Laparoscopy- 14 steps to improve your skills in Laparoscopic surgery

Early daysWhen I was training as a Registrar in the Obstetrics and Gynaecology Unit at Hospital Sultanah Aminah, Johor Bahru, between 1988 and 1991 the only laparoscopy we did was diagnostic laparoscopy and laparoscopic tubal ligation using the Falope ring. UK I went on to work in a small hospital in the UK.  Very few surgeries were done by laparoscopy in that hospital. One of my consultants was starting to do some hysteroscopic surgeries at that time.Specialist in OBGYNOn returning from the UK, I became a specialist at the same hospital. This was the time went the hospital acquired a video laparoscopy system. The general surgeons were doing laparoscopic cholecystectomy and I frequently watched them struggling with this surgery. I was trying out simple surgeries by laparoscopy which includes laparoscopic salpingectomy for ectopic pregnancies and simple laparoscopic cystectomies. We had several consultants from the National University Hospital, Singapore who used to come and do laparoscopy cases with us. I learned from them.Training in TaiwanI was frustrated, as my skills

Laparoscopy – Locating fibroids during Laparoscopic Myomectomy

Removal of fibroids by laparoscopy (Laparoscopic Myomectomy) is perhaps the most tedious of all laparoscopic surgeries. There are many steps namely:Devascularize the uterusRemoval of the fibroidsRepair the defectRemoval of the fibroid/s by morcellationMy biggest fear when performing myomectomy by laparoscopy is missing fibroids. There are several strategies for not missing a fibroid when performing this surgery. They are:Transvaginal ultrasound during the surgeryTransvaginal injection of methylene blue dye on the capsule of the fibroid MinilaparotomyIntraoperative ultrasound Transvaginal ultrasound during the surgery This can be done easily. Once all the visible fibroids are removed by laparoscopy, a transvaginal ultrasound (TVS) can be done to look at the uterus to see if there are any fibroids that are still remaining in the uterus. One trick is to place some fluid in the Pouch of Douglas and place the patient in the reverse Trendelenburg position when performing the transvaginal ultrasound. The advantage of this method is that it is easy to find an ultrasound with a