gynecology

The technical steps of traditional surgery are replicated by laparoscopic surgery, however, there are still some distinct variances because of the limitations of this approach. The technique for knotting and suturing in keyhole surgery is one of the most challenging. Laparoscopic keyhole surgery, a minimally invasive technique, enables complex procedures through tiny incisions. Laparoscopic keyhole surgery is a game-changer in the medical world. It offers patients less pain, faster recoveries, and improved cosmetic outcomes while allowing surgeons to perform intricate procedures with precision. This keyhole surgery technique represents the future of surgical care.

Laparoscopic suturing knots must be as secure as those done the old-fashioned way. The simplicity and speed of execution, the tightness of the knot, and its reproducibility are essential characteristics. It’s crucial to keep in mind that the knot’s safety depends on both the material and the knot used. A substance that tightens upon contact with ingested water, enhancing its binding capacity in the body.

METHOD AND MATERIALS

A continuous laparoscopic suturing initial knot can be tied in a variety of ways:

1. tying an intracorporeal knot using a needle holder and an auxiliary needle holder (in this specific instance, the total number of knots to be tied depends on the material used, as is the case in traditional surgery);
2. The needle pierces tissues, forms a slipknot on the suture’s end, and drags through the preformed loop, securing it.
3. Using interlaced thread, easily make loops by piercing the suture’s distal end with the needle.
4. special threads equipped with absorbable clips can also be used.

The optimal suture length for performing a separate stitch intracorporeal is 10 cm; this length facilitates knot-tying procedures. Use a 15 cm thread for continuous sutures, ensuring adequate length for the final knot. We successfully adopted Biosyn, a synthetic absorbable suture, with great results pre-commercial release, using 2/0 and 3/0 gauge curved needles. We use it for anastomosis and sutures in open and minimally invasive surgery, with clear benefits in the latter.

IN MINIMALLY INVASIVE SURGERY, THE INTRACORPOREAL KNOT-TYING TECHNIQUE REPLICATES THE PHASES OF A LAPAROSCOPIC METHOD THAT IS ALREADY FAMILIAR TO TRADITIONAL SURGERY. HOLD THE NEEDLE WITH ITS CONCAVITY DOWNWARD OR TOWARDS THE SURGEON FOR THE QUICKEST AND MOST STRAIGHTFORWARD TECHNIQUE. THE CURVED, RIGID NEEDLE FACILITATES QUICK AND EASY SPYRE EXECUTION BY THE HOLDER. BEFORE TYING THE KNOT ON THE NEEDLE HOLDER, THE END OF THE SUTURE SHOULD BE UNDER DIRECT EYESIGHT, NOT LONGER THAN 2 CM, AND PLACED SO THAT IT IS SIMPLE TO GRAB.

During knot-tying, the needle holder secures the thread near the suture for a tight closure. Grab the suture thread with the needle holder in a different way to tie an intracorporeal knot. One only needs to twist the instrument to wind the thread around the needle holder. The forceps then grab the needle as the needle holder catches the distal end of the suture. Pulling on both ends results in the knot.

THERE ARE NUMEROUS WAYS TO EXECUTE A PREPARED LOOP:

1. To tie the knot on the laparoscopic suture thread and determine the length of the distal end that can be used as a suspension or retraction point, introduce the distal end of the suture into the loop after completing a full loop around the last portion of the suture thread. All you need to do is insert the suture into the abdominal cavity. Since the knot on this kind of loop moves along the suture thread, it is preferable to use a different safety precaution to prevent the loop from becoming loosened or tightened while passing it through the trocar, especially if the latter is equipped with a universal valve. To accomplish this laparoscopic surgery, it is advisable to insert the suture while keeping the thread between the needle holder’s teeth at a distance of about 2 or 3 mm from the needle. In this way, the needle holder can easily grip the needle since it is close to the assistant needle holder.

AFTER THE NEEDLE-HOLDER GRABS THIS ONE, IT SLOWLY PULLS IT BACK, ALLOWING THE LOOP TO MOVE ON THE NEEDLE-HOLDER’S ROD AND KNOTTING IT, FORMING THE INITIAL KNOT OF THE SUTURE. TYING THE KNOT BY APPLYING COUNTER TRACTION TO THE DISTAL END OF THE SUTURE OR PRESSING THE LOOP WITH THE GRASPERS IS ALSO FEASIBLE.

• After completing a loop, either a simple or double one, insert the site inside the loop at the thread’s distal end to create a new loop inside the old one. Then retract the thread’s ends while maintaining counteraction at the end, which will form the height of the hole. Alternatively, you can make the same loop by tying a simple or double knot close to the suture’s distal tract and then inserting the suture’s distal end into the knot that you have already constructed.

In order to expedite the process of tying the initial knot of the keyhole suture, it is also possible, as in the first example previously described, to place the needle holder inside the loop after piercing the two limbs that need to be stitched together.

FAQS

• Are there any Advanced laparoscopic suturing training courses in Dubai?

MED PRO DOC Conferences will conduct a laparoscopic intensive Hands-on suturing program on the 21^st and 22^nd of October 2023.

• Does this particular course require any list of qualifications?

The minimum qualification required for this course is an MBBS degree.

• Will Hands-On training be provided during this course?

This course primarily deals with practical training.

• Are there any discounts available for this course?

Please visit our website info@medprodocuae.com for further details.

• Will the laparoscopic training course award CME credits after completion? yes, you will receive CME credits.

Gynecological surgery encompasses any surgical treatment involving the uterus, ovaries, cervix, fallopian tubes, and other female pelvic organs and structures, including the vagina and vulva. There are numerous causes for a woman to require gynecological surgery. If she has endometriosis, fibroids (benign tumors), ovarian cysts, malignancy, or chronic pelvic pain, she might need medical care if she has pelvic inflammatory disease, uterine prolapse, or unusual bleeding. Gyn surgery can also help with permanent birth control.

A woman may require an OB-GYN to perform surgery at various points in her life and for a variety of reasons. A younger woman might require the removal of ovarian cysts or fibroids in order to become pregnant. A hysterectomy may be necessary for an elderly lady. Surgical intervention can treat both endometriosis-related pelvic pain and irregular uterine bleeding. Additionally, doctors often perform Gyn surgery to terminate a failed pregnancy or prevent future pregnancies. Another frequent justification for surgery is gynecological cancer.

Options for gyn surgery include:

• Colposcopy
• Dilation and Curratage
• Ablating the endometrium
• Hysteroscopy
• Hysterectomy
• Procedure for loop electrosurgical excision (LEEP)
• Gyn surgery that is only minimally invasive
• Myomectomy
• Reconstruction of the pelvic floor
• Thoracic ligation
• Stenting of the uterine artery

What Advantages Do Minimally Invasive Gynecologic Procedures Offer?

You can avoid a significant abdominal incision with minimally invasive gynecological surgery. Our surgeons use a number of tiny incisions during treatments. Usually, each incision is less than an inch long.

You gain from:

• Quicker restoration of normalcy
• Less pain following surgery
• Reduced danger of complications and infections
• Hardly any scarring
• Less bleeding during surgery
• Reduction in hospital stay

Ongoing gynecological surgery procedures

• Cryosurgery for the Cervix

Occasionally, during a routine Pap test (a cervical cancer screening), abnormal cervical cells are found. Although abnormal cells don’t necessarily mean cancer, you will probably want to perform some additional tests or procedures.  

A healthcare professional might suggest you undergo cervical cryosurgery, commonly known as cryotherapy. In this highly effective gynecological treatment, the medical professional freezes a portion of the cervix.

Precancerous cells are abnormal cervical cells that have alterations that suggest they may develop into cancer. In order to prevent these cells from turning cancerous, cryosurgery eliminates them.

 Cervical dysplasia is the word a gynecologist might use to describe this disorder.

• Colposcopy

A colposcopy, a non-surgical diagnostic procedure, can more fully examine the cervix, vagina, and vulva. Occasionally, healthcare providers use a Pap smear that is abnormal when a person has one.

A healthcare professional performs the operation while using a colposcope, a magnifying device. During this process, if anything seems off, they may take a sample and send it to the lab for analysis.

Curettage and Dilation (D&C)

One of the most frequent gynecological surgery treatments is the dilation and curettage (D&C) operation. During this treatment, a medical professional uses a suction device or a sharp curette, a surgical tool used for scraping, to remove a part of your uterine lining.

The procedure can identify the following uterine conditions:

• Uterine cancer
• Uterine polyps (excessive development of uterine lining tissue)
• Endometrial hyperplasia, a thick uterine lining condition
• Hysteroscopy

Medical experts may do a hysteroscopy to identify or address uterine issues. This process could be applied to:

• Get rid of the scar tissue adhesions.
• The location of an IUD
• Determine the reason for the recurrent miscarriages

A medical expert uses a narrow, illuminated telescope-like instrument called a hysteroscope to enter your uterus through the vagina during this procedure. It then transmits images of your uterus to a screen for additional analysis.

• LEEP

A healthcare professional might advise a loop electrosurgical excision technique (LEEP) if a PAP smear reveals abnormal cells on the surface of the cervix.

The procedure entails using a thin, electrically charged wire loop to cut away the abnormal tissue. The quick operation is done in the office of a doctor while being given local anesthesia.

Laparoscopic surgery of the uterus

A Gyn surgery technique called a laparoscopy is typically done while the patient is unconscious.

 It can, however, be done while you’re awake and under different forms of anesthesia. It’s employed for:

• The fallopian tubes are tied during tubal ligation to provide permanent birth control.
• Removing the gallbladder
• Hernia surgery
• Treating uterine fibroids and endometriosis

A modest (1/2 to 3/4 inch) incision is made in the belly button or lower abdomen for a standard pelvic laparoscopy. After that, a surgeon will inject carbon dioxide into your belly to make it easier to observe your internal organs.

In accordance with your health, they might also

• Collect tissue samples
• Delete any scarring
• Fix your uterus.
• Take your ovaries out.

The muscles around the vagina tensing or contracting uncontrollably is known as Vaginismus. The vagina is a part of the female reproductive system. It links the cervix, which is the bottom portion of the uterus, to the exterior of the body. These involuntary Vaginal Spasms happen when something tries to enter the vagina, such as a penis, finger, tampon, or medical device. Vaginal Spasms can be either hardly tolerable or excruciatingly painful. The treatment of Vaginismus is the method of same like cosmetic Botulinum Toxin.

When a person has sex for the first time in their late teen years or early adulthood, vaginismus symptoms may manifest. The issue can also manifest itself when a person performs a tampon insertion for the first time or undergoes a pelvic checkup in a doctor’s office.

Some women experience vaginal spasms as they age. Years may pass before it occurs without any issues. Anytime there is vaginal penetration, spasms or discomfort may happen. Or you might only have them occasionally, such as during sex or pelvic exams.

What results in Vaginismus?

The cause of spasms in the vaginal muscles in some people is unknown to medical professionals. Sexual, psychological, and physical problems may result from it. Yeast infections, UTIs, and bladder infections can worsen pain from vaginismus.

A number of factors, including, may cause vaginal spasms:-

• Anxiety illnesses.
• Injuries developed during childbirth, such as vaginal tears.
• A prior operation.
• Fear of or unfavorable feelings towards sex, sometimes brought on by past rape, abuse, or trauma.

What are the characteristics of Vaginismus?

Vaginal spasms manifest as:

• A soreness or discomfort during vaginal penetration.
• Due to pain or spasms in the vaginal muscles, it is impossible to have intercourse or do a pelvic check.
• Painful sexual activity.

What is the management or medication for vaginismus?

Treatments for spasms in the vaginal muscles concentrate on easing your muscles’ reflexive tenseness. Treatments also target the concerns or anxieties that cause vaginismus.

• Topical treatment: Compound creams or topical lidocaine may ease the pain brought on by this ailment.
• Physical therapy for the pelvic floor: Will instruct you on how to relax your pelvic floor muscles.
• Therapy using vaginal dilators: Vaginal dilators are tubes of varying sizes. Their main objective is to expand the vagina. Dilators help people with vaginal spasms feel less sensitive to and more at ease with vaginal penetration. To make insertion simpler, you could use a topical numbing ointment on the vagina’s exterior first.
• Cognitive behavioral therapy (CBT): CBT aids in your comprehension of how ideas influence emotions and actions. Anxiety, sadness, and post-traumatic stress disorder (PTSD) can all be effectively treated with it.
• Sex therapy: Trained sex therapists assist singles and couples in rediscovering the joy of their sexual encounters.

Botulinum Toxin Treatment for Vaginismus

The method uses the same underlying idea as Cosmetic Botulinum Toxin. Muscles that ought not to be contracting are injected with the Botulinum Toxin.

Although the presence of needles in the vulva may indicate discomfort, procedure pain is rarely a concern. Botulinum Toxin treatment for vaginismus can be performed under either local or general anesthesia. Because of their medical condition, certain patients might benefit most from general anesthesia because it would be challenging to administer the required local anesthesia. It is often an outpatient operation in either case.

Patients typically require four to five days to recuperate from the operation, and Botulinum Toxin takes about a week to fully take action. In some instances, the injection by itself will be sufficient to permit painless entry.

In other circumstances, counseling will be used in conjunction with the surgery to address the mental problems that, of course, cannot be resolved with a procedure alone. Dilators will be used to relieve physical discomfort in these cases.

Most of the time, just one session is enough for patients to fully benefit from the treatment. Even though Botulinum Toxin only lasts three to five months, this long-lasting pain alleviation nevertheless happens because the initial treatment interrupts the pain cycle brought on by vaginismus. The body usually relaxes the muscles on its own once patients are able to engage in painless intercourse or penetration. But if the effects of the initial procedure start to wane after some time, it is still viable to undergo additional treatments.

The Botulinum Toxin technique for vaginal spasms has a 90–97% success rate, and side effects are negligible. The anesthesia carries a slight risk, just like any procedure. The potential for bladder problems and, in rare instances, patients reporting symptoms similar to botulism, such as blurred vision, are procedure-specific concerns.

How does Clitoral Unhooding work in cosmetic gynecology? 

After normal wedge labiaplasty, clitoral unhooding in cosmetic gynecology aids in reducing extra tissue on the sides and on top of the clitoris to minimize asymmetry. Each side extends the labia minora into the lateral clitoral hood, which might occasionally be excessive. Excess skin covering the clitoris can cause diminished sensitivity in some ladies, and Clitoral Hood Reduction may also be helpful for them. In this instance, the central clitoral hood (tissue directly covering the clitoris) is the area of interest. Some women who have lower sensitivity as a result of extra skin covering their clitoris may benefit from Clitoral Hood Reduction. Surgeons are able to perform a procedure known as clitoral hoodoplasty to enhance the clitoral hood’s look. And Other names for this Clitoral Hood Reduction technique include clitoroplasty or clitoral unhooding and clitoral hoodectomy.

Many women’s clitoral skin often seems disproportionate to their visible genital features, lacking symmetry and appropriate dimensions. When aroused, some people may experience pain there. They feel that the skin covering their clitoris is too broad, too long, too thick, and too wide, seeming as though the skin of the clitoral hood is excessive. When they glance at their labia minora and labia majora, clitoris, and the surrounding anatomy. They could think it resembles the male foreskin greater. Or they can think it’s so big that it hinders climax, stops sexual excitement, gets in the way, or just looks out of place. As patients age, the clitoral hood may occasionally grow larger.

Clitoral Hood Reduction: What Is it?

Clitoral hood reduction in cosmetic gynecology is a small surgical operation that helps to reveal the tip of the clitoris by removing or repositioning the extra skin that is over and around your clitoris, restoring proportion. Other names for this technique include clitoroplasty or clitoral unhooding and clitoral hoodectomy.

WHY IS REDUCING THE SIZE OF THE CLITORAL HOOD IMPORTANT?

To improve sexual sensation, one can reduce the size of an oversized or lengthy clitoral hood. It could also give the anatomy of the vaginal area a more balanced appearance.

BENEFITS

The benefits of Clitoral Hood Reduction include improved sex experience, a potential increase in the size and frequency of orgasms, and improved garment comfort. This surgery may benefit some ladies who experience pain in this area. Most women experience higher levels of self-worth, more intense sexual pleasure, and enhanced genital cosmetics. By lowering the tissue that forms the hood (Prepuce) covering the clitoris, men can increase the excitement of women, which nearly invariably leads to bigger, faster orgasms. Some people have speculated to some extent that excessive use of Prepuce tissue can also cause hygiene-related problems for women. Excessive use of this may create a favorable environment for bacterial populations to thrive and sometimes lead to conditions commonly referred to as “yeast” or vaginal infections, owing to the tissue’s close proximity to the vaginal canal.

Improper Clitoral Unhooding techniques may cause the clitoral node to be more painfully felt during routine motions since the clitoral node has many more nerve endings than the tissue areas around it. The majority of patients who have reported on their Clitoral Hood Reduction procedure have commented favorably, saying they’ve had increased orgasms. However, for surgeons who perform the procedure frequently, Clitoral Unhooding can result in an increased stimulus of the clitoral node. Before beginning a Clitoral Hoodectomy, the surgeon would typically test the area with cold and warm swabs to gauge how sensitive the clitoris is.

Approximately 25% of women with sexual dysfunction suffer from clitoral phimosis, a condition where the clitoral tissue is tightly connected to the surrounding skin, hindering natural movement and stimulation. Boston University School of Medicine researchers discovered this issue, which often requires surgical intervention or a Clitoral hoodectomy in cosmetic gynecology for treatment.

The Clitoral hoodoplasty in cosmetic gynecology procedure is as follows:

• Depending on the needs, the Clitoral hoodoplasty surgery could take one or two hours.
• Anesthesia makes the target area feel better
• The medical team should take extreme care when trimming out any extra skin around the clitoral hood.
• The surgeon then uses dissolvable stitches to close the wound.

FAQS

• Is the Clitoral Unhooding in Cosmetic Gynecology procedure available as a CME course?

We, Med Pro Doc conferences have included the Clitoral Unhooding procedure as a module in our upcoming Masterclass In Cosmetic Gynecology Course.

• When is this course scheduled?

We will conduct the Masterclass in Cosmetic Gynecology from 30th Sep to 1st Oct 2023.

• Is Practical Training scheduled for Clitoral Hood Reduction Procedure?

Practical training topics include Clitoral Unhooding and Clitoral Hood Reduction.

• Can the Clitoral Hoodoplasty Hands-on training be done on live patients?

You can only perform hands-on training on phantoms.

• Will CME credits be provided after the training?

It is in the processing stage. Please visit info@medprodocuae.com for further updates.

Medical procedures are used in Assisted Reproductive Technology (ART) to treat infertility. Artificial insemination, in-vitro fertilization, and surrogacy are all examples of assisted reproductive procedures. Infertility, as defined by the WHO (World Health Organization), is the inability to become pregnant after more than a year without the use of contraceptives. Besides, males and females can both experience infertility. Assisted Reproductive Procedures include cryopreservation of embryos or gametes, in vitro fertilization (IVF), the use of fertility drugs, Intracytoplasmic sperm injection (ICSI), and other procedures. When individuals utilize the procedures to address infertility, they refer to it as fertility treatment. Assisted Reproductive Techniques primarily deals with reproductive endocrinology and infertility. Additionally, Assisted Reproductive Technology influences surrogacy requests.
Assisted reproductive technology treats infertility by using both a woman’s egg and a man’s sperm. The process starts with the removal of a woman’s eggs, which are subsequently combined with sperm to create embryos. The woman’s body is then used to implant this embryo. The most widely practiced and successful Assisted Reproductive Technique is In Vitro Fertilization, or IVF, which is based on this idea.
In Numerous other instances, Assisted Reproductive Procedures involve donor sperm, donor eggs, or already frozen embryos. Techniques can occasionally also use a gestational carrier or surrogate. A woman is referred to as a surrogate if she conceives using a female partner’s egg and a male partner’s sperm. One of the difficulties and frequently occurring side effects of Assisted Reproductive Techniques is multiple pregnancies, but women can reduce and even avoid them by receiving a reduced total number of embryos.

What results in infertility?

Both men and women have the possibility of infertility. Several contributing elements or causes of infertility include:

Among men

• Impotence-related ejaculatory problems brought on by insufficient ejaculation or erectile dysfunction
• Oligospermia and azoospermia are two conditions that affect sperm production and sperm count. Some sperm cells are abnormal or die before reaching the egg.
• One of the primary factors that play a significant role is age. Older men have a lower sperm count.
• Structural defects impact sperm motility or shape, hindering sperm from attaching to or even swimming toward the egg

Among women

• Ovulation diseases, such as PCOS, prevent the ovary from producing eggs.
• Endometriosis, for example, is a condition in which the uterine lining is poor and the womb tissue invades, harming the nearby reproductive tissues.
• Blockage in the fallopian tube’s structure prevents the sperm from contacting the egg.
• Increased Age: As a woman ages, the quality of her eggs declines, which may limit her capacity to conceive.
• Technologies Used in Assisted Reproduction

Technologies Used in Assisted Reproduction

Assisted Reproductive Technology that are frequently employed include;

1. One of the most popular types of Assisted Reproductive technique is in vitro fertilization (IVF). Here, fertilization takes place external to the body.
2. Gamete intrafallopian transfer (GIFT): This procedure includes transferring sperm and eggs into a woman’s fallopian tube, where fertilization occurs.
3. In zygote intrafallopian transfer (ZIFT), also known as tubal embryo transfer, people use external fertilization, which is similar to IVF in this regard.
4. The person uses the fallopian tube, not the uterus, to place the immature embryo.
5. The couples typically employ the intracytoplasmic sperm injection (ICSI) method when the male partner is infertile. Sometimes older couples or even those who had unsuccessful IVF use it. Contrary to typical fertilization methods, where the sperm and egg are placed in a petri dish and the sperm fertilizes the egg on its own, the approach used here is the introduction of a single sperm into a mature egg.
6. Artificial insemination is the intentional insertion of sperm into a woman’s cervix or uterus in order to produce a pregnancy without a sexual encounter. It comes in the following varieties:
   • Intrauterine insemination
   • Intracervical insemination
   • Intratubal insemination

Q 1. Are Assisted Reproductive Technology CME courses available in Dubai?

Ans. Yes. Several institutes offer ART courses at affordable rates.
Q 2. Will Med Pro Doc Conferences conduct Assisted Reproductive Techniques courses in the near future?
Ans. We are planning to conduct an IVF course. Stay tuned for more updates.
Q 3. Will the course include Hands-On Training?
Ans. Yes. The course will include both clinical case discussion and Hands-On Training.
Q 4. Will it have any list of specifications?
Ans. You must hold an MBBS degree in order to be qualified for this program.
Q 5. Will there be any discount offers available at the time of the program?
Ans. We will update you once we finalize the schedule.