The lecture has been given on May 9th & 11th, 2011 by Dr. Abir Mohidien Said.

1. DR: AbirMohidien Said Operative Gynaecology

2. Operative Gynaecology About 80% of all the gyn.surgeries are elective, this means that there are other alternative treatments to be considered, the appropriateness of the dicision making depends on the physician & patient on an individual basis, prepair for operation is important, information about operation, risk, alternative.

3. D&C (dilitation&curtage) D&C one of the most commen minor gyn.op. D&C may be a diagnostic or a therapeutic procedure A diagnostic is performed for: Premenopausal irreguler menstrual bleeding Post menapausal bleeding Suspected Ca. of cervix or endometium(fractional curettage) Therapeutic effect with very heavy bleeding

4. Complication of the D&C Perforation of the uterus. It is not uncommen & occurs particulary with a retroverted uterus Infection ( always 2 typs antibiotic, aerobic&nonaerobic) Hemorrhage Continuing pregnancy Retained products of conception Cervical damage

5. Cervical conization A cone shaped portion of the cervix removed therapeutic & diagnostic purposes Therapeutic ( cervical dysplasia or chronic cervicitis) Performed by using knive or loop electrosurgical excision or by laser ( give nice scar & less bleeding)

6. Cervical conization

7. Laser Is commonly used to treat condylomas of the cervix, vagina,perinium & vulva To treat chronic cervicitis Dysplasia of the vulva Vaporization or coagulation of endometriosis ( laproscopic)

8. CondylomataAcuminata

9. Laproscopy Using a device called laparoscope( telescope) CO2 inflation ( few liters about 3-4 L) Laproscopy is two types: Diagnostic laparoscopy Operative Laparoscopy

10. Diagnostic Laparoscopy Unexplained infertility Tubal patancy testing Adenexal, uterin pathology congenital or acquired Acute abdomen, suspected ectopic gestation

11. Operative Laparoscopic Tubutomy & ectopic preg. removed Salpingectomy with Ectopic pregnancy Salpingo oophorectomy (prophylxic,ect) Exicesion of the ovarium cyst Oophorectomy exicesion Adhesion lysis Vaporization of the endometriosis LAVH Sterilisation & abdominal IUD removal

14. Commen complication Penetrating injuries from veress needle Perforation of the bowel Perforetion of the blood vessels Damage to bowel and bladder during diathermy Gas embolism Bleeding Infection

15. Hysteroscopy Now very commen, means the visualization of the endometrial & endocervicallining & the cavity by using a flexible or raged telescope. Diagnosis or operative Diagnosis of any congenital ( uterin septum etc) Operative of uterine pathology ( endometrial ,cervical polypectomy or submucus fibroids etc)

16. Hysteroscopy

18. complication Perforation during cevixdilitation Uterin perforation Bowel or bladder damage ( diathermy ) Fluid absorption ( manitol , NACL ) Bleeding Infection Air embolism

19. Cystoscopy Full bladder with water & induced the cystoscop throw the urethra to the blader Rigid or flexible cystoscop Gynaecologist used only for diagnostic, after recurrent cystitis, haematuria, suspected polyp & to se perforation, after induced tape of incontinence operation.( TVT, TOT)

23. Hysterectomy Total hysterectomy Subtotal/ supravaginal hysterectomy Radical hysterectomy( Wertheim operation) Total hyterectomy with bilatral/unilateral salpingo-oophorectomy Vaginal hysterectomy LAVH (laproscopically-assisted vaginal hysterectomy)

24. Complication Bleeding Wound infection (deep or superfacial) Cystitis Urin retention Embolism ( DVT, lung) Damage to the intestine, blader, ureter) Sever painfull Complication of GA

25. Urogynecological operation Stress incontinens (laxity of the urethra) TVT ( Tension -free Vaginal Tape) TOT ( Trans Obturator Tape) Burch operation (permanent stitches are placed near the neck of the bladder and fixed to the back of the pubic)

27. Colporrhaphy anterior Cystocele repair, large cystoceles may require surgery to push up the bladder away from the vagina & support it so it will stay in anormal position Complication: bladder perforation,urgeincontinence,infection & bleeding

29. Colporraphy posterior Rectocele repair, occurs when rectum start to fall to the front & pushes against the back wall of the vagina Push up the rectum away from the vagina & support it so it will stay in amore normal position Complication : intestine perforation, infection, bleeding,stenosis of vagina & dysparunia

31. Colporraphywith mesh

32. THANKS