Snehdeep Superspeciality Gynaecare

03/07/2025

*Cervical amputation and reconstruction using Sturmdorf sutures*
1. Cervical elongation is when the *Cx measures > 3.3 cm*

2. Supra vaginal elongation is associated with prolapse while *infra vaginal elongation is usually congenital*

3. Infra vaginal elongation is not associated with prolapse thus can be managed with simple amputation

4. Although few authors have used it even in nulliparous prolapse it's behaviour during the pregnancy is not established

5. Therefore *it is reserved for those who are unwilling for future childbirths*

6. It gives fantastic anatomical corrections

Many thanks
🙏🏻🙏🏻

https://youtu.be/I1oS_YE71h8?si=QtTs7UjmhGPwJeBA

16/06/2025

*Sometimes tiny hacks show dramatic results*
*GINGER AS AN ANTIEMETIC*

1. 20 yr lady presented with severe nausea and vomiting of pregnancy
2. She was admitted outside but antacids, antiemetics were failed to relieve her symptoms
3. She was dehydrated when presented
4. Urine ketones were 4+
5. She was rehydrated
6. Apart from routine care such intractable vimitings need promethazine and steroids
7. She even failed to respond to it
8. We then tried GINGER
9. Although various studies suggest oral ginger 250 mg-1g...
10. We used it as an inhalational agent
11. Whenever the patient felt urge to vomit or severe nausea she inhaled the ginger
12. And it worked
13. Gradually was relieved of her complaints
14. Ginger have anti serotonergic and anticholinergic properties
15. And might have prokinetic properties too
16. Intractable vomitings can be life threatening if unattended
17. It can lead to encephalopathy and psychosis, hepatic and renal failure so needs aggression
18. In very few rare cases MTP might be needed
Thanks
Gd day
🙏🏻🙏🏻

21/04/2025

*आयुष्य बदलवणारी ऑपरेशन्स*

शल्यचिकित्सक म्हणून तुम्ही अनेक किचकट आणि गुंतागुंतीच्या शस्त्रक्रिया करता पण यातील काही शस्त्रक्रिया रुग्णाचे आयुष्य अगदी पूर्णपणे बदलवून टाकणाऱ्या असतात...

अशीच एक शस्त्रक्रिया आहे मायांगाची जागा बनविण्याची...

सदर ताईचे कुटुंब मुलगी वयात येत नाही म्हणून साधारण 2- 3 वर्षापूर्वी मला दाखवण्यास आले...

तपासणीअंती असे लक्षात आले की तिला जन्मजातच गर्भाशयाची पिशवी आणि मायांगाची जागा नाही... त्यामुळे पाळी येण्याचा प्रश्नच नव्हता...तसेच मुले बाळे होण्याचाही....

असे निदान झाल्यावर कुटुंबाला नक्कीच धक्का बसतो.... पुरुषप्रधान समाजात गर्भपिशवी नसलेल्या मुलीचे आयुष्य कसे असेल याचा विचार करून कुटुंबियांचे तर हातपायच गळतात...

सदर निदान धक्कादायक असले तरी अशा मुलींची मायांगाची जागा आपण शस्त्रक्रिया करून बनवू शकतो...अशी जागा बनविल्यास मुलगी गृहस्थाश्रमात प्रवेश करू शकते.....म्हणजे पती- पत्नीमधील शारीरिक संबंध प्रस्थापित होऊ शकतात.. पण संतती निर्माण होऊ शकत नाही...

आपला समाज खूप मोठा आहे...समाजात असे अनेक पुरुष आहेत ज्यांना मुले-बाळे आहेत पण पत्नी हयात नाही किंवा असेही पुरुष आहेत ज्यांना मुले-बाळे नको आहेत. अशा पुरुषाशी अशा मुलींचा विवाह केल्यास सदर मुलीस आणि मुलास आयुष्य भाराचा जोडीदार मिळतो आणि दोघे वैवाहिक आयुष्यही जगू शकतात...

अशी शस्त्रक्रिया लग्नाच्या 4- 6 महिने आधी केल्यास ती जागा पुन्हा बंद होत नाही...विवाह करताना समोरच्याला सगळे खरे- खरे सांगितल्यास मुलीस भविष्यात कुठली अडचण येत नाही...

कुटुंबाने सगळे काही शांतपणे ऐकले...
2-3 वर्षानंतर मुलीचा विवाह ठरला... पत्नीचे अकाली निधन झालेला, मुले बाळे असलेला एक उपवर तरुण कुटुंबियांना भेटला...

लग्न करायचे पक्के ठरल्यावर आम्ही सदर ऑपरेशन केले...नाजूक आणि क्लिष्ट असलेले ऑपरेशन व्यवस्थित पार पडले...

विवाहही धूमधामित झाला...
विवाह झाल्यावर ओल्या हळदीसह आणि मेहंदीसह नव-दांपत्य मग आम्हाला भेटायला आले...
धन्यवाद देण्यासाठी...

कृतज्ञता दाखवण्यासाठी....

एका ऑपरेशन मुळे ताईला हक्काचा जोडीदार मिळाला....हक्काचे घर मिळाले....नवरोबालाही जिवाभावाचा साथी मिळाला....उघड्या पडलेल्या छोट्या लेकरांना आई मिळाली.....आई-वडिलांना सुखाचे दोन क्षण मिळाले...त्यांचा डोंगराएव्हढा भर हलका झाला...

मित्रांनो..ही आहे विज्ञानाची ताकद... विज्ञान कुणाचेही आयुष्य आमूलाग्र बदलवू शकते...फक्त गरज आहे प्रगल्भ विचारधारेची.....गरज आहे सत्याला सत्य म्हणून स्वीकारण्याची.....गरज आहे भावनिक न होता व्यवहार्य मार्ग शोधण्याची आणि हे सगळे या कुटुंबाने केले...

जनसामन्यांचे आयुष्य बदलवणाऱ्या अशा क्षणांचे साक्षीदार व्हायला मिळण्यासारखं दुसर भाग्य नाही...

असे क्षण खेचून आणण्यामध्ये आपल्या टीमचाही खारीचा वाटा आहे ही बाब नक्कीच सुखावणारी आहे...

समाजातील अशा अनेक तायांना अजूनही अशा उपचारांची गरज आहे...

ताईला आणि तिच्या नवरोबाला वैवाहिक आयुष्याच्या शुभेच्छा...
💐💐🥰🥰

17/04/2025

*Scar endometriosis*

1. We did 2 cases of scar endometriosis excision this month

2. Very rare pathology but on the rise

3. Surgery is the only curative option

4. Patients suffers from severe pain at scar site with aggravation during me**es

5. Exact predisposing factors are not known but common in obese

We are happy to help to help these women

Many thanks
🙏🏻🙏🏻

25/03/2025

*When an ultrasound comes to rescue you intra operatively*

*Story of a difficult localisation and difficult excision of the ACUM...*

20 yr newly wed lady reported with severe pain in abdomen during me**es from the last 2 years..
🥺🥺😣😣😫😖

O/E
She was vitally stable

TV USG s/o
*? Unicornuate uterus with a non communicating left horn with hematometra*
*? ACUM*

She was posted for hysterolaparoscopy

*On hysteroscopy 2 tubal ostia were seen ruling out the unicornuate uterus...*
✖️✖️

On laparoscopy both tubes were found patent ..

But the challenge was there was absence of a visual bulge at the site of pathology...
🧐🧐

*So localisation was challenging...*

Inadvertent overshooting might have caused injury to the ipsilateral tube, might have caused excessive myometrial injury or injury to the true endometrial cavity...
😳😳😬

But then ultrasound came to rescue..

Mass was localised with an ultrasound intraoperative

The depth of the lesion ans margins were mapped intraoperative...

Further challenge was to excise it in toto as it was situated deeply
😬😬

We opened the mass in midlineso as to see the extent of its depth...hematometra was drained...
🩸🩸

We remained close the margins so as to avoid excessive myometrial loss or inadvertent injury to the major uterine vessles..
👩‍❤️‍👨👩‍❤️‍👨

The mass was excised in toto
🗡️🗡️

Suturing at such depths was also difficult but all went well...
🔗🔗☺️☺️

*Discussion*

1.Accessary cavitated uterine mass /ACUM is a very rare entity with *less than 100 cases reported till date*

2. It's other nomenclature as *juvenile cystic adenomyosis/JCM nd uterus like mass /ULM has been discontinued*

3. *It can be mistaken for unicornuate uterus* with a non communicating rudimentary horn with hematometra herein only single tube is communicating to the cavity

4. *It can be mistaken for Roberts uterus* herein also single ostium is seen on hysteroscopybut there is a septum separating 2 cavities and cavity would look compressed on the side of hematometra. In our case the cavity was normal

5. *Surgical excision is the treatment of choice*

6. We were forntunate to treat 2 cases of ACUM previously

7. Both of them conceived naturally and delivered by LSCS

Yes...

Being well versed with your armamentarium saves you
💣🧨🪓🔪🗡️⚔️⛏️🪚🔩⚙️

Even if you map the lesion preoperatively even if you do all your homework some challenges come intraoperatively...

We routinely use intraoperative ultrasound in difficult cases...

What is opinion of the house ...

*Do you too use intraoperative ultrasound..*

*And for which indications...*

Many thanks
🙏🏻🙏🏻

Laparoscopic excision of the blind uterine cavity/ ACUM-The surgical catalogue by Dr Pradeep Ingale ..20 yr newly wed lady reported with severe pain in abdom...

14/03/2025

Thanks@nagarstories

13/03/2025

-surgical services
Super Speciality Hospitals

"Precision in every incision..."

One stop destination for all type of gynecological surgeries...
🙏🙏

06/03/2025

*When a very rare pathology comes as an intra operative surprise*
🧐🧐😳😳🥺🥺😱😱

*UTERINE DIVERTICULUM*

The story goes...
✒️✒️

A 50 year old lady came with h/o 2 years amenorrhea c/o on and off pain in abdomen and spotting PV from the last 15 days...
😖😖🩸🩸

She had h/o 3 FTNDs, TL was done..

*O/E*
She was vitally stable, afebrile

PS-Cx, Vg were healthy

Brownish coloured blood tinged discharge was coming through the os

*A soft mass of around 8-10 cm was palpable in left adnexa*

This mass was non tender on palpation

USG was s/o normal sized uterus and endometrium

Right o***y was atrophic

There was 8x10x10 cm lesion seen in the left adnexa adjacent to the uterus

Wall of the lesion was 5-10mm thick

It contained moving echoes with homogeneous echotexture...

LO could not be seen separately..

No e/o lymphadenopathy, ascites

*USG reported the mass lesion as a left ovarian endometriotic cyst*

*The patient was posted for TLH BSO in view symptomatic adnexal mass lesion*

*On laparoscopy*

Uterus was normal in size with normal bilateral tubes and ovaries

A 10x10x8 cm lesion was seen within the leaves of the left broad ligament

This lesion was moving with the uterus...

We excised this lesion alongwith the uterus

On cut section it was found to be

*UTERINE DIVERTICULUM*

*Discussion*
1. Uterine diverticulum is a very rare entity wherein outpouching forms from the uterus

2. Cavity of this lesion is in continuity with the uterine cavity

3. The defect is thought to be caused by defective fusion of the Mullerian ducts

4. It may be seen on anterior, posterior or lateral wall of the uterus

5. Lateral ones are surgically challenging as they tend to grow till the vital stuctured like ureter, pelvic vessles making these structures prone for the injury during the surgical excision

6. Step by step dissection and through knowledge of anatomy of the lateral pelvic wall safeguards ureter and pelvic vessels from injury

8. *It is so rare that only 24 cases of this pathology are reported till date*

Yes....god created women as a full suprise package... so unpredictable and so challenging ....😇😇

But at the same time he was kind enough to create gynecologists- a tribe of a professionally qualified persons trying to understand women...
👩🏻‍⚕️👩🏻‍⚕️👨🏻‍⚕️👨🏻‍⚕️🙂🙂

These poor fellows after learning volumes and spending years in their profession.... still find themselves on page 1 of the book called *"HOW TO UNDERSTAND A WOMEN..."*

More they try to understand... more complex the women become..

😃😃🙂😉🙃
😇😇🥰🥰

Come on....you can do it...
🤣🤣

https://youtu.be/m8rRmKcRwts?si=XKj27xQZZig6port

24/02/2025

Smiles after 5 years of marriage...
☺️☺️💃🏻💃🏻👼🏻👼🏻

G2P1L0
K/c/o type I diabetes on insulin since childhood
💉💉
Due to chronic injections she developed lipodystrophy over the thighs

She nearly defied death in her last pregnancy

Wherein she had abruption with IUFD and was having DIC when presented

Timely intervention and aggressive management with us could save her
🩺🩺🩸🩸

Meanwhile went in keto acidosis requiring ICU support 6 months after the first delivery as she missed insulin injections owing to financial constraints...
😢😢

She remained in touch with us..

Pre conceptional care done to correct the things

And she conceived

*Pregnacy was with multiple challenges*

Diabetes, short periconceptional period, previous preterm LSCS, previous severe preeclampsia with abruption and most importantly finances

The couple was so determined to overcome it all...
💪🏻💪🏻👏🏻👏🏻

All pain of lakhs of injections paid off...

And she delivered a healthy baby girl at term...
👼🏻👼🏻🥰🥰

A moment that changed life of the family

Infusing shower of positivity amidst the dark clouds of negativity...
🌧️🌧️🌑🌑

It's a blessing to contribute and witness such life changing moments
🥰🥰

Many thanks

Proud of you my team
💞💞💕💕🙏🏻🙏🏻