SUR 111 Introduction to GYN Surgeries - PowerPoint Presentation

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SUR 111

Introduction to GYN Surgeries

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Outline

Female Anatomy

Pathology

Miscellaneous Procedure Overview Instrumentation Review

Laparoscopy

(diagnostic or operative)

Hysteroscopy

D & C (dilation & curettage)

D & E (dilation & evacuation)

Suction Curettage

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FEMALE ANATOMY

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Pathology

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

) -

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(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.

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Endometriosis

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Ectopic Pregnancy

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Pedunculated

Myoma

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Prolapsed Uterus

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Rectocele

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Gynecological 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)

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Bartholin

Gland Cyst

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Instruments

Major Tray

Abdominal-Hysterectomy Tray

D&C TrayHysteroscopy Tray resectoscope & hysteroscopeLaparoscopic TrayCamera/scope tray/scope warmer

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Specific 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)

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Specific 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

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Specific 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

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Laparoscopy

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

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Laparoscopy 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

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Laparoscopy 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)

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Laparoscopic 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

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Laparoscopic 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

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Hysteroscopy

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

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Hysteroscopy

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

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Hysteroscopy 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

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Hysteroscopy 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

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Obstetrical 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

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D & 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

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D&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

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D&E

Definition- D & C performed after the thirteenth week of pregnancy

Procedure the same as a D & C

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Suction 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

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Summary

Female Anatomy

Pathology

Miscellaneous Procedure OverviewInstrumentation Review

Laparoscopy

(diagnostic or operative)

Hysteroscopy

D & C (dilation & curettage)

D & E (dilation & evacuation)

Suction Curettage