Laparoscopy - Best Private Hospital in Dubai Al Mankhool | IMH Dubai

PCOS (Polycystic Ovarian Syndrome)

PCOS (Polycystic Ovarian Syndrome) is the most common endocrine disorder among women between the ages of 18 and 44. It is a condition that affects almost 1 in 5 women and the incidence is rising. Exact cause is not known but there is genetic tendency and Life style changes are contributors for development of PCOS.
In PCOS, there is hormonal imbalance in woman’s sex hormones with increase in male hormone levels and insulin resistance in body. This leads to spectrum of symptoms in PCOS. Symptoms vary from person to person but common are Menstrual irregularities with tendency to delay menses ,missed periods or medicines to get periods ,Acne , Excessive hair growth on face ,body and hair loss on scalp ,Weight Gain and difficulty in losing weight .

PCOS also causes difficulty in conceiving and is the leading cause of anovulatory infertility. On ultrasound, there will be multiple small cysts seen in ovary like string of pearl. These cysts are actually immature follicles. In normal menstrual cycle, follicle develops and grows to form an egg which ovulates, but in PCOS follicular development is arrested at early stage due to disturbed ovarian function and they form multiple cysts
How do we treat PCOS?
PCOS can be controlled mainly by Change in life style with opting for healthy food habits and regular exercise keeps normal BMI (Body mass index). Gynecologist can prescribe medicines to increase the insulin sensitivity or pills to regularize cycles.
If fertility is a concern then further treatment to form egg may be required.
PCOS not only affects appearance, fertility but has long term health risks associated with metabolic effects like developing Diabetes, High blood pressure, dyslipidemia, heart disease and also risk of endometrial hyperplasia and endometrial (womb) cancer.
Regular health checkups are recommended to control PCOS and its long term effects.

Understanding Ovarian Cysts And How To Treat It

Finding out that you have ovarian cysts during a routine pelvic checkup can be a scary experience for any women. Most women immediately jump to conclusions about their condition and it’s severity. However, not all cysts are dangerous and malignant. For instance, ovarian cysts are one of the most common kinds of cysts that develops on a woman’s ovaries. Many women will develop at least one cyst during their lifetime. 

However, cysts can be the cause of one or more menstrual discomforts and their prolonged presence can lead to female infertility. So in this blog, we will discuss more about ovarian cysts, their symptoms and how our gynecologists will treat the condition once diagnosed. 

Understanding ovarian cysts

Ovarian cysts are small fluid filled sacs found on the ovaries. They are of various types like endometrioma cysts, functional cysts and dermoid cysts. Of these, the functional cysts are the most common type of cysts found in women.

Functional cysts are again divided into two types- the follicle cysts and corpus luteum cysts. A follicle is a sac like structure inside the ovary, in which an egg grows to maturity. During a woman’s menstrual cycle, this follicle breaks open to release the egg. However, in some cases, the follicle fails to break open, which leads the sac to fill with fluid, leading to the formation of an ovarian cyst. 

Normally, the follicle dissolves away after releasing the egg. But in some women, this sac remains on the ovary, gets filled with the liquid and seal the opening over time, leading to the formation of a corpus luteum cyst.

Unlike the fluid-filled water cysts, dermoid cysts contain fat or hair tissues, while cystadenomas are non-malignant growth on the outer surface of the ovaries. Endometriomas are cysts that are formed due to the growth of endometrial tissue on the ovaries, which is classified as a separate condition called endometriosis.

Another cystic formation in the ovaries is polycystic ovary syndrome, where a woman’s ovaries develop a large number of smaller cysts, leading to enlarged ovaries. Leaving this condition untreated can lead to potential infertility in the long run.

Most often, ovarian cysts do not cause any symptoms. However, when the cyst grows bigger, it can lead to symptoms like abdominal bloating, pelvic pain during menstruation, painful intercourse, painful bowel movements, nausea and vomiting. If you suffer from any of these symptoms repeatedly, you might need immediate medical attention from our gynecologists.

Similarly, if the cysts are too big, it can lead to ovarian torsion (twisting of the ovary) or the rupturing of the water cysts. This will cause severe pelvic pain, fever, faintness and dizziness. If not treated on time, this condition can lead to ovarian necrosis, which causes the ovarian tissues to die due to lack of blood.

Diagnosis and treatment of an ovarian cyst

To diagnose the presence of an ovarian cyst, our gynecologist will subject the patient to an ultrasound test and routine pelvic examination. The ultrasound imaging will help the specialist to determine the location, size, shape and composition of the cyst. 

As most cysts disappear on their own after a few weeks or months, our gynecologist might not recommend a treatment plan on the first go. If it is present even after several scanning and is slowly increasing in size, then the patient will be prescribed a treatment plan.

Our gynecologists usually treat ovarian cysts with the help of oral contraceptives, which prevent ovulation and development of new cysts. These contraceptive pills also reduce the chance of ovarian cancer in women. Sometimes, water cysts have to be surgically removed through a laparoscopy or keyhole surgery. The keyhole surgery is performed by making a tiny incision near the patient’s navel and inserting the surgical instrument to remove the cyst.
Women must remain cautious about their reproductive health at all times. If you suffer from any of the symptoms discussed above, consult with our gynecologists at the earliest. Early detection and cure will ensure better health and quality of life.

Endometriosis: Why Does It Need Early Detection And Treatment?

Growing up, most girls go through painful menstruation cramps. They depend upon painkiller tablets, hot water bags and dietary changes to cope with the pain, but leave it at just that. However, as more and more research is being done on the female reproductive health, it has become evident that any kind of pelvic pain and difficulties must be diagnosed and treated at the earliest.

For instance, endometriosis is a very painful disorder, in which the female uterus lining called the endometrium grows outside of the uterus. As this lining tissue normally forms inside the uterus, its presence anywhere outside it, like ovaries, fallopian tubes or other regions in the pelvis is considered to be abnormal. 

As menstruation is a natural process where the endometrial lining collapses and flows out of the uterus in the absence of an embryo during each menstrual period, the displaced endometrial tissue also acts the same. It thickens, breaks and bleeds, but gets trapped within the body as there is no way for the displaced tissue to exit the body. This causes the surrounding tissue to get irritates, leading to scarring and adhesions in the pelvic region.

The most common symptoms of Endometriosis is extreme pelvic pain, bleeding and cramping during the menstrual period. Women with the disorder may also experience painful intercourse during or after the act. Lower back and abdominal pain are also quite common in women suffering from endometriosis.

So why is it necessary to diagnose and treat the condition?

Most women who suffer from this condition suffer from severe pains especially during menstrual periods. Prolonged existence of the condition can also lead to fertility issues in women.

As the condition is difficult to manage on its own and has serious repercussions regarding the female’s ability to conceive, it is very important to go for an early diagnosis. Undergoing the right endometriosis treatment as recommended by a gynecologist will help women suffering from the condition to live a healthier life.

Diagnosis and treatment

To diagnose endometriosis, our gynecologists will check for physical clues. A pelvic exam, for instance will reveal the presence of abnormalities like cysts or scars behind your uterus or other reproductive organs. For further observations, our specialist will recommend an ultrasound examination. A standard ultrasound imaging test can identify cysts associated with endometriosis, which our gynecologists may recommend for you, to help them study and plan the endometriosis treatment.

An MRI on the other hand creates a detailed image of the organs and tissues inside the patient’s body. If our specialists recommend you for a surgery, the MRI test can help plan the procedure better depending upon the size and location of the endometriosis. 

For surgical removal of the endometrial tissue, our gynecologists may refer you to a surgeon. In this case, a small viewing instrument called a laparoscope is inserted into your body through a tiny incision near your navel, which will help the surgeon locate the tissue, understand it’s size and remove it accordingly from the body.

Do you suffer from extreme period pains or other pelvic discomforts? Consult with our gynecologist and start your endometriosis treatments today.


Laparoscopic Abdominal Cerclage an Excellent Option for Women with Recurrent Fetal Loss

Cervical incompetence or cervical insufficiency is one of the causes of preterm birth, leading to increased perinatalmorbidity and mortality.Cervical insufficiency is defined as “a painless dilatation of the cervix resulting in bulging or ruptured membranes and midtrimestermiscarriage”. It occurs in 0.5% to 1.0% of allpregnancies and in up to 8% of women with repeated second-trimester miscarriages. Late miscarriages and extreme premature birth are very traumatic for a couple physically and psychologically and It may lead to them delaying or even deciding against a future pregnancy.


Cervical cerclage placement is the treatment for this condition. Although most cerclages are placed transvaginally via the Shirodkar or McDonald technique, abdominal cerclage is necessary in women with a previous failed transvaginal cerclage or in those with minimal cervical tissue accessible vaginally .Approximately 13% ofpregnancies in women with cervical incompetence treated with vaginal cerclage will not be successful and will deliver previable infants despite this interventions .


Both laparoscopic and robotic approaches to this procedure have been developed, allowing patients to enjoy a more rapid recovery as well as to avoid an unnecessary laparotomy. The observational studies reporting outcomes for laparoscopic-abdominal cerclage quote fetal survival rates in the range of 81% to 100%.

Indications for abdominal cerclage
1. Short or no intravaginal portion of the cervix due to previous surgery like LEEP , LETZ and trachelectomy
2. Congenital malformation of uterus
3. Severe cervical lacerations during previous delivery
4. Previous failed vaginal cerclage

Laparoscopic Cerclage
Advances in the field of minimally invasive surgery resulted in development of a new approach to cervical cerclage placement. Laparoscopic cerclage offers the benefit of placing the cerclage at a higher level which reduces the chances of pretem delivery with added benefits of reduced blood loss, reduced postoperative pain, and fewer adhesions, as well as decreased length of hospital stay and overall faster recovery time. Laparoscopic cerclage can be placed either before conception (preconceptional or interval cerclage) or in early pregnancy (postconceptional).

Laparoscopic Cervical Cerclage before Pregnancy
Performing abdominal cerclage preconceptionally mitigates the concerns of difficult exposure due to an enlarged pregnant uterus, increased risk of bleeding, and possible risks to the pregnancy . Furthermore, it can be performed via laparoscopy, which is associated with a short hospital stay, lesspostoperative pain, and rapid recovery.

Yet preconceptionalabdominal cerclage had not been popular because of the possibility of a subsequent miscarriage or fetal loss in thepresence of the cerclage. This concern seems unwarranted.

One can still perfom dilation and curettage in the presence of abdominal cerclage without compromising its integrity . In the event of failed pregnancy in the secondtrimester, the cerclage can be removed laparoscopically. This will be followed by spontaneous expulsion of the fetus within a few days .

Laparoscopic cerclage during pregnancy

Postconceptional abdominal cerclage is required in pregnant women who for some reason cannot undergo vaginal cerclage. There is no differencein the rate of third-trimester delivery after abdominal cervical cerclage before
or during pregnancy.


Advantages of laparoscopic cerclage
• Higher placement stich relative to internal os
• Decreased incidence of slippage(less suture migration)
• Ability to leave the stitch in place between pregnancies
• Eliminates the risk of foreign body entering the vagina
• Less risk of PPROM compared to transvaginal(9% vs 29%)

Patients undergoing laparoscopic cerclage should be delivered by cesarean section and stich can be left in place for future pregnancies.

Laparoscopic cervical cerclage is a procedure that offers hope to women with recurrent pregnancy loss related to cervical incompetence and in whom transcervical cerclage would be difficult or impossible .