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Delivery
Normal Delivery: At the completion of 9month there is sudden onset of labour pains followed by membrane rupture with leaking of amniotic fluid. As labour progresses gradual cervical dilatation takes place. Head of the baby gets engaged in the cervix (Crowning). The mother has to bear down during the contraction thus, the baby is pushed down of vagina and delivered.
   
Vacuum or Forceps Delivery: When mother is exhausted and the baby's head is not pushed out then a silastic vaccum cup is applied to the baby's head through controlled suction and the delivery is conducted. Forcep is nowadays very rarely used to cutshort the second stage of labour.
   
Cesarean Delivery: A Caesarean section, (also C-section, Caesarian section, Cesarean section, Caesar, etc.) is a surgical procedure in which transverse incision is taken on the lower abdomen, a cosmetic incision (so that incision is not visual after delivery). The baby is delivered either by vaccum or forcep through this incision.
A Caesarean section is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk.
Myomectomy

The treatment for removing the fibroids from the uterine muscle is known as MYOMECTOMY. It is a specialised operation done by reproductive surgeons who have considerable experience in preserving the uterus for future fertility. Small fibroid can be removed laparoscopically with key hole incision. If the myomas are bigger in size then that can be removed by opening the abdominal cavity which is known as exploratory laparotomy with preservation of function of uterus.

 

Ovarian Cystectomy
Ovarian cystectomy involves removal of ovarian cyst along with the cyst wall from the ovary while preserving normal ovarian tissue.

Transvaginal aspiration of ovarian cyst under ultrasound guidance
Under general anesthesia, the ovarian cyst is aspirated with Ultra sound guidance by introducing the transvaginal sonographic probe along with the needle through vagina. The ovarian cyst is punctured and the contents of the cyst is aspirated. The fluid is further examined for histopathology and the treatment is advised according to the histopathology report.

Trans vaginal follicular study by Ultrasonography
Serial measurement of follicular growth is done using Transvaginal Ultrasonography for monitoring of follicular growth, blood supply to the uterus & endometrium, Powerpoint and endometrial growth
.

 

Laparoscopic surgeries
We have well-furnished maternity and general nursing home. We have 14 bedded hospital including well-furnished deluxe room with adequate ventilation with the attached washroom facility. For the entertainment we have musical system and LCD monitors to make the mind peaceful and pleasure of audio visual by service. All rooms are with air conditioned and with proper hygienic conditions. All the staff members are skilled personal and well trained in patients care. Our Operation theatre is well equipped with modern facilities, we use advanced machines like vessel sealer for laparoscopy and open surgery which brought from USA, monopolar, bipolar cautery to achieve the blood less surgery. We have a team of well trained, skilled and experienced surgeons to perform difficult surgeries. We have team of expert and experienced Anesthetist and pediatrician, neonatologist. Our hospital is collection center for many well known laboratories in the city of Mumbai.

 

Ectopic pregnancy removal




When the Ectopic pregnancy is detected in our hospital, we give medical and surgical treatment. By transvaginal ultrasonography and laparoscopic removal of ectopic pregnancy, or an open surgery.

An ectopic pregnancy can be removed from a fallopian tube by using salpingostomy or salpingectomy. But nowadays newer and most reliable technique we are using, in which the Antimesenteric border of the fallopian tube is cut over the ectopic pregnancy, and ectopic pregnancy is sucked out. If any bleeding, it is cauterised and the tube is left for natural healing. Milking of ectopic pregnancy through the fimbrial end can also be done and the pregnancy is sucked out. In both this procedures we can preserve the patency of tubes for future fertility conservation.

LAVH/LH (Laparoscopic assisted vaginal hysterectomy/Laparoscopic hysterectomy)





Laparoscopic-assisted vaginal hysterectomy (LAVH) is performed both laparoscopically and vaginally. Laparoscopic hysterectomy (LH) and total laparoscopic hysterectomy (TLH) are performed completely through the laparoscope with the vessel sealer to reduce the time and the blood loss, and the vaginal vault is sutured laparoscopically.

LAVH allows the surgeon to visualize the peritoneal cavity to cut adhesions, ablate endometriosis, and dissect the uterus from the pelvic cavity, then remove the dissected components via the vaginal canal. Advantages of this procedure include smaller incisional area, decreased postoperative pain, quicker recovery time, decreased length of hospital stay, and a faster return to normal activities.

 

Cholecystectomy
The laparoscopic removal of gallbladder replaces the conventional Open surgery. Cholecystectomy is the surgical removal of the gallbladder. It is a common treatment of symptomatic gallstones and other gallbladder conditions. This can be done using laparoscopy instead of open surgery for cholecystectomy. In few cases gall stone is impacted in the gall duct which is open in the sea of duodenum in the ampulla of waiter.

 

Appendectomy (Removal of appendix)
Key hole appendectomy can be performed through laparoscopy which replaces old traditional method of removal of Appendix. Laparoscopic Appendectomy is convenient for a patient as well as the surgeon, require minimum Anesthesia and surgical intervention hence post operative compliance is good, reduces the period of hospitalization. Patient can be discharge on the next day of surgery. In our hospital, we use this technique with minimum ports and vessel sealer.

 

Hernia repair with mesh insertion (umbilical/inguinal/Abdomen)




















A direct hernia often will be reduced with the balloon dissector, but if not, must be completely reduced. Femoral and obturator hernias should be reduced at this time as well.

If an inadvertent tear is created in the peritoneum during dissection, a competing intra-abdominal pneumoperitoneum may inhibit visualization of the preperitoneal space. A Veress needle placed in the upper abdomen usually allows for sufficient decompression. The peritoneal defect may be closed with sutures, endoloops, or clips to avoid the potential of postoperative adhesions of loops of bowel to the mesh. Alternatively, the procedure can be converted to a TAPP repair.

A 12 x 15 cm mesh is inserted through the 10 mm port and situated to cover all the hernia defects with ample overlap. The same fixation points are used, thus avoiding the same potential complications of nerve entrapment; some surgeons advocate avoiding fixation altogether.

The inferior and lateral aspects of the mesh are held in place while the pneumopreperitoneum is evacuated under direct visualization to ensure that the peritoneum does not slip underneath the mesh and cause an immediate recurrence.

The ports are removed and CO2 released. The fascia and skin incisions are closed in the usual manner

 

The ligasure vessel sealer system
The ligasure vessel sealer system gives you permanent sealing of the vessel. The ligasure systems revolutionary technology replaces almost all other hemostatic tools because it doesn't only ligate the vessel, it actually seals vessel walls to create a permanent vessel. It's a modern technology, it has a superior age over other ligasure, and it seals the vessel completely so we achieve complete hemostasis results in blood less surgery. It can be used in laparoscopy as well as abdominal and vaginal surgery. Ligasure vessel sealer is another American product in our list. Vaginal and abdominal hysterectomy (removal of uterus) can be done with the Hydro-dissection and vessel sealer.

 

Hysterectomy – Abdominal / Vaginal
Abdominal hysterectomy is a surgical procedure that removes uterus through an incision in lower abdomen. Uterus or womb is where a baby grows. A partial hysterectomy removes just the uterus, and a total hysterectomy removes the uterus and the cervix.
Sometimes a hysterectomy includes removal of one or both ovaries and fallopian tubes, a procedure called total hysterectomy with salpingo-oophorectomy.
Hysterectomy can also be performed vaginally (vaginal hysterectomy) or by a laparoscopic or robotic surgical approach — which uses long, thin instruments passed through small abdominal incisions. Abdominal hysterectomy is preferable when the uterus is big in size. We use vessel sealer – a blood less surgery.

 

Govt. approved Medical Termination of Pregnancy Centre
Our hospital is approved for Medical Termination of Pregnancy from government of Maharashtra.

 

Govt. approved Medical Termination of Pregnancy Centre
Various methods of contraceptions are advised Multiload, condom, merina, tubal ligation, oral contraception pills.

 

SUI (Stress Urinary Incontinence) repair with Trans Vaginal Tape
We use the modern technique to treat Stress Urinary Incontinence using the trans vaginal tape with 95% success in which we use very expensive tape with the mesh of a small pores through which a protein fibres enter into the tissue and the tape become part and parcel of the body. And this tape is brought through the obturator fossa upto the incision in the skin. Post operative compliance is good and patient is happy and relieve from the embarrassment of involuntary passage of small quantity of Urine when there is increase intra abdominal pressure.

 

Vesico vagina fistula repair
Nowadays the incidence of Vesico vagina fistula is very less but can be repaired using proper delayed absorbable suture material & require minimum anesthesia.

 

Ultrasonography
Transvaginal and abdominal ultrasonography with Colour Doppler
 

Transvaginal
– we use transvaginal sonography to know the size of the uterus and pathology of the uterus like fibroid, malignancy etc. But primarily our focus is to monitor the follicular growth.

During firth trimester we use transvaginal sonography for confirmation of pregnancy and to monitor fetal growth, ectopic pregnancy. Ectopic pregnancy can be treated by trans vaginal approach by injecting KCl or methotrexate.

Ovum Pick Up is done successfully transvaginally under general anesthesia, Embryo reduction can also be done by transvaginal approach.

Abdominal sonography is done to detect the large tumor, uterine & parauterine ovarian cyst, second & third trimester for fetal well being and serial monitor of fetus. We use the colour Doppler to know the blood supply to the Uterus, Placenta and the fetus.

 

 
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Dr. Ashok H. Shivdikar
Shivdikar Hospital & Fertility clinic
Shivdikar building No. 28-A, J.B. Road,
Opp. Shirodkar Market, Parel (East), Mumbai- 400 012