Fibroid Removal Surgery (Open Myomectomy) Cost in Pune
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WhatsApp ExpertFibroid Removal Surgery (Open Myomectomy) Cost Estimation in Pune
Knowing the fibroid surgery cost in Pune is essential if you are advised to have surgery for uterine fibroids. They are typically noncancerous growths in the uterus that can disrupt the harmony of your daily life.
Prioritising quality healthcare while keeping costs in mind is essential. The cost of fibroid removal surgery in Pune varies across different hospitals. Analysing quote components and available financial assistance can help you make an informed insurance decision.
What is an Uterine fibroid?
Uterine fibroids, also known as myomas or Rasoli in Hindi, are common growths in the uterus. They usually occur during the childbearing years and rarely become cancerous or increase the risk of other uterine cancers. Many people have fibroids without experiencing symptoms, and they may be discovered during a pelvic exam or prenatal ultrasound.
As per the statistics, the burden of uterine fibroids in India is 0.89% per year (percentage of annual increase). There is an annual change in the load of uterine fibroids in India, which is, on average, 0.89% annually (the true annual change is likely to be within the range of 0.85% to 0.93%).
Incidence (emergence of new cases) of fibroids in urban Maharashtra is most common in 31-40 years of age, i.e. 34.9%. Commonly observed symptoms are abdominal lump (41%) and abnormal uterine bleeding (24.1%). Prevalence (total existing cases) of submucosal fibroids was 38.6%, intramural fibroids 19.3%, submucosal polyp 14.5%, seedling fibroid 13.9% and subserosal fibroid 10.2%.3
Overview of Fibroid Surgery Costs in Pune
We understand that decoding the rasoli operation cost is vital before undergoing this procedure. The following table shows an expected price range:
Fibroid Surgery Costs | Estimated Range |
Minimum | ₹ 80,000 |
Average | ₹ 1,10,000 |
Maximum | ₹ 2,00,000 |
Disclaimer: These cost estimates are merely intended for general information. For the most recent information, it is crucial to speak directly with medical professionals.
Cost Breakup of Fibroid Surgery Cost in Pune
Fibroid surgery costs in Pune can have a varied range of components. The following table is a broad summary of the variables that influence the total price:
Cost Component | Estimated Cost Range |
Implant Cost (Laparoscope) | ₹20,500 (may be part of the package) |
Doctor's Visit | ₹1,000 - ₹1,200 |
Surgeon Fee | ₹60,000 |
Anaesthetist Fee | ₹18,000 |
Assistant Charge | ₹30,000 |
Nursing Charge per day | ₹1,500 - ₹2,000 |
Drugs and Consumables | ₹10,000 - ₹20,000 |
OT (Operating Theatre) Charge | ₹30,000 |
Investigations | ₹15,000 - ₹20,000 |
Room Rent per day | ₹6,000 - ₹8,000 per day |
Disclaimer: The figures presented here are approximate and subject to change. For accurate fibroid removal surgery costs, patients are strongly advised to consult with their healthcare providers.
Factors Affecting the Cost of Fibroid Surgery in Pune
The fibroid removal surgery cost in Pune is influenced by several factors given below. Given below are some of the cost variables:
Number, Size, and Location: Removing a single fibroid is less complex and expensive. Multiple fibroids increase surgical complexity, duration, and costs. Large fibroids require greater skill, specialised instruments, and higher costs.
Type of Surgery: Different surgical approaches, such as myomectomy or hysterectomy, have varying levels of complexity. For example, a laparoscopic myomectomy may be less invasive than an open abdominal myomectomy, affecting the total price.
Patient's Medical History: The woman’s overall health and clinical history can influence the complexity. Pre-existing conditions or complications may require additional precautions, testing, or specialised care, contributing to increased expenses.
Risk of Complications: Higher-risk cases may necessitate additional measures to address potential risks. Thus, extending hospital stays, more intensive postoperative care, and follow-up procedures.
Surgeon's Expertise: Surgeons with vast experience in handling complex cases may charge higher for their skills. Their ability to navigate challenging situations can impact the total cost.
Technological Requirements: Intricate cases may require advanced surgical technologies, equipment, or imaging techniques. Subsequently contributing to higher procedural costs.
Postoperative Care: More complicated cases may require extensive post-surgical care, including monitoring, medications, and follow-up appointments. The extended care and resources involved can influence expenses.
Hospital Facilities: Healthcare setups with advanced facilities to handle complex cases may charge higher. Access to specialised equipment, operating rooms, and support services contributes to the final amount.
Cost of Lab Tests Before Uterine Fibroid Treatment in Pune
The cost of lab tests before uterine fibroid treatment in Pune is variable. This depends on the specific tests required, the type of facility (private hospital, government hospital, etc.) and any insurance coverage you may have.
Here's a general breakdown of some common tests and their estimated costs:
Procedure | Cost Range |
Magnetic Resonance Imaging (MRI) | ₹6,000 to ₹8,000 |
Transvaginal Ultrasound | ₹1,000 to ₹1,500 |
Hysterosonography | ₹2,000 to ₹ 3,000 |
Hysterosalpingography | ₹1,500 to ₹4,000 |
Hysteroscopy | ₹10,000 to ₹12,000 |
Blood Test | ₹500 to ₹700 |
Histopathology (Biopsy) small sample | ₹3,000 to ₹5,000 |
Disclaimer: The price of these lab tests can differ significantly for different procedures. The degree of pain, the size of fibroids and the overall health status of the patient can impact the costs.
Insurance for Fibroid Removal Surgery Cost in Pune
Many health insurance plans cover fibroid removal surgery expenses. The covered amount for the expenses of a myomectomy surgery in Pune may vary depending on the conditions of your medical insurance.
The following are the few frequently asked queries for fibroid operation costs in Pune.
Is the fibroid operation cost in Pune covered under insurance?
Provide a list of insurance providers who offer coverage for fibroid removal surgery.
Is it possible to submit a cashless claim for myomectomy surgery costs in Pune at any network hospital?
How can I file a claim for reimbursement for the cost of the laparoscopic myomectomy?
Read further to learn about it in detail.
Is the Fibroid Operation Cost in Pune Covered Under Insurance?
While the uterine fibroid embolisation cost in India is mostly covered under insurance, several variables can impact reimbursement. These include the type of insurance plan, the policy-specific terms and conditions, and the medical necessity of the surgery.
The policies of various insurance plans, including employer-sponsored plans, government-sponsored plans, and private health insurance, may differ.
The medical necessity of the procedure often determines insurance coverage. The likelihood of a health plan covering fibroid surgery may increase if it is determined to be medically required to treat symptoms or other health issues.
List of Insurance Providers for Fibroid Removal Surgery
The fibroid removal surgery costs in Pune are covered by the General Insurance Public Sector Association (GIPSA) and non-GIPSA. Refer to the table below for the names of the insurance companies that cover uterine fibroid treatment costs in India.
Insurance Companies | Fibroid Removal Surgery |
Covered | |
Covered | |
Covered | |
Covered | |
Covered | |
Covered | |
Covered | |
Covered | |
Covered | |
Covered | |
Family Health Plan (FHPL) | Covered |
Covered | |
Covered | |
Covered | |
Covered | |
ICICI Prudential Life Insurance | Covered |
Covered | |
Covered | |
Covered | |
Covered | |
Covered | |
Covered | |
Vidal Health Insurance | Covered |
GIPSA | Covered |
Disclaimer: The above information is generic and does not constitute professional medical or insurance advice. The policies of insurance providers in the above list are subject to change.
Cashless Claim for Myomectomy Surgery Costs in Pune
One can submit a cashless claim for myomectomy surgery costs at some network hospitals in Pune. Here are the general steps to determine if digital claims for myomectomy surgery are possible:
Check Network Hospital: Insurance companies typically have a list of network hospitals where cashless facilities are available.
Pre-Authorisation: The process often includes submitting documents such as a letter from the treating doctor and estimates of the medical expenses.
Submit Necessary Documents: This may include the pre-authorisation letter, a copy of the health insurance card, and any other documents required by the insurance company.
Verification Process: The insurance desk at the hospital will typically verify the documents and coordinate with the insurance company to approve cashless treatment.
Approval or Denial: The insurance agency will assess the information and either approve or deny the claim. If approved, the hospital can proceed with the surgery, and the insurance company will settle the bills directly with the hospital. If denied, you may need to pay the expenses upfront and file for reimbursement later.
Reimbursement Claim for the Cost of the Laparoscopic Myomectomy
Filing a claim for reimbursement for the cost of a laparoscopic myomectomy involves a series of steps, including:
Collect detailed invoices from the hospital, surgeon, anaesthetist, and any other healthcare providers involved in the laparoscopic myomectomy.
Obtain the surgeon's report detailing the laparoscopic myomectomy procedure.
Procure a claim form from your insurance provider. It is typically available on the company’s website, or one can request it directly from the insurance company. Fill out the form accurately.
Attach all supporting documents, including the detailed invoices, surgeon's report, and any other documents requested by your health policy provider.
Submit the application and necessary documents to your insurance agency.
Follow-up with the insurance company if you haven't received an acknowledgement within a reasonable timeframe.
The agency will reimburse the eligible amount if your claim is approved. This compensation can be in the form of a direct bank deposit or a check.
HexaHealth representatives shall assist you in this process to ensure you have a seamless experience.
Medical Loan and EMI for the Cost of Fibroid Removal Surgery in Pune
You can consider a medical loan to cover the cost of fibroid removal surgery in Pune and may plan to repay it through EMIs. It's crucial to carefully read the terms and conditions, including interest rates, processing fees, and any hidden charges associated with the medical loan.
Before proceeding, you can consult with HexaHealth experts to explore various financing options for making an informed decision. Please reach out to us at (+91) 88606-88606.
Fibroid Surgery Cost from Expert Doctors in Pune
The fibroid operation cost in Pune can differ based on the expertise and credentials of the surgeon. It is recommended to arrange consultations with the following specialists for understanding the process better:
Dr Rachna Parmar: She is an experienced obstetrics and gynaecology surgeon with 25 years of practice. Dr Parmar is currently affiliated with Parmar Multispeciality Hospital And Maternity Home. Her specialities include fibroid surgery, high-risk pregnancy, ultrasound sonography, and many more.
Dr Komal Bhadu: Recognised as a proficient gynaecologist, she is associated with Amayra Polyclinic and Dental Hub in Pune. She brings 9 years of experience in obstetrics, gynaecology, and laparoscopic surgery. Dr Bhadu has notably assisted 272 women through family planning and infertility surgeries. Fibroid removal surgery is one of her proficient areas.
Dr Bharati Dhorepatil: With 39 years of clinical experience in obstetrics and gynaecology, Dr Dhorepatil is currently practising at Shree Hospital, Kharadi. Her expertise includes fibroid surgery, infertility, IVF, among many others.
Dr Rahul Bhagchand Chavan: An esteemed obstetrician and gynaecologist empanelled with Amayra Polyclinic and Dental Hub. With a decade of experience in his field, he has established himself as a skilled professional. His special interests are open fibroid removal surgery and open ovarian cyst surgery, among several others.
Dr Nikhil Mahadar: An eminent obstetrician and gynaecologist affiliated with Srushti Hospital in Wakad. He brings 14 years of professional experience to his practice in this field. The special interests of Dr Mahadar include fibroid removal surgery, infertility treatment, and high-risk pregnancy and labour.
Dr Meenakshi Avinash Pawar: She is a well-known obstetrician and gynaecologist at Amayra Polyclinic and Dental Hub. In her 14 years of clinical career, she has handled numerous complex cases. Dr Pawar is known for treatments like fibroid surgery, vaginoplasty, IVF, and more.
Dr Kamate Ramit Raosaheb: A prominent gynaecologist practising at Nakshatra Fertility, Intimacy and Cosmetic Clinic in Balewadi. He has 14 years of expertise in obstetrics and gynaecology. Dr Pawar’s specialisations include open fibroid removal surgery, normal delivery, caesarean section, to name a few.
Dr Sandip Narkhede: Affiliated with Life Care Speciality Hospital in Sanghavi, he is a reputed obstetrician, gynaecologist, and sexologist. Dr Narkhede has 17 years of medical experience in his field and is known for his accurate diagnosis. He has performed numerous fibroid removal surgeries in his career.
Dr Mugdha Joshi: Associated with Chellaram Hospital - Diabetes Care & Multispeciality, she is an obstetrics and gynaecology specialist. Dr Joshi has over 17 years of practice in fibroid removal surgeries. Her skills also include laparoscopic surgery, dilation and curettage (D&C), IUD placement, and various other procedures.
Note: There are several other uterine fibroid specialists in the city for affordable treatment. You can get in touch with these experts via HexaHealth.
Fibroid Surgery Cost from Top Hospitals in Pune
The laparoscopic fibroid removal costs in Pune may significantly differ based on the healthcare facility selected. The city has several centres that offer cost-effective choices for this surgery. The following are some of the top hospitals:
Parmar Multispeciality Hospital and Maternity Home: This centre in Pune has fully equipped facilities and experienced medical staff. The team offers a high standard of patient care and treatment. It is renowned for treating conditions like uterine fibroids, ovarian cysts, endometriosis, and more.
Shree Hospital: A 75-bed hospital with fully functional ICUs and modern operation theatres. It offers a range of treatment services led by well-trained and qualified doctors. The specialists perform procedures like fibroid removal, cervical cancer treatment, IVF, etc.
Srushti Hospital: With multiple beds and modern operation theatres, it is one of the best hospitals for gynaecology treatment in Pune. The healthcare facility has an experienced team of doctors and nursing staff. They maintain the utmost standard of treatment and patient care through state-of-the-art competence. It also has sonography facilities for on-spot diagnosis and treatment.
Nakshatra Clinic: It has a team of highly experienced and well-qualified doctors, along with proficient nursing staff and latest facilities. This ensures a high standard of treatment and patient care. They offer treatments for fibroids, infertility, etc.
Life Care Multispeciality Hospital: This facility features multiple beds, fully equipped ICUs, and modern operation theatres. The medical team comprises extremely competent doctors, along with dedicated paramedical staff. It is one of the best centres for fibroid removal in Pune.
Chellaram Hospital: It is a unit of the Chellaram Foundation. The hospital offers various medical services with exceptionally skilled doctors and modern facilities. Patients can get treatments in gynaecology, ophthalmology, cardiology, general surgery, etc. The facility is celebrated for complex procedures like fibroid removal surgery.
Note: Contact your selected hospital for accurate costs of fibroid removal surgery in Pune.
Why Pick HexaHealth in Pune for Fibroid Surgery?
HexaHealth is a patient-focused platform that manages a patient's whole surgical experience. They assist in selecting the best surgeon and facility.
Apart from this, below are a few other perks you get by choosing HexaHealth:
Take advantage of internationally renowned specialists whose combined experience exceeds 100 years, guaranteeing unparalleled expertise in fibroid excision surgery.
Use our special service to access top physicians at prestigious Pune hospitals. We offer free professional advice so you can make well-informed judgments.
Put your trust in a group that has executed more than 40,000 gynaecological procedures with success, exhibiting unmatched proficiency.
Access the newest minimally invasive techniques that ensure accurate, efficient, and quick fibroid removal with cutting-edge technical solutions.
Have faith in the expertise of our interdisciplinary team to manage a range of gynaecological disorders. These include simple to intricate procedures, such as gynae-oncology and gynae-urology.
Take advantage of our advanced modular operating rooms, NABH accreditation, and commitment to global clinical and safety standards.
Select from the best and most affordable surgical solutions, ensuring that every patient can have effective and accessible fibroid removal surgery.
Take advantage of personalised care and one-on-one support from our committed HexaHealth buddies. They are a round-the-clock medical care coordinator who will walk you through your treatment plan.
Get full support in organising your visit, including booking airfare, coordinating your hospital stay, and scheduling doctor's visits. We guarantee a smooth and easy process for the patients and their families.
Recuperate in comfortable rooms with contemporary conveniences, securing a stress-free and comfortable environment.
You can feel at peace knowing that we prioritise your safety and are dedicated to COVID-safe procedures.
Enjoy complete privacy and security, knowing that HexaHealth values your privacy above everything else.
Complimentary pick-and-drop service to and from the hospital on the day of operation.
You have financial flexibility by selecting from various payment alternatives, such as cash, credit card, debit card, check, and free EMI.
What is Uterine Fibroid Removal?
Uterine fibroid removal refers to a surgical procedure that removes uterine fibroids. These fibroids can cause a variety of symptoms, including:
Heavy and prolonged menstrual bleeding
Pelvic pain and pressure
Frequent urination
Difficulty getting pregnant
Miscarriage
There are several different types of uterine fibroid removal procedures. Each comes with its own advantages and disadvantages. The best type of procedure for you will depend on several factors, including:
The size, location, and number of fibroids you have
Your symptoms
Your desire to have children in the future
Frequently Asked Questions (FAQ)
What is the minimum cost of fibroid surgery in Pune?
The minimum cost of fibroid surgery in Pune is estimated to be ₹80,000. It should be noted that these costs may vary based on some factors mentioned above.
What is the average cost of fibroid surgery in Pune?
The average cost of fibroid surgery in Pune is estimated to be ₹1,10,000. This is an estimate only. The average cost might vary depending on the other factors as well.
What is the maximum cost I can expect for fibroid surgery in Pune?
The maximum cost for fibroid surgery in Pune is estimated to be ₹2,00,000. This cost might vary depending on the severity of the pain.
How do factors like hospital reputation and doctor's experience impact the cost of fibroid surgery in Pune?
Hospitals with a good reputation often invest in state-of-the-art facilities, advanced medical technologies, and a comfortable patient environment. These amenities can contribute to higher overall costs.
Experienced and highly skilled surgeons typically charge higher fees for their services. Their expertise, success rates, and reputation contribute to the overall cost of the surgery.
Does the case's complexity influence the overall fibroid surgery cost?
Yes, the case's complexity can influence the overall cost of fibroid surgery. Multiple fibroids, larger-sized fibroids, or fibroids in challenging locations may require more intricate surgical techniques, leading to increased surgical time and potential complexity.
Are there geographical variations within Pune that affect the cost of fibroid surgery?
There can be geographical variations within Pune that affect the cost of fibroid surgery. The costs associated with medical services, including surgical procedures, can vary based on the location within a city.
Can you provide a breakdown of the cost of fibroid surgery in Pune?
The breakdown of fibroid surgery costs is as follows:
Doctor's Visit: ₹1,000 - ₹1,200
Surgeon Fee: ₹60,000
Anaesthetist Fee: ₹18,000
Implant Cost (Laparoscope): ₹20,500
Investigations: ₹15,000 - ₹20,000
Drugs and Consumables: ₹10,000 - ₹20,000
Are there any hidden costs or additional charges that patients should be aware of?
Patients should be aware of potential hidden costs when considering medical procedures such as fibroid surgery. These might not be explicitly mentioned in the initial estimates. Preoperative testing, anaesthesia charges and postoperative care might come under these costs.
Does health insurance cover any part of the fibroid surgery cost in Pune?
Health insurance coverage for fibroid surgery can vary based on the specific insurance plan, policy terms, and individual circumstances. It is recommended to consult your insurer.
Are there EMI financing options available for fibroid surgery in Pune?
Yes, many healthcare facilities and medical service providers offer EMI (Equated Monthly Instalments) financing options. It helps individuals manage the costs of medical procedures, including fibroid surgery.
Am I eligible for insurance coverage or financing options for uterine fibroid removal surgery?
Eligibility for insurance coverage or financing options for uterine fibroid removal surgery can depend on various factors. These include your insurance policy, financial situation, and the specific terms and conditions of the financing options.
What sets HexaHealth apart as the preferred choice for fibroid surgery in Pune?
HexaHealth is the best option in Pune for fibroid removal surgery. Our experts help you get a special combination of experience, individualised treatment, and state-of-the-art facilities to guarantee that your medical care is unmatched.
What are the various techniques used in fibroid surgery, and how does the choice of technique impact the procedure?
Fibroid surgery, also known as myomectomy, involves the removal of uterine fibroids, which are noncancerous growths that develop in the uterus's wall. The choice of technique used depends on factors such as:
Size, location, and number of fibroids
Patient's symptoms
The desire for future fertility
What is the best way of treating uterine fibroid?
There is no one-size-fits-all approach; treatment options range from conservative management to surgical interventions. The best approach depends on individual circumstances, and the decision should be made in consultation with a healthcare provider. Factors such as the woman's age and desire for future fertility determine the most appropriate treatment strategy.
What is the need for fibroid surgery, and what are the primary benefits?
The primary benefit of fibroid surgery is symptom relief. Fibroid surgery aims to alleviate symptoms such as heavy period bleeding, pelvic pain and pressure on surrounding organs. This can significantly improve a woman's quality of life. It allows for the removal of fibroids without removing the entire uterus.
Can you explain the steps involved in the fibroid surgery procedure?
The specific steps involved in fibroid surgery, or myomectomy, can vary depending on the surgical technique used. In an abdominal myomectomy, the surgeon identifies and removes the fibroids while preserving the healthy uterine tissue. The removal method can vary; the surgeon may use techniques such as enucleation or morcellation.
Is the patient awake during fibroid removal surgery?
No, the patient is not awake during fibroid removal surgery, also known as myomectomy. Fibroid removal surgeries are typically performed under general anaesthesia.
How many days does one have to spend in the hospital for Fibroid Removal Surgery in Pune?
The duration of hospital stay for fibroid removal surgery in Pune can vary depending on the complexity of the procedure and the individual recovery. Patients undergoing an abdominal myomectomy, which involves a larger incision, may typically stay in the hospital for 2 to 4 days.
Patients undergoing a laparoscopic myomectomy, a minimally invasive approach, may have a shorter hospital stay, often around 1 to 2 days.
What is the recovery process like after fibroid surgery?
The recovery process after fibroid surgery, or myomectomy, varies. It depends on the surgery performed (e.g., abdominal myomectomy, laparoscopic myomectomy, hysteroscopic myomectomy) and individual factors.
What tests are involved in the evaluation before recommending fibroid surgery?
The specific tests and evaluations may vary based on individual circumstances, but common assessments include:
Pelvic examination
Imaging studies
Hysteroscopy
Blood tests
Endometrial biopsy
Laparoscopy
How much time does the fibroid removal surgery take on average?
The duration of fibroid removal surgery, or myomectomy, can vary depending on several factors. Abdominal myomectomy, which involves making an incision in the abdominal wall to access the uterus, typically takes about 1 to 3 hours. Laparoscopic myomectomy is a minimally invasive procedure and takes about 1 to 2 hours.
What are the potential risks and complications associated with fibroid surgery?
Fibroid surgery, or myomectomy, is generally considered safe and effective. However, like any other surgical process, it carries certain risks and potential complications. These may include:
Scarring due to an incision in the abdominal wall
Uterine rupture during labour
Is fibroid surgery recommended for all cases of uterine fibroids?
Fibroid surgery, also known as myomectomy, is not recommended for all cases of uterine fibroids. The decision to undergo fibroid surgery is based on several factors. Healthcare providers carefully consider each patient's circumstances and preferences.
Can fibroid surgery be performed as an outpatient procedure?
The feasibility of performing fibroid surgery as an outpatient procedure depends on various factors, including the type and complexity of the surgery. Some laparoscopic myomectomies, which involve making small incisions and using a camera and specialised instruments, may be performed on an outpatient basis.
How soon can patients resume normal activities after fibroid surgery?
The timeline for resuming normal activities after fibroid surgery, or myomectomy, varies based on the patient's overall health and recovery rate. Patients undergoing hysteroscopic myomectomy resume normal activities within a few days to a week.
What happens if uterine fibroids are left untreated?
Uterine fibroids, in some cases, may not cause significant symptoms and may not require treatment. However, if left untreated, fibroids can lead to various complications and symptoms that impact a woman's health and quality of life. The consequences of untreated uterine fibroids may include increased menstrual bleeding and severe pelvic pain and discomfort.
Can uterine fibroid lead to cancer?
Fibroids themselves are not considered cancerous. However, there is a very rare risk of a type of cancer called leiomyosarcoma developing in a fibroid or the uterine muscle. The risk of leiomyosarcoma associated with fibroids is very low, estimated to be less than 1 in 1,000 cases.
References
All the articles on HexaHealth are supported by verified medically-recognized sources such as; peer-reviewed academic research papers, research institutions, and medical journals. Our medical reviewers also check references of the articles to prioritize accuracy and relevance. Refer to our detailed editorial policy for more information.
- Mayo Clinic. Uterine Fibroids [Internet]. Mayoclinic.org. 2018.
- Lou Z, Huang Y, Li S, Luo Z, Li C, Chu K, et al. Global, regional, and national time trends in incidence, prevalence, years lived with disability for uterine fibroids, 1990–2019: an age-period-cohort
- Ngorili GS, Yadav BB, Takalkar AA. Epidemiological study of uterine fibroids: our experience from urban Maharashtra. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 20
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