Common gynecological procedures - PowerPoint Presentation

Slide1

Common gynecological procedures

Nebras Abu Abed

Hysteroscopy

Hysteroscopy

 is the inspection of the 

uterine cavity

 by 

endoscopy

 with access through the 

cervix

. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention (operative hysteroscopy

).

A

hysteroscope

is an endoscope that carries

optical and light channels

or fibers. It is introduced in a sheath that provides an inflow and outflow channel for insufflation of the uterine cavity. In addition, an

operative channel

may be present to introduce scissors, graspers or biopsy

instruments

Two main types : rigid and flexible

The flexible

hysteroscope

is most commonly used for

office hysteroscopy

. It is notable for its flexibility, with a tip that deflects over a range of 120-160°. Its most appropriate use is to accommodate the

irregularly shaped uterus and to navigate around intrauterine lesions

. It is also used for diagnostic and operative procedures.

During insertion,

the flexible contour accommodates to the cervix more easily

than does a rigid scope of a similarly small diameter.

Media

The use of media is critical for panoramic inspection of the uterine cavity. The medium opens the potential space of the otherwise narrow uterine cavity

.

Insufflation by using either

gas

(CO2) or

fluid

(NS

).

Carbon dioxide (CO

2

) is rapidly absorbed and easily cleared from the body by

respiration.

The gas easily flows through narrow channels in small-diameter scopes, making it useful for office-based diagnostic hysteroscopy.

However, this method offers no way to clear blood from the

scope

.

The advantage of fluid over gas is the

symmetric distention of the uterus with fluid

and

its effective ability to flush

blood, mucus, bubbles, and small tissue fragments out of the visual field.

 With a patient in

the lithotomy position

, the cervix is visualized by placing a

speculum

in the vagina. The distal end of

the telescope is passed into a dilated cervical canal

, and, under direct visualization, the instrument is advanced into the uterine cavity. A camera is commonly attached to the proximal end of the

hysteroscope

to broadcast the image onto a large video screen. 

Indications

Any abnormal bleeding from the uterus can be investigated by hysteroscopy, including

:

• Postmenopausal bleeding

.

• Irregular menstruation, intermenstrual bleeding and

postcoital

bleeding.

•

Persistent heavy menstrual bleeding

Persistent discharge

.

•

Suspected uterine malformations

.

• Suspected

Asherman’s

syndrome.

•

Essure

hysteroscopic

sterilization(

Essure

contraceptive

tubal

occlusion

device

)

•

endometrial

biopsy

An operating

hysteroscope

can also be used to resect endometrial pathology such

as fibroids and

polyp

s

and

uterine

septums

Serious

side effects may include

persistent pain

,

perforation of the uterus and fallopian tubes

, and

migration of the coils into the pelvis or abdomen

Complications

•

Perforation of the uterus

.

• Cervical damage – if cervical dilatation is necessary.

•

If there is infection present, hysteroscopy can cause ascending infection

.

•

Bleeding

https://www.youtube.com/watch?v=MzixPFAsnAU

laparoscopy

Laparoscopy allows visualization of the peritoneal cavity. This involves insertion of a needle called a

Veress

needle into a suitable puncture point in the umbilicus. This allows insufflation of the peritoneal cavity with carbon dioxide so that a larger instrument can be inserted.

Indications

•

Suspected ectopic pregnancy.

•

Ovarian cyst accident and acute pelvic pain.

•

Undiagnosed pelvic pain.

•

Tubal patency testing.

•

Sterilization.

•

endometriosis

•

ovarian cystectomy or oophorectomy

Complications

Complications

are

uncommon

, but include

damage to any of the intra-abdominal structures

, such as bowel and major blood vessels. The bladder is always emptied prior to the procedure to avoid bladder injury

. Incisional hernia has been reported

MYOMECTOMY

fertility

sparing surgical technique for resection of fibroids

.

Abdominal MYOMECTOMY .

Vaginal

myomectomy.

Endoscopic

myomectomy: -

hysteroscopic

-

laparoscop

indications

Abdominal pain/pressure symptoms

.

Suspicion of malignancy.

Infertility

and/or recurrent pregnancy loss.

Abnormal

bleeding

complications

Intraoperative bleeding from vascular fibroids.

Risk

of unplanned hysterectomy.

Postoperative

intra-abdominal adhesions.

hysterosaplingography

Is a Diagnostic Outpatient radiologic imaging procedure performed without anesthesia

..

A cannula is placed in

the

endocervical

canal

and radio opaque fluid is injected allowing assessment of uterine malformation

malformation

(uterine septum ) and

Asherman's

syndrome

.

Tubal pathology

can also be assessed by observing internal tubal anatomy and seeing whether the dye spills in to pelvis cavity