Preface

Preface

About the author

Dr S. Selva (Sevellaraja Supermaniam) is a Consultant Obstetrician and Gynaecologist and a subspecialist in Reproductive Medicine at a private hospital in Melaka, Malaysia. He heads the O&G unit and the IVF Centre at the hospital.

Dr. S. Selva obtained his undergraduate degree from the University of Malaya in 1985. After working in various hospitals in Malaysia and the United Kingdom, he became a member of the Royal College of Obstetricians and Gynaecologists, United Kingdom, in 1991. He then served as a specialist and later a consultant OBGYN in Johor Bahru. In 1994, he left the public service and joined a private hospital in Melaka and has been there since. Dr. S. Selva obtained his Masters in Reproductive Medicine from the University of Western Sydney in 2003. He also became a Fellow Of the Royal College of Obstetricians and Gynaecologists, United Kingdom and a Fellow of the International College of Surgeons, in 2003. He then obtained the Bachelor of Endoscopy from Belgium in 2013.

Dr S. Selva received his initial training in laparoscopic surgery under Prof. Soong Kwei Yong and Dr. Lee Chyi Long at the Chang Gung Memorial Hospital, Taipeh in 1994. He has been a dedicated laparoscopic surgeon since then, having performed about 5000 laparoscopic surgery cases so far. The types of cases that he performs involve advanced techniques such as single incision laparoscopic surgery, laparoscopic surgery for rectovaginal endometriosis, laparoscopic sacrocolpopexy and laparoscopic radical hysterectomy. He has also trained many national and international gynaecologists in laparoscopic surgery. He recently started a fellowship in laparoscopic surgery and infertility, the first of its kind in Malaysia. So far he has trained 3 Fellows. Dr. Selva has been performing 3D laparoscopy since 2013.

Dr S. Selva is the immediate past President of the Asia Pacific Association of Gynaecological Endoscopy (APAGE). He is also a reviewer of the Journal of APAGE (GMIT- Gynaecological Minimally Invasive Therapy). Dr. S. Selva is a board member of the International Society of Gynaecological Endoscopy. He is a Past President of the Obstetrical and Gynaecological Society of Malaysia and currently chairs its endoscopic subcommittee and is involved in promoting gynaecological endoscopic surgery in Malaysia. He was the organizing chairman of the International Society of Gynaecological Endoscopy Congress in Kuala Lumpur in 2004. He was also the organizing chairman of the annual congress of the Asia Pacific Association Of Gynaecological Endoscopy (APAGE 2014). He has organized numerous workshops in laparoscopic surgery and has also been the preceptor for many laparoscopic surgery workshops in Malaysia and abroad. Dr. S. Selva has also won numerous awards for video presentations in laparoscopic surgery, at the annual Malaysian Congress of O&G. He has written a chapter entitled “Polycystic Ovarian Syndrome” in the book, Obstetrics and Gynaecology for Postgraduates. He has also written a chapter entitled “ Single Incision Laparoscopic Surgery using Common Laparoscopic Instruments” in the book, Practical Endoscopy Tips by Experts.

Besides laparoscopy, Dr. Selva is also an IVF specialist having obtained his training at King’s College in London in 1997. In 1997, he started the IVF Centre at the hospital he currently works in.

Introduction

Although laparoscopic surgery in gynaecology has been in existence for over 30 years, the public is still unaware of its benefits. It is frequently perceived as dangerous and risky surgery. The aim of this book is to educate the public on the availability and benefits of laparoscopic or “keyhole surgery” for different gynaecological diseases.

In order to understand laparoscopic surgery in gynaecology, it is important to understand common gynaecological conditions. The first part of this book is dedicated to the explanation of common gynaecological diseases in women. In the second part, I will deal with how laparoscopic surgery is performed, its advantages and disadvantages and all the different types of gynaecological conditions for which laparoscopic surgery can be performed.

Although this book is entitled laparoscopic surgery in gynaecology, I have included the other component of minimally invasive surgery in gynaecology which is hysteroscopy, covered in Part 3. Endoscopic surgery or minimally invasive surgery, which is the term that encompasses both laparoscopic and hysteroscopic surgery should have been the correct title for this book, but I decided on “Laparoscopy” because it is the more commonly known term to the general public. I have also included interesting facts and cases in some of the chapters to further augment the understanding of the topic.

There are many medical terms and abbreviations used throughout this book. I have added a glossary of some of these medical terms at the end of this book. When the symbol (g) appears after a word, it means that an explanation of that word can be obtained in the glossary. I have also included a list of medical abbreviations used in this book. Please refer to them when necessary.

I have spent a considerable amount of time creating videos for many of the chapters in this book. They cover many of the chapters in the written format with videos of surgeries. I have given the URL (on vimeo) where these videos can be viewed. I have also given QR codes for each videos, so that it will be easy for you to access these videos. The QR code to get to the channel on vimeo, which contains all the videos is:

Another way of viewing these videos through your mobile devices is to download an app that can be obtained for free from my webpage www.selvaapps.com.

If you would like these videos in DVDs or a thumbdrive you can purchase them by writing to me at [email protected] Readers will benefit most by reading a chapter and then watching the accompanying video on that chapter. This will give a better understanding of the topic discussed. My own experience has taught me that one can learn much more from a video than from merely reading a book, (especially if it concerns technical issues such as those discussed in this book).

I hope you will enjoy reading this book and watching the videos, as much as I have had in preparing this book.

Dr. S. Selva

(Sevellaraja Supermaniam)

Melaka, Malaysia

November 2016

Dedication

To my wife Sarojini and my children: Ashmeera, Amita and Ainesh.

Acknowledgements

A number of people have influenced my career development. I would like to convey my deepest gratitude to these people:

My teachers:

  • Dato’ Dr Alex Mathews and Dr Padmawathy, for my initial training in Obstetrics and Gynaecology.

  • Prof. Soong Kwei Yong and Prof. Lee Chyi Long for introducing me to operative laparoscopy.

  • Dr Masaaki Ando, Dr. Rakesh Sinha, Dr. Suresh Nair, Dr. Prashant Manghesikar, Prof. Joo Hun Nam, Prof. Arnauld Wattiez, Dr Harry Reich, Dr Bruno J. Van Herendael for teaching me advanced laparoscopic surgery during live surgery workshops organised in Malaysia.

Dr Masaaki Ando, Dr. Rakesh Sinha and Dr Shailesh Puntambaker for allowing me to visit their centres to observe and assist in laparoscopic surgery.

My patients who have trusted me to treat them and operate on them. Without them I would not have been able to gain all the experience needed to perform advanced laparoscopic surgery.

Dr. Vijaendreh Subramaniam, gynaecological oncologist, for collaborating with me in performing laparoscopic radical hysterectomies.

Miss Allison Beh Kheng Yin for the illustrations.

My wife, Sarojini for all her support and advice. Her editing skills have enabled me to make this technical book more readable for the general public.

Foreword

Foreword By Dato’ Dr. Alex Mathews

Laparoscopic surgery, also known as minimally invasive surgery, has come a long way and has revolutionised the performance of a large number of surgical procedures. It is now utilised in most surgical specialities.

Laparoscopic surgery in gynaecology has developed into a highly sophisticated and precise form of surgery. Today many advanced gynaecological procedures can be performed safely and effectively using laparoscopic techniques.

In surgeries, there are usually 2 separate steps; the first, an incision (a cut) through the skin layer of the body and the second, the actual surgery deeper inside the body. In these conventional “open” surgeries, the cut on the skin layer is fairly large. This is to ensure good visibility and manoeuvrability for the surgery to be done effectively. The pain and discomfort after surgery, in most cases, is mainly from the cut on this skin layer.

In laparoscopic surgery one difference is that the cut on the skin layer is much smaller. The surgery is performed through small cuts using specially designed instruments that can be manipulated through these incisions. The internal structures are clearly visible to the surgeon because of highly specialised small cameras placed inside the body that transmit the image onto a high-definition video screen. The surgeon operates while looking at the screen. The assistant and observers can follow the entire surgery on the screen.

Major advantages of laparoscopic surgery include less tissue damage, clearer vision, and often better access to hidden structures. Several procedures never before possible with conventional surgery are now being done laparoscopically with great efficiency and minimal damage to surrounding tissues. The recovery period is shorter and return to work is much quicker without compromise on outcome.

However, the training of a laparoscopic surgeon is a long and intensive process. Basic training is done first on laboratory models. Then, there is a process of watching and assisting senior surgeons. The trainee surgeons then perform surgeries under direct supervision. Only then do surgeons embark on surgery independantly.

Surgeons continually update their skills through advanced training. As in all surgeries, complications can occur, but with due care and proper training these can be reduced to a minimum.

One of the pioneers of advanced laparoscopic gynaecological surgery in Malaysia is the author if this book, Dr. S. Selva.

Dr. Selva started laparoscopic surgery early. Initially, there was only very basic equipment available. However, Dr. Selva quickly advanced his skills, training in some of the best centres overseas.

Today Dr. Selva is an acknowledged expert and trainer and innovator in advanced techniques. He has a busy schedule providing training to surgeons who want to improve their skills.

Dr. Selva has another passion, i.e. a long standing desire to help patients and other lay-persons understand gynaecological laparoscopic procedures. He does this in his book using clear descriptions, pictures, and videos of actual surgeries. He, thus, helps lay-persons to participate meaningfully in making decisions in consultation with their doctors.

This book with the accompanying videos is an excellent contribution to public medical education.

I have no doubt it will be useful for many. Even medical practitioners of other disciplines will find this book interesting and informative.

To all who have any interest in knowing more about this subject I can heartily commend this remarkable publication.

Dato’ Dr. Alex Mathews FRCOG

Consultant Obstetrician and Gynaecologist, Gleneagles Hospital,
Kuala Lumpur,

Former Head of Department,
General Hospital Kuala Lumpur, Malaysia
Former Head of Obstetrics and Gynaecology Services, Ministry Of Health, Malaysia.

Copyright

First Published in 2016
Copyright © 2016 Dr. S. Selva (Sevellaraja A/L N. Supermaniam)

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission from the author.

Published by Adequate Wonder Sdn. Bhd Suite 105, Mahkota Medical Centre,
3, Mahkota Melaka, Jalan Merdeka, 75000, Melaka, Malaysia

ISBN: 978-967-14113-0-8
Perpustakaan Negara Malaysia Cataloging-in-Publication Data

S. Selva.
Laparoscopic Surgery in Gynaecology and Common Diseases in Women

ISBN : 978-967-14113-0-8
Gynecology Handbook manuals, etc.
2. Laparoscopic Surgery Handbooks, manuals, etc. 3. Women’s Diseases

DISCLAIMER

Although every effort has been made to ensure that the drug doses and other information are presented accurately in this publication, the ultimate responsibility rests with the prescribing physician. Neither the publishers nor the author can be held responsible for errors or for any consequences arising from the use of information contained herein. For detailed prescribing information or instructions on the use of any product or procedure discussed herein, please consult the prescribing information or instructional material issued by the manufacturer, In view of the ongoing research, equipment development, changes in governmental regulations and the rapid accumulation of information relating to the biomedical sciences, the reader is urged to carefully review and evaluate the information provided herein.

Case Studies

Case No.
Description of Case
Page
2.1
5 of 6 sisters with fibroids
45
2.2
Fibroids that caused sudden inability to urinate
47
3.1
Spontaneous pregnancy immediately after laparoscopic cystectomy for an endometrioma
69
3.2
Successful spontaneous pregnancy after taking oral contraceptive pills to decrease the recurrence rate of endometrioma
73
4.1
Severe dysmenorrhea caused by endometriosis and adenomyosis treated with Depoprovera® injection
83
4.2
Successful IVF in a patient with adenomyosis
85
5.1
Twisted gangrenous ovarian cyst
99
6.1
Endometrial polyp that was a cancer
109
7.1
Pregnant after laparoscopic surgery for ectopic pregnancy
7.1
11.1
Twin pregnancies with IVF in a lady with a complete uterine septum
166
11.2
Excision of a non-communicating rudimentary horn
167
17.1
Rectal injury
241
17.2
Bladder injury
243
17.3
Small intestine injury
245
17.4
Postoperative bleeding
246
17.5
Accidental injury to the right external iliac vein during laparoscopic radical hysterectomy
247
24.1
Spontaneous pregnancy after laparoscopic myomectomy
298
24.2
Laparoscopic myomectomy for large uterine fibroids
301
24.3
Laparoscopic myomectomy for a large submucous fibroid
303
25.1
Pregnancy after IVF in a patient who had undergone bilateral cystectomy for endometrioma
313
25.2
Spontaneous pregnancy in a young lady who underwent 2 previous laparoscopic cystectomies for large endometriomas
314
26.1
Spontaneous pregnancy after laparoscopic salpingotomy for an ectopic tubal pregnancy
323
26.2
Laparoscopic resection of a cornual ectopic pregnancy
326
27.1
Laparoscopic salpingoophrectomy and omentectomy for an ovarian cancer
338
28.1
Spontaneous pregnancy after reversal of tubal ligation
349
29.1
Bilateral hydrosalpinx : laparoscopic bilateral salpingectomy done followed by 2 successful IVF cycles
352
30.2
Laparoscopic adhesiolysis and fimbrioplasty done followed by a successful IVF cycle
366
31.1
Spontaneous pregnancy after adenomyomectomy
371
31.2
Hysterectomy done for severe adenomyosis
373
32.1
Laparoscopic sacrocolpopexy for vaginal vault prolapse
385
34.1
Cancer of the endometrium: Total Laparoscopic Hysterectomy and Bilateral Salpingoophrectomy and Pelvic Lymphadenectomy
405
35.1
Cancer of the cervix stage 1B: Laparoscopic radical hysterectomy and pelvic lymphadenectomy
411
36.1
Uterine perforation during office hysteroscopy
427
40.1
Hysteroscopic resection of uterine septum resulted in a spontaneous pregnancy in a woman with 2 previous miscarriages
459
40.2
Hysteroscopic lysis of intrauterine adhesions leading to spontaneous pregnancy
457
41.1
Spontaneous pregnancy after transcervical resection of fibroid for submucous fibroid
467

Interesting Facts

Fact No.
Topic
Page
2.1
Can the diagnosis of uterine sarcoma be made without surgery?
51
3.1
Use of oral contraceptive pills in young unmarried women
76
15.1
Why is laparoscopic surgery not so popular among gynaecologists?
222
16.1
Is enema necessary before laparoscopic surgery?
230
18.1
Controversy on morcellation of fibroids
260
21.1
Should all women with infertility undergo a routine laparoscopy?
278
24.1
Can laparoscopic myomectomy be performed in women who never had sexual intercourse (virgo intacta) ?
305
33.1
Should the ovaries be removed during hysterectomy?
398
33.2
What is the difference between subtotal hysterectomy and total hysterectomy?
399

Videos that accompany this book

All videos can be obtained at this channel: https://vimeo.com/channels/1005699

Videos in Each Chapter

Video 1.1 Normal female pelvic anatomy – https://vimeo.com/149588511

Video 2.1 Uterine fibroid – https://vimeo.com/149599112

Video 3.1 Endometriosis – https://vimeo.com/149606168

Video 4.1 Adenomyosis – https://vimeo.com/149611964

Video 5.1 Ovarian cyst – https://vimeo.com/149616411

Video 5.2 Twisted ovarian cyst Laparoscopic Right Salpingoophrectomy – https://vimeo.com/149700129

Video 5.3 Laparoscopic surgery for bleeding ovarian cyst – https://vimeo.com/159002671

Video 6.1 Endometrial Polyp – https://vimeo.com/159004117

Video 7.1 Ectopic pregnancy – https://vimeo.com/149705868

Video 8.1 Tubal block and hydrosalpinx – https://vimeo.com/159005056

Video 9.1 Pelvic inflammatory disease – https://vimeo.com/159011692

Video 10.1 Uterovaginal prolapse – https://vimeo.com/149728206

Video 11.1 Congenital uterine abnormalities – https://vimeo.com/159012013

Video 11.2 Excision of non communicating uterine horn – https://vimeo.com/159012375

Video 15.1 Laparoscopic Surgery in Gynaecology an overview – https://vimeo.com/149733613

Video 17.1 Complications of laparoscopic surgery – https://vimeo.com/149741703

Video 18.1 Laparoscopic tissue removal – https://vimeo.com/155090018

Video 19.1 How is single incision laparoscopic surgery performed – https://vimeo.com/149741718

Video 19.2 Single incision bilateral tubal ligation with Filshie’s clip – https://vimeo.com/149741716

Video 19.3 Single incision laparoscopic salpingoophrectomy for ovarian cyst – https://vimeo.com/149741720

Video 19.4 Single incision laparoscopic cystectomy – https://vimeo.com/149741715   

Video 19.5 Single incision laparoscopic salpingectomy for Ectopic Pregnancy – https://vimeo.com/149741723

Video 19.6 Single Incision Total Laparoscopic Hysterectomy – https://vimeo.com/149741719

Video 19.7 Single Incision Laparoscopic Myomectomy – https://vimeo.com/149741721

Video 20.1 3D laparoscopy – https://vimeo.com/159012750

Video 22.1 Laparoscopic sterilization – https://vimeo.com/149484799

Video 23.1 Laparoscopic surgery for polycystic ovarian syndrome – https://vimeo.com/159013473

Video 24.1  How is laparoscopic myomectomy performed? – https://vimeo.com/150033425

Video 24.2 Laparoscopic myomectomy for a large uterine fibroid – https://vimeo.com/150296714

Video 24.3 Laparoscopic myomectomy for a large submucous fibroid – https://vimeo.com/150158638

Video 25.1 Laparoscopic surgery for endometriosis – https://vimeo.com/149998622

Video 25.2 Laparoscopic cystectomy for endometrioma and ovarian cysts – https://vimeo.com/149998620

Video 25.3 Laparoscopic surgery for rectovaginal endometriosis – https://vimeo.com/159015020

Video 25.4 Laparoscopic management of bladder endometriosis – https://vimeo.com/163190083

Video 26.1 Laparoscopic salpingectomy for ectopic pregnancy – https://vimeo.com/149858701

Video 26.2 Laparoscopic salpingotomy for ectopic pregnancy – https://vimeo.com/149858702

Video 26.3 Laparoscopic resection of cornual ectopic pregnancy – https://vimeo.com/150044031

Video 26.4 Laparoscopic excision of ovarian ectopic pregnancy – https://vimeo.com/149858698

Video 26.5 Laparoscopic salpingoophrectomy for a large ectopic pregnancy with a concomitant intrauterine pregnancy heterotrophic pregnancy – https://vimeo.com/149858699

Video 27.1 Laparoscopic cystectomy for a large Dermoid cyst – https://vimeo.com/150455054

Video 27.2 Laparoscopic cystectomy for a mucinous cystadenoma – https://vimeo.com/159017867

Video 27.3 Laparoscopic salpingoophrectomy and omentectomy for an ovarian cancer – https://vimeo.com/159018922

Video 28.1 Reversal of tubal ligation – https://vimeo.com/150044038

Video 29.1 Laparoscopic bilateral salpingectomy for bilateral Hydrosalpinx – https://vimeo.com/150044052

Video 29.2 Laparoscopic bilateral fimbrioplasty for bilateral Hydrosalpinx – https://vimeo.com/150044057

Video 29.3 Hysteroscopic Cannulation for Proximal Tubal Block – https://vimeo.com/150044067

Video 29.4 Laparoscopic salpingectomy for a twisted gangrenous hydrosalpinx – https://vimeo.com/159019614

Video 30.1 Laparoscopic salpingectomy in a patient with recurrent pelvic inflammatory disease – https://vimeo.com/159027900

Video 30.2 Laparoscopic adhesiolysis and fimbrioplasty done followed by a successful IVF cycle – https://vimeo.com/159031234

Video 31.1 Laparoscopic excision of adenomyosis – https://vimeo.com/159031690

Video 32.1 Laparoscopic surgery for uterovaginal prolapse – https://vimeo.com/150044077

Video 32.2 Laparoscopic sacrocolpopexy for vaginal vault Prolapse – https://vimeo.com/150044082

Video 32.3 Subtotal hysterectomy and sacrocolpopexy – https://vimeo.com/150044086

Video 33.1 Total laparoscopic hysterectomy – https://vimeo.com/150079694

Video 33.3 Total laparoscopic hysterectomy for severe endometriosis – https://vimeo.com/150079701

Video 34.1 Total laparoscopic hysterectomy and pelvic lymphadenectomy for endometrial cancer – https://vimeo.com/159032432

Video 35.1 Laparoscopic radical hysterectomy for cervical cancer – https://vimeo.com/150127506

Video 36.1 Overview of hysteroscopy – https://vimeo.com/150239548

Video 37.1 Diagnostic Hysteroscopy – https://vimeo.com/150317709

Video 40.1 Hysteroscopic resection of uterine septum – https://vimeo.com/159033073

Video 41.1 Transcervical resection of fibroid – https://vimeo.com/149851760

Table of Contents

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