Objective: To study the laparoscopic and hysteroscopic appearances of female genital tract tuberculosis (FGTB). Study design: This is a hospital-based prospective observational study. Materials and methods: The study was conducted in the Department of Obstetrics and Gynecology, Vardhman Laparoscopy Centre, from July 1, 2014 to June 31, 2017. A total of 2,200 patients presenting with infertility were subjected to endoscopic evaluation, and the findings suggestive of TB were recorded. Results: Out of total 2,200 patients who underwent endoscopic evaluation for infertility, 33 and 21.5% had findings suggestive of TB on laparoscopy and hysteroscopy respectively, and 59.5 and 55.6% of these patients had laparoscopic and hysteroscopic findings of early-stage disease respectively. Conclusion: Endoscopic evaluation of unexplained infertility is an indispensable tool for early diagnosis of FGTB and providing antitubercular treatment, while it is in the reversible stage.

The use of vasoconstrictor agents like vasopressin during laparoscopic myomectomy reduces blood loss during surgery and reduces operative time. However, certain side effects related to the cardiovascular system have also been reported with its use. These side effects could possibly be due to inadvertent intravascular injection of the drug. The author aims to describe a new design of an injection needle, Pisat's Visual Vasopressor Injection Needle (VVIN) that can be used during laparoscopic myomectomy to reduce the likelihood of an inadvertent intravascular injection of a vasoconstrictor solution.

Let us start with the question, if instruments make good surgeon? Instruments and apparatuses for laparoscopic hysterectomies have been developed over the last 40 years for interventions with multiple ports as well as for single-port surgery. A good surgeon bases his surgical plan on his knowledge of anatomy, recognizing the presented disease, his intuitiveness, and on optimal instruments and coagulation systems. With this issue, we are dealing in three parts: 1. History 2. General systems for adhesion prevention, mesh, stitching and knotting techniques, staples, glue, drains, rinsing solutions, and suction 3. Instruments and apparatuses for laparoscopic hysterectomies Instrument trolleys gather all equipment used in gynecological and general laparoscopic surgery. These smart carts are available as rolling carts or on special platforms hanging down from the ceiling. Operating room settings, like OR1^TM Neo (Karl Storz GmbH, Tuttlingen, Germany) or the Endoalpha or Visera Elite of Olympus or the Stryker unit with SDC Ultra as digital documentation system, form the basis to position the necessary equipment for easy use of the surgeon. The idea of warming and humidifying the CO² gas to avoid peritoneal damage has been well described by Philippe Konincks and Douglas Ott. The HumiGard^TM of Fisher and Paykel Health care (Auckland, New Zealand) provides heated, filtered, and humidified gas for abdominal insufflation with a predetermined temperature. Today, every CO₂ pneu automatic provides up to 37°C heated CO₂ gas, which is controlled by a pressure regulator within the machine by applying the Quatro-test. In the Quatrotest, the volume of gas flowing through the Veress needle during insufflation, intra-abdominal pressure, total volume, and preset filling pressure are measured. Cold light provided by xenon lamps is already substituted by light-emitting diode light. Video camera setup with three-chip cameras is substituted recently by HC camera systems and can be used for laparoscopy as well as in hysteroscopy. High-resolution video with video monitors guarantees optimal picture quality. The technological development allows the use of larger monitors in high-definition quality that facilitates a relaxed working atmosphere for the surgeon. A realistic, nearly true to life three-dimensional (3D) picture is possible due to various technological elements, such as digital simulation, a second camera system, or the use of shutter lens. Digital devices for the video camera control the picture quality and facilitate automatic white balancing. The Karl Storz Company already offers the TRICAM 3D imaging system that allows the surgeon to view crisp, clear image through a pair of lightweight polarizing glasses. The ENDOCAMELEON laparoscope provides a viewing angle that can be adjusted continuously between 0 and 120.

Classic intrafascial subtotal hysterectomy (CISH) technique is one method of intrafascial supracervical or subtotal hysterectomy that was performed by laparoscopy in Kiel, Germany, from 1989 until 2005 and has then been replaced by laparoscopic subtotal hysterectomy (LASH) or (LSH) technique, we intend to give in this article a review on both valuable technologies. Many clinicians do not like subtotal hysterectomy at all; however, in our time of understanding that less might be more effective than more for some patients, we are happy to stress the fact of this surgical technology and are giving the background of its development.

Objective: To assess the efficacy of temporary ovarian suspension following laparoscopic surgery for severe pelvic endometriosis in the prevention of postoperative ovarian adhesions and its correlation with the pregnancy outcome. Study design: Prospective double-blind randomized controlled trial. Materials and methods: The study was conducted in the Department of Obstetrics and Gynaecology, Vardhman Laparoscopy Centre from January 1, 2011 to September 30, 2017 on 100 endometriotic patients. Results: On ultrasonographic follow-up, the study group showed significantly lesser incidence of readhesions compared with control group (20% vs 65%). Of these, 28 conceived (56%): 4 delivered, 22 pregnancy continues (85%), and 2 woman had an ectopic pregnancy. Five patients had a second-look laparoscopy out of which in 4 cases (80%), we found no evidence of recurrent adhesions. Only 1 patient had minimal adhesions. Conclusion: The study suggests that temporary ovarian suspension could be an effective and feasible surgical technique, which might actually help reduce postoperative adhesion.

A 24-year-old nullipara presented to our outpatient department with severe menorrhagia and infertility with a 20 weeks size uterus. The sonography showed a large submucous myoma. Diagnostic hysteroscopy showed an obliterated endometrial cavity. Laparoscopic myomectomy was done leaving behind an intact endometrium.

Cesarean scar pregnancy (CSP) is defined as an implantation of pregnancy in a fibrous tissue scar of a previous cesarean section. It is considered as one of the rarest forms of ectopic pregnancy and can be life threatening. The incidence of CSP is steadily rising in view of increasing cesarean section rates. A very high index of clinical suspicion is required for the diagnosis and further management. Through this case report, we demonstrate the laparoscopic management of a previous failed methotrexate (MTX) therapy in a CSP.