure you will have a clinical examination and usually an ultrasound scan of the pelvis. A transvaginal ultrasound gives a clearer picture of the uterus and ovaries. In some cases an MRI or a specialised test such as HyCoSy (a dye test for the fallopian tubes) or 3D saline infusion sonography may be done first.

If these imaging tests do not give a clear answer, or if treatment is needed at the same time, your gynaecologist may recommend a diagnostic hysteroscopy or laparoscopy. During a diagnostic laparoscopy the surgeon can also take small tissue samples (biopsies) for laboratory testing.

The hospital will give you instructions on how to prepare, which usually include not eating or drinking for several hours before the procedure and sometimes stopping certain medicines such as blood thinners.

Non-surgical treatment options and when surgery is advised

Many gynaecological conditions can be managed without surgery at first.

Heavy periods may be treated with:

• Hormonal tablets
• A hormonal intrauterine system
• Tranexamic acid

Pain from endometriosis can be eased with anti-inflammatory painkillers or hormonal therapy such as:

• The combined pill
• Progestogens
• A GnRH analogue

Small, asymptomatic ovarian cysts are often watched with repeat ultrasounds because they frequently resolve on their own.

Surgery is usually advised when medical treatment has not controlled symptoms, when a fibroid or cyst is large or growing, when endometriosis is severe, when there is a septum or adhesions inside the uterus affecting fertility, or when a tissue diagnosis is needed. Diagnostic hysterolaparoscopy is also considered essential in the work-up of infertility, especially primary infertility.

Your surgeon will discuss whether a diagnostic procedure alone is enough or whether an operative procedure should be done at the same sitting.

Preparing for gynaecologic endoscopy surgery

Your surgical team will ask you to come for a pre-anaesthesia check a few days before the operation. This usually includes blood tests, a urine test, a chest X-ray and an ECG. If you take medicines for blood pressure, diabetes, thyroid or blood thinners, tell the anaesthetist so they can advise which ones to continue or pause.

You will be asked not to eat or drink anything for at least six hours before the procedure because the operation is done under general anaesthesia. Bring a list of your current medicines, any recent scan reports, your insurance or scheme card and comfortable loose clothing to wear home.

An attendant should plan to stay with you at the hospital and drive you home afterwards, as you cannot drive for at least 48 hours after general anaesthesia.

How gynaecologic endoscopy is done

The operation is performed in a modular operation theatre under general anaesthesia so you are asleep and feel no pain. For laparoscopy, the surgeon makes a small cut near the belly button and pumps carbon dioxide gas into the abdomen to create space to see the organs clearly.

A thin telescope with a camera (laparoscope) is inserted through this cut and the picture is shown on a screen. One to three more small cuts may be made to pass surgical instruments. For hysteroscopy, a thin telescope is passed through the vagina and cervix into the uterus; no abdominal cuts are needed.

The surgeon may perform diagnostic hysteroscopy to view the uterine cavity, or operative hysteroscopy to remove polyps, fibroids, a septum or adhesions. Diagnostic laparoscopy is used to assess infertility, chronic pelvic pain or endometriosis.

Operative laparoscopy can:

• Remove ovarian cysts
• Fibroids (myomectomy)
• Excise endometriosis
• Perform tubal surgery

At the end, the gas is let out and the cuts are closed with stitches or clips and a dressing is applied. The operation usually takes 45 minutes to two hours depending on what is found and what needs to be done.

Risks and possible complications of gynaecologic endoscopy

Laparoscopy is a common procedure and serious complications are rare. In studies, major complications from gynaecological laparoscopy occur in about three to six per 1,000 cases. These numbers have remained largely unchanged over the last two decades despite new entry devices and techniques. Complications related to laparoscopic access represent one third to one half of these adverse events.

In about 0.4 of 1,000 procedures, serious and potentially life-threatening events such as perforation of the bowel, major abdominal vessels or vessels of the abdominal wall have been reported. If the surgeon cannot safely complete the operation laparoscopically, they may need to switch to an open procedure with a larger incision. A hernia at the port site can occur.

Morcellation (cutting tissue into smaller pieces to remove it through the small cuts) carries a risk of spreading undetected sarcoma, parasitic myomas and potential damage to bowel or major blood vessels. Contained tissue extraction systems have been developed to reduce this risk and are becoming standard practice where morcellation is needed.

After surgery, pain from residual gas and shoulder tip pain are common. You will be given pain medication to keep you comfortable. Contact the hospital immediately if you develop a high temperature, feel hot, cold or shivery, have increasing pain, swelling, bleeding, pus or redness around the wounds, a very fast heartbeat, chest pain or severe difficulty breathing.

Recovery and aftercare after gynaecologic endoscopy

After the operation you will stay in the recovery room for about an hour while your vital signs are monitored until you wake up. Most people can leave hospital either on the same day or the day after laparoscopy. Hospital stay at Jaipur Hospital ranges from day care to two nights.

For diagnostic laparoscopy, recovery to normal activities usually takes up to 10 days; if surgery was performed, full recovery can take up to six to eight weeks. For hysteroscopic procedures, recovery is typically two to three days. Take paracetamol or ibuprofen for pain as advised. Drink plenty of fluids and eat a healthy diet.

Wear compression stockings if you have been given them. Move around as much as you can and do foot and leg exercises while resting. Keep the wound dry for the first 24 hours; you can shower after this but avoid very hot water. Do not have a bath for the first two weeks or until the wound has healed.

Do not drive for 48 hours or until you can do an emergency stop (check with your insurer first). Do not fly for 48 hours after the procedure. Avoid alcohol for 48 hours and do not smoke as it can slow healing. You can usually return to work after three days for minor procedures, but check with your surgeon.

Light exercise can often start after about a week, depending on the surgery. When you can resume sexual activity depends on the procedure; ask your surgeon. Schedule your follow-up appointment before leaving the hospital so your healing can be checked.

Results of gynaecologic endoscopy: how well it works and recurrence

Minimally invasive surgery is now the standard of care for many gynaecological conditions.

Proven benefits compared with open surgery include:

• Decreased blood loss
• Less postoperative pain
• Fewer perioperative complications
• Shorter hospitalisation
• Faster recovery

In a large trial for uterine cancer staging, laparoscopic surgery was superior for short-term safety and length of stay. The potential for increased risk of cancer recurrence with laparoscopy versus open surgery was found to be small.

For endometriosis, laparoscopic investigation finds visible disease in about two-thirds of adolescents with chronic pelvic pain or dysmenorrhea, and about one-third of those have moderate to severe disease. In studies of laparoscopic myomectomy, pregnancy outcomes after using barbed sutures for uterine closure are comparable to those with conventional sutures.

Barbed sutures have also been shown to reduce suturing time, operating time, blood loss, hospital stay and complication rates.

A Cochrane review comparing contained manual morcellation with uncontained power morcellation during laparoscopic myomectomy included two randomised trials with 176 women; neither study reported complications such as leiomyosarcoma during or after surgery in either group, but the quality of evidence was extremely low. The authors were uncertain whether in-bag morcellation reduces total operation time or improves ease of morcellation. Your surgeon will discuss the expected results for your specific condition and the chance of the problem returning.

Cost and insurance for gynaecologic endoscopy in Jaipur

The typical price range for gynaecologic endoscopy in India is ₹40,000 to ₹1,50,000. The final cost depends on the type of procedure (diagnostic or operative), the complexity of the case, the length of hospital stay and any additional services needed.

Jaipur Hospital is a NABH-accredited multispeciality hospital established in February 1991 with modular operation theatres, a 24×7 emergency department, in-house pharmacy, diagnostic laboratory and imaging. The hospital accepts RGHS, MAA Yojana, CGHS and a panel of private insurers and TPAs. Ask the hospital for an estimate based on your planned procedure and your insurance or scheme coverage.