Laparoscopic Videos from World Laparoscopy Hospital

Laparoscopic Myomectomy for Multiple Myoma

Laparoscopic myomectomy in multiple fibroids. Myomectomy is the surgery of choice for women who have symptomatic fibroids and who wish to retain their uterus. ... It is known that uterine fibroids are estrogen dependent. During pregnancy these fibroids increase in size, whereas in the puerperium and menopause they shrink. In laparoscopic or robotic myomectomy, minimally invasive procedures, your surgeon accesses and removes fibroids through several small abdominal incisions. Laparoscopic myomectomy. Your surgeon makes a small incision in or near your bellybutton. Then he or she inserts a laparoscope ― a narrow tube fitted with a camera ― into your abdomen. Your surgeon performs the surgery with instruments inserted through other small incisions in your abdominal wall. Robotic myomectomy. Instruments are inserted through small incisions similar to those in a laparoscopic myomectomy, and the surgeon controls movement of instruments from a separate console. Sometimes, the fibroid is cut into pieces and removed through a small incision in the abdominal wall. Other times the fibroid is removed through a bigger incision in your abdomen so it can be removed without being cut into pieces. Rarely, the fibroid may be removed through an incision in your vagina (colpotomy).

Laparoscopic Cholecystectomy for Stone impacted at Hartmann's pouch

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Cholecystectomy for Stone impacted at Hartmann's pouch. Manipulating the gallbladder with the left-hand instrument is a key part of performing a laparoscopic cholecystectomy. In these case stone should be removed from hartmann pouch. If a stone is impacted in the Hartmann’s pouch, this manipulation can be difficult, and can cause cramp and exhaustion of the surgeon’s left hand or injury to the gallbladder if a toothed instrument is used to improve grip. For the experienced laparoscopic surgeon, this tip makes manoeuvrability of the thickened, impacted Hartmann’s pouch simpler. We have used it in the acute and elective setting to great effect. The tape provides gentle traction and can be resisted easily if there are any concerns about placement as dissection continues.

Lecture on Laparoscopic Appendectomy for Acute Appendicitis

https://www.laparoscopyhospital.com/ This video is lecture of Dr R K Mishra on Laparoscopic Appendectomy. Laparoscopic Appendectomy can be performed by single incision, two port or three incisions, one umbilical and one suprapubic are made; permanent material used comprises: grasping forceps, hook, scissors, needle holders, three metal trocars and four other usual instruments, and a single strand of cotton. There is possibility of using endobag and in few cases no need to use of operative extractors bags, clips, endoloops, staples or bipolar or harmonic energy instruments. Allows triangulation and instrumentation in the conventional manner.

Mishra's Knot - Ideal for Laparoscopic Cholecystectomy

This video demonstrate Mishra's Knot used in laparoscopic cholecystectomy. This is an Ideal for Laparoscopic Cholecystectomy. Tying extracorporeal knot to the cystic duct has many advantages. This knot is also can be used for in mass ligation and partial cholecystectomy.

Laparoscopic inguinal hernia repair "IPOM" with Dual-Mesh

https://www.laparoscopyhospital.com/ This video demonstrate laparoscopic inguinal hernia by IPOM. Dr R K Mishra report their experience on laparoscopic hernioplasty using the Intraperitoneal Onlay Mesh Repair (IPOM). Many patients had a bilateral hernia, and many of which were recurrent and some had recurrent hernia. Overall, a total of 85 hernias were treated. The hernia repair was performed utilizing Polyurathane Dual Mesh. The prostheses were fixed with titanium spiral tacks (Protack, AutoSuture, Tyco Healthcare). No intraoperative complications occurred and no conversion was necessary. Mean resumption of normal activity was 10 days with return to work within two weeks. At an average 24 months follow-up, were recorded. The results of this study as well as the meta-analysis of the series presented in the Literature, indicate that the IPOM may be a feasible, safe and effective procedure in the treatment of inguinal hernia repair is performed during other laparoscopic procedures. The IPOM has infact been shown to be faster and easier than the other more commonly performed laparoscopic hernioplasties (TAPP and TEP). These data may also suggest to utilize this technique in particular cases of primitive hernia such as very active young males or heavy duty workers. However the limited experience and the short follow-up ask for long term studies to definitely ascertain the true incidence of recurrence and therefore the effectiveness of this attractive procedure.

Cholecystectomy and Appendectomy together by Mishra's knot.

https://www.laparoscopyhospital.com/SERV02.HTM Combined laparoscopic appendectomy and cholecystectomy produces good outcomes than either procedure performed independently, with a not increased incidence of wound complications and morbidity. Overall, however, patients who undergo simultaneous procedures appear much faster recovery. Further investigation is needed to define appropriate indications for these concomitant procedures as well as to identify the key factors that determine outcomes. An operative experience of three patients who underwent incidental laparoscopic appendectomy during laparoscopic cholecystectomy is presented. The technique and indications is shown in this video. We conclude with our experience that incidental laparoscopic appendectomy is possible and safe with existing incisions performed in gallbladder surgery. However, well-controlled prospective studies should be performed prior to wide application of this technique.

Laparoscopic Cholecystectomy with Laparoscopic Ovarian Drilling

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Cholecystectomy with Laparoscopic Ovarian Drilling in same patient by Dr R K Mishra at World Laparoscopy Hospital. Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women who have polycystic ovary syndrome (PCOS). Electrocautery or a laser is used to destroy parts of the ovaries. A laparoscopic cholecystectomy is a surgery during which the doctor removes your gallbladder. This procedure uses several small cuts instead of one large one. A laparoscope, a narrow tube with a camera, is inserted through one incision. This allows surgeon to see gallbladder on a HD monitor. Laparoscopic cholecystectomy is Gold standard for Gallstone disease.

Laparoscopic Extracorporeal Square Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Extracorporeal Square Knot. Laparoscopic Square knot is used for any structure which is tough and under tension. It can be used for approximation of vaginal vault, Rectus Divarication, Myomectomy, Crural Approximation etc...

Laparoscopic Surgeon's Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ Laparoscopic knot-tying is an advanced skill. The traditional surgeon's knot is often used in laparoscopic surgery for every tissue. Surgeons knot is most versatile knot in laparoscopic surgery. It can be used in many situations like bowel anastomosis, pyeloplasty, tubal recanalization etc... Surgeons knot can be terminated at the end of a continuous suture line in laparoscopic surgery by again surgeons knot or square knot. The Aberdeen knot has been shown to be stronger and more secure than the surgeon's knot for ending a suture line but is rarely used in laparoscopic surgery. We have developed a new technique to make the surgeons knot laparoscopically. Any surgeon's concern about the ease and safety of laparoscopic knotting is natural, and knots performed laparoscopically must be as safe as those traditionally performed. A knot should secure proper tissue approximation, and be simple, easy, quick, and reliable.

Retroperitoneoscopic Nephrectomy and Ureterolithotomy

https://www.laparoscopyhospital.com/ This video demonstrate Retroperitoneoscopic Nephrectomy and Ureterolithotomy. The emergence of minimally invasive surgery about 20 years ago revolutionized urological surgery. Advances in retroperitoneoscopy allowed the widespread use of minimally invasive techniques in almost the entire range of urology. In this context, laparoscopy and later retroperitoneoscopy were developed and applied in a wide spectrum of urological diseases. Both approaches have since presented benefits and disadvantages that have been documented in various series. However, few comparative studies have been conducted. Retroperitoneoscopy can be accomplished placing the patient in lateral or prone position. This technique requires experience to find the way to the retroperitoneum. The main landmark during surgery is the psoas muscle. The prone approach is very versatile because it gives the surgeon the chance to reach the adrenal gland and the upper and lower urinary tract, and also allows a bilateral procedure to be achieved. Furthermore, this access leaves the kidney in place and has the advantage of a direct approach to the vessels. On the other hand, it is not the best option when mobilization of the lower ureter and urgent conversion are needed.

Gastrointestinal Endoscopy Procedure Preparation & Risks

https://www.laparoscopyhospital.com/ This video is lecture of Gastrointestinal Endoscopy Procedure Preparation & Risks by Dr. R. K. Mishra at World Laparoscopy Hospital. Endoscopy has several names, depending on which portion of digestive tract by physician seeks to inspect. Upper GI endoscopy (EGD): This procedure enables the examination of the esophagus, stomach and the upper small bowel called duodenum. Colonoscopy: This procedure enables the doctor to see ulcers, inflamed mucous lining of your intestine, abnormal growths and bleeding in your colon, or large bowel. Enteroscopy: Enteroscopy is a recent diagnostic tool that allows a doctor to see your small bowel. The procedure may be used in the following ways: To diagnose and treat hidden GI bleeding To detect the cause for malabsorption To confirm problems of the small bowel seen on an X-ray During surgery, to locate and remove sores with little damage to healthy tissue

Laparoscopic Management of Ovarian Teratoma

https://www.laparoscopyhospital.com This video demonstrate laparoscopic cystectomy for ovarian teratoma. Germ cell tumours begin in egg cells in women or sperm cells in men. There are 2 main types of ovarian teratoma: mature teratoma, which is non cancerous (benign). immature teratoma, which is cancerous. Immature teratomas are usually diagnosed in girls and young women up to their early 20s. These cancers are rare. They are called immature because the cancer cells are at a very early stage of development. Most immature teratomas of the ovary are cured, even if they are diagnosed at an advanced stage. Keywords: Laparoscopy, Dermoid cyst, Ovarian cyst, Operative laparoscopy. Benign cystic teratomas, or dermoid cysts, are germ cell tumors of the ovary that account for 20-25% of all ovarian tumors and are bilateral in 10-15% of cases. They have a low incidence of malignancy, reported as 1-3%. The majority of dermoid cysts are asymptomatic and are often discovered incidentally upon pelvic exam. The potential for complications such as torsion, spontaneous rupture, risk of chemical peritonitis, and malignancy usually makes surgical treatment necessary upon diagnosis. Traditional therapy for a dermoid cyst has been cystectomy or oophorectomy via laparotomy. The laparoscopic approach has become increasingly accepted since 1989. Because most patients with cystic teratomas are of reproductive age, a conservative approach is ideal; laparoscopy may minimize adhesion formation and thus decrease the chance of compromising fertility. The management of ovarian teratomas in normal conditions is well established, but in rare giant cases (tumor diameter over 15 cm), the choice of management, such as laparotomic or laparoscopic approaches, are controversial and may be therapeutically challenging for surgeons.

Laparoscopic Removal of Huge Ovarian Cyst

https://www.laparoscopyhospital.com/gynaecological-laparoscopy.html Laparoscopic surgery has been increasingly applied to different gynecologic ovaries surgical problems with excellent surgical outcome and rapid recovery. Large ovarian cysts, a relatively common gynecologic problem, pose certain challenges to laparoscopic management. Laparoscopy is a safe technique for managing patients with large ovarian cysts and is associated with low conversion and complication rates. The chance of finding unexpected ovarian cancer varies according to the patients’ selection criteria but is low overall. With proper patient selection, the size of an ovarian cyst should not constitute a contraindication to laparoscopic surgery. Experience in advanced laparoscopic surgery and the availability of a gynecologic oncologist should make the procedure safely applicable to a broader patient population.

Laparoscopic PCOD Management

https://www.laparoscopyhospital.com/gynaecological-laparoscopy.html This video demonstrate laparoscopic ovarian drilling for PCOS (Polycystic Ovary Syndrome) Treatment. The exact mechanism of Ovarian Drilling in PCOS is yet to be elucidated. The most plausible one is the destruction of ovarian follicles and stroma resulting in a decrease in androgen and inhibin levels and a secondary rise in follicle-stimulating hormone (FSH) levels. Production of inflammatory growth factors like insulin-like growth factor-1, in response to thermal injury is in Laparoscopic Ovarian Drilling to Treat PCOS Infertility, further potentiates the actions of FSH on folliculogenesis, while increased blood flow to the ovary provoked by surgery, facilitates increased delivery of gonadotropins. The number of punctures is empirically chosen depending on the ovarian size. In the original procedure, 3-8 diathermy punctures (each of 3 mm diameter and 2-4 mm depth) per ovary were applied, using power setting of 40W W for 2-4 s

Sleeve Gastrectomy

https://www.laparoscopyhospital.com/bariatric-surgery.html This video demonstrate laparoscopic sleeve gastrectomy performed by Dr R K Mishra at World Laparoscopy Hospital. The laparoscopic sleeve gastrectomy (SG) or gastric sleeve surgery, involves re-shaping the stomach from a pouch-like shape into a long tube, or “sleeve”. Pre-surgery the stomach looks like a kidney bean and can expand to the volume of several liter-size bottles of soda. With staples, the stomach is converted to look like a banana. This weight loss surgery reduces the capacity and prevents the stomach from expanding significantly. Before sleeve gastrectomy a regular stomach can hold about six cups of food. The new small stomach can hold about a half cup in volume, resulting in a ‘restrictive’ weight loss of the person. This type of laparoscopic sleeve gastrectomy bariatric surgery can be done as a stand-alone procedure or as part of a staged operation. The weight loss is projected to be in the range of 55 to 70 percent of excess body weight. There is no malabsorption created and no foreign body or implant involved. Long-term results are becoming available and the data suggest the weight loss is similar to gastric bypass.

Laparoscopic Tumble Square Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Tumble Square Knot. Laparoscopic Tumble Square Knot is the only knots that can be used when the suture does not slide freely through the tissue and anchoring device. Laparoscopic Tumble Square Knot configurations also theoretically avoid suture damage from abrasion and tissue damage during sliding. The major disadvantage of static knots is the propensity of the loop to loosen before the second half-hitch is seated to the point that it provisionally “locks” the knot. One method of minimizing this effect is by using a maryland to push the square knot on which one limb is tumbled which holds the tissue loop tight as it advances sequential half-hitches.

Laparoscopic sleeve gastrectomy with endoscopic calibration

Endoscopic calibration is associated with lower postoperative complications after laparoscopic sleeve gastrectomy. The use of the endoscope for the calibration of the gastric sleeve, instead of the standard use of the bougie, is a safe procedure and gives the surgeon a higher sense of security. The aim is to evaluate the effect of the use of endoscopic guidance on postoperative complications and mid-term results of the bariatric procedure. Gastrointestinal complication after sleeve gastrectomy surgery may be summarized as follow: acute bleeding and/or anemia, staple-line complications such as anastomotic leaks, fistulae, and strictures, erosion and slippage, bezoars, and choledocholithiasis. An endoscopy is the preferred strategy, unless there is a suspicion of leaks or fistulae, in which case preliminary contrast radiography may be more appropriate. Endoscopic treatment plays an important role in the management of a variety of staple-line complications during and even after surgery, such as stomal stenosis and anastomotic leaks. The intraoperative tightness check with blue dye and air insufflation through an orogastric tube in the bougie calibration group is done in all the patients. In the endoscopic calibration the check with blue dye is much better in all cases.

Unedited Laparoscopic Hysterectomy - Dr. R. K. Mishra

https://www.laparoscopyhospital.com/ Minimal Access Laparoscopic Hysterectomy is becoming a very common procedure, although significant concerns about the procedure voiced by many gynecologists are twofold: The ability to confidently close the vaginal cuff laparoscopically and the fear of cuff dehiscence and ureteric injury. This has resulted in many practitioners securing the uterine artery vaginally and closing the cuff vaginally, which increases operating time, or converting to LAVH or LSH. We have developed a nice desiccation technique of uterine artery during Total Laparoscopic Hysterectomy and vaginal cuff closure technique following TLH that incorporates the same surgical principles as closure for an abdominal hysterectomy. It is easy to learn and simple continuous suturing is required intracorporeally to close the vault. Mean surgical time is half an hour. This video demonstrates the use of a vessel sealing device to perform a laparoscopic hysterectomy with an obliterated posterior cul-de-sac. This technique demonstrates how to dissect the anterior compartment first. Then we controlled the large uterine vessels.

Laparoscopic Suturing Melzer's Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ Laparoscopic suturing and knot tying require a lot of patience and practice and can be difficult, time consuming, and frustrating in spite of the advances made in the fields of instrumentation, optics, and imaging. The new technique described here is an effort to make the procedure simpler by providing extracorporeal control of one limb of the suture. It involves percutaneous placement of the needle end of the suture in the abdomen and its removal using a modified 10 cm long cloth-sewing needle.

Laparoscopic Tayside Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Tayside Knot. This is an extracorporeal knot can be used to ligate tubular structure. The Tayside knot is suitable for use with all braided sutures (2/0 or stronger) as well as dacron. It is used with Dacron for ligation of vessels such as the azygous vein, splenic artery/vein or the inferior mesenteric artery/vein. A variety of slipknots are used by various professions and in certain leisure activities. Some of these have been adapted for use in endoscopic surgery. The holding strength of individual types of slipknots is influenced by a number of factors including the ligature material used and its caliber. Thus a slipknot may be secure when tied in catgut but unsafe with other materials. In addition, some slipknots are difficult to tie or jam lock too easily for reliable placement by push rod before locking.

Sleeve Gastrectomy in Patient Previously operated for Ventral Hernia

Generally it should not be a problem to have a sleeve after incisional hernia repair, even with mesh. You do not need to worry about the insufflation of the abdomen stretching the mesh if you go through palmer's point. All laparoscopic incisions are small and do not disrupt the integrity of the mesh. The only incision that is a little larger is the one that the resected stomach is removed through. Ideally you want to do the sleeve laparoscopically. Yes, there will be a lot of adhesions, but an experienced laparoscopic bariatric surgeon can get it done with the laparoscope. The mesh can be re-sewn and it will heal fine. It is hard to say for sure without knowing where on your abdominal wall the mesh was placed, but I have operated on numerous patients with prior hernia repairs and it isn't a challenge that can't be overcome. If the hernia was from a prior C-section, meaning lower on your abdominal wall, then the laparoscopic port sites for a VSG should not interfere.

Gastric Banding

https://www.laparoscopyhospital.com/ Laparoscopic gastric banding is surgery to help with weight loss. The surgeon places a band around the upper part of your stomach to create a small pouch to hold food. The band limits the amount of food you can eat by making you feel full after eating small amounts of food. A plastic tube runs from the silicone band to a device just under the skin. Saline (sterile salt water) can be injected or removed through the skin, flowing into or out of the silicone band. Injecting saline fills the band and makes it tighter. In this way, the band can be tightened or loosened as needed to reduce side effects and improve weight loss.

How to Perform Safe Laparoscopic Appendectomy - Lecture by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate How to Perform Safe Laparoscopic Appendectomy - Lecture by Dr R K Mishra. Appendicitis is one of the most common surgical problems and appendectomy is one of the most common surgery. One out of every 2,000 people has an appendectomy sometime during their lifetime. Treatment requires an operation to remove the infected appendix. Traditionally, the appendix is removed through an incision in the right lower abdominal wall. ADVANTAGES OF LAPAROSCOPIC APPENDECTOMY: Results may vary depending upon the type of procedure and patient’s overall condition. Common advantages are: Less postoperative pain May shorten hospital stay May result in a quicker return to bowel function Quicker return to normal activity Better cosmetic results

Total Laparoscopic Hysterectomy with Bilateral Salpingo Oophorectomy

https://www.laparoscopyhospital.com/ This video demonstrate TLH with BSO by Dr R K Mishra at World Laparoscopy Hospital. The use of laparoscopic hysterectomy has recently been reported as an alternative to traditional abdominal hysterectomy and the utilization of a mini-endoscopic technique has also been recorded. This prospective randomized study has demonstrated that after laparoscopic hysterectomy, patients recovered more quickly and had less pain, and the incidence of complications was also low. One serious complication after laparoscopic hysterectomy is increased ureteric injury, but in our opinion it is possible to avoid major complications by paying particular attention to the surgical details.

Dundee Jamming Knot and Aberdeen Termination demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This Video demonstrate Dundee Jamming Knot Continuous Suturing and Aberdeen Termination. Continuous suturing is required in laparoscopic surgery to close delicate long suture line. It can be started with Dundee Jamming Knot. The final knot of a continuous suture can be accomplished in the traditional way of open surgery as Aberdeen Termination. Dundee Jamming Knot and Aberdeen Termination are two surgical knots in the same direction and a final one in the opposite direction, tying the final loop of the continuous suture with the end of the suture with the needle, or it is possible to recur to the “Aberdeen knot,”8 in which a final knot is accomplished by creating a new loop in the already existing one. The final loop of the suture is kept loosely; then, grasping the needle with the assistant needle holder, the needle holder is inserted into the loop, and the suture thread is grasped at its middle and retracted without the grasper dropping the needle. This process generates a new loop in the already existing one, which is tied guiding the needle holder through the loop and applying countertraction between the needle holder and the assistant needle holder. This procedure is repeated twice. Finally, the end of the suture is guided with the needle through the last generated loop, and, using retraction, the final tightening of the knot is performed. If, at the end of the suture, the thread were too short to accomplish one of the described procedures.

Torted Ovarian Dermoid Cyst in 7 Year Old Girl

Ovarian torsion in children is an uncommon cause of acute abdominal pain but mandates early surgical management to prevent further adnexal damage. The clinical presentation mimics other pathologies, such as appendicitis. Ovarian torsion should be considered in any female child with acute onset lower abdominal pain accompanied by vomiting. Pain can be characterized as constant or colicky, but unlike with appendicitis, does not typically migrate. Sterile pyuria is found in a substantial proportion of cases. Ultrasound is the most useful initial diagnostic modality, but the absence of flow on Doppler imaging is not always present. Conservative management with detorsion and oophoropexy is recommended.

Laparoscopic Radical Hysterectomy

https://www.laparoscopyhospital.com/ This video is lecture of Laparoscopic Radical Hysterectomy by Dr R K Mishra. This procedure is used to treat stage I or IIA cervical cancer. Radical hysterectomy involves surgical removal of the uterus, the supporting ligaments and the upper vagina, together with removal of the pelvic lymph nodes and sometimes the para-aortic lymph nodes. Laparoscopic radical hysterectomy is a feasible alternative to laparotomy for early stage cervical cancer. Similar surgical outcomes are achieved with significantly less morbidity.

Laparoscopic Sleeve Gastrectomy Surgery Video Explained Step by Step

This video demonstrate Laparoscopic Sleeve Gastrectomy which is a popular Bariatric Surgery for morbid obesity. Sleeve gastrectomy is a simpler bariatric operation than the gastric bypass procedure for morbid obesity because it does not involve rerouting of or reconnection of the intestines. The sleeve gastrectomy, unlike the Lap-band, does not require the use of a banding device to be implanted around a portion of the stomach. Laparoscopic Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. The sleeve gastrectomy, by reducing the size of the stomach, allows the patient to feel full after eating less and taking in fewer calories. The surgery removes that portion of the stomach that produces a hormone that can makes a patient feel hungry.

Dangerous way of Performing Laparoscopic Cholecystectomy

https://www.laparoscopyhospital.com/ This Video demonstrate a dangerous way of Performing Laparoscopic Cholecystectomy by Harmonic Scalpel In Mass Shearing. Ideally a nice dissection of calot's triangle with critical view of safety should be done. World wide laparoscopic cholecystectomy (LC) has become the customary method for treating gallstones, some incidents and complications appear rather more frequently than with the open technique. Several aspects of these complications and their treatment possibilities are analysed and clipless cholecystectomy with Harmonic scalpel is one of them. During the past decade world wide laparoscopic cholecystectomy has become the procedure of choice in the surgical treatment of symptomatic gallstone. The operation is not completely risk-free, some incidents and complications being more frequent than with open cholecystectomy. The use of the Harmonic scalpel is deemed safe and comparable to clip placement at the discretion of the surgeon for cystic duct ligation. According to the article published by many author, harmonic shears is effective and safe in laparoscopic cholecystectomy as a sole instrument for sealing and division of the artery and cystic duct. The main advantages could be related to the safety and decreased operative time. Further research with larger homogeneous studies and assessments of cost-effectiveness would further enhance the increasing use of the Harmonic scalpel in laparoscopic cholecystectomy.

Obesity Surgery - Vertical Sleeve Gastrectomy

https://www.laparoscopyhospital.com How does the Vertical Sleeve Gastrectomy compare to the other surgeries? Simple operation with low mortality risk. Technically easy to perform with low peri-operative risks. Minimal short-term and long-term complication rates. Short-term risks of staple line bleeding or leakage are very rare. The only long-term risk is GERD in some patients. Weight loss comparable with the gastric bypass. Gastric sleeve is not reversible. Part of the stomach is permanently removed. It is important to understand that reversing any weight loss operation (such as gastric band or gastric bypass) will result in weight regain back to original weight. You should not have any weight loss operation if you intend to ever reverse it. Though gastric sleeve is not reversible, it can be changed to gastric bypass if there was any need. Most illnesses that are related to obesity can be improved or even cured by weight loss surgery. These include: sleep apnoea, diabetes, high cholesterol, hypertension, stress incontinence, depression, acid reflux, joint pain, as well as osteoarthritis. Losing weight for obese patients also means greater outcomes from pregnancy, increased fertility, and a lower risk of cancer. The surgery increases life expectancy, on the whole.

Torted Ovarian Dermoid Cyst in Pregnant Patient

https://www.laparoscopyhospital.com/ This video is Laparoscopic management of Torted Ovarian Dermoid Cyst in Pregnant Patient. Dermoid cyst (Mature cystic teratoma), the most common type of primordial germ cell ovarian tumors is usually benign and asymptomatic. It can be malignant in 5% of cases. The incidence of torsion in pregnant patients with ovarian cyst persisting during pregnancy is approximately 15%. Benign dermoid cysts/teratomas are the most frequent ovarian tumors, with an incidence ranging from 5% to 25% of all ovarian neoplasms [3]. They are of germ cell origin and composed of multiple types of tissue. Torsion of the cystic contents and ovary may occur in them, thus leading to vascular infarction and necrosis. Torsion of the pedicle has been reported to be the most frequent complication, occurring in 16.1% of cases [3]. Traditional risk factors for ovarian torsion are increased ovarian size, ovarian tumors, ovarian hyperstimulation, and pregnancy

Basic Steps of Hysterectomy

https://www.laparoscopyhospital.com/ This video demonstrate step by step total laparoscopic hysterectomy. Hysterectomy is the removal of the uterus with surgery. There are many reasons a hysterectomy can be performed such as fibroids, heavy or irregular menstrual bleeding, prolapse, chronic uterine pain, pelvic inflammatory disease, pre-cancerous conditions, cancer and endometriosis. hysterectomy depending on the clinical circumstances. A hysterectomy can be performed using a laparoscope, which is a thin keyhole camera that allows the surgeon to see the pelvic organs. The laparoscope and other instruments are inserted through small incisions in the skin and then used by the surgeon to remove the uterus. hysterectomy depending on the clinical circumstances. A hysterectomy can be performed using a laparoscope, which is a thin keyhole camera that allows the surgeon to see the pelvic organs. The laparoscope and other instruments are inserted through small incisions in the skin and then used by the surgeon to remove the uterus.

Laparoscopic Weston Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ The Weston slip knot was initially described in the obstetric and gynecology literature and is also used in arthroscopic surgery.The advantage of this knot is that it is relatively easy to tie outside, can then slip easily into place and be tightly secured. The post strand does not move throughout the knot; the loop strand is the longer strand which is moved to make the knot. The advantage of the Weston knot is that it locks readily and is not bulky.

Laparoscopic Nephrectomy Lecture by Dr R K Mishra

This video is of Laparoscopic Nephrectomy Lecture by Dr R K Mishra. A laparoscopic nephrectomy is minimally invasive operation to remove kidney. A laparoscopic nephrectomy involves removing an entire kidney through keyhole incisions in the flank, the side of the body between the ribs and the hip. A laparoscopic nephrectomy removes the kidney by using laparoscopic equipment. Long thin instruments are passed through up to five small incisions made in the flank, each about 1cm in length. The abdomen is first filled with carbon dioxide, which separates the tissues to allow for vision during the surgery. A camera is then passed, giving the urologist a detailed picture inside the abdomen. The other incisions are used to pass cutting and suturing instruments so the blood supply to the kidney can be isolated and tied off and the kidney removed either with or without its surrounding structures. A wound drain is then inserted to drain any wound ooze. This is usually stitched in place and stays in for 1 – 2 days. A nephrectomy is usually done for one of two reasons, either for cancer of the kidney or because of a non- functioning kidney. In the case of kidney cancer a radical laparoscopic nephrectomy is done. This is done in an attempt to rid the body of cancer by removing the entire kidney and adrenal gland, with its surrounding fat and attached vessels. In more advanced cases it may be done to stop continued bleeding from the effected kidney. For non-functioning kidneys, which are either caused by large stones, a lack of blood supply or abnormal kidney structure, a simple laparoscopic nephrectomy is done. This is where only the kidney itself is taken and the adrenal gland and other structures are left behind. A simple nephrectomy is usually done to avoid recurrent infection and pain and the possibility of severe illness because of infection.

Rudimentary Uterus

https://www.laparoscopyhospital.com This video demonstrate rudimentary uterus with absence of both ovaries and 46 ,XX normal karyotype. Genetic investigation revealed a 46,XX karyotype without any mosaicism. Diagnostic laparoscopy was performed. During laparoscopic pelvic exploration, a rudimentary uterus without ovaries and normal bilateral fallopian tubes were observed. If gonadal agenesis is thought to be the cause of primary amenorrhea in patients with normal secondary sexual characteristics, we believe that laparoscopic evaluation is the gold standard in diagnosis.

Laparoscopic Management of Chronic Ectopic and Myomectomy in same patient

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Management of Chronic Ectopic and Myomectomy in same patient at same session. Chronic ectopic pregnancy is a form of tubal pregnancy in which salient minor ruptures or abortions of an ectopic pregnancy instead of a single episode of bleeding, incites an inflammatory response often leading to the formation of a pelvic mass. Ectopic pregnancy presents diagnostic dilemmas in the absence of classical symptoms. MRI and laparoscopy are important tools in such cases. If patient has fibroid uterus it can be operated at same session.

Laparoscopic Surgery for Ectopic Pregnancy - Lecture by Dr R K Mishra

This video is lecture of Dr R K Mishra on laparoscopic management of ectopic pregnancy. Most ectopic pregnancies occur in the fallopian tube, but they can also happen in the neck of the womb, in the ovary, or in the abdominal cavity. Laparoscopic Salpingostomy or Salpingectomy is the method of choice for the management of ectopic pregnancy. In a normal pregnancy, fertilization occurs in the fallopian tubes, where an egg, or ovum, meets a sperm cell. The fertilized egg then travels into the uterus and becomes implanted in the womb lining. The embryo develops into a fetus and remains in the uterus until birth. An ectopic pregnancy can be fatal without prompt treatment. For example, the fallopian tube can burst, causing internal abdominal bleeding, shock, and serious blood loss. According to the Centers for Disease Control and Prevention, between 1 and 2 percent of all pregnancies are ectopic. However, ectopic pregnancy is the cause of 3 to 4 percent of pregnancy-related deaths. Ectopic surgery The fallopian tubes can be repaired or removed with surgery. Keyhole surgery can be performed to remove the ectopic tissue. This is also known as a laparoscopy. In a laparoscopy, the surgeon makes a small incision in or near the navel and inserts a device called a laparoscope to view the area. Other surgical instruments are inserted into a tube, or through other small incisions, to remove the ectopic tissue. If the area is damaged, surgeons might be able to repair the fallopian tubes, but they will probably have to remove the affected tube as part of this procedure. If the other fallopian tube is still intact, a healthy pregnancy is still possible. If severe internal bleeding has occurred, a larger incision may be needed. This procedure would be called a laparotomy.

Lecture PPH Stapler piles surgery Step by Step by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate PPH stapled Piles Surgery step by step by Dr R K Mishra. PPH-stapler procedure for treatment of haemorrhoidal prolapse is an important improvement. Haemorrhoidal disease is the most frequent and ancient proctological pathology. Haemorrhoidectomy is always feared for intensive post-operative pain and complications. Stapled hemorrhoidopexy is good procedure but may be followed by severe postoperative complications of which haemorrhage is one of the most serious early events. Surgical techniques have advanced more and more with the aim of reducing the post-surgical complications and to help a faster recovery. “Open hemorrhoidectomy”, according to Milligan-Morgan procedure, has been the most used method in Europe, also in the “Ligasure” and “Ultracision” variants. “Closed hemorrhoidectomy”, according to Ferguson procedure, has been the most used method in the USA. Stapled hemorrhoidopexy (PPH-stapler) is an alternative method to conventional surgical procedures. It has many advantages such as less pain, faster recovery and a quicker return to normal activities. PPH stapler procedure for treatment of haemorrhoidal prolapse.

Laparoscopic Repair of Lumber Incisional Hernia

https://www.laparoscopyhospital.com Lumbar incisional hernias are often diffuse with fascial defects that are usually hard to appreciate. Computed tomography scan is the diagnostic modality of choice and allows differentiating them from abdominal wall musculature denervation atrophy complicating flank incisions. Repairing these hernias is difficult due to the surrounding structures. Principles of laparoscopic repair include lateral decubitus positioning with table flexed, adhesiolysis, and reduction of hernia contents, securing ePTFE mesh with spiral tacks and transfascial sutures to an intercostal space superiorly, iliac crest periosteum inferiorly, and rectus muscle anteriorly. Posteriorly, the mesh is secured to psoas major fascia with intracorporeal sutures to avoid nerve injury. Lumbar incisional hernia must be differentiated from muscle atrophy with no fascial defect. The laparoscopic approach provides an attractive option for this often challenging problem.

Laparoscopic Surgery Training in Dubai

https://www.laparoscopyhospital.com/dubai.html The laparoscopy training institute of World Laparoscopy Hospital in Dubai provides exposure in live operational and surgical procedures. The training also includes practical and theoretical sessions. Free hands-on training in the latest of da vinci laparoscopic robots is also included in the course structure. The world laparoscopy hospital provides a modern facility for micro laparoscopic surgery as they incorporate the application of state of the art HD laparoscopic lab and surgical instruments. At World Laparoscopy Hospital we recognize the value of every psurgeon and are guided by our commitment to excellence and leadership to train them. We demonstrate this by providing exemplary physical, emotional and spiritual care for each of our trainees. We have Fellowship Program in Minimal Access Surgery for Surgeons and Gynecologists.

Laparoscopic Roeder's knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ Laparoscopic Roeder's knot is one of the oldest knot used in laparoscopic surgery. Laparoscopic Roeder's knot is one of the most popular extracorporeal knot. This technique of the extracorporeal knotting is simple, easy, and reproducible with good knot and loop security and can be used with multifilament suture material of 90cm. Laparoscopic extracorporeal knot is popular for appendectomy, cholecystectomy, and any tubular structure upto 8mm structure.

Laparoscopic Appendectomy - Immediate Laparoscopy is Ideal for Acute Appendicitis

Acute appendicitis is inflammation of the appendix, the narrow, finger-shaped organ that branches off the first part of the large intestine on the right side of the abdomen. This video demonstrate laparoscopic appendectomy performed for acute appendicitis by Dr R K Mishra. Although the appendix is a vestigial organ with no known function, it can become diseased. Acute appendicitis remains the most common surgical emergency. The lifetime risk of developing an appendicitis is reported to be 6.7% in females and 8.7% in males. The peak incidence occurs in the first and second decade of life, while it is uncommon to face appendicitis in children younger than 5 years of age. The clinical presentation may be varied and often is similar to other medical conditions, so a misdiagnosis can be frequent and the most common one is usually gastroenteritis. Our diagnostic and therapeutic protocol from about ten years was the following: if the patient was thought to have an acute appendicitis preoperatively diagnosed by physical, laboratory findings and ultrasound examination, antibiotic treatment was started immediately with laparoscopic appendectomy. Laparoscopy is now demonstrated to be the optimal approach also to treat complicated appendicitis, but this standardized operation is not always easy to perform for new surgeons.

Laparoscopic Surgery for Hydatid Cyst Disease

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic lecture of treatment of hydatid disease of the liver is an alternative to open surgery in well-selected patients. Important steps are the evacuation of the cyst contents without spillage, sterilization of the cyst cavity with scolicidal agents and cavity management using classical surgical techniques. The laparoscopic approach is safe with acceptable mortality and morbidity for both conservative and radical resections in selected patients. Clinical outcomes are comparable to open surgery, albeit in a selected group of patients.

Laparoscopic Surgery for Peritoneal Inclusion cyst with Bilateral Endometrioma

This Video demonstrate Laparoscopic Management of Inclusion cyst with Bilateral Endometrioma. Peritoneal inclusion cyst (PIC) is defined as a fluid-filled mesothelial-lined cysts of the pelvis and it is most frequently encountered in women of reproductive age. The treatment options are observation, hormonal management, imaging-guided aspiration, image-guided sclerotherapy and surgical excision. Peritoneal inclusion cysts are uncommon abdominopelvic cysts seen in reproductive age group women. It is often misdiagnosed clinically as an ovarian tumor due to similar presentation and mimicking findings on radiology. We describe a woman presenting with pelvic mass. Her clinical finding on radiology suggested an ovarian tumor; however, biopsy revealed it as peritoneal inclusion cysts.

Laparoscopic Ventral and Incisional Hernia Repair: Pros and Cons

https://www.laparoscopyhospital.com/ This video is lecture of Pros and Cons of Laparoscopic Ventral and Incisional Hernia Repair by Dr. R. K. Mishra at World Laparoscopy Hospital. The purpose of this lecture is to analyse the surgical techniques, perioperative complications, and recurrence rate of laparoscopic ventral hernia repair (LVHR) including incisional Hernia, in comparison with the open ventral hernia repair (OVHR), based on the international literature. Incisional hernia is a common long-term complication of abdominal surgery and is estimated to occur in 3% to 13% of laparotomy incisions. The laparoscopic technique has numerous variations of the methodology used by surgeons, although several common steps are followed by all. The procedure starts with entering the peritoneal cavity by using a Veress needle, an open Hasson method, or an optical trocar allowing view of the abdominal wall layers during penetration. Palmer's point is the best place to access. This lecture indicates that LVHR is a safe and effective approach to abdominal wall hernias. The technique offers the advantages of the laparoscopic approach, ie, a short hospital stay, less postoperative pain, and early convalescence. The procedure carries an acceptable risk of complications compared to open surgery, a low risk of recurrence, and an excellent cosmetic result. It is considered a good alternative to its open counterpart, at least in experienced hands.

Hysterectomy for Large Uterus

https://www.laparoscopyhospital.com This video demonstrate Total Laparoscopic Hysterectomy for Large Uterus. Hysterectomy is the most common gynecologic surgical procedure performed, accounting for 1600,000 procedures per year. The most common indication for a hysterectomy is abnormal uterine bleeding, which is frequently caused by uterine leiomyoma, which is present in 25-50% of reproductive-aged women. Total Laparoscopic Hysterectomy is method of choice for large uterus if surgeon has sufficient experience.

Laparoscopic Nissen fundoplication - Dr R K Mishra

Laparoscopic Nissen fundoplication is a surgical procedure that alleviates gastroesophageal reflux disease (GERD) symptoms when lifestyle changes or anti-reflux medications have not controlled symptoms. The procedure was first performed in 1951 as an open-surgical procedure. Patients were hospitalized for 7 to 10 days after the procedure. Today, the Nissen fundoplication is performed in approximately 90 minutes. A majority of the time the patient is in the hospital overnight and is discharged the morning after surgery. Laparoscopic Nissen fundoplication is one of the popular surgery performed by general surgeon. Almost 90% of all the fundoplication in whole world is now performed via laparoscopic surgery. It is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia. In GERD, it is usually performed when medical therapy has failed; but, with a Type II (paraesophageal) hiatus hernia, it is the first-line procedure. The Nissen fundoplication is total (360°), but partial fundoplications known as Thal (270° anterior), Belsey (270° anterior transthoracic), Dor (anterior 180–200°), Lind (300° posterior), and Toupet fundoplications (posterior 270°) are alternative procedures with somewhat different indications and outcomes. In this procedure, the top part of the stomach (approximately 5 percent) is wrapped around the esophagus to form an additional valve to keep stomach contents from flowing up into the esophagus. The patient has five or six incisions, about ¼-inch each, in the abdomen. Post-operation, after arousing from the anesthesia, the patient is given liquids to drink, advancing then to a soft diet. It is a successful treatment in about 95 percent of the patients who have surgery.

Laparoscopic Mishra's Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This is a video of Laparoscopic Mishra's Knot. Laparoscopic suturing and knotting is important for surgeons and gynecologist. Mishra's Knot is one of the important extracorporeal knot for any tubular structure. Configuration of Mishra's Knot is 1:1:1:1:1:1:1. This knot is secured upto 18mm of tubular structure.

Laparoscopic Fundoplication

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Fundoplication Surgery for GERD. A Nissen fundoplication, or laparoscopic Nissen fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease and hiatal hernia. The fundoplication operation is usually carried out using keyhole surgery (laparoscopy). The surgeon uses a telescope, with a miniature video camera mounted on it, inserted through a small incision (cut) to see inside the abdomen. Carbon dioxide gas is used to inflate the abdomen to create space in which the surgeon can operate using specialised instruments that are also passed through other smaller incisions (cuts) in the abdomen. The operation itself has two parts. Firstly the surgeon will examine the diaphragm to check the size of the opening around the oesophagus. If it too loose, the surgeon will tighten this. The second part of the operation involves wrapping the upper part of the stomach (fundus) around the base of the oesophagus and loosely stitching it in place. This tightens the sphincter enough to reduce reflux but not so tight as to affect swallowing.

Laparoscopic Tubal Patency Test Hysteroscopy and Ovarian Drilling

This surgery was performed to evaluate the effectiveness of hydrolaparoscopy among infertile women with a Polycystic Ovarian Syndrome (PCOS) resistant to clomephine. PCOS is characterized by presence of the hyperandrogenism, oligo- or anovulation. It is one of the most common reproductive endocrine disorders in the adolescent women. Females with PCOS present with a dysregulation in the menstrual cycle, hirsutism, anovulation, acne, and obesity. An approximately 5-10% of women in Poland suffer from PCOS and 10-15% of them are infertile

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Laparoscopic Nephrectomy Lecture by Dr R K Mishra

This video is of Laparoscopic Nephrectomy Lecture by Dr R K Mishra. A laparoscopic nephrectomy is minimally invasive operation to remove kidney. A laparoscopic nephrectomy involves removing an entire kidney through keyhole incisions in the flank, the side of the body between the ribs and the hip. A laparoscopic nephrectomy removes the kidney by using laparoscopic equipment. Long thin instruments are passed through up to five small incisions made in the flank, each about 1cm in length. The abdomen is first filled with carbon dioxide, which separates the tissues to allow for vision during the surgery. A camera is then passed, giving the urologist a detailed picture inside the abdomen. The other incisions are used to pass cutting and suturing instruments so the blood supply to the kidney can be isolated and tied off and the kidney removed either with or without its surrounding structures. A wound drain is then inserted to drain any wound ooze. This is usually stitched in place and stays in for 1 – 2 days. A nephrectomy is usually done for one of two reasons, either for cancer of the kidney or because of a non- functioning kidney. In the case of kidney cancer a radical laparoscopic nephrectomy is done. This is done in an attempt to rid the body of cancer by removing the entire kidney and adrenal gland, with its surrounding fat and attached vessels. In more advanced cases it may be done to stop continued bleeding from the effected kidney. For non-functioning kidneys, which are either caused by large stones, a lack of blood supply or abnormal kidney structure, a simple laparoscopic nephrectomy is done. This is where only the kidney itself is taken and the adrenal gland and other structures are left behind. A simple nephrectomy is usually done to avoid recurrent infection and pain and the possibility of severe illness because of infection.

Torted Ovarian Dermoid Cyst in Pregnant Patient

https://www.laparoscopyhospital.com/ This video is Laparoscopic management of Torted Ovarian Dermoid Cyst in Pregnant Patient. Dermoid cyst (Mature cystic teratoma), the most common type of primordial germ cell ovarian tumors is usually benign and asymptomatic. It can be malignant in 5% of cases. The incidence of torsion in pregnant patients with ovarian cyst persisting during pregnancy is approximately 15%. Benign dermoid cysts/teratomas are the most frequent ovarian tumors, with an incidence ranging from 5% to 25% of all ovarian neoplasms [3]. They are of germ cell origin and composed of multiple types of tissue. Torsion of the cystic contents and ovary may occur in them, thus leading to vascular infarction and necrosis. Torsion of the pedicle has been reported to be the most frequent complication, occurring in 16.1% of cases [3]. Traditional risk factors for ovarian torsion are increased ovarian size, ovarian tumors, ovarian hyperstimulation, and pregnancy

Gastrointestinal Endoscopy Procedure Preparation & Risks

https://www.laparoscopyhospital.com/ This video is lecture of Gastrointestinal Endoscopy Procedure Preparation & Risks by Dr. R. K. Mishra at World Laparoscopy Hospital. Endoscopy has several names, depending on which portion of digestive tract by physician seeks to inspect. Upper GI endoscopy (EGD): This procedure enables the examination of the esophagus, stomach and the upper small bowel called duodenum. Colonoscopy: This procedure enables the doctor to see ulcers, inflamed mucous lining of your intestine, abnormal growths and bleeding in your colon, or large bowel. Enteroscopy: Enteroscopy is a recent diagnostic tool that allows a doctor to see your small bowel. The procedure may be used in the following ways: To diagnose and treat hidden GI bleeding To detect the cause for malabsorption To confirm problems of the small bowel seen on an X-ray During surgery, to locate and remove sores with little damage to healthy tissue

Laparoscopic PCOD Management

https://www.laparoscopyhospital.com/gynaecological-laparoscopy.html This video demonstrate laparoscopic ovarian drilling for PCOS (Polycystic Ovary Syndrome) Treatment. The exact mechanism of Ovarian Drilling in PCOS is yet to be elucidated. The most plausible one is the destruction of ovarian follicles and stroma resulting in a decrease in androgen and inhibin levels and a secondary rise in follicle-stimulating hormone (FSH) levels. Production of inflammatory growth factors like insulin-like growth factor-1, in response to thermal injury is in Laparoscopic Ovarian Drilling to Treat PCOS Infertility, further potentiates the actions of FSH on folliculogenesis, while increased blood flow to the ovary provoked by surgery, facilitates increased delivery of gonadotropins. The number of punctures is empirically chosen depending on the ovarian size. In the original procedure, 3-8 diathermy punctures (each of 3 mm diameter and 2-4 mm depth) per ovary were applied, using power setting of 40W W for 2-4 s

Cholecystectomy and Appendectomy together by Mishra's knot.

https://www.laparoscopyhospital.com/SERV02.HTM Combined laparoscopic appendectomy and cholecystectomy produces good outcomes than either procedure performed independently, with a not increased incidence of wound complications and morbidity. Overall, however, patients who undergo simultaneous procedures appear much faster recovery. Further investigation is needed to define appropriate indications for these concomitant procedures as well as to identify the key factors that determine outcomes. An operative experience of three patients who underwent incidental laparoscopic appendectomy during laparoscopic cholecystectomy is presented. The technique and indications is shown in this video. We conclude with our experience that incidental laparoscopic appendectomy is possible and safe with existing incisions performed in gallbladder surgery. However, well-controlled prospective studies should be performed prior to wide application of this technique.

Laparoscopic Surgery for Peritoneal Inclusion cyst with Bilateral Endometrioma

This Video demonstrate Laparoscopic Management of Inclusion cyst with Bilateral Endometrioma. Peritoneal inclusion cyst (PIC) is defined as a fluid-filled mesothelial-lined cysts of the pelvis and it is most frequently encountered in women of reproductive age. The treatment options are observation, hormonal management, imaging-guided aspiration, image-guided sclerotherapy and surgical excision. Peritoneal inclusion cysts are uncommon abdominopelvic cysts seen in reproductive age group women. It is often misdiagnosed clinically as an ovarian tumor due to similar presentation and mimicking findings on radiology. We describe a woman presenting with pelvic mass. Her clinical finding on radiology suggested an ovarian tumor; however, biopsy revealed it as peritoneal inclusion cysts.

Gastric Banding

https://www.laparoscopyhospital.com/ Laparoscopic gastric banding is surgery to help with weight loss. The surgeon places a band around the upper part of your stomach to create a small pouch to hold food. The band limits the amount of food you can eat by making you feel full after eating small amounts of food. A plastic tube runs from the silicone band to a device just under the skin. Saline (sterile salt water) can be injected or removed through the skin, flowing into or out of the silicone band. Injecting saline fills the band and makes it tighter. In this way, the band can be tightened or loosened as needed to reduce side effects and improve weight loss.

Laparoscopic Sleeve Gastrectomy Surgery Video Explained Step by Step

This video demonstrate Laparoscopic Sleeve Gastrectomy which is a popular Bariatric Surgery for morbid obesity. Sleeve gastrectomy is a simpler bariatric operation than the gastric bypass procedure for morbid obesity because it does not involve rerouting of or reconnection of the intestines. The sleeve gastrectomy, unlike the Lap-band, does not require the use of a banding device to be implanted around a portion of the stomach. Laparoscopic Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. The sleeve gastrectomy, by reducing the size of the stomach, allows the patient to feel full after eating less and taking in fewer calories. The surgery removes that portion of the stomach that produces a hormone that can makes a patient feel hungry.

Laparoscopic Extracorporeal Square Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Extracorporeal Square Knot. Laparoscopic Square knot is used for any structure which is tough and under tension. It can be used for approximation of vaginal vault, Rectus Divarication, Myomectomy, Crural Approximation etc...

Lecture PPH Stapler piles surgery Step by Step by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate PPH stapled Piles Surgery step by step by Dr R K Mishra. PPH-stapler procedure for treatment of haemorrhoidal prolapse is an important improvement. Haemorrhoidal disease is the most frequent and ancient proctological pathology. Haemorrhoidectomy is always feared for intensive post-operative pain and complications. Stapled hemorrhoidopexy is good procedure but may be followed by severe postoperative complications of which haemorrhage is one of the most serious early events. Surgical techniques have advanced more and more with the aim of reducing the post-surgical complications and to help a faster recovery. “Open hemorrhoidectomy”, according to Milligan-Morgan procedure, has been the most used method in Europe, also in the “Ligasure” and “Ultracision” variants. “Closed hemorrhoidectomy”, according to Ferguson procedure, has been the most used method in the USA. Stapled hemorrhoidopexy (PPH-stapler) is an alternative method to conventional surgical procedures. It has many advantages such as less pain, faster recovery and a quicker return to normal activities. PPH stapler procedure for treatment of haemorrhoidal prolapse.

Laparoscopic Surgery Training in Dubai

https://www.laparoscopyhospital.com/dubai.html The laparoscopy training institute of World Laparoscopy Hospital in Dubai provides exposure in live operational and surgical procedures. The training also includes practical and theoretical sessions. Free hands-on training in the latest of da vinci laparoscopic robots is also included in the course structure. The world laparoscopy hospital provides a modern facility for micro laparoscopic surgery as they incorporate the application of state of the art HD laparoscopic lab and surgical instruments. At World Laparoscopy Hospital we recognize the value of every psurgeon and are guided by our commitment to excellence and leadership to train them. We demonstrate this by providing exemplary physical, emotional and spiritual care for each of our trainees. We have Fellowship Program in Minimal Access Surgery for Surgeons and Gynecologists.

Mishra's Knot - Ideal for Laparoscopic Cholecystectomy

This video demonstrate Mishra's Knot used in laparoscopic cholecystectomy. This is an Ideal for Laparoscopic Cholecystectomy. Tying extracorporeal knot to the cystic duct has many advantages. This knot is also can be used for in mass ligation and partial cholecystectomy.

Laparoscopic Myomectomy for Multiple Myoma

Laparoscopic myomectomy in multiple fibroids. Myomectomy is the surgery of choice for women who have symptomatic fibroids and who wish to retain their uterus. ... It is known that uterine fibroids are estrogen dependent. During pregnancy these fibroids increase in size, whereas in the puerperium and menopause they shrink. In laparoscopic or robotic myomectomy, minimally invasive procedures, your surgeon accesses and removes fibroids through several small abdominal incisions. Laparoscopic myomectomy. Your surgeon makes a small incision in or near your bellybutton. Then he or she inserts a laparoscope ― a narrow tube fitted with a camera ― into your abdomen. Your surgeon performs the surgery with instruments inserted through other small incisions in your abdominal wall. Robotic myomectomy. Instruments are inserted through small incisions similar to those in a laparoscopic myomectomy, and the surgeon controls movement of instruments from a separate console. Sometimes, the fibroid is cut into pieces and removed through a small incision in the abdominal wall. Other times the fibroid is removed through a bigger incision in your abdomen so it can be removed without being cut into pieces. Rarely, the fibroid may be removed through an incision in your vagina (colpotomy).

Sleeve Gastrectomy in Patient Previously operated for Ventral Hernia

Generally it should not be a problem to have a sleeve after incisional hernia repair, even with mesh. You do not need to worry about the insufflation of the abdomen stretching the mesh if you go through palmer's point. All laparoscopic incisions are small and do not disrupt the integrity of the mesh. The only incision that is a little larger is the one that the resected stomach is removed through. Ideally you want to do the sleeve laparoscopically. Yes, there will be a lot of adhesions, but an experienced laparoscopic bariatric surgeon can get it done with the laparoscope. The mesh can be re-sewn and it will heal fine. It is hard to say for sure without knowing where on your abdominal wall the mesh was placed, but I have operated on numerous patients with prior hernia repairs and it isn't a challenge that can't be overcome. If the hernia was from a prior C-section, meaning lower on your abdominal wall, then the laparoscopic port sites for a VSG should not interfere.

Laparoscopic Ventral and Incisional Hernia Repair: Pros and Cons

https://www.laparoscopyhospital.com/ This video is lecture of Pros and Cons of Laparoscopic Ventral and Incisional Hernia Repair by Dr. R. K. Mishra at World Laparoscopy Hospital. The purpose of this lecture is to analyse the surgical techniques, perioperative complications, and recurrence rate of laparoscopic ventral hernia repair (LVHR) including incisional Hernia, in comparison with the open ventral hernia repair (OVHR), based on the international literature. Incisional hernia is a common long-term complication of abdominal surgery and is estimated to occur in 3% to 13% of laparotomy incisions. The laparoscopic technique has numerous variations of the methodology used by surgeons, although several common steps are followed by all. The procedure starts with entering the peritoneal cavity by using a Veress needle, an open Hasson method, or an optical trocar allowing view of the abdominal wall layers during penetration. Palmer's point is the best place to access. This lecture indicates that LVHR is a safe and effective approach to abdominal wall hernias. The technique offers the advantages of the laparoscopic approach, ie, a short hospital stay, less postoperative pain, and early convalescence. The procedure carries an acceptable risk of complications compared to open surgery, a low risk of recurrence, and an excellent cosmetic result. It is considered a good alternative to its open counterpart, at least in experienced hands.

Obesity Surgery - Vertical Sleeve Gastrectomy

https://www.laparoscopyhospital.com How does the Vertical Sleeve Gastrectomy compare to the other surgeries? Simple operation with low mortality risk. Technically easy to perform with low peri-operative risks. Minimal short-term and long-term complication rates. Short-term risks of staple line bleeding or leakage are very rare. The only long-term risk is GERD in some patients. Weight loss comparable with the gastric bypass. Gastric sleeve is not reversible. Part of the stomach is permanently removed. It is important to understand that reversing any weight loss operation (such as gastric band or gastric bypass) will result in weight regain back to original weight. You should not have any weight loss operation if you intend to ever reverse it. Though gastric sleeve is not reversible, it can be changed to gastric bypass if there was any need. Most illnesses that are related to obesity can be improved or even cured by weight loss surgery. These include: sleep apnoea, diabetes, high cholesterol, hypertension, stress incontinence, depression, acid reflux, joint pain, as well as osteoarthritis. Losing weight for obese patients also means greater outcomes from pregnancy, increased fertility, and a lower risk of cancer. The surgery increases life expectancy, on the whole.

Laparoscopic Mishra's Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This is a video of Laparoscopic Mishra's Knot. Laparoscopic suturing and knotting is important for surgeons and gynecologist. Mishra's Knot is one of the important extracorporeal knot for any tubular structure. Configuration of Mishra's Knot is 1:1:1:1:1:1:1. This knot is secured upto 18mm of tubular structure.

Total Laparoscopic Hysterectomy with Bilateral Salpingo Oophorectomy

https://www.laparoscopyhospital.com/ This video demonstrate TLH with BSO by Dr R K Mishra at World Laparoscopy Hospital. The use of laparoscopic hysterectomy has recently been reported as an alternative to traditional abdominal hysterectomy and the utilization of a mini-endoscopic technique has also been recorded. This prospective randomized study has demonstrated that after laparoscopic hysterectomy, patients recovered more quickly and had less pain, and the incidence of complications was also low. One serious complication after laparoscopic hysterectomy is increased ureteric injury, but in our opinion it is possible to avoid major complications by paying particular attention to the surgical details.

Laparoscopic Surgery for Hydatid Cyst Disease

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic lecture of treatment of hydatid disease of the liver is an alternative to open surgery in well-selected patients. Important steps are the evacuation of the cyst contents without spillage, sterilization of the cyst cavity with scolicidal agents and cavity management using classical surgical techniques. The laparoscopic approach is safe with acceptable mortality and morbidity for both conservative and radical resections in selected patients. Clinical outcomes are comparable to open surgery, albeit in a selected group of patients.

Laparoscopic Appendectomy - Immediate Laparoscopy is Ideal for Acute Appendicitis

Acute appendicitis is inflammation of the appendix, the narrow, finger-shaped organ that branches off the first part of the large intestine on the right side of the abdomen. This video demonstrate laparoscopic appendectomy performed for acute appendicitis by Dr R K Mishra. Although the appendix is a vestigial organ with no known function, it can become diseased. Acute appendicitis remains the most common surgical emergency. The lifetime risk of developing an appendicitis is reported to be 6.7% in females and 8.7% in males. The peak incidence occurs in the first and second decade of life, while it is uncommon to face appendicitis in children younger than 5 years of age. The clinical presentation may be varied and often is similar to other medical conditions, so a misdiagnosis can be frequent and the most common one is usually gastroenteritis. Our diagnostic and therapeutic protocol from about ten years was the following: if the patient was thought to have an acute appendicitis preoperatively diagnosed by physical, laboratory findings and ultrasound examination, antibiotic treatment was started immediately with laparoscopic appendectomy. Laparoscopy is now demonstrated to be the optimal approach also to treat complicated appendicitis, but this standardized operation is not always easy to perform for new surgeons.

Laparoscopic Tayside Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Tayside Knot. This is an extracorporeal knot can be used to ligate tubular structure. The Tayside knot is suitable for use with all braided sutures (2/0 or stronger) as well as dacron. It is used with Dacron for ligation of vessels such as the azygous vein, splenic artery/vein or the inferior mesenteric artery/vein. A variety of slipknots are used by various professions and in certain leisure activities. Some of these have been adapted for use in endoscopic surgery. The holding strength of individual types of slipknots is influenced by a number of factors including the ligature material used and its caliber. Thus a slipknot may be secure when tied in catgut but unsafe with other materials. In addition, some slipknots are difficult to tie or jam lock too easily for reliable placement by push rod before locking.

Laparoscopic Management of Ovarian Teratoma

https://www.laparoscopyhospital.com This video demonstrate laparoscopic cystectomy for ovarian teratoma. Germ cell tumours begin in egg cells in women or sperm cells in men. There are 2 main types of ovarian teratoma: mature teratoma, which is non cancerous (benign). immature teratoma, which is cancerous. Immature teratomas are usually diagnosed in girls and young women up to their early 20s. These cancers are rare. They are called immature because the cancer cells are at a very early stage of development. Most immature teratomas of the ovary are cured, even if they are diagnosed at an advanced stage. Keywords: Laparoscopy, Dermoid cyst, Ovarian cyst, Operative laparoscopy. Benign cystic teratomas, or dermoid cysts, are germ cell tumors of the ovary that account for 20-25% of all ovarian tumors and are bilateral in 10-15% of cases. They have a low incidence of malignancy, reported as 1-3%. The majority of dermoid cysts are asymptomatic and are often discovered incidentally upon pelvic exam. The potential for complications such as torsion, spontaneous rupture, risk of chemical peritonitis, and malignancy usually makes surgical treatment necessary upon diagnosis. Traditional therapy for a dermoid cyst has been cystectomy or oophorectomy via laparotomy. The laparoscopic approach has become increasingly accepted since 1989. Because most patients with cystic teratomas are of reproductive age, a conservative approach is ideal; laparoscopy may minimize adhesion formation and thus decrease the chance of compromising fertility. The management of ovarian teratomas in normal conditions is well established, but in rare giant cases (tumor diameter over 15 cm), the choice of management, such as laparotomic or laparoscopic approaches, are controversial and may be therapeutically challenging for surgeons.

Laparoscopic sleeve gastrectomy with endoscopic calibration

Endoscopic calibration is associated with lower postoperative complications after laparoscopic sleeve gastrectomy. The use of the endoscope for the calibration of the gastric sleeve, instead of the standard use of the bougie, is a safe procedure and gives the surgeon a higher sense of security. The aim is to evaluate the effect of the use of endoscopic guidance on postoperative complications and mid-term results of the bariatric procedure. Gastrointestinal complication after sleeve gastrectomy surgery may be summarized as follow: acute bleeding and/or anemia, staple-line complications such as anastomotic leaks, fistulae, and strictures, erosion and slippage, bezoars, and choledocholithiasis. An endoscopy is the preferred strategy, unless there is a suspicion of leaks or fistulae, in which case preliminary contrast radiography may be more appropriate. Endoscopic treatment plays an important role in the management of a variety of staple-line complications during and even after surgery, such as stomal stenosis and anastomotic leaks. The intraoperative tightness check with blue dye and air insufflation through an orogastric tube in the bougie calibration group is done in all the patients. In the endoscopic calibration the check with blue dye is much better in all cases.

Laparoscopic Suturing Melzer's Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ Laparoscopic suturing and knot tying require a lot of patience and practice and can be difficult, time consuming, and frustrating in spite of the advances made in the fields of instrumentation, optics, and imaging. The new technique described here is an effort to make the procedure simpler by providing extracorporeal control of one limb of the suture. It involves percutaneous placement of the needle end of the suture in the abdomen and its removal using a modified 10 cm long cloth-sewing needle.

Laparoscopic Cholecystectomy for Stone impacted at Hartmann's pouch

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Cholecystectomy for Stone impacted at Hartmann's pouch. Manipulating the gallbladder with the left-hand instrument is a key part of performing a laparoscopic cholecystectomy. In these case stone should be removed from hartmann pouch. If a stone is impacted in the Hartmann’s pouch, this manipulation can be difficult, and can cause cramp and exhaustion of the surgeon’s left hand or injury to the gallbladder if a toothed instrument is used to improve grip. For the experienced laparoscopic surgeon, this tip makes manoeuvrability of the thickened, impacted Hartmann’s pouch simpler. We have used it in the acute and elective setting to great effect. The tape provides gentle traction and can be resisted easily if there are any concerns about placement as dissection continues.

Laparoscopic Weston Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ The Weston slip knot was initially described in the obstetric and gynecology literature and is also used in arthroscopic surgery.The advantage of this knot is that it is relatively easy to tie outside, can then slip easily into place and be tightly secured. The post strand does not move throughout the knot; the loop strand is the longer strand which is moved to make the knot. The advantage of the Weston knot is that it locks readily and is not bulky.

How to Perform Safe Laparoscopic Appendectomy - Lecture by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate How to Perform Safe Laparoscopic Appendectomy - Lecture by Dr R K Mishra. Appendicitis is one of the most common surgical problems and appendectomy is one of the most common surgery. One out of every 2,000 people has an appendectomy sometime during their lifetime. Treatment requires an operation to remove the infected appendix. Traditionally, the appendix is removed through an incision in the right lower abdominal wall. ADVANTAGES OF LAPAROSCOPIC APPENDECTOMY: Results may vary depending upon the type of procedure and patient’s overall condition. Common advantages are: Less postoperative pain May shorten hospital stay May result in a quicker return to bowel function Quicker return to normal activity Better cosmetic results

Laparoscopic Radical Hysterectomy

https://www.laparoscopyhospital.com/ This video is lecture of Laparoscopic Radical Hysterectomy by Dr R K Mishra. This procedure is used to treat stage I or IIA cervical cancer. Radical hysterectomy involves surgical removal of the uterus, the supporting ligaments and the upper vagina, together with removal of the pelvic lymph nodes and sometimes the para-aortic lymph nodes. Laparoscopic radical hysterectomy is a feasible alternative to laparotomy for early stage cervical cancer. Similar surgical outcomes are achieved with significantly less morbidity.

Laparoscopic Surgeon's Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ Laparoscopic knot-tying is an advanced skill. The traditional surgeon's knot is often used in laparoscopic surgery for every tissue. Surgeons knot is most versatile knot in laparoscopic surgery. It can be used in many situations like bowel anastomosis, pyeloplasty, tubal recanalization etc... Surgeons knot can be terminated at the end of a continuous suture line in laparoscopic surgery by again surgeons knot or square knot. The Aberdeen knot has been shown to be stronger and more secure than the surgeon's knot for ending a suture line but is rarely used in laparoscopic surgery. We have developed a new technique to make the surgeons knot laparoscopically. Any surgeon's concern about the ease and safety of laparoscopic knotting is natural, and knots performed laparoscopically must be as safe as those traditionally performed. A knot should secure proper tissue approximation, and be simple, easy, quick, and reliable.

Basic Steps of Hysterectomy

https://www.laparoscopyhospital.com/ This video demonstrate step by step total laparoscopic hysterectomy. Hysterectomy is the removal of the uterus with surgery. There are many reasons a hysterectomy can be performed such as fibroids, heavy or irregular menstrual bleeding, prolapse, chronic uterine pain, pelvic inflammatory disease, pre-cancerous conditions, cancer and endometriosis. hysterectomy depending on the clinical circumstances. A hysterectomy can be performed using a laparoscope, which is a thin keyhole camera that allows the surgeon to see the pelvic organs. The laparoscope and other instruments are inserted through small incisions in the skin and then used by the surgeon to remove the uterus. hysterectomy depending on the clinical circumstances. A hysterectomy can be performed using a laparoscope, which is a thin keyhole camera that allows the surgeon to see the pelvic organs. The laparoscope and other instruments are inserted through small incisions in the skin and then used by the surgeon to remove the uterus.

Laparoscopic Cholecystectomy with Laparoscopic Ovarian Drilling

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Cholecystectomy with Laparoscopic Ovarian Drilling in same patient by Dr R K Mishra at World Laparoscopy Hospital. Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women who have polycystic ovary syndrome (PCOS). Electrocautery or a laser is used to destroy parts of the ovaries. A laparoscopic cholecystectomy is a surgery during which the doctor removes your gallbladder. This procedure uses several small cuts instead of one large one. A laparoscope, a narrow tube with a camera, is inserted through one incision. This allows surgeon to see gallbladder on a HD monitor. Laparoscopic cholecystectomy is Gold standard for Gallstone disease.

Torted Ovarian Dermoid Cyst in 7 Year Old Girl

Ovarian torsion in children is an uncommon cause of acute abdominal pain but mandates early surgical management to prevent further adnexal damage. The clinical presentation mimics other pathologies, such as appendicitis. Ovarian torsion should be considered in any female child with acute onset lower abdominal pain accompanied by vomiting. Pain can be characterized as constant or colicky, but unlike with appendicitis, does not typically migrate. Sterile pyuria is found in a substantial proportion of cases. Ultrasound is the most useful initial diagnostic modality, but the absence of flow on Doppler imaging is not always present. Conservative management with detorsion and oophoropexy is recommended.

Laparoscopic Tumble Square Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Tumble Square Knot. Laparoscopic Tumble Square Knot is the only knots that can be used when the suture does not slide freely through the tissue and anchoring device. Laparoscopic Tumble Square Knot configurations also theoretically avoid suture damage from abrasion and tissue damage during sliding. The major disadvantage of static knots is the propensity of the loop to loosen before the second half-hitch is seated to the point that it provisionally “locks” the knot. One method of minimizing this effect is by using a maryland to push the square knot on which one limb is tumbled which holds the tissue loop tight as it advances sequential half-hitches.

Laparoscopic Removal of Huge Ovarian Cyst

https://www.laparoscopyhospital.com/gynaecological-laparoscopy.html Laparoscopic surgery has been increasingly applied to different gynecologic ovaries surgical problems with excellent surgical outcome and rapid recovery. Large ovarian cysts, a relatively common gynecologic problem, pose certain challenges to laparoscopic management. Laparoscopy is a safe technique for managing patients with large ovarian cysts and is associated with low conversion and complication rates. The chance of finding unexpected ovarian cancer varies according to the patients’ selection criteria but is low overall. With proper patient selection, the size of an ovarian cyst should not constitute a contraindication to laparoscopic surgery. Experience in advanced laparoscopic surgery and the availability of a gynecologic oncologist should make the procedure safely applicable to a broader patient population.

Lecture on Laparoscopic Appendectomy for Acute Appendicitis

https://www.laparoscopyhospital.com/ This video is lecture of Dr R K Mishra on Laparoscopic Appendectomy. Laparoscopic Appendectomy can be performed by single incision, two port or three incisions, one umbilical and one suprapubic are made; permanent material used comprises: grasping forceps, hook, scissors, needle holders, three metal trocars and four other usual instruments, and a single strand of cotton. There is possibility of using endobag and in few cases no need to use of operative extractors bags, clips, endoloops, staples or bipolar or harmonic energy instruments. Allows triangulation and instrumentation in the conventional manner.

Laparoscopic Nissen fundoplication - Dr R K Mishra

Laparoscopic Nissen fundoplication is a surgical procedure that alleviates gastroesophageal reflux disease (GERD) symptoms when lifestyle changes or anti-reflux medications have not controlled symptoms. The procedure was first performed in 1951 as an open-surgical procedure. Patients were hospitalized for 7 to 10 days after the procedure. Today, the Nissen fundoplication is performed in approximately 90 minutes. A majority of the time the patient is in the hospital overnight and is discharged the morning after surgery. Laparoscopic Nissen fundoplication is one of the popular surgery performed by general surgeon. Almost 90% of all the fundoplication in whole world is now performed via laparoscopic surgery. It is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia. In GERD, it is usually performed when medical therapy has failed; but, with a Type II (paraesophageal) hiatus hernia, it is the first-line procedure. The Nissen fundoplication is total (360°), but partial fundoplications known as Thal (270° anterior), Belsey (270° anterior transthoracic), Dor (anterior 180–200°), Lind (300° posterior), and Toupet fundoplications (posterior 270°) are alternative procedures with somewhat different indications and outcomes. In this procedure, the top part of the stomach (approximately 5 percent) is wrapped around the esophagus to form an additional valve to keep stomach contents from flowing up into the esophagus. The patient has five or six incisions, about ¼-inch each, in the abdomen. Post-operation, after arousing from the anesthesia, the patient is given liquids to drink, advancing then to a soft diet. It is a successful treatment in about 95 percent of the patients who have surgery.

Laparoscopic Tubal Patency Test Hysteroscopy and Ovarian Drilling

This surgery was performed to evaluate the effectiveness of hydrolaparoscopy among infertile women with a Polycystic Ovarian Syndrome (PCOS) resistant to clomephine. PCOS is characterized by presence of the hyperandrogenism, oligo- or anovulation. It is one of the most common reproductive endocrine disorders in the adolescent women. Females with PCOS present with a dysregulation in the menstrual cycle, hirsutism, anovulation, acne, and obesity. An approximately 5-10% of women in Poland suffer from PCOS and 10-15% of them are infertile

Laparoscopic Surgery for Ectopic Pregnancy - Lecture by Dr R K Mishra

This video is lecture of Dr R K Mishra on laparoscopic management of ectopic pregnancy. Most ectopic pregnancies occur in the fallopian tube, but they can also happen in the neck of the womb, in the ovary, or in the abdominal cavity. Laparoscopic Salpingostomy or Salpingectomy is the method of choice for the management of ectopic pregnancy. In a normal pregnancy, fertilization occurs in the fallopian tubes, where an egg, or ovum, meets a sperm cell. The fertilized egg then travels into the uterus and becomes implanted in the womb lining. The embryo develops into a fetus and remains in the uterus until birth. An ectopic pregnancy can be fatal without prompt treatment. For example, the fallopian tube can burst, causing internal abdominal bleeding, shock, and serious blood loss. According to the Centers for Disease Control and Prevention, between 1 and 2 percent of all pregnancies are ectopic. However, ectopic pregnancy is the cause of 3 to 4 percent of pregnancy-related deaths. Ectopic surgery The fallopian tubes can be repaired or removed with surgery. Keyhole surgery can be performed to remove the ectopic tissue. This is also known as a laparoscopy. In a laparoscopy, the surgeon makes a small incision in or near the navel and inserts a device called a laparoscope to view the area. Other surgical instruments are inserted into a tube, or through other small incisions, to remove the ectopic tissue. If the area is damaged, surgeons might be able to repair the fallopian tubes, but they will probably have to remove the affected tube as part of this procedure. If the other fallopian tube is still intact, a healthy pregnancy is still possible. If severe internal bleeding has occurred, a larger incision may be needed. This procedure would be called a laparotomy.

Dundee Jamming Knot and Aberdeen Termination demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This Video demonstrate Dundee Jamming Knot Continuous Suturing and Aberdeen Termination. Continuous suturing is required in laparoscopic surgery to close delicate long suture line. It can be started with Dundee Jamming Knot. The final knot of a continuous suture can be accomplished in the traditional way of open surgery as Aberdeen Termination. Dundee Jamming Knot and Aberdeen Termination are two surgical knots in the same direction and a final one in the opposite direction, tying the final loop of the continuous suture with the end of the suture with the needle, or it is possible to recur to the “Aberdeen knot,”8 in which a final knot is accomplished by creating a new loop in the already existing one. The final loop of the suture is kept loosely; then, grasping the needle with the assistant needle holder, the needle holder is inserted into the loop, and the suture thread is grasped at its middle and retracted without the grasper dropping the needle. This process generates a new loop in the already existing one, which is tied guiding the needle holder through the loop and applying countertraction between the needle holder and the assistant needle holder. This procedure is repeated twice. Finally, the end of the suture is guided with the needle through the last generated loop, and, using retraction, the final tightening of the knot is performed. If, at the end of the suture, the thread were too short to accomplish one of the described procedures.

Laparoscopic inguinal hernia repair "IPOM" with Dual-Mesh

https://www.laparoscopyhospital.com/ This video demonstrate laparoscopic inguinal hernia by IPOM. Dr R K Mishra report their experience on laparoscopic hernioplasty using the Intraperitoneal Onlay Mesh Repair (IPOM). Many patients had a bilateral hernia, and many of which were recurrent and some had recurrent hernia. Overall, a total of 85 hernias were treated. The hernia repair was performed utilizing Polyurathane Dual Mesh. The prostheses were fixed with titanium spiral tacks (Protack, AutoSuture, Tyco Healthcare). No intraoperative complications occurred and no conversion was necessary. Mean resumption of normal activity was 10 days with return to work within two weeks. At an average 24 months follow-up, were recorded. The results of this study as well as the meta-analysis of the series presented in the Literature, indicate that the IPOM may be a feasible, safe and effective procedure in the treatment of inguinal hernia repair is performed during other laparoscopic procedures. The IPOM has infact been shown to be faster and easier than the other more commonly performed laparoscopic hernioplasties (TAPP and TEP). These data may also suggest to utilize this technique in particular cases of primitive hernia such as very active young males or heavy duty workers. However the limited experience and the short follow-up ask for long term studies to definitely ascertain the true incidence of recurrence and therefore the effectiveness of this attractive procedure.

Sleeve Gastrectomy

https://www.laparoscopyhospital.com/bariatric-surgery.html This video demonstrate laparoscopic sleeve gastrectomy performed by Dr R K Mishra at World Laparoscopy Hospital. The laparoscopic sleeve gastrectomy (SG) or gastric sleeve surgery, involves re-shaping the stomach from a pouch-like shape into a long tube, or “sleeve”. Pre-surgery the stomach looks like a kidney bean and can expand to the volume of several liter-size bottles of soda. With staples, the stomach is converted to look like a banana. This weight loss surgery reduces the capacity and prevents the stomach from expanding significantly. Before sleeve gastrectomy a regular stomach can hold about six cups of food. The new small stomach can hold about a half cup in volume, resulting in a ‘restrictive’ weight loss of the person. This type of laparoscopic sleeve gastrectomy bariatric surgery can be done as a stand-alone procedure or as part of a staged operation. The weight loss is projected to be in the range of 55 to 70 percent of excess body weight. There is no malabsorption created and no foreign body or implant involved. Long-term results are becoming available and the data suggest the weight loss is similar to gastric bypass.

Unedited Laparoscopic Hysterectomy - Dr. R. K. Mishra

https://www.laparoscopyhospital.com/ Minimal Access Laparoscopic Hysterectomy is becoming a very common procedure, although significant concerns about the procedure voiced by many gynecologists are twofold: The ability to confidently close the vaginal cuff laparoscopically and the fear of cuff dehiscence and ureteric injury. This has resulted in many practitioners securing the uterine artery vaginally and closing the cuff vaginally, which increases operating time, or converting to LAVH or LSH. We have developed a nice desiccation technique of uterine artery during Total Laparoscopic Hysterectomy and vaginal cuff closure technique following TLH that incorporates the same surgical principles as closure for an abdominal hysterectomy. It is easy to learn and simple continuous suturing is required intracorporeally to close the vault. Mean surgical time is half an hour. This video demonstrates the use of a vessel sealing device to perform a laparoscopic hysterectomy with an obliterated posterior cul-de-sac. This technique demonstrates how to dissect the anterior compartment first. Then we controlled the large uterine vessels.

Retroperitoneoscopic Nephrectomy and Ureterolithotomy

https://www.laparoscopyhospital.com/ This video demonstrate Retroperitoneoscopic Nephrectomy and Ureterolithotomy. The emergence of minimally invasive surgery about 20 years ago revolutionized urological surgery. Advances in retroperitoneoscopy allowed the widespread use of minimally invasive techniques in almost the entire range of urology. In this context, laparoscopy and later retroperitoneoscopy were developed and applied in a wide spectrum of urological diseases. Both approaches have since presented benefits and disadvantages that have been documented in various series. However, few comparative studies have been conducted. Retroperitoneoscopy can be accomplished placing the patient in lateral or prone position. This technique requires experience to find the way to the retroperitoneum. The main landmark during surgery is the psoas muscle. The prone approach is very versatile because it gives the surgeon the chance to reach the adrenal gland and the upper and lower urinary tract, and also allows a bilateral procedure to be achieved. Furthermore, this access leaves the kidney in place and has the advantage of a direct approach to the vessels. On the other hand, it is not the best option when mobilization of the lower ureter and urgent conversion are needed.

Hysterectomy for Large Uterus

https://www.laparoscopyhospital.com This video demonstrate Total Laparoscopic Hysterectomy for Large Uterus. Hysterectomy is the most common gynecologic surgical procedure performed, accounting for 1600,000 procedures per year. The most common indication for a hysterectomy is abnormal uterine bleeding, which is frequently caused by uterine leiomyoma, which is present in 25-50% of reproductive-aged women. Total Laparoscopic Hysterectomy is method of choice for large uterus if surgeon has sufficient experience.

Laparoscopic Fundoplication

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Fundoplication Surgery for GERD. A Nissen fundoplication, or laparoscopic Nissen fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease and hiatal hernia. The fundoplication operation is usually carried out using keyhole surgery (laparoscopy). The surgeon uses a telescope, with a miniature video camera mounted on it, inserted through a small incision (cut) to see inside the abdomen. Carbon dioxide gas is used to inflate the abdomen to create space in which the surgeon can operate using specialised instruments that are also passed through other smaller incisions (cuts) in the abdomen. The operation itself has two parts. Firstly the surgeon will examine the diaphragm to check the size of the opening around the oesophagus. If it too loose, the surgeon will tighten this. The second part of the operation involves wrapping the upper part of the stomach (fundus) around the base of the oesophagus and loosely stitching it in place. This tightens the sphincter enough to reduce reflux but not so tight as to affect swallowing.

Laparoscopic Repair of Lumber Incisional Hernia

https://www.laparoscopyhospital.com Lumbar incisional hernias are often diffuse with fascial defects that are usually hard to appreciate. Computed tomography scan is the diagnostic modality of choice and allows differentiating them from abdominal wall musculature denervation atrophy complicating flank incisions. Repairing these hernias is difficult due to the surrounding structures. Principles of laparoscopic repair include lateral decubitus positioning with table flexed, adhesiolysis, and reduction of hernia contents, securing ePTFE mesh with spiral tacks and transfascial sutures to an intercostal space superiorly, iliac crest periosteum inferiorly, and rectus muscle anteriorly. Posteriorly, the mesh is secured to psoas major fascia with intracorporeal sutures to avoid nerve injury. Lumbar incisional hernia must be differentiated from muscle atrophy with no fascial defect. The laparoscopic approach provides an attractive option for this often challenging problem.

Dangerous way of Performing Laparoscopic Cholecystectomy

https://www.laparoscopyhospital.com/ This Video demonstrate a dangerous way of Performing Laparoscopic Cholecystectomy by Harmonic Scalpel In Mass Shearing. Ideally a nice dissection of calot's triangle with critical view of safety should be done. World wide laparoscopic cholecystectomy (LC) has become the customary method for treating gallstones, some incidents and complications appear rather more frequently than with the open technique. Several aspects of these complications and their treatment possibilities are analysed and clipless cholecystectomy with Harmonic scalpel is one of them. During the past decade world wide laparoscopic cholecystectomy has become the procedure of choice in the surgical treatment of symptomatic gallstone. The operation is not completely risk-free, some incidents and complications being more frequent than with open cholecystectomy. The use of the Harmonic scalpel is deemed safe and comparable to clip placement at the discretion of the surgeon for cystic duct ligation. According to the article published by many author, harmonic shears is effective and safe in laparoscopic cholecystectomy as a sole instrument for sealing and division of the artery and cystic duct. The main advantages could be related to the safety and decreased operative time. Further research with larger homogeneous studies and assessments of cost-effectiveness would further enhance the increasing use of the Harmonic scalpel in laparoscopic cholecystectomy.

Laparoscopic Management of Chronic Ectopic and Myomectomy in same patient

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Management of Chronic Ectopic and Myomectomy in same patient at same session. Chronic ectopic pregnancy is a form of tubal pregnancy in which salient minor ruptures or abortions of an ectopic pregnancy instead of a single episode of bleeding, incites an inflammatory response often leading to the formation of a pelvic mass. Ectopic pregnancy presents diagnostic dilemmas in the absence of classical symptoms. MRI and laparoscopy are important tools in such cases. If patient has fibroid uterus it can be operated at same session.

Laparoscopic Roeder's knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ Laparoscopic Roeder's knot is one of the oldest knot used in laparoscopic surgery. Laparoscopic Roeder's knot is one of the most popular extracorporeal knot. This technique of the extracorporeal knotting is simple, easy, and reproducible with good knot and loop security and can be used with multifilament suture material of 90cm. Laparoscopic extracorporeal knot is popular for appendectomy, cholecystectomy, and any tubular structure upto 8mm structure.

Rudimentary Uterus

https://www.laparoscopyhospital.com This video demonstrate rudimentary uterus with absence of both ovaries and 46 ,XX normal karyotype. Genetic investigation revealed a 46,XX karyotype without any mosaicism. Diagnostic laparoscopy was performed. During laparoscopic pelvic exploration, a rudimentary uterus without ovaries and normal bilateral fallopian tubes were observed. If gonadal agenesis is thought to be the cause of primary amenorrhea in patients with normal secondary sexual characteristics, we believe that laparoscopic evaluation is the gold standard in diagnosis.

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Cholecystectomy and Appendectomy together by Mishra's knot.

https://www.laparoscopyhospital.com/SERV02.HTM Combined laparoscopic appendectomy and cholecystectomy produces good outcomes than either procedure performed independently, with a not increased incidence of wound complications and morbidity. Overall, however, patients who undergo simultaneous procedures appear much faster recovery. Further investigation is needed to define appropriate indications for these concomitant procedures as well as to identify the key factors that determine outcomes. An operative experience of three patients who underwent incidental laparoscopic appendectomy during laparoscopic cholecystectomy is presented. The technique and indications is shown in this video. We conclude with our experience that incidental laparoscopic appendectomy is possible and safe with existing incisions performed in gallbladder surgery. However, well-controlled prospective studies should be performed prior to wide application of this technique.

Laparoscopic Surgery for Peritoneal Inclusion cyst with Bilateral Endometrioma

This Video demonstrate Laparoscopic Management of Inclusion cyst with Bilateral Endometrioma. Peritoneal inclusion cyst (PIC) is defined as a fluid-filled mesothelial-lined cysts of the pelvis and it is most frequently encountered in women of reproductive age. The treatment options are observation, hormonal management, imaging-guided aspiration, image-guided sclerotherapy and surgical excision. Peritoneal inclusion cysts are uncommon abdominopelvic cysts seen in reproductive age group women. It is often misdiagnosed clinically as an ovarian tumor due to similar presentation and mimicking findings on radiology. We describe a woman presenting with pelvic mass. Her clinical finding on radiology suggested an ovarian tumor; however, biopsy revealed it as peritoneal inclusion cysts.

How to Perform Safe Laparoscopic Appendectomy - Lecture by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate How to Perform Safe Laparoscopic Appendectomy - Lecture by Dr R K Mishra. Appendicitis is one of the most common surgical problems and appendectomy is one of the most common surgery. One out of every 2,000 people has an appendectomy sometime during their lifetime. Treatment requires an operation to remove the infected appendix. Traditionally, the appendix is removed through an incision in the right lower abdominal wall. ADVANTAGES OF LAPAROSCOPIC APPENDECTOMY: Results may vary depending upon the type of procedure and patient’s overall condition. Common advantages are: Less postoperative pain May shorten hospital stay May result in a quicker return to bowel function Quicker return to normal activity Better cosmetic results

Laparoscopic PCOD Management

https://www.laparoscopyhospital.com/gynaecological-laparoscopy.html This video demonstrate laparoscopic ovarian drilling for PCOS (Polycystic Ovary Syndrome) Treatment. The exact mechanism of Ovarian Drilling in PCOS is yet to be elucidated. The most plausible one is the destruction of ovarian follicles and stroma resulting in a decrease in androgen and inhibin levels and a secondary rise in follicle-stimulating hormone (FSH) levels. Production of inflammatory growth factors like insulin-like growth factor-1, in response to thermal injury is in Laparoscopic Ovarian Drilling to Treat PCOS Infertility, further potentiates the actions of FSH on folliculogenesis, while increased blood flow to the ovary provoked by surgery, facilitates increased delivery of gonadotropins. The number of punctures is empirically chosen depending on the ovarian size. In the original procedure, 3-8 diathermy punctures (each of 3 mm diameter and 2-4 mm depth) per ovary were applied, using power setting of 40W W for 2-4 s

Laparoscopic Suturing Melzer's Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ Laparoscopic suturing and knot tying require a lot of patience and practice and can be difficult, time consuming, and frustrating in spite of the advances made in the fields of instrumentation, optics, and imaging. The new technique described here is an effort to make the procedure simpler by providing extracorporeal control of one limb of the suture. It involves percutaneous placement of the needle end of the suture in the abdomen and its removal using a modified 10 cm long cloth-sewing needle.

Laparoscopic Surgery for Ectopic Pregnancy - Lecture by Dr R K Mishra

This video is lecture of Dr R K Mishra on laparoscopic management of ectopic pregnancy. Most ectopic pregnancies occur in the fallopian tube, but they can also happen in the neck of the womb, in the ovary, or in the abdominal cavity. Laparoscopic Salpingostomy or Salpingectomy is the method of choice for the management of ectopic pregnancy. In a normal pregnancy, fertilization occurs in the fallopian tubes, where an egg, or ovum, meets a sperm cell. The fertilized egg then travels into the uterus and becomes implanted in the womb lining. The embryo develops into a fetus and remains in the uterus until birth. An ectopic pregnancy can be fatal without prompt treatment. For example, the fallopian tube can burst, causing internal abdominal bleeding, shock, and serious blood loss. According to the Centers for Disease Control and Prevention, between 1 and 2 percent of all pregnancies are ectopic. However, ectopic pregnancy is the cause of 3 to 4 percent of pregnancy-related deaths. Ectopic surgery The fallopian tubes can be repaired or removed with surgery. Keyhole surgery can be performed to remove the ectopic tissue. This is also known as a laparoscopy. In a laparoscopy, the surgeon makes a small incision in or near the navel and inserts a device called a laparoscope to view the area. Other surgical instruments are inserted into a tube, or through other small incisions, to remove the ectopic tissue. If the area is damaged, surgeons might be able to repair the fallopian tubes, but they will probably have to remove the affected tube as part of this procedure. If the other fallopian tube is still intact, a healthy pregnancy is still possible. If severe internal bleeding has occurred, a larger incision may be needed. This procedure would be called a laparotomy.

Laparoscopic Mishra's Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This is a video of Laparoscopic Mishra's Knot. Laparoscopic suturing and knotting is important for surgeons and gynecologist. Mishra's Knot is one of the important extracorporeal knot for any tubular structure. Configuration of Mishra's Knot is 1:1:1:1:1:1:1. This knot is secured upto 18mm of tubular structure.

Lecture PPH Stapler piles surgery Step by Step by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate PPH stapled Piles Surgery step by step by Dr R K Mishra. PPH-stapler procedure for treatment of haemorrhoidal prolapse is an important improvement. Haemorrhoidal disease is the most frequent and ancient proctological pathology. Haemorrhoidectomy is always feared for intensive post-operative pain and complications. Stapled hemorrhoidopexy is good procedure but may be followed by severe postoperative complications of which haemorrhage is one of the most serious early events. Surgical techniques have advanced more and more with the aim of reducing the post-surgical complications and to help a faster recovery. “Open hemorrhoidectomy”, according to Milligan-Morgan procedure, has been the most used method in Europe, also in the “Ligasure” and “Ultracision” variants. “Closed hemorrhoidectomy”, according to Ferguson procedure, has been the most used method in the USA. Stapled hemorrhoidopexy (PPH-stapler) is an alternative method to conventional surgical procedures. It has many advantages such as less pain, faster recovery and a quicker return to normal activities. PPH stapler procedure for treatment of haemorrhoidal prolapse.

Obesity Surgery - Vertical Sleeve Gastrectomy

https://www.laparoscopyhospital.com How does the Vertical Sleeve Gastrectomy compare to the other surgeries? Simple operation with low mortality risk. Technically easy to perform with low peri-operative risks. Minimal short-term and long-term complication rates. Short-term risks of staple line bleeding or leakage are very rare. The only long-term risk is GERD in some patients. Weight loss comparable with the gastric bypass. Gastric sleeve is not reversible. Part of the stomach is permanently removed. It is important to understand that reversing any weight loss operation (such as gastric band or gastric bypass) will result in weight regain back to original weight. You should not have any weight loss operation if you intend to ever reverse it. Though gastric sleeve is not reversible, it can be changed to gastric bypass if there was any need. Most illnesses that are related to obesity can be improved or even cured by weight loss surgery. These include: sleep apnoea, diabetes, high cholesterol, hypertension, stress incontinence, depression, acid reflux, joint pain, as well as osteoarthritis. Losing weight for obese patients also means greater outcomes from pregnancy, increased fertility, and a lower risk of cancer. The surgery increases life expectancy, on the whole.

Basic Steps of Hysterectomy

https://www.laparoscopyhospital.com/ This video demonstrate step by step total laparoscopic hysterectomy. Hysterectomy is the removal of the uterus with surgery. There are many reasons a hysterectomy can be performed such as fibroids, heavy or irregular menstrual bleeding, prolapse, chronic uterine pain, pelvic inflammatory disease, pre-cancerous conditions, cancer and endometriosis. hysterectomy depending on the clinical circumstances. A hysterectomy can be performed using a laparoscope, which is a thin keyhole camera that allows the surgeon to see the pelvic organs. The laparoscope and other instruments are inserted through small incisions in the skin and then used by the surgeon to remove the uterus. hysterectomy depending on the clinical circumstances. A hysterectomy can be performed using a laparoscope, which is a thin keyhole camera that allows the surgeon to see the pelvic organs. The laparoscope and other instruments are inserted through small incisions in the skin and then used by the surgeon to remove the uterus.

Laparoscopic inguinal hernia repair "IPOM" with Dual-Mesh

https://www.laparoscopyhospital.com/ This video demonstrate laparoscopic inguinal hernia by IPOM. Dr R K Mishra report their experience on laparoscopic hernioplasty using the Intraperitoneal Onlay Mesh Repair (IPOM). Many patients had a bilateral hernia, and many of which were recurrent and some had recurrent hernia. Overall, a total of 85 hernias were treated. The hernia repair was performed utilizing Polyurathane Dual Mesh. The prostheses were fixed with titanium spiral tacks (Protack, AutoSuture, Tyco Healthcare). No intraoperative complications occurred and no conversion was necessary. Mean resumption of normal activity was 10 days with return to work within two weeks. At an average 24 months follow-up, were recorded. The results of this study as well as the meta-analysis of the series presented in the Literature, indicate that the IPOM may be a feasible, safe and effective procedure in the treatment of inguinal hernia repair is performed during other laparoscopic procedures. The IPOM has infact been shown to be faster and easier than the other more commonly performed laparoscopic hernioplasties (TAPP and TEP). These data may also suggest to utilize this technique in particular cases of primitive hernia such as very active young males or heavy duty workers. However the limited experience and the short follow-up ask for long term studies to definitely ascertain the true incidence of recurrence and therefore the effectiveness of this attractive procedure.

Laparoscopic Nephrectomy Lecture by Dr R K Mishra

This video is of Laparoscopic Nephrectomy Lecture by Dr R K Mishra. A laparoscopic nephrectomy is minimally invasive operation to remove kidney. A laparoscopic nephrectomy involves removing an entire kidney through keyhole incisions in the flank, the side of the body between the ribs and the hip. A laparoscopic nephrectomy removes the kidney by using laparoscopic equipment. Long thin instruments are passed through up to five small incisions made in the flank, each about 1cm in length. The abdomen is first filled with carbon dioxide, which separates the tissues to allow for vision during the surgery. A camera is then passed, giving the urologist a detailed picture inside the abdomen. The other incisions are used to pass cutting and suturing instruments so the blood supply to the kidney can be isolated and tied off and the kidney removed either with or without its surrounding structures. A wound drain is then inserted to drain any wound ooze. This is usually stitched in place and stays in for 1 – 2 days. A nephrectomy is usually done for one of two reasons, either for cancer of the kidney or because of a non- functioning kidney. In the case of kidney cancer a radical laparoscopic nephrectomy is done. This is done in an attempt to rid the body of cancer by removing the entire kidney and adrenal gland, with its surrounding fat and attached vessels. In more advanced cases it may be done to stop continued bleeding from the effected kidney. For non-functioning kidneys, which are either caused by large stones, a lack of blood supply or abnormal kidney structure, a simple laparoscopic nephrectomy is done. This is where only the kidney itself is taken and the adrenal gland and other structures are left behind. A simple nephrectomy is usually done to avoid recurrent infection and pain and the possibility of severe illness because of infection.

Laparoscopic Repair of Lumber Incisional Hernia

https://www.laparoscopyhospital.com Lumbar incisional hernias are often diffuse with fascial defects that are usually hard to appreciate. Computed tomography scan is the diagnostic modality of choice and allows differentiating them from abdominal wall musculature denervation atrophy complicating flank incisions. Repairing these hernias is difficult due to the surrounding structures. Principles of laparoscopic repair include lateral decubitus positioning with table flexed, adhesiolysis, and reduction of hernia contents, securing ePTFE mesh with spiral tacks and transfascial sutures to an intercostal space superiorly, iliac crest periosteum inferiorly, and rectus muscle anteriorly. Posteriorly, the mesh is secured to psoas major fascia with intracorporeal sutures to avoid nerve injury. Lumbar incisional hernia must be differentiated from muscle atrophy with no fascial defect. The laparoscopic approach provides an attractive option for this often challenging problem.

Laparoscopic Management of Chronic Ectopic and Myomectomy in same patient

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Management of Chronic Ectopic and Myomectomy in same patient at same session. Chronic ectopic pregnancy is a form of tubal pregnancy in which salient minor ruptures or abortions of an ectopic pregnancy instead of a single episode of bleeding, incites an inflammatory response often leading to the formation of a pelvic mass. Ectopic pregnancy presents diagnostic dilemmas in the absence of classical symptoms. MRI and laparoscopy are important tools in such cases. If patient has fibroid uterus it can be operated at same session.

Laparoscopic Tayside Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Tayside Knot. This is an extracorporeal knot can be used to ligate tubular structure. The Tayside knot is suitable for use with all braided sutures (2/0 or stronger) as well as dacron. It is used with Dacron for ligation of vessels such as the azygous vein, splenic artery/vein or the inferior mesenteric artery/vein. A variety of slipknots are used by various professions and in certain leisure activities. Some of these have been adapted for use in endoscopic surgery. The holding strength of individual types of slipknots is influenced by a number of factors including the ligature material used and its caliber. Thus a slipknot may be secure when tied in catgut but unsafe with other materials. In addition, some slipknots are difficult to tie or jam lock too easily for reliable placement by push rod before locking.

Laparoscopic Myomectomy for Multiple Myoma

Laparoscopic myomectomy in multiple fibroids. Myomectomy is the surgery of choice for women who have symptomatic fibroids and who wish to retain their uterus. ... It is known that uterine fibroids are estrogen dependent. During pregnancy these fibroids increase in size, whereas in the puerperium and menopause they shrink. In laparoscopic or robotic myomectomy, minimally invasive procedures, your surgeon accesses and removes fibroids through several small abdominal incisions. Laparoscopic myomectomy. Your surgeon makes a small incision in or near your bellybutton. Then he or she inserts a laparoscope ― a narrow tube fitted with a camera ― into your abdomen. Your surgeon performs the surgery with instruments inserted through other small incisions in your abdominal wall. Robotic myomectomy. Instruments are inserted through small incisions similar to those in a laparoscopic myomectomy, and the surgeon controls movement of instruments from a separate console. Sometimes, the fibroid is cut into pieces and removed through a small incision in the abdominal wall. Other times the fibroid is removed through a bigger incision in your abdomen so it can be removed without being cut into pieces. Rarely, the fibroid may be removed through an incision in your vagina (colpotomy).

Laparoscopic Tubal Patency Test Hysteroscopy and Ovarian Drilling

This surgery was performed to evaluate the effectiveness of hydrolaparoscopy among infertile women with a Polycystic Ovarian Syndrome (PCOS) resistant to clomephine. PCOS is characterized by presence of the hyperandrogenism, oligo- or anovulation. It is one of the most common reproductive endocrine disorders in the adolescent women. Females with PCOS present with a dysregulation in the menstrual cycle, hirsutism, anovulation, acne, and obesity. An approximately 5-10% of women in Poland suffer from PCOS and 10-15% of them are infertile

Laparoscopic Nissen fundoplication - Dr R K Mishra

Laparoscopic Nissen fundoplication is a surgical procedure that alleviates gastroesophageal reflux disease (GERD) symptoms when lifestyle changes or anti-reflux medications have not controlled symptoms. The procedure was first performed in 1951 as an open-surgical procedure. Patients were hospitalized for 7 to 10 days after the procedure. Today, the Nissen fundoplication is performed in approximately 90 minutes. A majority of the time the patient is in the hospital overnight and is discharged the morning after surgery. Laparoscopic Nissen fundoplication is one of the popular surgery performed by general surgeon. Almost 90% of all the fundoplication in whole world is now performed via laparoscopic surgery. It is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia. In GERD, it is usually performed when medical therapy has failed; but, with a Type II (paraesophageal) hiatus hernia, it is the first-line procedure. The Nissen fundoplication is total (360°), but partial fundoplications known as Thal (270° anterior), Belsey (270° anterior transthoracic), Dor (anterior 180–200°), Lind (300° posterior), and Toupet fundoplications (posterior 270°) are alternative procedures with somewhat different indications and outcomes. In this procedure, the top part of the stomach (approximately 5 percent) is wrapped around the esophagus to form an additional valve to keep stomach contents from flowing up into the esophagus. The patient has five or six incisions, about ¼-inch each, in the abdomen. Post-operation, after arousing from the anesthesia, the patient is given liquids to drink, advancing then to a soft diet. It is a successful treatment in about 95 percent of the patients who have surgery.

Lecture on Laparoscopic Appendectomy for Acute Appendicitis

https://www.laparoscopyhospital.com/ This video is lecture of Dr R K Mishra on Laparoscopic Appendectomy. Laparoscopic Appendectomy can be performed by single incision, two port or three incisions, one umbilical and one suprapubic are made; permanent material used comprises: grasping forceps, hook, scissors, needle holders, three metal trocars and four other usual instruments, and a single strand of cotton. There is possibility of using endobag and in few cases no need to use of operative extractors bags, clips, endoloops, staples or bipolar or harmonic energy instruments. Allows triangulation and instrumentation in the conventional manner.

Laparoscopic Management of Ovarian Teratoma

https://www.laparoscopyhospital.com This video demonstrate laparoscopic cystectomy for ovarian teratoma. Germ cell tumours begin in egg cells in women or sperm cells in men. There are 2 main types of ovarian teratoma: mature teratoma, which is non cancerous (benign). immature teratoma, which is cancerous. Immature teratomas are usually diagnosed in girls and young women up to their early 20s. These cancers are rare. They are called immature because the cancer cells are at a very early stage of development. Most immature teratomas of the ovary are cured, even if they are diagnosed at an advanced stage. Keywords: Laparoscopy, Dermoid cyst, Ovarian cyst, Operative laparoscopy. Benign cystic teratomas, or dermoid cysts, are germ cell tumors of the ovary that account for 20-25% of all ovarian tumors and are bilateral in 10-15% of cases. They have a low incidence of malignancy, reported as 1-3%. The majority of dermoid cysts are asymptomatic and are often discovered incidentally upon pelvic exam. The potential for complications such as torsion, spontaneous rupture, risk of chemical peritonitis, and malignancy usually makes surgical treatment necessary upon diagnosis. Traditional therapy for a dermoid cyst has been cystectomy or oophorectomy via laparotomy. The laparoscopic approach has become increasingly accepted since 1989. Because most patients with cystic teratomas are of reproductive age, a conservative approach is ideal; laparoscopy may minimize adhesion formation and thus decrease the chance of compromising fertility. The management of ovarian teratomas in normal conditions is well established, but in rare giant cases (tumor diameter over 15 cm), the choice of management, such as laparotomic or laparoscopic approaches, are controversial and may be therapeutically challenging for surgeons.

Mishra's Knot - Ideal for Laparoscopic Cholecystectomy

This video demonstrate Mishra's Knot used in laparoscopic cholecystectomy. This is an Ideal for Laparoscopic Cholecystectomy. Tying extracorporeal knot to the cystic duct has many advantages. This knot is also can be used for in mass ligation and partial cholecystectomy.

Laparoscopic Fundoplication

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Fundoplication Surgery for GERD. A Nissen fundoplication, or laparoscopic Nissen fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease and hiatal hernia. The fundoplication operation is usually carried out using keyhole surgery (laparoscopy). The surgeon uses a telescope, with a miniature video camera mounted on it, inserted through a small incision (cut) to see inside the abdomen. Carbon dioxide gas is used to inflate the abdomen to create space in which the surgeon can operate using specialised instruments that are also passed through other smaller incisions (cuts) in the abdomen. The operation itself has two parts. Firstly the surgeon will examine the diaphragm to check the size of the opening around the oesophagus. If it too loose, the surgeon will tighten this. The second part of the operation involves wrapping the upper part of the stomach (fundus) around the base of the oesophagus and loosely stitching it in place. This tightens the sphincter enough to reduce reflux but not so tight as to affect swallowing.

Retroperitoneoscopic Nephrectomy and Ureterolithotomy

https://www.laparoscopyhospital.com/ This video demonstrate Retroperitoneoscopic Nephrectomy and Ureterolithotomy. The emergence of minimally invasive surgery about 20 years ago revolutionized urological surgery. Advances in retroperitoneoscopy allowed the widespread use of minimally invasive techniques in almost the entire range of urology. In this context, laparoscopy and later retroperitoneoscopy were developed and applied in a wide spectrum of urological diseases. Both approaches have since presented benefits and disadvantages that have been documented in various series. However, few comparative studies have been conducted. Retroperitoneoscopy can be accomplished placing the patient in lateral or prone position. This technique requires experience to find the way to the retroperitoneum. The main landmark during surgery is the psoas muscle. The prone approach is very versatile because it gives the surgeon the chance to reach the adrenal gland and the upper and lower urinary tract, and also allows a bilateral procedure to be achieved. Furthermore, this access leaves the kidney in place and has the advantage of a direct approach to the vessels. On the other hand, it is not the best option when mobilization of the lower ureter and urgent conversion are needed.

Total Laparoscopic Hysterectomy with Bilateral Salpingo Oophorectomy

https://www.laparoscopyhospital.com/ This video demonstrate TLH with BSO by Dr R K Mishra at World Laparoscopy Hospital. The use of laparoscopic hysterectomy has recently been reported as an alternative to traditional abdominal hysterectomy and the utilization of a mini-endoscopic technique has also been recorded. This prospective randomized study has demonstrated that after laparoscopic hysterectomy, patients recovered more quickly and had less pain, and the incidence of complications was also low. One serious complication after laparoscopic hysterectomy is increased ureteric injury, but in our opinion it is possible to avoid major complications by paying particular attention to the surgical details.

Laparoscopic Removal of Huge Ovarian Cyst

https://www.laparoscopyhospital.com/gynaecological-laparoscopy.html Laparoscopic surgery has been increasingly applied to different gynecologic ovaries surgical problems with excellent surgical outcome and rapid recovery. Large ovarian cysts, a relatively common gynecologic problem, pose certain challenges to laparoscopic management. Laparoscopy is a safe technique for managing patients with large ovarian cysts and is associated with low conversion and complication rates. The chance of finding unexpected ovarian cancer varies according to the patients’ selection criteria but is low overall. With proper patient selection, the size of an ovarian cyst should not constitute a contraindication to laparoscopic surgery. Experience in advanced laparoscopic surgery and the availability of a gynecologic oncologist should make the procedure safely applicable to a broader patient population.

Sleeve Gastrectomy

https://www.laparoscopyhospital.com/bariatric-surgery.html This video demonstrate laparoscopic sleeve gastrectomy performed by Dr R K Mishra at World Laparoscopy Hospital. The laparoscopic sleeve gastrectomy (SG) or gastric sleeve surgery, involves re-shaping the stomach from a pouch-like shape into a long tube, or “sleeve”. Pre-surgery the stomach looks like a kidney bean and can expand to the volume of several liter-size bottles of soda. With staples, the stomach is converted to look like a banana. This weight loss surgery reduces the capacity and prevents the stomach from expanding significantly. Before sleeve gastrectomy a regular stomach can hold about six cups of food. The new small stomach can hold about a half cup in volume, resulting in a ‘restrictive’ weight loss of the person. This type of laparoscopic sleeve gastrectomy bariatric surgery can be done as a stand-alone procedure or as part of a staged operation. The weight loss is projected to be in the range of 55 to 70 percent of excess body weight. There is no malabsorption created and no foreign body or implant involved. Long-term results are becoming available and the data suggest the weight loss is similar to gastric bypass.

Laparoscopic Extracorporeal Square Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Extracorporeal Square Knot. Laparoscopic Square knot is used for any structure which is tough and under tension. It can be used for approximation of vaginal vault, Rectus Divarication, Myomectomy, Crural Approximation etc...

Hysterectomy for Large Uterus

https://www.laparoscopyhospital.com This video demonstrate Total Laparoscopic Hysterectomy for Large Uterus. Hysterectomy is the most common gynecologic surgical procedure performed, accounting for 1600,000 procedures per year. The most common indication for a hysterectomy is abnormal uterine bleeding, which is frequently caused by uterine leiomyoma, which is present in 25-50% of reproductive-aged women. Total Laparoscopic Hysterectomy is method of choice for large uterus if surgeon has sufficient experience.

Dangerous way of Performing Laparoscopic Cholecystectomy

https://www.laparoscopyhospital.com/ This Video demonstrate a dangerous way of Performing Laparoscopic Cholecystectomy by Harmonic Scalpel In Mass Shearing. Ideally a nice dissection of calot's triangle with critical view of safety should be done. World wide laparoscopic cholecystectomy (LC) has become the customary method for treating gallstones, some incidents and complications appear rather more frequently than with the open technique. Several aspects of these complications and their treatment possibilities are analysed and clipless cholecystectomy with Harmonic scalpel is one of them. During the past decade world wide laparoscopic cholecystectomy has become the procedure of choice in the surgical treatment of symptomatic gallstone. The operation is not completely risk-free, some incidents and complications being more frequent than with open cholecystectomy. The use of the Harmonic scalpel is deemed safe and comparable to clip placement at the discretion of the surgeon for cystic duct ligation. According to the article published by many author, harmonic shears is effective and safe in laparoscopic cholecystectomy as a sole instrument for sealing and division of the artery and cystic duct. The main advantages could be related to the safety and decreased operative time. Further research with larger homogeneous studies and assessments of cost-effectiveness would further enhance the increasing use of the Harmonic scalpel in laparoscopic cholecystectomy.

Laparoscopic Weston Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ The Weston slip knot was initially described in the obstetric and gynecology literature and is also used in arthroscopic surgery.The advantage of this knot is that it is relatively easy to tie outside, can then slip easily into place and be tightly secured. The post strand does not move throughout the knot; the loop strand is the longer strand which is moved to make the knot. The advantage of the Weston knot is that it locks readily and is not bulky.

Laparoscopic Appendectomy - Immediate Laparoscopy is Ideal for Acute Appendicitis

Acute appendicitis is inflammation of the appendix, the narrow, finger-shaped organ that branches off the first part of the large intestine on the right side of the abdomen. This video demonstrate laparoscopic appendectomy performed for acute appendicitis by Dr R K Mishra. Although the appendix is a vestigial organ with no known function, it can become diseased. Acute appendicitis remains the most common surgical emergency. The lifetime risk of developing an appendicitis is reported to be 6.7% in females and 8.7% in males. The peak incidence occurs in the first and second decade of life, while it is uncommon to face appendicitis in children younger than 5 years of age. The clinical presentation may be varied and often is similar to other medical conditions, so a misdiagnosis can be frequent and the most common one is usually gastroenteritis. Our diagnostic and therapeutic protocol from about ten years was the following: if the patient was thought to have an acute appendicitis preoperatively diagnosed by physical, laboratory findings and ultrasound examination, antibiotic treatment was started immediately with laparoscopic appendectomy. Laparoscopy is now demonstrated to be the optimal approach also to treat complicated appendicitis, but this standardized operation is not always easy to perform for new surgeons.

Laparoscopic Surgery Training in Dubai

https://www.laparoscopyhospital.com/dubai.html The laparoscopy training institute of World Laparoscopy Hospital in Dubai provides exposure in live operational and surgical procedures. The training also includes practical and theoretical sessions. Free hands-on training in the latest of da vinci laparoscopic robots is also included in the course structure. The world laparoscopy hospital provides a modern facility for micro laparoscopic surgery as they incorporate the application of state of the art HD laparoscopic lab and surgical instruments. At World Laparoscopy Hospital we recognize the value of every psurgeon and are guided by our commitment to excellence and leadership to train them. We demonstrate this by providing exemplary physical, emotional and spiritual care for each of our trainees. We have Fellowship Program in Minimal Access Surgery for Surgeons and Gynecologists.

Sleeve Gastrectomy in Patient Previously operated for Ventral Hernia

Generally it should not be a problem to have a sleeve after incisional hernia repair, even with mesh. You do not need to worry about the insufflation of the abdomen stretching the mesh if you go through palmer's point. All laparoscopic incisions are small and do not disrupt the integrity of the mesh. The only incision that is a little larger is the one that the resected stomach is removed through. Ideally you want to do the sleeve laparoscopically. Yes, there will be a lot of adhesions, but an experienced laparoscopic bariatric surgeon can get it done with the laparoscope. The mesh can be re-sewn and it will heal fine. It is hard to say for sure without knowing where on your abdominal wall the mesh was placed, but I have operated on numerous patients with prior hernia repairs and it isn't a challenge that can't be overcome. If the hernia was from a prior C-section, meaning lower on your abdominal wall, then the laparoscopic port sites for a VSG should not interfere.

Laparoscopic Surgeon's Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ Laparoscopic knot-tying is an advanced skill. The traditional surgeon's knot is often used in laparoscopic surgery for every tissue. Surgeons knot is most versatile knot in laparoscopic surgery. It can be used in many situations like bowel anastomosis, pyeloplasty, tubal recanalization etc... Surgeons knot can be terminated at the end of a continuous suture line in laparoscopic surgery by again surgeons knot or square knot. The Aberdeen knot has been shown to be stronger and more secure than the surgeon's knot for ending a suture line but is rarely used in laparoscopic surgery. We have developed a new technique to make the surgeons knot laparoscopically. Any surgeon's concern about the ease and safety of laparoscopic knotting is natural, and knots performed laparoscopically must be as safe as those traditionally performed. A knot should secure proper tissue approximation, and be simple, easy, quick, and reliable.

Laparoscopic sleeve gastrectomy with endoscopic calibration

Endoscopic calibration is associated with lower postoperative complications after laparoscopic sleeve gastrectomy. The use of the endoscope for the calibration of the gastric sleeve, instead of the standard use of the bougie, is a safe procedure and gives the surgeon a higher sense of security. The aim is to evaluate the effect of the use of endoscopic guidance on postoperative complications and mid-term results of the bariatric procedure. Gastrointestinal complication after sleeve gastrectomy surgery may be summarized as follow: acute bleeding and/or anemia, staple-line complications such as anastomotic leaks, fistulae, and strictures, erosion and slippage, bezoars, and choledocholithiasis. An endoscopy is the preferred strategy, unless there is a suspicion of leaks or fistulae, in which case preliminary contrast radiography may be more appropriate. Endoscopic treatment plays an important role in the management of a variety of staple-line complications during and even after surgery, such as stomal stenosis and anastomotic leaks. The intraoperative tightness check with blue dye and air insufflation through an orogastric tube in the bougie calibration group is done in all the patients. In the endoscopic calibration the check with blue dye is much better in all cases.

Laparoscopic Roeder's knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ Laparoscopic Roeder's knot is one of the oldest knot used in laparoscopic surgery. Laparoscopic Roeder's knot is one of the most popular extracorporeal knot. This technique of the extracorporeal knotting is simple, easy, and reproducible with good knot and loop security and can be used with multifilament suture material of 90cm. Laparoscopic extracorporeal knot is popular for appendectomy, cholecystectomy, and any tubular structure upto 8mm structure.

Laparoscopic Sleeve Gastrectomy Surgery Video Explained Step by Step

This video demonstrate Laparoscopic Sleeve Gastrectomy which is a popular Bariatric Surgery for morbid obesity. Sleeve gastrectomy is a simpler bariatric operation than the gastric bypass procedure for morbid obesity because it does not involve rerouting of or reconnection of the intestines. The sleeve gastrectomy, unlike the Lap-band, does not require the use of a banding device to be implanted around a portion of the stomach. Laparoscopic Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. The sleeve gastrectomy, by reducing the size of the stomach, allows the patient to feel full after eating less and taking in fewer calories. The surgery removes that portion of the stomach that produces a hormone that can makes a patient feel hungry.

Laparoscopic Radical Hysterectomy

https://www.laparoscopyhospital.com/ This video is lecture of Laparoscopic Radical Hysterectomy by Dr R K Mishra. This procedure is used to treat stage I or IIA cervical cancer. Radical hysterectomy involves surgical removal of the uterus, the supporting ligaments and the upper vagina, together with removal of the pelvic lymph nodes and sometimes the para-aortic lymph nodes. Laparoscopic radical hysterectomy is a feasible alternative to laparotomy for early stage cervical cancer. Similar surgical outcomes are achieved with significantly less morbidity.

Unedited Laparoscopic Hysterectomy - Dr. R. K. Mishra

https://www.laparoscopyhospital.com/ Minimal Access Laparoscopic Hysterectomy is becoming a very common procedure, although significant concerns about the procedure voiced by many gynecologists are twofold: The ability to confidently close the vaginal cuff laparoscopically and the fear of cuff dehiscence and ureteric injury. This has resulted in many practitioners securing the uterine artery vaginally and closing the cuff vaginally, which increases operating time, or converting to LAVH or LSH. We have developed a nice desiccation technique of uterine artery during Total Laparoscopic Hysterectomy and vaginal cuff closure technique following TLH that incorporates the same surgical principles as closure for an abdominal hysterectomy. It is easy to learn and simple continuous suturing is required intracorporeally to close the vault. Mean surgical time is half an hour. This video demonstrates the use of a vessel sealing device to perform a laparoscopic hysterectomy with an obliterated posterior cul-de-sac. This technique demonstrates how to dissect the anterior compartment first. Then we controlled the large uterine vessels.

Rudimentary Uterus

https://www.laparoscopyhospital.com This video demonstrate rudimentary uterus with absence of both ovaries and 46 ,XX normal karyotype. Genetic investigation revealed a 46,XX karyotype without any mosaicism. Diagnostic laparoscopy was performed. During laparoscopic pelvic exploration, a rudimentary uterus without ovaries and normal bilateral fallopian tubes were observed. If gonadal agenesis is thought to be the cause of primary amenorrhea in patients with normal secondary sexual characteristics, we believe that laparoscopic evaluation is the gold standard in diagnosis.

Laparoscopic Cholecystectomy with Laparoscopic Ovarian Drilling

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Cholecystectomy with Laparoscopic Ovarian Drilling in same patient by Dr R K Mishra at World Laparoscopy Hospital. Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women who have polycystic ovary syndrome (PCOS). Electrocautery or a laser is used to destroy parts of the ovaries. A laparoscopic cholecystectomy is a surgery during which the doctor removes your gallbladder. This procedure uses several small cuts instead of one large one. A laparoscope, a narrow tube with a camera, is inserted through one incision. This allows surgeon to see gallbladder on a HD monitor. Laparoscopic cholecystectomy is Gold standard for Gallstone disease.

Torted Ovarian Dermoid Cyst in 7 Year Old Girl

Ovarian torsion in children is an uncommon cause of acute abdominal pain but mandates early surgical management to prevent further adnexal damage. The clinical presentation mimics other pathologies, such as appendicitis. Ovarian torsion should be considered in any female child with acute onset lower abdominal pain accompanied by vomiting. Pain can be characterized as constant or colicky, but unlike with appendicitis, does not typically migrate. Sterile pyuria is found in a substantial proportion of cases. Ultrasound is the most useful initial diagnostic modality, but the absence of flow on Doppler imaging is not always present. Conservative management with detorsion and oophoropexy is recommended.

Laparoscopic Cholecystectomy for Stone impacted at Hartmann's pouch

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Cholecystectomy for Stone impacted at Hartmann's pouch. Manipulating the gallbladder with the left-hand instrument is a key part of performing a laparoscopic cholecystectomy. In these case stone should be removed from hartmann pouch. If a stone is impacted in the Hartmann’s pouch, this manipulation can be difficult, and can cause cramp and exhaustion of the surgeon’s left hand or injury to the gallbladder if a toothed instrument is used to improve grip. For the experienced laparoscopic surgeon, this tip makes manoeuvrability of the thickened, impacted Hartmann’s pouch simpler. We have used it in the acute and elective setting to great effect. The tape provides gentle traction and can be resisted easily if there are any concerns about placement as dissection continues.

Laparoscopic Tumble Square Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Tumble Square Knot. Laparoscopic Tumble Square Knot is the only knots that can be used when the suture does not slide freely through the tissue and anchoring device. Laparoscopic Tumble Square Knot configurations also theoretically avoid suture damage from abrasion and tissue damage during sliding. The major disadvantage of static knots is the propensity of the loop to loosen before the second half-hitch is seated to the point that it provisionally “locks” the knot. One method of minimizing this effect is by using a maryland to push the square knot on which one limb is tumbled which holds the tissue loop tight as it advances sequential half-hitches.

Gastrointestinal Endoscopy Procedure Preparation & Risks

https://www.laparoscopyhospital.com/ This video is lecture of Gastrointestinal Endoscopy Procedure Preparation & Risks by Dr. R. K. Mishra at World Laparoscopy Hospital. Endoscopy has several names, depending on which portion of digestive tract by physician seeks to inspect. Upper GI endoscopy (EGD): This procedure enables the examination of the esophagus, stomach and the upper small bowel called duodenum. Colonoscopy: This procedure enables the doctor to see ulcers, inflamed mucous lining of your intestine, abnormal growths and bleeding in your colon, or large bowel. Enteroscopy: Enteroscopy is a recent diagnostic tool that allows a doctor to see your small bowel. The procedure may be used in the following ways: To diagnose and treat hidden GI bleeding To detect the cause for malabsorption To confirm problems of the small bowel seen on an X-ray During surgery, to locate and remove sores with little damage to healthy tissue

Torted Ovarian Dermoid Cyst in Pregnant Patient

https://www.laparoscopyhospital.com/ This video is Laparoscopic management of Torted Ovarian Dermoid Cyst in Pregnant Patient. Dermoid cyst (Mature cystic teratoma), the most common type of primordial germ cell ovarian tumors is usually benign and asymptomatic. It can be malignant in 5% of cases. The incidence of torsion in pregnant patients with ovarian cyst persisting during pregnancy is approximately 15%. Benign dermoid cysts/teratomas are the most frequent ovarian tumors, with an incidence ranging from 5% to 25% of all ovarian neoplasms [3]. They are of germ cell origin and composed of multiple types of tissue. Torsion of the cystic contents and ovary may occur in them, thus leading to vascular infarction and necrosis. Torsion of the pedicle has been reported to be the most frequent complication, occurring in 16.1% of cases [3]. Traditional risk factors for ovarian torsion are increased ovarian size, ovarian tumors, ovarian hyperstimulation, and pregnancy

Gastric Banding

https://www.laparoscopyhospital.com/ Laparoscopic gastric banding is surgery to help with weight loss. The surgeon places a band around the upper part of your stomach to create a small pouch to hold food. The band limits the amount of food you can eat by making you feel full after eating small amounts of food. A plastic tube runs from the silicone band to a device just under the skin. Saline (sterile salt water) can be injected or removed through the skin, flowing into or out of the silicone band. Injecting saline fills the band and makes it tighter. In this way, the band can be tightened or loosened as needed to reduce side effects and improve weight loss.

Laparoscopic Ventral and Incisional Hernia Repair: Pros and Cons

https://www.laparoscopyhospital.com/ This video is lecture of Pros and Cons of Laparoscopic Ventral and Incisional Hernia Repair by Dr. R. K. Mishra at World Laparoscopy Hospital. The purpose of this lecture is to analyse the surgical techniques, perioperative complications, and recurrence rate of laparoscopic ventral hernia repair (LVHR) including incisional Hernia, in comparison with the open ventral hernia repair (OVHR), based on the international literature. Incisional hernia is a common long-term complication of abdominal surgery and is estimated to occur in 3% to 13% of laparotomy incisions. The laparoscopic technique has numerous variations of the methodology used by surgeons, although several common steps are followed by all. The procedure starts with entering the peritoneal cavity by using a Veress needle, an open Hasson method, or an optical trocar allowing view of the abdominal wall layers during penetration. Palmer's point is the best place to access. This lecture indicates that LVHR is a safe and effective approach to abdominal wall hernias. The technique offers the advantages of the laparoscopic approach, ie, a short hospital stay, less postoperative pain, and early convalescence. The procedure carries an acceptable risk of complications compared to open surgery, a low risk of recurrence, and an excellent cosmetic result. It is considered a good alternative to its open counterpart, at least in experienced hands.

Dundee Jamming Knot and Aberdeen Termination demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This Video demonstrate Dundee Jamming Knot Continuous Suturing and Aberdeen Termination. Continuous suturing is required in laparoscopic surgery to close delicate long suture line. It can be started with Dundee Jamming Knot. The final knot of a continuous suture can be accomplished in the traditional way of open surgery as Aberdeen Termination. Dundee Jamming Knot and Aberdeen Termination are two surgical knots in the same direction and a final one in the opposite direction, tying the final loop of the continuous suture with the end of the suture with the needle, or it is possible to recur to the “Aberdeen knot,”8 in which a final knot is accomplished by creating a new loop in the already existing one. The final loop of the suture is kept loosely; then, grasping the needle with the assistant needle holder, the needle holder is inserted into the loop, and the suture thread is grasped at its middle and retracted without the grasper dropping the needle. This process generates a new loop in the already existing one, which is tied guiding the needle holder through the loop and applying countertraction between the needle holder and the assistant needle holder. This procedure is repeated twice. Finally, the end of the suture is guided with the needle through the last generated loop, and, using retraction, the final tightening of the knot is performed. If, at the end of the suture, the thread were too short to accomplish one of the described procedures.

Laparoscopic Surgery for Hydatid Cyst Disease

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic lecture of treatment of hydatid disease of the liver is an alternative to open surgery in well-selected patients. Important steps are the evacuation of the cyst contents without spillage, sterilization of the cyst cavity with scolicidal agents and cavity management using classical surgical techniques. The laparoscopic approach is safe with acceptable mortality and morbidity for both conservative and radical resections in selected patients. Clinical outcomes are comparable to open surgery, albeit in a selected group of patients.

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Laparoscopic Cholecystectomy for Stone impacted at Hartmann's pouch

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Cholecystectomy for Stone impacted at Hartmann's pouch. Manipulating the gallbladder with the left-hand instrument is a key part of performing a laparoscopic cholecystectomy. In these case stone should be removed from hartmann pouch. If a stone is impacted in the Hartmann’s pouch, this manipulation can be difficult, and can cause cramp and exhaustion of the surgeon’s left hand or injury to the gallbladder if a toothed instrument is used to improve grip. For the experienced laparoscopic surgeon, this tip makes manoeuvrability of the thickened, impacted Hartmann’s pouch simpler. We have used it in the acute and elective setting to great effect. The tape provides gentle traction and can be resisted easily if there are any concerns about placement as dissection continues.

Obesity Surgery - Vertical Sleeve Gastrectomy

https://www.laparoscopyhospital.com How does the Vertical Sleeve Gastrectomy compare to the other surgeries? Simple operation with low mortality risk. Technically easy to perform with low peri-operative risks. Minimal short-term and long-term complication rates. Short-term risks of staple line bleeding or leakage are very rare. The only long-term risk is GERD in some patients. Weight loss comparable with the gastric bypass. Gastric sleeve is not reversible. Part of the stomach is permanently removed. It is important to understand that reversing any weight loss operation (such as gastric band or gastric bypass) will result in weight regain back to original weight. You should not have any weight loss operation if you intend to ever reverse it. Though gastric sleeve is not reversible, it can be changed to gastric bypass if there was any need. Most illnesses that are related to obesity can be improved or even cured by weight loss surgery. These include: sleep apnoea, diabetes, high cholesterol, hypertension, stress incontinence, depression, acid reflux, joint pain, as well as osteoarthritis. Losing weight for obese patients also means greater outcomes from pregnancy, increased fertility, and a lower risk of cancer. The surgery increases life expectancy, on the whole.

Torted Ovarian Dermoid Cyst in Pregnant Patient

https://www.laparoscopyhospital.com/ This video is Laparoscopic management of Torted Ovarian Dermoid Cyst in Pregnant Patient. Dermoid cyst (Mature cystic teratoma), the most common type of primordial germ cell ovarian tumors is usually benign and asymptomatic. It can be malignant in 5% of cases. The incidence of torsion in pregnant patients with ovarian cyst persisting during pregnancy is approximately 15%. Benign dermoid cysts/teratomas are the most frequent ovarian tumors, with an incidence ranging from 5% to 25% of all ovarian neoplasms [3]. They are of germ cell origin and composed of multiple types of tissue. Torsion of the cystic contents and ovary may occur in them, thus leading to vascular infarction and necrosis. Torsion of the pedicle has been reported to be the most frequent complication, occurring in 16.1% of cases [3]. Traditional risk factors for ovarian torsion are increased ovarian size, ovarian tumors, ovarian hyperstimulation, and pregnancy

Total Laparoscopic Hysterectomy with Bilateral Salpingo Oophorectomy

https://www.laparoscopyhospital.com/ This video demonstrate TLH with BSO by Dr R K Mishra at World Laparoscopy Hospital. The use of laparoscopic hysterectomy has recently been reported as an alternative to traditional abdominal hysterectomy and the utilization of a mini-endoscopic technique has also been recorded. This prospective randomized study has demonstrated that after laparoscopic hysterectomy, patients recovered more quickly and had less pain, and the incidence of complications was also low. One serious complication after laparoscopic hysterectomy is increased ureteric injury, but in our opinion it is possible to avoid major complications by paying particular attention to the surgical details.

Hysterectomy for Large Uterus

https://www.laparoscopyhospital.com This video demonstrate Total Laparoscopic Hysterectomy for Large Uterus. Hysterectomy is the most common gynecologic surgical procedure performed, accounting for 1600,000 procedures per year. The most common indication for a hysterectomy is abnormal uterine bleeding, which is frequently caused by uterine leiomyoma, which is present in 25-50% of reproductive-aged women. Total Laparoscopic Hysterectomy is method of choice for large uterus if surgeon has sufficient experience.

Laparoscopic Nissen fundoplication - Dr R K Mishra

Laparoscopic Nissen fundoplication is a surgical procedure that alleviates gastroesophageal reflux disease (GERD) symptoms when lifestyle changes or anti-reflux medications have not controlled symptoms. The procedure was first performed in 1951 as an open-surgical procedure. Patients were hospitalized for 7 to 10 days after the procedure. Today, the Nissen fundoplication is performed in approximately 90 minutes. A majority of the time the patient is in the hospital overnight and is discharged the morning after surgery. Laparoscopic Nissen fundoplication is one of the popular surgery performed by general surgeon. Almost 90% of all the fundoplication in whole world is now performed via laparoscopic surgery. It is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia. In GERD, it is usually performed when medical therapy has failed; but, with a Type II (paraesophageal) hiatus hernia, it is the first-line procedure. The Nissen fundoplication is total (360°), but partial fundoplications known as Thal (270° anterior), Belsey (270° anterior transthoracic), Dor (anterior 180–200°), Lind (300° posterior), and Toupet fundoplications (posterior 270°) are alternative procedures with somewhat different indications and outcomes. In this procedure, the top part of the stomach (approximately 5 percent) is wrapped around the esophagus to form an additional valve to keep stomach contents from flowing up into the esophagus. The patient has five or six incisions, about ¼-inch each, in the abdomen. Post-operation, after arousing from the anesthesia, the patient is given liquids to drink, advancing then to a soft diet. It is a successful treatment in about 95 percent of the patients who have surgery.

Laparoscopic Roeder's knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ Laparoscopic Roeder's knot is one of the oldest knot used in laparoscopic surgery. Laparoscopic Roeder's knot is one of the most popular extracorporeal knot. This technique of the extracorporeal knotting is simple, easy, and reproducible with good knot and loop security and can be used with multifilament suture material of 90cm. Laparoscopic extracorporeal knot is popular for appendectomy, cholecystectomy, and any tubular structure upto 8mm structure.

Torted Ovarian Dermoid Cyst in 7 Year Old Girl

Ovarian torsion in children is an uncommon cause of acute abdominal pain but mandates early surgical management to prevent further adnexal damage. The clinical presentation mimics other pathologies, such as appendicitis. Ovarian torsion should be considered in any female child with acute onset lower abdominal pain accompanied by vomiting. Pain can be characterized as constant or colicky, but unlike with appendicitis, does not typically migrate. Sterile pyuria is found in a substantial proportion of cases. Ultrasound is the most useful initial diagnostic modality, but the absence of flow on Doppler imaging is not always present. Conservative management with detorsion and oophoropexy is recommended.

Laparoscopic Repair of Lumber Incisional Hernia

https://www.laparoscopyhospital.com Lumbar incisional hernias are often diffuse with fascial defects that are usually hard to appreciate. Computed tomography scan is the diagnostic modality of choice and allows differentiating them from abdominal wall musculature denervation atrophy complicating flank incisions. Repairing these hernias is difficult due to the surrounding structures. Principles of laparoscopic repair include lateral decubitus positioning with table flexed, adhesiolysis, and reduction of hernia contents, securing ePTFE mesh with spiral tacks and transfascial sutures to an intercostal space superiorly, iliac crest periosteum inferiorly, and rectus muscle anteriorly. Posteriorly, the mesh is secured to psoas major fascia with intracorporeal sutures to avoid nerve injury. Lumbar incisional hernia must be differentiated from muscle atrophy with no fascial defect. The laparoscopic approach provides an attractive option for this often challenging problem.

Laparoscopic Surgery for Hydatid Cyst Disease

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic lecture of treatment of hydatid disease of the liver is an alternative to open surgery in well-selected patients. Important steps are the evacuation of the cyst contents without spillage, sterilization of the cyst cavity with scolicidal agents and cavity management using classical surgical techniques. The laparoscopic approach is safe with acceptable mortality and morbidity for both conservative and radical resections in selected patients. Clinical outcomes are comparable to open surgery, albeit in a selected group of patients.

Lecture PPH Stapler piles surgery Step by Step by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate PPH stapled Piles Surgery step by step by Dr R K Mishra. PPH-stapler procedure for treatment of haemorrhoidal prolapse is an important improvement. Haemorrhoidal disease is the most frequent and ancient proctological pathology. Haemorrhoidectomy is always feared for intensive post-operative pain and complications. Stapled hemorrhoidopexy is good procedure but may be followed by severe postoperative complications of which haemorrhage is one of the most serious early events. Surgical techniques have advanced more and more with the aim of reducing the post-surgical complications and to help a faster recovery. “Open hemorrhoidectomy”, according to Milligan-Morgan procedure, has been the most used method in Europe, also in the “Ligasure” and “Ultracision” variants. “Closed hemorrhoidectomy”, according to Ferguson procedure, has been the most used method in the USA. Stapled hemorrhoidopexy (PPH-stapler) is an alternative method to conventional surgical procedures. It has many advantages such as less pain, faster recovery and a quicker return to normal activities. PPH stapler procedure for treatment of haemorrhoidal prolapse.

Laparoscopic PCOD Management

https://www.laparoscopyhospital.com/gynaecological-laparoscopy.html This video demonstrate laparoscopic ovarian drilling for PCOS (Polycystic Ovary Syndrome) Treatment. The exact mechanism of Ovarian Drilling in PCOS is yet to be elucidated. The most plausible one is the destruction of ovarian follicles and stroma resulting in a decrease in androgen and inhibin levels and a secondary rise in follicle-stimulating hormone (FSH) levels. Production of inflammatory growth factors like insulin-like growth factor-1, in response to thermal injury is in Laparoscopic Ovarian Drilling to Treat PCOS Infertility, further potentiates the actions of FSH on folliculogenesis, while increased blood flow to the ovary provoked by surgery, facilitates increased delivery of gonadotropins. The number of punctures is empirically chosen depending on the ovarian size. In the original procedure, 3-8 diathermy punctures (each of 3 mm diameter and 2-4 mm depth) per ovary were applied, using power setting of 40W W for 2-4 s

How to Perform Safe Laparoscopic Appendectomy - Lecture by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate How to Perform Safe Laparoscopic Appendectomy - Lecture by Dr R K Mishra. Appendicitis is one of the most common surgical problems and appendectomy is one of the most common surgery. One out of every 2,000 people has an appendectomy sometime during their lifetime. Treatment requires an operation to remove the infected appendix. Traditionally, the appendix is removed through an incision in the right lower abdominal wall. ADVANTAGES OF LAPAROSCOPIC APPENDECTOMY: Results may vary depending upon the type of procedure and patient’s overall condition. Common advantages are: Less postoperative pain May shorten hospital stay May result in a quicker return to bowel function Quicker return to normal activity Better cosmetic results

Laparoscopic Appendectomy - Immediate Laparoscopy is Ideal for Acute Appendicitis

Acute appendicitis is inflammation of the appendix, the narrow, finger-shaped organ that branches off the first part of the large intestine on the right side of the abdomen. This video demonstrate laparoscopic appendectomy performed for acute appendicitis by Dr R K Mishra. Although the appendix is a vestigial organ with no known function, it can become diseased. Acute appendicitis remains the most common surgical emergency. The lifetime risk of developing an appendicitis is reported to be 6.7% in females and 8.7% in males. The peak incidence occurs in the first and second decade of life, while it is uncommon to face appendicitis in children younger than 5 years of age. The clinical presentation may be varied and often is similar to other medical conditions, so a misdiagnosis can be frequent and the most common one is usually gastroenteritis. Our diagnostic and therapeutic protocol from about ten years was the following: if the patient was thought to have an acute appendicitis preoperatively diagnosed by physical, laboratory findings and ultrasound examination, antibiotic treatment was started immediately with laparoscopic appendectomy. Laparoscopy is now demonstrated to be the optimal approach also to treat complicated appendicitis, but this standardized operation is not always easy to perform for new surgeons.

Laparoscopic Fundoplication

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Fundoplication Surgery for GERD. A Nissen fundoplication, or laparoscopic Nissen fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease and hiatal hernia. The fundoplication operation is usually carried out using keyhole surgery (laparoscopy). The surgeon uses a telescope, with a miniature video camera mounted on it, inserted through a small incision (cut) to see inside the abdomen. Carbon dioxide gas is used to inflate the abdomen to create space in which the surgeon can operate using specialised instruments that are also passed through other smaller incisions (cuts) in the abdomen. The operation itself has two parts. Firstly the surgeon will examine the diaphragm to check the size of the opening around the oesophagus. If it too loose, the surgeon will tighten this. The second part of the operation involves wrapping the upper part of the stomach (fundus) around the base of the oesophagus and loosely stitching it in place. This tightens the sphincter enough to reduce reflux but not so tight as to affect swallowing.

Laparoscopic sleeve gastrectomy with endoscopic calibration

Endoscopic calibration is associated with lower postoperative complications after laparoscopic sleeve gastrectomy. The use of the endoscope for the calibration of the gastric sleeve, instead of the standard use of the bougie, is a safe procedure and gives the surgeon a higher sense of security. The aim is to evaluate the effect of the use of endoscopic guidance on postoperative complications and mid-term results of the bariatric procedure. Gastrointestinal complication after sleeve gastrectomy surgery may be summarized as follow: acute bleeding and/or anemia, staple-line complications such as anastomotic leaks, fistulae, and strictures, erosion and slippage, bezoars, and choledocholithiasis. An endoscopy is the preferred strategy, unless there is a suspicion of leaks or fistulae, in which case preliminary contrast radiography may be more appropriate. Endoscopic treatment plays an important role in the management of a variety of staple-line complications during and even after surgery, such as stomal stenosis and anastomotic leaks. The intraoperative tightness check with blue dye and air insufflation through an orogastric tube in the bougie calibration group is done in all the patients. In the endoscopic calibration the check with blue dye is much better in all cases.

Laparoscopic Surgery for Ectopic Pregnancy - Lecture by Dr R K Mishra

This video is lecture of Dr R K Mishra on laparoscopic management of ectopic pregnancy. Most ectopic pregnancies occur in the fallopian tube, but they can also happen in the neck of the womb, in the ovary, or in the abdominal cavity. Laparoscopic Salpingostomy or Salpingectomy is the method of choice for the management of ectopic pregnancy. In a normal pregnancy, fertilization occurs in the fallopian tubes, where an egg, or ovum, meets a sperm cell. The fertilized egg then travels into the uterus and becomes implanted in the womb lining. The embryo develops into a fetus and remains in the uterus until birth. An ectopic pregnancy can be fatal without prompt treatment. For example, the fallopian tube can burst, causing internal abdominal bleeding, shock, and serious blood loss. According to the Centers for Disease Control and Prevention, between 1 and 2 percent of all pregnancies are ectopic. However, ectopic pregnancy is the cause of 3 to 4 percent of pregnancy-related deaths. Ectopic surgery The fallopian tubes can be repaired or removed with surgery. Keyhole surgery can be performed to remove the ectopic tissue. This is also known as a laparoscopy. In a laparoscopy, the surgeon makes a small incision in or near the navel and inserts a device called a laparoscope to view the area. Other surgical instruments are inserted into a tube, or through other small incisions, to remove the ectopic tissue. If the area is damaged, surgeons might be able to repair the fallopian tubes, but they will probably have to remove the affected tube as part of this procedure. If the other fallopian tube is still intact, a healthy pregnancy is still possible. If severe internal bleeding has occurred, a larger incision may be needed. This procedure would be called a laparotomy.

Lecture on Laparoscopic Appendectomy for Acute Appendicitis

https://www.laparoscopyhospital.com/ This video is lecture of Dr R K Mishra on Laparoscopic Appendectomy. Laparoscopic Appendectomy can be performed by single incision, two port or three incisions, one umbilical and one suprapubic are made; permanent material used comprises: grasping forceps, hook, scissors, needle holders, three metal trocars and four other usual instruments, and a single strand of cotton. There is possibility of using endobag and in few cases no need to use of operative extractors bags, clips, endoloops, staples or bipolar or harmonic energy instruments. Allows triangulation and instrumentation in the conventional manner.

Laparoscopic Tumble Square Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Tumble Square Knot. Laparoscopic Tumble Square Knot is the only knots that can be used when the suture does not slide freely through the tissue and anchoring device. Laparoscopic Tumble Square Knot configurations also theoretically avoid suture damage from abrasion and tissue damage during sliding. The major disadvantage of static knots is the propensity of the loop to loosen before the second half-hitch is seated to the point that it provisionally “locks” the knot. One method of minimizing this effect is by using a maryland to push the square knot on which one limb is tumbled which holds the tissue loop tight as it advances sequential half-hitches.

Cholecystectomy and Appendectomy together by Mishra's knot.

https://www.laparoscopyhospital.com/SERV02.HTM Combined laparoscopic appendectomy and cholecystectomy produces good outcomes than either procedure performed independently, with a not increased incidence of wound complications and morbidity. Overall, however, patients who undergo simultaneous procedures appear much faster recovery. Further investigation is needed to define appropriate indications for these concomitant procedures as well as to identify the key factors that determine outcomes. An operative experience of three patients who underwent incidental laparoscopic appendectomy during laparoscopic cholecystectomy is presented. The technique and indications is shown in this video. We conclude with our experience that incidental laparoscopic appendectomy is possible and safe with existing incisions performed in gallbladder surgery. However, well-controlled prospective studies should be performed prior to wide application of this technique.

Unedited Laparoscopic Hysterectomy - Dr. R. K. Mishra

https://www.laparoscopyhospital.com/ Minimal Access Laparoscopic Hysterectomy is becoming a very common procedure, although significant concerns about the procedure voiced by many gynecologists are twofold: The ability to confidently close the vaginal cuff laparoscopically and the fear of cuff dehiscence and ureteric injury. This has resulted in many practitioners securing the uterine artery vaginally and closing the cuff vaginally, which increases operating time, or converting to LAVH or LSH. We have developed a nice desiccation technique of uterine artery during Total Laparoscopic Hysterectomy and vaginal cuff closure technique following TLH that incorporates the same surgical principles as closure for an abdominal hysterectomy. It is easy to learn and simple continuous suturing is required intracorporeally to close the vault. Mean surgical time is half an hour. This video demonstrates the use of a vessel sealing device to perform a laparoscopic hysterectomy with an obliterated posterior cul-de-sac. This technique demonstrates how to dissect the anterior compartment first. Then we controlled the large uterine vessels.

Laparoscopic inguinal hernia repair "IPOM" with Dual-Mesh

https://www.laparoscopyhospital.com/ This video demonstrate laparoscopic inguinal hernia by IPOM. Dr R K Mishra report their experience on laparoscopic hernioplasty using the Intraperitoneal Onlay Mesh Repair (IPOM). Many patients had a bilateral hernia, and many of which were recurrent and some had recurrent hernia. Overall, a total of 85 hernias were treated. The hernia repair was performed utilizing Polyurathane Dual Mesh. The prostheses were fixed with titanium spiral tacks (Protack, AutoSuture, Tyco Healthcare). No intraoperative complications occurred and no conversion was necessary. Mean resumption of normal activity was 10 days with return to work within two weeks. At an average 24 months follow-up, were recorded. The results of this study as well as the meta-analysis of the series presented in the Literature, indicate that the IPOM may be a feasible, safe and effective procedure in the treatment of inguinal hernia repair is performed during other laparoscopic procedures. The IPOM has infact been shown to be faster and easier than the other more commonly performed laparoscopic hernioplasties (TAPP and TEP). These data may also suggest to utilize this technique in particular cases of primitive hernia such as very active young males or heavy duty workers. However the limited experience and the short follow-up ask for long term studies to definitely ascertain the true incidence of recurrence and therefore the effectiveness of this attractive procedure.

Laparoscopic Suturing Melzer's Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ Laparoscopic suturing and knot tying require a lot of patience and practice and can be difficult, time consuming, and frustrating in spite of the advances made in the fields of instrumentation, optics, and imaging. The new technique described here is an effort to make the procedure simpler by providing extracorporeal control of one limb of the suture. It involves percutaneous placement of the needle end of the suture in the abdomen and its removal using a modified 10 cm long cloth-sewing needle.

Laparoscopic Cholecystectomy with Laparoscopic Ovarian Drilling

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Cholecystectomy with Laparoscopic Ovarian Drilling in same patient by Dr R K Mishra at World Laparoscopy Hospital. Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women who have polycystic ovary syndrome (PCOS). Electrocautery or a laser is used to destroy parts of the ovaries. A laparoscopic cholecystectomy is a surgery during which the doctor removes your gallbladder. This procedure uses several small cuts instead of one large one. A laparoscope, a narrow tube with a camera, is inserted through one incision. This allows surgeon to see gallbladder on a HD monitor. Laparoscopic cholecystectomy is Gold standard for Gallstone disease.

Retroperitoneoscopic Nephrectomy and Ureterolithotomy

https://www.laparoscopyhospital.com/ This video demonstrate Retroperitoneoscopic Nephrectomy and Ureterolithotomy. The emergence of minimally invasive surgery about 20 years ago revolutionized urological surgery. Advances in retroperitoneoscopy allowed the widespread use of minimally invasive techniques in almost the entire range of urology. In this context, laparoscopy and later retroperitoneoscopy were developed and applied in a wide spectrum of urological diseases. Both approaches have since presented benefits and disadvantages that have been documented in various series. However, few comparative studies have been conducted. Retroperitoneoscopy can be accomplished placing the patient in lateral or prone position. This technique requires experience to find the way to the retroperitoneum. The main landmark during surgery is the psoas muscle. The prone approach is very versatile because it gives the surgeon the chance to reach the adrenal gland and the upper and lower urinary tract, and also allows a bilateral procedure to be achieved. Furthermore, this access leaves the kidney in place and has the advantage of a direct approach to the vessels. On the other hand, it is not the best option when mobilization of the lower ureter and urgent conversion are needed.

Laparoscopic Surgery for Peritoneal Inclusion cyst with Bilateral Endometrioma

This Video demonstrate Laparoscopic Management of Inclusion cyst with Bilateral Endometrioma. Peritoneal inclusion cyst (PIC) is defined as a fluid-filled mesothelial-lined cysts of the pelvis and it is most frequently encountered in women of reproductive age. The treatment options are observation, hormonal management, imaging-guided aspiration, image-guided sclerotherapy and surgical excision. Peritoneal inclusion cysts are uncommon abdominopelvic cysts seen in reproductive age group women. It is often misdiagnosed clinically as an ovarian tumor due to similar presentation and mimicking findings on radiology. We describe a woman presenting with pelvic mass. Her clinical finding on radiology suggested an ovarian tumor; however, biopsy revealed it as peritoneal inclusion cysts.

Mishra's Knot - Ideal for Laparoscopic Cholecystectomy

This video demonstrate Mishra's Knot used in laparoscopic cholecystectomy. This is an Ideal for Laparoscopic Cholecystectomy. Tying extracorporeal knot to the cystic duct has many advantages. This knot is also can be used for in mass ligation and partial cholecystectomy.

Laparoscopic Sleeve Gastrectomy Surgery Video Explained Step by Step

This video demonstrate Laparoscopic Sleeve Gastrectomy which is a popular Bariatric Surgery for morbid obesity. Sleeve gastrectomy is a simpler bariatric operation than the gastric bypass procedure for morbid obesity because it does not involve rerouting of or reconnection of the intestines. The sleeve gastrectomy, unlike the Lap-band, does not require the use of a banding device to be implanted around a portion of the stomach. Laparoscopic Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. The sleeve gastrectomy, by reducing the size of the stomach, allows the patient to feel full after eating less and taking in fewer calories. The surgery removes that portion of the stomach that produces a hormone that can makes a patient feel hungry.

Laparoscopic Surgery Training in Dubai

https://www.laparoscopyhospital.com/dubai.html The laparoscopy training institute of World Laparoscopy Hospital in Dubai provides exposure in live operational and surgical procedures. The training also includes practical and theoretical sessions. Free hands-on training in the latest of da vinci laparoscopic robots is also included in the course structure. The world laparoscopy hospital provides a modern facility for micro laparoscopic surgery as they incorporate the application of state of the art HD laparoscopic lab and surgical instruments. At World Laparoscopy Hospital we recognize the value of every psurgeon and are guided by our commitment to excellence and leadership to train them. We demonstrate this by providing exemplary physical, emotional and spiritual care for each of our trainees. We have Fellowship Program in Minimal Access Surgery for Surgeons and Gynecologists.

Laparoscopic Tayside Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Tayside Knot. This is an extracorporeal knot can be used to ligate tubular structure. The Tayside knot is suitable for use with all braided sutures (2/0 or stronger) as well as dacron. It is used with Dacron for ligation of vessels such as the azygous vein, splenic artery/vein or the inferior mesenteric artery/vein. A variety of slipknots are used by various professions and in certain leisure activities. Some of these have been adapted for use in endoscopic surgery. The holding strength of individual types of slipknots is influenced by a number of factors including the ligature material used and its caliber. Thus a slipknot may be secure when tied in catgut but unsafe with other materials. In addition, some slipknots are difficult to tie or jam lock too easily for reliable placement by push rod before locking.

Laparoscopic Weston Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ The Weston slip knot was initially described in the obstetric and gynecology literature and is also used in arthroscopic surgery.The advantage of this knot is that it is relatively easy to tie outside, can then slip easily into place and be tightly secured. The post strand does not move throughout the knot; the loop strand is the longer strand which is moved to make the knot. The advantage of the Weston knot is that it locks readily and is not bulky.

Dundee Jamming Knot and Aberdeen Termination demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This Video demonstrate Dundee Jamming Knot Continuous Suturing and Aberdeen Termination. Continuous suturing is required in laparoscopic surgery to close delicate long suture line. It can be started with Dundee Jamming Knot. The final knot of a continuous suture can be accomplished in the traditional way of open surgery as Aberdeen Termination. Dundee Jamming Knot and Aberdeen Termination are two surgical knots in the same direction and a final one in the opposite direction, tying the final loop of the continuous suture with the end of the suture with the needle, or it is possible to recur to the “Aberdeen knot,”8 in which a final knot is accomplished by creating a new loop in the already existing one. The final loop of the suture is kept loosely; then, grasping the needle with the assistant needle holder, the needle holder is inserted into the loop, and the suture thread is grasped at its middle and retracted without the grasper dropping the needle. This process generates a new loop in the already existing one, which is tied guiding the needle holder through the loop and applying countertraction between the needle holder and the assistant needle holder. This procedure is repeated twice. Finally, the end of the suture is guided with the needle through the last generated loop, and, using retraction, the final tightening of the knot is performed. If, at the end of the suture, the thread were too short to accomplish one of the described procedures.

Laparoscopic Nephrectomy Lecture by Dr R K Mishra

This video is of Laparoscopic Nephrectomy Lecture by Dr R K Mishra. A laparoscopic nephrectomy is minimally invasive operation to remove kidney. A laparoscopic nephrectomy involves removing an entire kidney through keyhole incisions in the flank, the side of the body between the ribs and the hip. A laparoscopic nephrectomy removes the kidney by using laparoscopic equipment. Long thin instruments are passed through up to five small incisions made in the flank, each about 1cm in length. The abdomen is first filled with carbon dioxide, which separates the tissues to allow for vision during the surgery. A camera is then passed, giving the urologist a detailed picture inside the abdomen. The other incisions are used to pass cutting and suturing instruments so the blood supply to the kidney can be isolated and tied off and the kidney removed either with or without its surrounding structures. A wound drain is then inserted to drain any wound ooze. This is usually stitched in place and stays in for 1 – 2 days. A nephrectomy is usually done for one of two reasons, either for cancer of the kidney or because of a non- functioning kidney. In the case of kidney cancer a radical laparoscopic nephrectomy is done. This is done in an attempt to rid the body of cancer by removing the entire kidney and adrenal gland, with its surrounding fat and attached vessels. In more advanced cases it may be done to stop continued bleeding from the effected kidney. For non-functioning kidneys, which are either caused by large stones, a lack of blood supply or abnormal kidney structure, a simple laparoscopic nephrectomy is done. This is where only the kidney itself is taken and the adrenal gland and other structures are left behind. A simple nephrectomy is usually done to avoid recurrent infection and pain and the possibility of severe illness because of infection.

Sleeve Gastrectomy in Patient Previously operated for Ventral Hernia

Generally it should not be a problem to have a sleeve after incisional hernia repair, even with mesh. You do not need to worry about the insufflation of the abdomen stretching the mesh if you go through palmer's point. All laparoscopic incisions are small and do not disrupt the integrity of the mesh. The only incision that is a little larger is the one that the resected stomach is removed through. Ideally you want to do the sleeve laparoscopically. Yes, there will be a lot of adhesions, but an experienced laparoscopic bariatric surgeon can get it done with the laparoscope. The mesh can be re-sewn and it will heal fine. It is hard to say for sure without knowing where on your abdominal wall the mesh was placed, but I have operated on numerous patients with prior hernia repairs and it isn't a challenge that can't be overcome. If the hernia was from a prior C-section, meaning lower on your abdominal wall, then the laparoscopic port sites for a VSG should not interfere.

Gastrointestinal Endoscopy Procedure Preparation & Risks

https://www.laparoscopyhospital.com/ This video is lecture of Gastrointestinal Endoscopy Procedure Preparation & Risks by Dr. R. K. Mishra at World Laparoscopy Hospital. Endoscopy has several names, depending on which portion of digestive tract by physician seeks to inspect. Upper GI endoscopy (EGD): This procedure enables the examination of the esophagus, stomach and the upper small bowel called duodenum. Colonoscopy: This procedure enables the doctor to see ulcers, inflamed mucous lining of your intestine, abnormal growths and bleeding in your colon, or large bowel. Enteroscopy: Enteroscopy is a recent diagnostic tool that allows a doctor to see your small bowel. The procedure may be used in the following ways: To diagnose and treat hidden GI bleeding To detect the cause for malabsorption To confirm problems of the small bowel seen on an X-ray During surgery, to locate and remove sores with little damage to healthy tissue

Sleeve Gastrectomy

https://www.laparoscopyhospital.com/bariatric-surgery.html This video demonstrate laparoscopic sleeve gastrectomy performed by Dr R K Mishra at World Laparoscopy Hospital. The laparoscopic sleeve gastrectomy (SG) or gastric sleeve surgery, involves re-shaping the stomach from a pouch-like shape into a long tube, or “sleeve”. Pre-surgery the stomach looks like a kidney bean and can expand to the volume of several liter-size bottles of soda. With staples, the stomach is converted to look like a banana. This weight loss surgery reduces the capacity and prevents the stomach from expanding significantly. Before sleeve gastrectomy a regular stomach can hold about six cups of food. The new small stomach can hold about a half cup in volume, resulting in a ‘restrictive’ weight loss of the person. This type of laparoscopic sleeve gastrectomy bariatric surgery can be done as a stand-alone procedure or as part of a staged operation. The weight loss is projected to be in the range of 55 to 70 percent of excess body weight. There is no malabsorption created and no foreign body or implant involved. Long-term results are becoming available and the data suggest the weight loss is similar to gastric bypass.

Laparoscopic Surgeon's Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ Laparoscopic knot-tying is an advanced skill. The traditional surgeon's knot is often used in laparoscopic surgery for every tissue. Surgeons knot is most versatile knot in laparoscopic surgery. It can be used in many situations like bowel anastomosis, pyeloplasty, tubal recanalization etc... Surgeons knot can be terminated at the end of a continuous suture line in laparoscopic surgery by again surgeons knot or square knot. The Aberdeen knot has been shown to be stronger and more secure than the surgeon's knot for ending a suture line but is rarely used in laparoscopic surgery. We have developed a new technique to make the surgeons knot laparoscopically. Any surgeon's concern about the ease and safety of laparoscopic knotting is natural, and knots performed laparoscopically must be as safe as those traditionally performed. A knot should secure proper tissue approximation, and be simple, easy, quick, and reliable.

Laparoscopic Tubal Patency Test Hysteroscopy and Ovarian Drilling

This surgery was performed to evaluate the effectiveness of hydrolaparoscopy among infertile women with a Polycystic Ovarian Syndrome (PCOS) resistant to clomephine. PCOS is characterized by presence of the hyperandrogenism, oligo- or anovulation. It is one of the most common reproductive endocrine disorders in the adolescent women. Females with PCOS present with a dysregulation in the menstrual cycle, hirsutism, anovulation, acne, and obesity. An approximately 5-10% of women in Poland suffer from PCOS and 10-15% of them are infertile

Laparoscopic Management of Chronic Ectopic and Myomectomy in same patient

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Management of Chronic Ectopic and Myomectomy in same patient at same session. Chronic ectopic pregnancy is a form of tubal pregnancy in which salient minor ruptures or abortions of an ectopic pregnancy instead of a single episode of bleeding, incites an inflammatory response often leading to the formation of a pelvic mass. Ectopic pregnancy presents diagnostic dilemmas in the absence of classical symptoms. MRI and laparoscopy are important tools in such cases. If patient has fibroid uterus it can be operated at same session.

Laparoscopic Removal of Huge Ovarian Cyst

https://www.laparoscopyhospital.com/gynaecological-laparoscopy.html Laparoscopic surgery has been increasingly applied to different gynecologic ovaries surgical problems with excellent surgical outcome and rapid recovery. Large ovarian cysts, a relatively common gynecologic problem, pose certain challenges to laparoscopic management. Laparoscopy is a safe technique for managing patients with large ovarian cysts and is associated with low conversion and complication rates. The chance of finding unexpected ovarian cancer varies according to the patients’ selection criteria but is low overall. With proper patient selection, the size of an ovarian cyst should not constitute a contraindication to laparoscopic surgery. Experience in advanced laparoscopic surgery and the availability of a gynecologic oncologist should make the procedure safely applicable to a broader patient population.

Laparoscopic Radical Hysterectomy

https://www.laparoscopyhospital.com/ This video is lecture of Laparoscopic Radical Hysterectomy by Dr R K Mishra. This procedure is used to treat stage I or IIA cervical cancer. Radical hysterectomy involves surgical removal of the uterus, the supporting ligaments and the upper vagina, together with removal of the pelvic lymph nodes and sometimes the para-aortic lymph nodes. Laparoscopic radical hysterectomy is a feasible alternative to laparotomy for early stage cervical cancer. Similar surgical outcomes are achieved with significantly less morbidity.

Laparoscopic Ventral and Incisional Hernia Repair: Pros and Cons

https://www.laparoscopyhospital.com/ This video is lecture of Pros and Cons of Laparoscopic Ventral and Incisional Hernia Repair by Dr. R. K. Mishra at World Laparoscopy Hospital. The purpose of this lecture is to analyse the surgical techniques, perioperative complications, and recurrence rate of laparoscopic ventral hernia repair (LVHR) including incisional Hernia, in comparison with the open ventral hernia repair (OVHR), based on the international literature. Incisional hernia is a common long-term complication of abdominal surgery and is estimated to occur in 3% to 13% of laparotomy incisions. The laparoscopic technique has numerous variations of the methodology used by surgeons, although several common steps are followed by all. The procedure starts with entering the peritoneal cavity by using a Veress needle, an open Hasson method, or an optical trocar allowing view of the abdominal wall layers during penetration. Palmer's point is the best place to access. This lecture indicates that LVHR is a safe and effective approach to abdominal wall hernias. The technique offers the advantages of the laparoscopic approach, ie, a short hospital stay, less postoperative pain, and early convalescence. The procedure carries an acceptable risk of complications compared to open surgery, a low risk of recurrence, and an excellent cosmetic result. It is considered a good alternative to its open counterpart, at least in experienced hands.

Rudimentary Uterus

https://www.laparoscopyhospital.com This video demonstrate rudimentary uterus with absence of both ovaries and 46 ,XX normal karyotype. Genetic investigation revealed a 46,XX karyotype without any mosaicism. Diagnostic laparoscopy was performed. During laparoscopic pelvic exploration, a rudimentary uterus without ovaries and normal bilateral fallopian tubes were observed. If gonadal agenesis is thought to be the cause of primary amenorrhea in patients with normal secondary sexual characteristics, we believe that laparoscopic evaluation is the gold standard in diagnosis.

Basic Steps of Hysterectomy

https://www.laparoscopyhospital.com/ This video demonstrate step by step total laparoscopic hysterectomy. Hysterectomy is the removal of the uterus with surgery. There are many reasons a hysterectomy can be performed such as fibroids, heavy or irregular menstrual bleeding, prolapse, chronic uterine pain, pelvic inflammatory disease, pre-cancerous conditions, cancer and endometriosis. hysterectomy depending on the clinical circumstances. A hysterectomy can be performed using a laparoscope, which is a thin keyhole camera that allows the surgeon to see the pelvic organs. The laparoscope and other instruments are inserted through small incisions in the skin and then used by the surgeon to remove the uterus. hysterectomy depending on the clinical circumstances. A hysterectomy can be performed using a laparoscope, which is a thin keyhole camera that allows the surgeon to see the pelvic organs. The laparoscope and other instruments are inserted through small incisions in the skin and then used by the surgeon to remove the uterus.

Laparoscopic Management of Ovarian Teratoma

https://www.laparoscopyhospital.com This video demonstrate laparoscopic cystectomy for ovarian teratoma. Germ cell tumours begin in egg cells in women or sperm cells in men. There are 2 main types of ovarian teratoma: mature teratoma, which is non cancerous (benign). immature teratoma, which is cancerous. Immature teratomas are usually diagnosed in girls and young women up to their early 20s. These cancers are rare. They are called immature because the cancer cells are at a very early stage of development. Most immature teratomas of the ovary are cured, even if they are diagnosed at an advanced stage. Keywords: Laparoscopy, Dermoid cyst, Ovarian cyst, Operative laparoscopy. Benign cystic teratomas, or dermoid cysts, are germ cell tumors of the ovary that account for 20-25% of all ovarian tumors and are bilateral in 10-15% of cases. They have a low incidence of malignancy, reported as 1-3%. The majority of dermoid cysts are asymptomatic and are often discovered incidentally upon pelvic exam. The potential for complications such as torsion, spontaneous rupture, risk of chemical peritonitis, and malignancy usually makes surgical treatment necessary upon diagnosis. Traditional therapy for a dermoid cyst has been cystectomy or oophorectomy via laparotomy. The laparoscopic approach has become increasingly accepted since 1989. Because most patients with cystic teratomas are of reproductive age, a conservative approach is ideal; laparoscopy may minimize adhesion formation and thus decrease the chance of compromising fertility. The management of ovarian teratomas in normal conditions is well established, but in rare giant cases (tumor diameter over 15 cm), the choice of management, such as laparotomic or laparoscopic approaches, are controversial and may be therapeutically challenging for surgeons.

Laparoscopic Mishra's Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This is a video of Laparoscopic Mishra's Knot. Laparoscopic suturing and knotting is important for surgeons and gynecologist. Mishra's Knot is one of the important extracorporeal knot for any tubular structure. Configuration of Mishra's Knot is 1:1:1:1:1:1:1. This knot is secured upto 18mm of tubular structure.

Dangerous way of Performing Laparoscopic Cholecystectomy

https://www.laparoscopyhospital.com/ This Video demonstrate a dangerous way of Performing Laparoscopic Cholecystectomy by Harmonic Scalpel In Mass Shearing. Ideally a nice dissection of calot's triangle with critical view of safety should be done. World wide laparoscopic cholecystectomy (LC) has become the customary method for treating gallstones, some incidents and complications appear rather more frequently than with the open technique. Several aspects of these complications and their treatment possibilities are analysed and clipless cholecystectomy with Harmonic scalpel is one of them. During the past decade world wide laparoscopic cholecystectomy has become the procedure of choice in the surgical treatment of symptomatic gallstone. The operation is not completely risk-free, some incidents and complications being more frequent than with open cholecystectomy. The use of the Harmonic scalpel is deemed safe and comparable to clip placement at the discretion of the surgeon for cystic duct ligation. According to the article published by many author, harmonic shears is effective and safe in laparoscopic cholecystectomy as a sole instrument for sealing and division of the artery and cystic duct. The main advantages could be related to the safety and decreased operative time. Further research with larger homogeneous studies and assessments of cost-effectiveness would further enhance the increasing use of the Harmonic scalpel in laparoscopic cholecystectomy.

Laparoscopic Extracorporeal Square Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Extracorporeal Square Knot. Laparoscopic Square knot is used for any structure which is tough and under tension. It can be used for approximation of vaginal vault, Rectus Divarication, Myomectomy, Crural Approximation etc...

Gastric Banding

https://www.laparoscopyhospital.com/ Laparoscopic gastric banding is surgery to help with weight loss. The surgeon places a band around the upper part of your stomach to create a small pouch to hold food. The band limits the amount of food you can eat by making you feel full after eating small amounts of food. A plastic tube runs from the silicone band to a device just under the skin. Saline (sterile salt water) can be injected or removed through the skin, flowing into or out of the silicone band. Injecting saline fills the band and makes it tighter. In this way, the band can be tightened or loosened as needed to reduce side effects and improve weight loss.

Laparoscopic Myomectomy for Multiple Myoma

Laparoscopic myomectomy in multiple fibroids. Myomectomy is the surgery of choice for women who have symptomatic fibroids and who wish to retain their uterus. ... It is known that uterine fibroids are estrogen dependent. During pregnancy these fibroids increase in size, whereas in the puerperium and menopause they shrink. In laparoscopic or robotic myomectomy, minimally invasive procedures, your surgeon accesses and removes fibroids through several small abdominal incisions. Laparoscopic myomectomy. Your surgeon makes a small incision in or near your bellybutton. Then he or she inserts a laparoscope ― a narrow tube fitted with a camera ― into your abdomen. Your surgeon performs the surgery with instruments inserted through other small incisions in your abdominal wall. Robotic myomectomy. Instruments are inserted through small incisions similar to those in a laparoscopic myomectomy, and the surgeon controls movement of instruments from a separate console. Sometimes, the fibroid is cut into pieces and removed through a small incision in the abdominal wall. Other times the fibroid is removed through a bigger incision in your abdomen so it can be removed without being cut into pieces. Rarely, the fibroid may be removed through an incision in your vagina (colpotomy).

https://www.laparoscopyhospital.com/

Laparoscopic Surgeon's Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ Laparoscopic knot-tying is an advanced skill. The traditional surgeon's knot is often used in laparoscopic surgery for every tissue. Surgeons knot is most versatile knot in laparoscopic surgery. It can be used in many situations like bowel anastomosis, pyeloplasty, tubal recanalization etc... Surgeons knot can be terminated at the end of a continuous suture line in laparoscopic surgery by again surgeons knot or square knot. The Aberdeen knot has been shown to be stronger and more secure than the surgeon's knot for ending a suture line but is rarely used in laparoscopic surgery. We have developed a new technique to make the surgeons knot laparoscopically. Any surgeon's concern about the ease and safety of laparoscopic knotting is natural, and knots performed laparoscopically must be as safe as those traditionally performed. A knot should secure proper tissue approximation, and be simple, easy, quick, and reliable.

Laparoscopic Cholecystectomy with Laparoscopic Ovarian Drilling

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Cholecystectomy with Laparoscopic Ovarian Drilling in same patient by Dr R K Mishra at World Laparoscopy Hospital. Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women who have polycystic ovary syndrome (PCOS). Electrocautery or a laser is used to destroy parts of the ovaries. A laparoscopic cholecystectomy is a surgery during which the doctor removes your gallbladder. This procedure uses several small cuts instead of one large one. A laparoscope, a narrow tube with a camera, is inserted through one incision. This allows surgeon to see gallbladder on a HD monitor. Laparoscopic cholecystectomy is Gold standard for Gallstone disease.

Laparoscopic Removal of Huge Ovarian Cyst

https://www.laparoscopyhospital.com/gynaecological-laparoscopy.html Laparoscopic surgery has been increasingly applied to different gynecologic ovaries surgical problems with excellent surgical outcome and rapid recovery. Large ovarian cysts, a relatively common gynecologic problem, pose certain challenges to laparoscopic management. Laparoscopy is a safe technique for managing patients with large ovarian cysts and is associated with low conversion and complication rates. The chance of finding unexpected ovarian cancer varies according to the patients’ selection criteria but is low overall. With proper patient selection, the size of an ovarian cyst should not constitute a contraindication to laparoscopic surgery. Experience in advanced laparoscopic surgery and the availability of a gynecologic oncologist should make the procedure safely applicable to a broader patient population.

Rudimentary Uterus

https://www.laparoscopyhospital.com This video demonstrate rudimentary uterus with absence of both ovaries and 46 ,XX normal karyotype. Genetic investigation revealed a 46,XX karyotype without any mosaicism. Diagnostic laparoscopy was performed. During laparoscopic pelvic exploration, a rudimentary uterus without ovaries and normal bilateral fallopian tubes were observed. If gonadal agenesis is thought to be the cause of primary amenorrhea in patients with normal secondary sexual characteristics, we believe that laparoscopic evaluation is the gold standard in diagnosis.

Laparoscopic Surgery for Ectopic Pregnancy - Lecture by Dr R K Mishra

This video is lecture of Dr R K Mishra on laparoscopic management of ectopic pregnancy. Most ectopic pregnancies occur in the fallopian tube, but they can also happen in the neck of the womb, in the ovary, or in the abdominal cavity. Laparoscopic Salpingostomy or Salpingectomy is the method of choice for the management of ectopic pregnancy. In a normal pregnancy, fertilization occurs in the fallopian tubes, where an egg, or ovum, meets a sperm cell. The fertilized egg then travels into the uterus and becomes implanted in the womb lining. The embryo develops into a fetus and remains in the uterus until birth. An ectopic pregnancy can be fatal without prompt treatment. For example, the fallopian tube can burst, causing internal abdominal bleeding, shock, and serious blood loss. According to the Centers for Disease Control and Prevention, between 1 and 2 percent of all pregnancies are ectopic. However, ectopic pregnancy is the cause of 3 to 4 percent of pregnancy-related deaths. Ectopic surgery The fallopian tubes can be repaired or removed with surgery. Keyhole surgery can be performed to remove the ectopic tissue. This is also known as a laparoscopy. In a laparoscopy, the surgeon makes a small incision in or near the navel and inserts a device called a laparoscope to view the area. Other surgical instruments are inserted into a tube, or through other small incisions, to remove the ectopic tissue. If the area is damaged, surgeons might be able to repair the fallopian tubes, but they will probably have to remove the affected tube as part of this procedure. If the other fallopian tube is still intact, a healthy pregnancy is still possible. If severe internal bleeding has occurred, a larger incision may be needed. This procedure would be called a laparotomy.

Mishra's Knot - Ideal for Laparoscopic Cholecystectomy

This video demonstrate Mishra's Knot used in laparoscopic cholecystectomy. This is an Ideal for Laparoscopic Cholecystectomy. Tying extracorporeal knot to the cystic duct has many advantages. This knot is also can be used for in mass ligation and partial cholecystectomy.

Laparoscopic Surgery Training in Dubai

https://www.laparoscopyhospital.com/dubai.html The laparoscopy training institute of World Laparoscopy Hospital in Dubai provides exposure in live operational and surgical procedures. The training also includes practical and theoretical sessions. Free hands-on training in the latest of da vinci laparoscopic robots is also included in the course structure. The world laparoscopy hospital provides a modern facility for micro laparoscopic surgery as they incorporate the application of state of the art HD laparoscopic lab and surgical instruments. At World Laparoscopy Hospital we recognize the value of every psurgeon and are guided by our commitment to excellence and leadership to train them. We demonstrate this by providing exemplary physical, emotional and spiritual care for each of our trainees. We have Fellowship Program in Minimal Access Surgery for Surgeons and Gynecologists.

Laparoscopic Extracorporeal Square Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Extracorporeal Square Knot. Laparoscopic Square knot is used for any structure which is tough and under tension. It can be used for approximation of vaginal vault, Rectus Divarication, Myomectomy, Crural Approximation etc...

Laparoscopic Mishra's Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This is a video of Laparoscopic Mishra's Knot. Laparoscopic suturing and knotting is important for surgeons and gynecologist. Mishra's Knot is one of the important extracorporeal knot for any tubular structure. Configuration of Mishra's Knot is 1:1:1:1:1:1:1. This knot is secured upto 18mm of tubular structure.

Gastric Banding

https://www.laparoscopyhospital.com/ Laparoscopic gastric banding is surgery to help with weight loss. The surgeon places a band around the upper part of your stomach to create a small pouch to hold food. The band limits the amount of food you can eat by making you feel full after eating small amounts of food. A plastic tube runs from the silicone band to a device just under the skin. Saline (sterile salt water) can be injected or removed through the skin, flowing into or out of the silicone band. Injecting saline fills the band and makes it tighter. In this way, the band can be tightened or loosened as needed to reduce side effects and improve weight loss.

Laparoscopic Cholecystectomy for Stone impacted at Hartmann's pouch

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Cholecystectomy for Stone impacted at Hartmann's pouch. Manipulating the gallbladder with the left-hand instrument is a key part of performing a laparoscopic cholecystectomy. In these case stone should be removed from hartmann pouch. If a stone is impacted in the Hartmann’s pouch, this manipulation can be difficult, and can cause cramp and exhaustion of the surgeon’s left hand or injury to the gallbladder if a toothed instrument is used to improve grip. For the experienced laparoscopic surgeon, this tip makes manoeuvrability of the thickened, impacted Hartmann’s pouch simpler. We have used it in the acute and elective setting to great effect. The tape provides gentle traction and can be resisted easily if there are any concerns about placement as dissection continues.

Laparoscopic Ventral and Incisional Hernia Repair: Pros and Cons

https://www.laparoscopyhospital.com/ This video is lecture of Pros and Cons of Laparoscopic Ventral and Incisional Hernia Repair by Dr. R. K. Mishra at World Laparoscopy Hospital. The purpose of this lecture is to analyse the surgical techniques, perioperative complications, and recurrence rate of laparoscopic ventral hernia repair (LVHR) including incisional Hernia, in comparison with the open ventral hernia repair (OVHR), based on the international literature. Incisional hernia is a common long-term complication of abdominal surgery and is estimated to occur in 3% to 13% of laparotomy incisions. The laparoscopic technique has numerous variations of the methodology used by surgeons, although several common steps are followed by all. The procedure starts with entering the peritoneal cavity by using a Veress needle, an open Hasson method, or an optical trocar allowing view of the abdominal wall layers during penetration. Palmer's point is the best place to access. This lecture indicates that LVHR is a safe and effective approach to abdominal wall hernias. The technique offers the advantages of the laparoscopic approach, ie, a short hospital stay, less postoperative pain, and early convalescence. The procedure carries an acceptable risk of complications compared to open surgery, a low risk of recurrence, and an excellent cosmetic result. It is considered a good alternative to its open counterpart, at least in experienced hands.

Laparoscopic inguinal hernia repair "IPOM" with Dual-Mesh

https://www.laparoscopyhospital.com/ This video demonstrate laparoscopic inguinal hernia by IPOM. Dr R K Mishra report their experience on laparoscopic hernioplasty using the Intraperitoneal Onlay Mesh Repair (IPOM). Many patients had a bilateral hernia, and many of which were recurrent and some had recurrent hernia. Overall, a total of 85 hernias were treated. The hernia repair was performed utilizing Polyurathane Dual Mesh. The prostheses were fixed with titanium spiral tacks (Protack, AutoSuture, Tyco Healthcare). No intraoperative complications occurred and no conversion was necessary. Mean resumption of normal activity was 10 days with return to work within two weeks. At an average 24 months follow-up, were recorded. The results of this study as well as the meta-analysis of the series presented in the Literature, indicate that the IPOM may be a feasible, safe and effective procedure in the treatment of inguinal hernia repair is performed during other laparoscopic procedures. The IPOM has infact been shown to be faster and easier than the other more commonly performed laparoscopic hernioplasties (TAPP and TEP). These data may also suggest to utilize this technique in particular cases of primitive hernia such as very active young males or heavy duty workers. However the limited experience and the short follow-up ask for long term studies to definitely ascertain the true incidence of recurrence and therefore the effectiveness of this attractive procedure.

Laparoscopic PCOD Management

https://www.laparoscopyhospital.com/gynaecological-laparoscopy.html This video demonstrate laparoscopic ovarian drilling for PCOS (Polycystic Ovary Syndrome) Treatment. The exact mechanism of Ovarian Drilling in PCOS is yet to be elucidated. The most plausible one is the destruction of ovarian follicles and stroma resulting in a decrease in androgen and inhibin levels and a secondary rise in follicle-stimulating hormone (FSH) levels. Production of inflammatory growth factors like insulin-like growth factor-1, in response to thermal injury is in Laparoscopic Ovarian Drilling to Treat PCOS Infertility, further potentiates the actions of FSH on folliculogenesis, while increased blood flow to the ovary provoked by surgery, facilitates increased delivery of gonadotropins. The number of punctures is empirically chosen depending on the ovarian size. In the original procedure, 3-8 diathermy punctures (each of 3 mm diameter and 2-4 mm depth) per ovary were applied, using power setting of 40W W for 2-4 s

Sleeve Gastrectomy

https://www.laparoscopyhospital.com/bariatric-surgery.html This video demonstrate laparoscopic sleeve gastrectomy performed by Dr R K Mishra at World Laparoscopy Hospital. The laparoscopic sleeve gastrectomy (SG) or gastric sleeve surgery, involves re-shaping the stomach from a pouch-like shape into a long tube, or “sleeve”. Pre-surgery the stomach looks like a kidney bean and can expand to the volume of several liter-size bottles of soda. With staples, the stomach is converted to look like a banana. This weight loss surgery reduces the capacity and prevents the stomach from expanding significantly. Before sleeve gastrectomy a regular stomach can hold about six cups of food. The new small stomach can hold about a half cup in volume, resulting in a ‘restrictive’ weight loss of the person. This type of laparoscopic sleeve gastrectomy bariatric surgery can be done as a stand-alone procedure or as part of a staged operation. The weight loss is projected to be in the range of 55 to 70 percent of excess body weight. There is no malabsorption created and no foreign body or implant involved. Long-term results are becoming available and the data suggest the weight loss is similar to gastric bypass.

Obesity Surgery - Vertical Sleeve Gastrectomy

https://www.laparoscopyhospital.com How does the Vertical Sleeve Gastrectomy compare to the other surgeries? Simple operation with low mortality risk. Technically easy to perform with low peri-operative risks. Minimal short-term and long-term complication rates. Short-term risks of staple line bleeding or leakage are very rare. The only long-term risk is GERD in some patients. Weight loss comparable with the gastric bypass. Gastric sleeve is not reversible. Part of the stomach is permanently removed. It is important to understand that reversing any weight loss operation (such as gastric band or gastric bypass) will result in weight regain back to original weight. You should not have any weight loss operation if you intend to ever reverse it. Though gastric sleeve is not reversible, it can be changed to gastric bypass if there was any need. Most illnesses that are related to obesity can be improved or even cured by weight loss surgery. These include: sleep apnoea, diabetes, high cholesterol, hypertension, stress incontinence, depression, acid reflux, joint pain, as well as osteoarthritis. Losing weight for obese patients also means greater outcomes from pregnancy, increased fertility, and a lower risk of cancer. The surgery increases life expectancy, on the whole.

Retroperitoneoscopic Nephrectomy and Ureterolithotomy

https://www.laparoscopyhospital.com/ This video demonstrate Retroperitoneoscopic Nephrectomy and Ureterolithotomy. The emergence of minimally invasive surgery about 20 years ago revolutionized urological surgery. Advances in retroperitoneoscopy allowed the widespread use of minimally invasive techniques in almost the entire range of urology. In this context, laparoscopy and later retroperitoneoscopy were developed and applied in a wide spectrum of urological diseases. Both approaches have since presented benefits and disadvantages that have been documented in various series. However, few comparative studies have been conducted. Retroperitoneoscopy can be accomplished placing the patient in lateral or prone position. This technique requires experience to find the way to the retroperitoneum. The main landmark during surgery is the psoas muscle. The prone approach is very versatile because it gives the surgeon the chance to reach the adrenal gland and the upper and lower urinary tract, and also allows a bilateral procedure to be achieved. Furthermore, this access leaves the kidney in place and has the advantage of a direct approach to the vessels. On the other hand, it is not the best option when mobilization of the lower ureter and urgent conversion are needed.

Laparoscopic Sleeve Gastrectomy Surgery Video Explained Step by Step

This video demonstrate Laparoscopic Sleeve Gastrectomy which is a popular Bariatric Surgery for morbid obesity. Sleeve gastrectomy is a simpler bariatric operation than the gastric bypass procedure for morbid obesity because it does not involve rerouting of or reconnection of the intestines. The sleeve gastrectomy, unlike the Lap-band, does not require the use of a banding device to be implanted around a portion of the stomach. Laparoscopic Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. The sleeve gastrectomy, by reducing the size of the stomach, allows the patient to feel full after eating less and taking in fewer calories. The surgery removes that portion of the stomach that produces a hormone that can makes a patient feel hungry.

Total Laparoscopic Hysterectomy with Bilateral Salpingo Oophorectomy

https://www.laparoscopyhospital.com/ This video demonstrate TLH with BSO by Dr R K Mishra at World Laparoscopy Hospital. The use of laparoscopic hysterectomy has recently been reported as an alternative to traditional abdominal hysterectomy and the utilization of a mini-endoscopic technique has also been recorded. This prospective randomized study has demonstrated that after laparoscopic hysterectomy, patients recovered more quickly and had less pain, and the incidence of complications was also low. One serious complication after laparoscopic hysterectomy is increased ureteric injury, but in our opinion it is possible to avoid major complications by paying particular attention to the surgical details.

Laparoscopic Tubal Patency Test Hysteroscopy and Ovarian Drilling

This surgery was performed to evaluate the effectiveness of hydrolaparoscopy among infertile women with a Polycystic Ovarian Syndrome (PCOS) resistant to clomephine. PCOS is characterized by presence of the hyperandrogenism, oligo- or anovulation. It is one of the most common reproductive endocrine disorders in the adolescent women. Females with PCOS present with a dysregulation in the menstrual cycle, hirsutism, anovulation, acne, and obesity. An approximately 5-10% of women in Poland suffer from PCOS and 10-15% of them are infertile

Hysterectomy for Large Uterus

https://www.laparoscopyhospital.com This video demonstrate Total Laparoscopic Hysterectomy for Large Uterus. Hysterectomy is the most common gynecologic surgical procedure performed, accounting for 1600,000 procedures per year. The most common indication for a hysterectomy is abnormal uterine bleeding, which is frequently caused by uterine leiomyoma, which is present in 25-50% of reproductive-aged women. Total Laparoscopic Hysterectomy is method of choice for large uterus if surgeon has sufficient experience.

Torted Ovarian Dermoid Cyst in Pregnant Patient

https://www.laparoscopyhospital.com/ This video is Laparoscopic management of Torted Ovarian Dermoid Cyst in Pregnant Patient. Dermoid cyst (Mature cystic teratoma), the most common type of primordial germ cell ovarian tumors is usually benign and asymptomatic. It can be malignant in 5% of cases. The incidence of torsion in pregnant patients with ovarian cyst persisting during pregnancy is approximately 15%. Benign dermoid cysts/teratomas are the most frequent ovarian tumors, with an incidence ranging from 5% to 25% of all ovarian neoplasms [3]. They are of germ cell origin and composed of multiple types of tissue. Torsion of the cystic contents and ovary may occur in them, thus leading to vascular infarction and necrosis. Torsion of the pedicle has been reported to be the most frequent complication, occurring in 16.1% of cases [3]. Traditional risk factors for ovarian torsion are increased ovarian size, ovarian tumors, ovarian hyperstimulation, and pregnancy

Laparoscopic Weston Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ The Weston slip knot was initially described in the obstetric and gynecology literature and is also used in arthroscopic surgery.The advantage of this knot is that it is relatively easy to tie outside, can then slip easily into place and be tightly secured. The post strand does not move throughout the knot; the loop strand is the longer strand which is moved to make the knot. The advantage of the Weston knot is that it locks readily and is not bulky.

Dundee Jamming Knot and Aberdeen Termination demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This Video demonstrate Dundee Jamming Knot Continuous Suturing and Aberdeen Termination. Continuous suturing is required in laparoscopic surgery to close delicate long suture line. It can be started with Dundee Jamming Knot. The final knot of a continuous suture can be accomplished in the traditional way of open surgery as Aberdeen Termination. Dundee Jamming Knot and Aberdeen Termination are two surgical knots in the same direction and a final one in the opposite direction, tying the final loop of the continuous suture with the end of the suture with the needle, or it is possible to recur to the “Aberdeen knot,”8 in which a final knot is accomplished by creating a new loop in the already existing one. The final loop of the suture is kept loosely; then, grasping the needle with the assistant needle holder, the needle holder is inserted into the loop, and the suture thread is grasped at its middle and retracted without the grasper dropping the needle. This process generates a new loop in the already existing one, which is tied guiding the needle holder through the loop and applying countertraction between the needle holder and the assistant needle holder. This procedure is repeated twice. Finally, the end of the suture is guided with the needle through the last generated loop, and, using retraction, the final tightening of the knot is performed. If, at the end of the suture, the thread were too short to accomplish one of the described procedures.

Gastrointestinal Endoscopy Procedure Preparation & Risks

https://www.laparoscopyhospital.com/ This video is lecture of Gastrointestinal Endoscopy Procedure Preparation & Risks by Dr. R. K. Mishra at World Laparoscopy Hospital. Endoscopy has several names, depending on which portion of digestive tract by physician seeks to inspect. Upper GI endoscopy (EGD): This procedure enables the examination of the esophagus, stomach and the upper small bowel called duodenum. Colonoscopy: This procedure enables the doctor to see ulcers, inflamed mucous lining of your intestine, abnormal growths and bleeding in your colon, or large bowel. Enteroscopy: Enteroscopy is a recent diagnostic tool that allows a doctor to see your small bowel. The procedure may be used in the following ways: To diagnose and treat hidden GI bleeding To detect the cause for malabsorption To confirm problems of the small bowel seen on an X-ray During surgery, to locate and remove sores with little damage to healthy tissue

Laparoscopic Repair of Lumber Incisional Hernia

https://www.laparoscopyhospital.com Lumbar incisional hernias are often diffuse with fascial defects that are usually hard to appreciate. Computed tomography scan is the diagnostic modality of choice and allows differentiating them from abdominal wall musculature denervation atrophy complicating flank incisions. Repairing these hernias is difficult due to the surrounding structures. Principles of laparoscopic repair include lateral decubitus positioning with table flexed, adhesiolysis, and reduction of hernia contents, securing ePTFE mesh with spiral tacks and transfascial sutures to an intercostal space superiorly, iliac crest periosteum inferiorly, and rectus muscle anteriorly. Posteriorly, the mesh is secured to psoas major fascia with intracorporeal sutures to avoid nerve injury. Lumbar incisional hernia must be differentiated from muscle atrophy with no fascial defect. The laparoscopic approach provides an attractive option for this often challenging problem.

Laparoscopic Myomectomy for Multiple Myoma

Laparoscopic myomectomy in multiple fibroids. Myomectomy is the surgery of choice for women who have symptomatic fibroids and who wish to retain their uterus. ... It is known that uterine fibroids are estrogen dependent. During pregnancy these fibroids increase in size, whereas in the puerperium and menopause they shrink. In laparoscopic or robotic myomectomy, minimally invasive procedures, your surgeon accesses and removes fibroids through several small abdominal incisions. Laparoscopic myomectomy. Your surgeon makes a small incision in or near your bellybutton. Then he or she inserts a laparoscope ― a narrow tube fitted with a camera ― into your abdomen. Your surgeon performs the surgery with instruments inserted through other small incisions in your abdominal wall. Robotic myomectomy. Instruments are inserted through small incisions similar to those in a laparoscopic myomectomy, and the surgeon controls movement of instruments from a separate console. Sometimes, the fibroid is cut into pieces and removed through a small incision in the abdominal wall. Other times the fibroid is removed through a bigger incision in your abdomen so it can be removed without being cut into pieces. Rarely, the fibroid may be removed through an incision in your vagina (colpotomy).

Sleeve Gastrectomy in Patient Previously operated for Ventral Hernia

Generally it should not be a problem to have a sleeve after incisional hernia repair, even with mesh. You do not need to worry about the insufflation of the abdomen stretching the mesh if you go through palmer's point. All laparoscopic incisions are small and do not disrupt the integrity of the mesh. The only incision that is a little larger is the one that the resected stomach is removed through. Ideally you want to do the sleeve laparoscopically. Yes, there will be a lot of adhesions, but an experienced laparoscopic bariatric surgeon can get it done with the laparoscope. The mesh can be re-sewn and it will heal fine. It is hard to say for sure without knowing where on your abdominal wall the mesh was placed, but I have operated on numerous patients with prior hernia repairs and it isn't a challenge that can't be overcome. If the hernia was from a prior C-section, meaning lower on your abdominal wall, then the laparoscopic port sites for a VSG should not interfere.

Laparoscopic Radical Hysterectomy

https://www.laparoscopyhospital.com/ This video is lecture of Laparoscopic Radical Hysterectomy by Dr R K Mishra. This procedure is used to treat stage I or IIA cervical cancer. Radical hysterectomy involves surgical removal of the uterus, the supporting ligaments and the upper vagina, together with removal of the pelvic lymph nodes and sometimes the para-aortic lymph nodes. Laparoscopic radical hysterectomy is a feasible alternative to laparotomy for early stage cervical cancer. Similar surgical outcomes are achieved with significantly less morbidity.

Torted Ovarian Dermoid Cyst in 7 Year Old Girl

Ovarian torsion in children is an uncommon cause of acute abdominal pain but mandates early surgical management to prevent further adnexal damage. The clinical presentation mimics other pathologies, such as appendicitis. Ovarian torsion should be considered in any female child with acute onset lower abdominal pain accompanied by vomiting. Pain can be characterized as constant or colicky, but unlike with appendicitis, does not typically migrate. Sterile pyuria is found in a substantial proportion of cases. Ultrasound is the most useful initial diagnostic modality, but the absence of flow on Doppler imaging is not always present. Conservative management with detorsion and oophoropexy is recommended.

Cholecystectomy and Appendectomy together by Mishra's knot.

https://www.laparoscopyhospital.com/SERV02.HTM Combined laparoscopic appendectomy and cholecystectomy produces good outcomes than either procedure performed independently, with a not increased incidence of wound complications and morbidity. Overall, however, patients who undergo simultaneous procedures appear much faster recovery. Further investigation is needed to define appropriate indications for these concomitant procedures as well as to identify the key factors that determine outcomes. An operative experience of three patients who underwent incidental laparoscopic appendectomy during laparoscopic cholecystectomy is presented. The technique and indications is shown in this video. We conclude with our experience that incidental laparoscopic appendectomy is possible and safe with existing incisions performed in gallbladder surgery. However, well-controlled prospective studies should be performed prior to wide application of this technique.

Laparoscopic Tayside Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Tayside Knot. This is an extracorporeal knot can be used to ligate tubular structure. The Tayside knot is suitable for use with all braided sutures (2/0 or stronger) as well as dacron. It is used with Dacron for ligation of vessels such as the azygous vein, splenic artery/vein or the inferior mesenteric artery/vein. A variety of slipknots are used by various professions and in certain leisure activities. Some of these have been adapted for use in endoscopic surgery. The holding strength of individual types of slipknots is influenced by a number of factors including the ligature material used and its caliber. Thus a slipknot may be secure when tied in catgut but unsafe with other materials. In addition, some slipknots are difficult to tie or jam lock too easily for reliable placement by push rod before locking.

Lecture on Laparoscopic Appendectomy for Acute Appendicitis

https://www.laparoscopyhospital.com/ This video is lecture of Dr R K Mishra on Laparoscopic Appendectomy. Laparoscopic Appendectomy can be performed by single incision, two port or three incisions, one umbilical and one suprapubic are made; permanent material used comprises: grasping forceps, hook, scissors, needle holders, three metal trocars and four other usual instruments, and a single strand of cotton. There is possibility of using endobag and in few cases no need to use of operative extractors bags, clips, endoloops, staples or bipolar or harmonic energy instruments. Allows triangulation and instrumentation in the conventional manner.

Laparoscopic sleeve gastrectomy with endoscopic calibration

Endoscopic calibration is associated with lower postoperative complications after laparoscopic sleeve gastrectomy. The use of the endoscope for the calibration of the gastric sleeve, instead of the standard use of the bougie, is a safe procedure and gives the surgeon a higher sense of security. The aim is to evaluate the effect of the use of endoscopic guidance on postoperative complications and mid-term results of the bariatric procedure. Gastrointestinal complication after sleeve gastrectomy surgery may be summarized as follow: acute bleeding and/or anemia, staple-line complications such as anastomotic leaks, fistulae, and strictures, erosion and slippage, bezoars, and choledocholithiasis. An endoscopy is the preferred strategy, unless there is a suspicion of leaks or fistulae, in which case preliminary contrast radiography may be more appropriate. Endoscopic treatment plays an important role in the management of a variety of staple-line complications during and even after surgery, such as stomal stenosis and anastomotic leaks. The intraoperative tightness check with blue dye and air insufflation through an orogastric tube in the bougie calibration group is done in all the patients. In the endoscopic calibration the check with blue dye is much better in all cases.

Laparoscopic Tumble Square Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Tumble Square Knot. Laparoscopic Tumble Square Knot is the only knots that can be used when the suture does not slide freely through the tissue and anchoring device. Laparoscopic Tumble Square Knot configurations also theoretically avoid suture damage from abrasion and tissue damage during sliding. The major disadvantage of static knots is the propensity of the loop to loosen before the second half-hitch is seated to the point that it provisionally “locks” the knot. One method of minimizing this effect is by using a maryland to push the square knot on which one limb is tumbled which holds the tissue loop tight as it advances sequential half-hitches.

How to Perform Safe Laparoscopic Appendectomy - Lecture by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate How to Perform Safe Laparoscopic Appendectomy - Lecture by Dr R K Mishra. Appendicitis is one of the most common surgical problems and appendectomy is one of the most common surgery. One out of every 2,000 people has an appendectomy sometime during their lifetime. Treatment requires an operation to remove the infected appendix. Traditionally, the appendix is removed through an incision in the right lower abdominal wall. ADVANTAGES OF LAPAROSCOPIC APPENDECTOMY: Results may vary depending upon the type of procedure and patient’s overall condition. Common advantages are: Less postoperative pain May shorten hospital stay May result in a quicker return to bowel function Quicker return to normal activity Better cosmetic results

Laparoscopic Roeder's knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ Laparoscopic Roeder's knot is one of the oldest knot used in laparoscopic surgery. Laparoscopic Roeder's knot is one of the most popular extracorporeal knot. This technique of the extracorporeal knotting is simple, easy, and reproducible with good knot and loop security and can be used with multifilament suture material of 90cm. Laparoscopic extracorporeal knot is popular for appendectomy, cholecystectomy, and any tubular structure upto 8mm structure.

Laparoscopic Fundoplication

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Fundoplication Surgery for GERD. A Nissen fundoplication, or laparoscopic Nissen fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease and hiatal hernia. The fundoplication operation is usually carried out using keyhole surgery (laparoscopy). The surgeon uses a telescope, with a miniature video camera mounted on it, inserted through a small incision (cut) to see inside the abdomen. Carbon dioxide gas is used to inflate the abdomen to create space in which the surgeon can operate using specialised instruments that are also passed through other smaller incisions (cuts) in the abdomen. The operation itself has two parts. Firstly the surgeon will examine the diaphragm to check the size of the opening around the oesophagus. If it too loose, the surgeon will tighten this. The second part of the operation involves wrapping the upper part of the stomach (fundus) around the base of the oesophagus and loosely stitching it in place. This tightens the sphincter enough to reduce reflux but not so tight as to affect swallowing.

Laparoscopic Surgery for Hydatid Cyst Disease

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic lecture of treatment of hydatid disease of the liver is an alternative to open surgery in well-selected patients. Important steps are the evacuation of the cyst contents without spillage, sterilization of the cyst cavity with scolicidal agents and cavity management using classical surgical techniques. The laparoscopic approach is safe with acceptable mortality and morbidity for both conservative and radical resections in selected patients. Clinical outcomes are comparable to open surgery, albeit in a selected group of patients.

Basic Steps of Hysterectomy

https://www.laparoscopyhospital.com/ This video demonstrate step by step total laparoscopic hysterectomy. Hysterectomy is the removal of the uterus with surgery. There are many reasons a hysterectomy can be performed such as fibroids, heavy or irregular menstrual bleeding, prolapse, chronic uterine pain, pelvic inflammatory disease, pre-cancerous conditions, cancer and endometriosis. hysterectomy depending on the clinical circumstances. A hysterectomy can be performed using a laparoscope, which is a thin keyhole camera that allows the surgeon to see the pelvic organs. The laparoscope and other instruments are inserted through small incisions in the skin and then used by the surgeon to remove the uterus. hysterectomy depending on the clinical circumstances. A hysterectomy can be performed using a laparoscope, which is a thin keyhole camera that allows the surgeon to see the pelvic organs. The laparoscope and other instruments are inserted through small incisions in the skin and then used by the surgeon to remove the uterus.

Lecture PPH Stapler piles surgery Step by Step by Dr R K Mishra

https://www.laparoscopyhospital.com/ This video demonstrate PPH stapled Piles Surgery step by step by Dr R K Mishra. PPH-stapler procedure for treatment of haemorrhoidal prolapse is an important improvement. Haemorrhoidal disease is the most frequent and ancient proctological pathology. Haemorrhoidectomy is always feared for intensive post-operative pain and complications. Stapled hemorrhoidopexy is good procedure but may be followed by severe postoperative complications of which haemorrhage is one of the most serious early events. Surgical techniques have advanced more and more with the aim of reducing the post-surgical complications and to help a faster recovery. “Open hemorrhoidectomy”, according to Milligan-Morgan procedure, has been the most used method in Europe, also in the “Ligasure” and “Ultracision” variants. “Closed hemorrhoidectomy”, according to Ferguson procedure, has been the most used method in the USA. Stapled hemorrhoidopexy (PPH-stapler) is an alternative method to conventional surgical procedures. It has many advantages such as less pain, faster recovery and a quicker return to normal activities. PPH stapler procedure for treatment of haemorrhoidal prolapse.

Laparoscopic Management of Ovarian Teratoma

https://www.laparoscopyhospital.com This video demonstrate laparoscopic cystectomy for ovarian teratoma. Germ cell tumours begin in egg cells in women or sperm cells in men. There are 2 main types of ovarian teratoma: mature teratoma, which is non cancerous (benign). immature teratoma, which is cancerous. Immature teratomas are usually diagnosed in girls and young women up to their early 20s. These cancers are rare. They are called immature because the cancer cells are at a very early stage of development. Most immature teratomas of the ovary are cured, even if they are diagnosed at an advanced stage. Keywords: Laparoscopy, Dermoid cyst, Ovarian cyst, Operative laparoscopy. Benign cystic teratomas, or dermoid cysts, are germ cell tumors of the ovary that account for 20-25% of all ovarian tumors and are bilateral in 10-15% of cases. They have a low incidence of malignancy, reported as 1-3%. The majority of dermoid cysts are asymptomatic and are often discovered incidentally upon pelvic exam. The potential for complications such as torsion, spontaneous rupture, risk of chemical peritonitis, and malignancy usually makes surgical treatment necessary upon diagnosis. Traditional therapy for a dermoid cyst has been cystectomy or oophorectomy via laparotomy. The laparoscopic approach has become increasingly accepted since 1989. Because most patients with cystic teratomas are of reproductive age, a conservative approach is ideal; laparoscopy may minimize adhesion formation and thus decrease the chance of compromising fertility. The management of ovarian teratomas in normal conditions is well established, but in rare giant cases (tumor diameter over 15 cm), the choice of management, such as laparotomic or laparoscopic approaches, are controversial and may be therapeutically challenging for surgeons.

Laparoscopic Surgery for Peritoneal Inclusion cyst with Bilateral Endometrioma

This Video demonstrate Laparoscopic Management of Inclusion cyst with Bilateral Endometrioma. Peritoneal inclusion cyst (PIC) is defined as a fluid-filled mesothelial-lined cysts of the pelvis and it is most frequently encountered in women of reproductive age. The treatment options are observation, hormonal management, imaging-guided aspiration, image-guided sclerotherapy and surgical excision. Peritoneal inclusion cysts are uncommon abdominopelvic cysts seen in reproductive age group women. It is often misdiagnosed clinically as an ovarian tumor due to similar presentation and mimicking findings on radiology. We describe a woman presenting with pelvic mass. Her clinical finding on radiology suggested an ovarian tumor; however, biopsy revealed it as peritoneal inclusion cysts.

Laparoscopic Appendectomy - Immediate Laparoscopy is Ideal for Acute Appendicitis

Acute appendicitis is inflammation of the appendix, the narrow, finger-shaped organ that branches off the first part of the large intestine on the right side of the abdomen. This video demonstrate laparoscopic appendectomy performed for acute appendicitis by Dr R K Mishra. Although the appendix is a vestigial organ with no known function, it can become diseased. Acute appendicitis remains the most common surgical emergency. The lifetime risk of developing an appendicitis is reported to be 6.7% in females and 8.7% in males. The peak incidence occurs in the first and second decade of life, while it is uncommon to face appendicitis in children younger than 5 years of age. The clinical presentation may be varied and often is similar to other medical conditions, so a misdiagnosis can be frequent and the most common one is usually gastroenteritis. Our diagnostic and therapeutic protocol from about ten years was the following: if the patient was thought to have an acute appendicitis preoperatively diagnosed by physical, laboratory findings and ultrasound examination, antibiotic treatment was started immediately with laparoscopic appendectomy. Laparoscopy is now demonstrated to be the optimal approach also to treat complicated appendicitis, but this standardized operation is not always easy to perform for new surgeons.

Laparoscopic Suturing Melzer's Knot demonstration by Dr R K Mishra

https://www.laparoscopyhospital.com/ Laparoscopic suturing and knot tying require a lot of patience and practice and can be difficult, time consuming, and frustrating in spite of the advances made in the fields of instrumentation, optics, and imaging. The new technique described here is an effort to make the procedure simpler by providing extracorporeal control of one limb of the suture. It involves percutaneous placement of the needle end of the suture in the abdomen and its removal using a modified 10 cm long cloth-sewing needle.

Laparoscopic Nephrectomy Lecture by Dr R K Mishra

This video is of Laparoscopic Nephrectomy Lecture by Dr R K Mishra. A laparoscopic nephrectomy is minimally invasive operation to remove kidney. A laparoscopic nephrectomy involves removing an entire kidney through keyhole incisions in the flank, the side of the body between the ribs and the hip. A laparoscopic nephrectomy removes the kidney by using laparoscopic equipment. Long thin instruments are passed through up to five small incisions made in the flank, each about 1cm in length. The abdomen is first filled with carbon dioxide, which separates the tissues to allow for vision during the surgery. A camera is then passed, giving the urologist a detailed picture inside the abdomen. The other incisions are used to pass cutting and suturing instruments so the blood supply to the kidney can be isolated and tied off and the kidney removed either with or without its surrounding structures. A wound drain is then inserted to drain any wound ooze. This is usually stitched in place and stays in for 1 – 2 days. A nephrectomy is usually done for one of two reasons, either for cancer of the kidney or because of a non- functioning kidney. In the case of kidney cancer a radical laparoscopic nephrectomy is done. This is done in an attempt to rid the body of cancer by removing the entire kidney and adrenal gland, with its surrounding fat and attached vessels. In more advanced cases it may be done to stop continued bleeding from the effected kidney. For non-functioning kidneys, which are either caused by large stones, a lack of blood supply or abnormal kidney structure, a simple laparoscopic nephrectomy is done. This is where only the kidney itself is taken and the adrenal gland and other structures are left behind. A simple nephrectomy is usually done to avoid recurrent infection and pain and the possibility of severe illness because of infection.

Laparoscopic Nissen fundoplication - Dr R K Mishra

Laparoscopic Nissen fundoplication is a surgical procedure that alleviates gastroesophageal reflux disease (GERD) symptoms when lifestyle changes or anti-reflux medications have not controlled symptoms. The procedure was first performed in 1951 as an open-surgical procedure. Patients were hospitalized for 7 to 10 days after the procedure. Today, the Nissen fundoplication is performed in approximately 90 minutes. A majority of the time the patient is in the hospital overnight and is discharged the morning after surgery. Laparoscopic Nissen fundoplication is one of the popular surgery performed by general surgeon. Almost 90% of all the fundoplication in whole world is now performed via laparoscopic surgery. It is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia. In GERD, it is usually performed when medical therapy has failed; but, with a Type II (paraesophageal) hiatus hernia, it is the first-line procedure. The Nissen fundoplication is total (360°), but partial fundoplications known as Thal (270° anterior), Belsey (270° anterior transthoracic), Dor (anterior 180–200°), Lind (300° posterior), and Toupet fundoplications (posterior 270°) are alternative procedures with somewhat different indications and outcomes. In this procedure, the top part of the stomach (approximately 5 percent) is wrapped around the esophagus to form an additional valve to keep stomach contents from flowing up into the esophagus. The patient has five or six incisions, about ¼-inch each, in the abdomen. Post-operation, after arousing from the anesthesia, the patient is given liquids to drink, advancing then to a soft diet. It is a successful treatment in about 95 percent of the patients who have surgery.

Unedited Laparoscopic Hysterectomy - Dr. R. K. Mishra

https://www.laparoscopyhospital.com/ Minimal Access Laparoscopic Hysterectomy is becoming a very common procedure, although significant concerns about the procedure voiced by many gynecologists are twofold: The ability to confidently close the vaginal cuff laparoscopically and the fear of cuff dehiscence and ureteric injury. This has resulted in many practitioners securing the uterine artery vaginally and closing the cuff vaginally, which increases operating time, or converting to LAVH or LSH. We have developed a nice desiccation technique of uterine artery during Total Laparoscopic Hysterectomy and vaginal cuff closure technique following TLH that incorporates the same surgical principles as closure for an abdominal hysterectomy. It is easy to learn and simple continuous suturing is required intracorporeally to close the vault. Mean surgical time is half an hour. This video demonstrates the use of a vessel sealing device to perform a laparoscopic hysterectomy with an obliterated posterior cul-de-sac. This technique demonstrates how to dissect the anterior compartment first. Then we controlled the large uterine vessels.

Laparoscopic Management of Chronic Ectopic and Myomectomy in same patient

https://www.laparoscopyhospital.com/ This video demonstrate Laparoscopic Management of Chronic Ectopic and Myomectomy in same patient at same session. Chronic ectopic pregnancy is a form of tubal pregnancy in which salient minor ruptures or abortions of an ectopic pregnancy instead of a single episode of bleeding, incites an inflammatory response often leading to the formation of a pelvic mass. Ectopic pregnancy presents diagnostic dilemmas in the absence of classical symptoms. MRI and laparoscopy are important tools in such cases. If patient has fibroid uterus it can be operated at same session.

Dangerous way of Performing Laparoscopic Cholecystectomy

https://www.laparoscopyhospital.com/ This Video demonstrate a dangerous way of Performing Laparoscopic Cholecystectomy by Harmonic Scalpel In Mass Shearing. Ideally a nice dissection of calot's triangle with critical view of safety should be done. World wide laparoscopic cholecystectomy (LC) has become the customary method for treating gallstones, some incidents and complications appear rather more frequently than with the open technique. Several aspects of these complications and their treatment possibilities are analysed and clipless cholecystectomy with Harmonic scalpel is one of them. During the past decade world wide laparoscopic cholecystectomy has become the procedure of choice in the surgical treatment of symptomatic gallstone. The operation is not completely risk-free, some incidents and complications being more frequent than with open cholecystectomy. The use of the Harmonic scalpel is deemed safe and comparable to clip placement at the discretion of the surgeon for cystic duct ligation. According to the article published by many author, harmonic shears is effective and safe in laparoscopic cholecystectomy as a sole instrument for sealing and division of the artery and cystic duct. The main advantages could be related to the safety and decreased operative time. Further research with larger homogeneous studies and assessments of cost-effectiveness would further enhance the increasing use of the Harmonic scalpel in laparoscopic cholecystectomy.

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