Outline Female Anatomy Pathology Miscellaneous Procedure Overview Instrumentation Review Laparoscopy diagnostic or operative Hysteroscopy D amp C dilation amp curettage D amp E dilation amp evacuation ID: 907829
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Slide1
SUR 111
Introduction to GYN Surgeries
Slide2Outline
Female Anatomy
Pathology
Miscellaneous Procedure Overview Instrumentation Review
Laparoscopy
(diagnostic or operative)
Hysteroscopy
D & C (dilation & curettage)
D & E (dilation & evacuation)
Suction Curettage
Slide3FEMALE ANATOMY
Slide4Slide5Pathology
Benign
Cysts
Polyps (pedunculated lesion)FistulasDysplasia= abnormal tissue growth
Leiomyoma
/
Myoma
/Fibroid - smooth muscle tumor
Fibroma
- connective tissue tumor
Malignant
Vulvar
Vaginal
Cervical
Uterine
Ovarian
Other
Endometriosis
-
the presence and growth of functioning endometrial tissue in places other than the uterus that often results in severe pain
Cystocele
-
herniation
of bladder into vagina
Rectocele
(posterior
colporrhaphy
) -
herniation
of rectum into vagina
Enterocele
-
herniation
of cul-de-sac of Douglas/includes loops of intestines into vagina
Ectopic
Pregnancy
-
The implantation and subsequent development of a fertilized egg outside the uterus
Incompetent Cervix
(
cerclage
) -
Slide6(PID) Pelvic inflammatory disease
(
PID) is a general term that refers to infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus) and other reproductive organs. It is a common and serious complication of some sexually transmitted diseases (STDs), especially Chlamydia and Gonorrhea.
PID can damage the fallopian tubes and tissues in and near the uterus and ovaries. PID can lead to serious consequences including infertility, ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere outside of the womb), abscess formation, and chronic pelvic pain.
Slide7Endometriosis
Slide8Ectopic Pregnancy
Slide9Pedunculated
Myoma
Slide10Prolapsed Uterus
Slide11Rectocele
Slide12Gynecological Procedures
Colposcopy
Hysteroscopy
D & C
D & E
Laparoscopy
Hysterectomy Oophorectomy Salpingectomy
Abdominal Hysterectomy
subtotal
total
radical (Wertheim)
Vaginal
LAVH
A & P
Repair - repair-reconstruction vagina, pelvic floor, muscles, fascia, of rectum, urethra, bladder, perineum to
cystocele
and
rectocele
to restore bladder and rectum to normal position
Bartholin’s
Cyst (I & D)
Slide13Bartholin
Gland Cyst
Slide14Instruments
Major Tray
Abdominal-Hysterectomy Tray
D&C TrayHysteroscopy Tray resectoscope & hysteroscopeLaparoscopic TrayCamera/scope tray/scope warmer
Slide15Specific Vaginal Instruments
Auvard weighted speculum
Graves speculum
Sims vaginal speculum (single or double ended)Delivery forcepsGoodell uterine dilator
Sims uterine sound
Bozeman uterine dressing forcep
Hegar uterine dilators
Heaney uterine dilators
Emmett uterine tenaculum
Sims uterine curettes (blunt/sharp)
Slide16Specific Abdominal Hysterectomy Instruments
Abdominal retractor tray
richardsons, deavers, malleables, Balfour
w/bladder blade
O’Sullivan-O’Connor abdominal Retractor
Franz Abdominal Retractor
Heaney Hysterectomy Forceps
Heaney-Ballentine Hysterectomy Forceps
Heaney Needleholder
Jorgenson Curved Scissors
Lister Bandage Scissors Pennington Forceps
Slide17Specific Laparoscopy Instruments
Scope, Light cord (scope tray)
Camera (camera sleeve if not sterile)
Insufflation tubing (silastic tubing)Verres Needle (insufflation needle)
Intrauterine cannula (chromotubation)
Uterine manipulator
Trocar Sleeves, Trocars
Accessory Instruments: cautery adapted, graspers, scissors, loop applicators, suturing devices, resectoscopes
Scope warmer
Multi-fire laparoscopic staplers
Slide18Laparoscopy
Definition-Visualization of the peritoneal cavity through the anterior abdominal wall
(For optimal visualization must have pneumoperitoneum)
Procedures-Diagnosis, Evaluation, InterventionLaser and Electrosurgery may be used
Slide19Laparoscopy Continued
Instruments:
Verres Needle
Silastic Tubing with connectorTrocar and Sleeve x 2Laparoscope Laparoscopic scissorsLight Cord Laparoscopic graspersCamera Bipolar forceps (Kleppinger)
Biopsy forceps Ball and Loop Electrodes
Slide20Laparoscopy Procedure
Small incision at umbilicus
Abdominal tissue elevated with a towel clip or pinched up and a Veres needle is inserted into the peritoneal cavity, attach a 10ml syringe to it with about 3ml of NS (The surgeon uses it to determine whether he is clear of vessels or bowel)
Silastic tubing is attached (you have thrown off one end to hook up to the insufflator) The peritoneum is filled with carbon dioxide or nitrous oxide gas (separates organs for optimal visibility)
Slide21Laparoscopic Procedure
Continued
Veres needle withdrawn and operating laparoscope inserted (accomodates Kleppinger or scissors)
Trocars inserted (sleeve may or may not be used) Ports established to accommodate camera in one (umbilical incision) and other instruments needed in the other (May reattach silastic tubing to one of the trocar sleeves and not use a veres needle)
Procedure done (May involve two more trochars, one in LLQ and one in RLQ)
One trochar may accommodate LR irrigation/suction apparatus/Other may accommodate graspers
Items removed, sleeve may be left to allow gas to escape or may be sucked out with suction
Slide22Laparoscopic Procedure
Continued
Skin is closed with a 3-0 Vicryl PS-2 cutting (May use a 3-0 SH Vicryl taper prior to skin closure depending on abdominal thickness
Steri-strips may be used and Bandaids are applied to the incision sitesA peri-pad is placed for the patient
Keep in mind that depending on the procedure performed, there may be laser, cautery, other suture, a knot pusher for tying, endoscopic staplers, etc. needed
Slide23Hysteroscopy
Definition-Endoscopic visualization of the uterine cavity and openings or orifices to the fallopian tubes
Introduced vaginally
Used for diagnosis and interventionDiagnosis/Intervention: abnormal bleeding, endometriosis, IUD removal, infertility evaluation, polyps, sterilization, and adhesions
Laser/electrosurgery may be used
Biopsy forceps, scissors, etc. may be used
Slide24Hysteroscopy
Procedure
Graves Speculum (other speculum) Lubrication available (NS or K-Y)
Anterior edge of cervix is grasped with a tenaculum and pulled forwardDepth of cavity may be measured with a uterine sound or modified grasper with sound
Cervix
may
be dilated with Pratt, Hanks, or Hegar dilators
Scope/irrigator is inserted (uterus is distended with Sorbitol, NS, Dextran (Hyskon), or Dextose solution)
Uterine cavity is explored
Slide25Hysteroscopy Procedure
Continued
Depending on findings or procedure, may use biopsy forceps, cautery, scissors, resectoscope with roller ball, laser, or tubal occlusive devices.
Biopsies will need to be collected on a piece of telfaIf Hyskon/Dextran is used clean instruments immediately as it will harden and make instruments difficult to clean
Slide26Hysteroscopy Irrigation
Hysteroscopy solutions (for uterine distention)
Dextrose 5% (D5W)
Dextran 70% in dextroseGlycine
Sorbitol
Above may all be used with laser or cautery
Hyskon (rarely used anymore due to
↑ laser use)
No cautery or lasers may be used as would cause systemic absorption>systemic side effects
Slide27Obstetrical Complications
Abortions
Missed
- parts of non-living conception and in uterus more than 2 monthsIncomplete - products of conception retained in uterus
Imminent
- about to abort
Spontaneous
- abortion occurs without being induced
Voluntary
Slide28D & C
Definition- dilation and curettage
Use diagnostic and therapeutic
Diagnostic: dysmenorrhea, endometriosis, rule out pregnacy before sterilization, infertilityTherapeutic: polyps, evaculate retained placenta post-child birth, IUD retrieval, placement of radioactive devices for treatment of cancers, incomplete miscarriage/abortion
Slide29D&C
Procedure
Speculum (Graves, other)
Local anesthesia may be injected if the patient is awakeCervix is grasped with tenaculum and dilated with Pratt, Hanks, or Hegar dilators
Uterine sound may be used to determine depth of the uterine cavity
Smooth, sharp, or Heany uterine curettes will be used to clean out the uterine cavity
Suction may be used in conjuction or solo
Tissue may be sent for culture place it on a piece of telfa
Peri-pad placed
Slide30D&E
Definition- D & C performed after the thirteenth week of pregnancy
Procedure the same as a D & C
Slide31Suction Curettage
Definition-Suction/vacuum aspiration of the uterus
Used in therapeutic abortions, incomplete abortions, or miscarriages
Procedure: Speculum, tenaculum, dilators, suction apparatus, curettes may be needed, peri-pad placed
Slide32Summary
Female Anatomy
Pathology
Miscellaneous Procedure OverviewInstrumentation Review
Laparoscopy
(diagnostic or operative)
Hysteroscopy
D & C (dilation & curettage)
D & E (dilation & evacuation)
Suction Curettage