Foreword by Pravin M PatelForeword
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Step by Step Gynecological Endoscopy Surgery
© 2006, Sudhir R Shah, Manish R Pandya, Beena N Trivedi, Dipal D Solanki
All rights reserved. No part of this publication and interactive CD ROMs should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher.
First Edition : 2006
Typeset at JPBMP typesetting unit
Printed at Paras
who kept full faith in us and encouraged us indirectly to write this book.
Our family members
without whose constant inspiration and cooperation this attempt would have not been completed.
It's a matter of pleasure for me to write a Foreword for this small but extremely informative and much needed publication required in present era of Gynecological Endoscopy Surgery.
Endoscopy surgery has proved its place in present operative gynecological practice. Before 20 years when I started our advanced endoscopy clinic at Ahmedabad, the field of endoscopy surgery was in its newborn status. It was completely a new type of surgical aspect during those days and instrumentations were limited. We had to do long hour counseling to convince the patients for this newer surgery.
The long 20 years has changed the scenario. Now more and more gynecologist are accepting this route of surgery knowing its benefits very well. More and more training centers are available in our own country to teach the new comers in perfect manner.
This book will help a lot to the bunch of new comers as well as the seniors who has not yet entered into this field of surgery. It gives information from beginning like ABCD of endoscopy. Reading this book, is must for new comers before switching over to more complex advance endoscopy surgery. This book will also help them in knowing how to establish endoscopy surgical unit at private level.
I congratulate Dr Sudhir R Shah, who happened to be my senior registrar at VS Hospital. Dr Manish R Pandya is very enthusiastic and hardworking surgeon and made his name in this field in very short period. He has to his credit many recorded teaching VDOs for new comers. Dr Beena N Trivedi and Dr Dipal D Solanki are emerging endoscopic surgeons and very soon they will be in the national scenario.
I am sure this book will be of great help to all practicing gynecologist. It will help them to understand the basics of this surgery and give them the initial confidence which is highly needed.
Pravin M Patel
Chairman Endoscopy Committee FOGSI (Elected)
Past Vice President FOGSI
Advance Endoscopy and Fertility Centre
Next decade is of endoscopic surgery in gynecological practice. Open incision surgery will be a forgotten art and Key Hole Surgery will replace it in most of the surgical aspects. Every Gynecologist has to learn and expertise in this new and fascinating surgery.
The main purpose of publishing this small book is to stimulate more and more gynecologist to start laparoscopic surgery. This is neither a textbook nor an operative manual but collections of some routine information and steps for the benefits of the beginners. It is the outcome of what we read, watched and listened at various conferences and learned out of our surgical practice. It can just be used as ready reference book.
This small book is for those:
- Who want to start laparoscopic unit at their private practice.
- Who have strong desire to do laparoscopic surgery in most of the cases.
- Who are still thinking more about open incision surgery but are open minded instead of open enough to accept this new route and technique.
It will lead to do endoscopy easily and confidently. Read this book and you deserve all success.
Sudhir R Shah
Manish R Pandya
Beena N Trivedi
Dipal D SolankiAcknowledgements
We are thankful to our idols and friends
Dr Rohit V Bhatt, Baroda, who is one of the very few gynecologists, who started laparoscopy surgery in India before 25 years, and trained hundreds of gynecologists in this field.
Dr Pravin M Patel Endoscopy Surgeon: Advance Endoscopy and fertility Centre and Melbourne IVF, Ahmedabad, who taught us ABCD of endoscopic surgery.
Dr PG Paul Endoscopy Surgeon: Kerala, whose book on endoscopic surgery encouraged us to take first step towards initiating this new surgery.
Dr Rakesh Sinha Endoscopy Surgeon: BEAMS Mumbai who developed confidence in us.
Dr Manish R Pandya Endoscopy Surgeon, Surendranagar and co-author of this book, whose operative steps in CD brought tons of confidence in us.
Mrs Jyoti Shah, Dr Nehal Pandya, Dr Nimish Trivedi and Dr Dharmesh Solanki, better halves of the team of authors.
Our Theater staff to assist us in all means.
Dr Manish Pandya Hospital Staff, Surendranagar Numbers of our friends and colleagues who helped us in many ways.Introduction
Any new surgical technique faces few problems in its initial phase.
First is the faith and acceptance by the surgeons themselves.
Next and most importantly is acceptance by patients involved and public in general.
Gynecological endoscopy surgery or key hole surgery (KHS) started since last two decades.
In the initial phase of this new techniques there was little poor response by gynecologists as a general. This was because:
- It was a new technique.
- It involves sophisticated and costly instrumentations.
- Special set up is to be established to carry out the surgeries in perfect manner.
- Less expert surgeons to train the new comers in this field.
- Juniors were not much encouraged by their seniors as the seniors themselves were not trained and hence more criticisms against the new techniques by surgeons who were experts in open incision surgery (OIS).
- Since surgeons had no confidence, patients were not properly guided and hence patients were opting for OIS.
- It is purely a teamwork and special training was also needed for non-medical staff involved. Because of these collective reasons the newer technique has to remain in its latent phase for a longer period.
The scenario has completely changed now.
- Instrumentations have become cheaper than before.
- Better instruments are in market.
- It is easier now to start a new set up for endoscopic surgery even at private hospital where the availability of space is less.
- Training has become cheaper, easily available at better center in India.
- Surgeons have surely accepted the advantages of key hole surgery (KHS).
- Indications of the KHS have increased.
- Surgeons have started to believe that KHS is easy and can be performed with ease and confidence.
- Trained staff is available or can be trained easily.
- Maintenance has become easier.
- To top of all it has become a demanding surgery by patients and general public.
Endoscopic surgery is the surgery of this new era and it will become routine for majority of surgical indications in next five years. The place of OIS will be taken by KHS.
- This is because of its advantages.
- Easy and less invasive surgery.
- Recovery is fast.
- No big skin incisions.
- Hospital stay is less.
- Postoperative period is normal.
- Early ambulation.
- Early discharge from hospital.
Endoscopic surgery has benefit of minimal access approach, less tissue trauma, more comfort, early recovery to patient. It gives pleasure of magnification and good focus of camera eye on tissue to be dissected. There is often less bleeding due to raised intra-abdominal pressure and use of electrosurgery.
On the other hand, indirect visualization of two dimensional image create lack of depth perception which lead to sense of insecurity to surgeon.
It is advisable to develop hands-eye co-ordination of altered anatomical perception of magnified image. Use of long rigid instruments with absent tectile perception demand expertization of ambidextrous technique of endoscopic surgery. Synchronization of the teamwork, up to the mark infrastructure added with desire, determination, dedication on part of the surgeon over come any obstacle.
The real purpose of preparing this small ready to read book is to provide the basics of this surgery.
To help the surgeons who are still going for OIS and have a desire to switch over to KHS.
To help the new comers to guide how to start the new set up for gynecological endoscopic surgery.
To build up more confidence in those surgeons who have recently started this type of unit.
This is not a textbook but a small ready to learn book for gynecological endoscopy surgery and hence the title is Step by Step Gynecological Endoscopy Surgery. This book will cover laparoscopy part of endoscopy.
Sudhir R Shah
Manish R Pandya
Beena N Trivedi
Dipal D Solanki