Hysteroscopy

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Hysteroscopy

  1. 1. HYSTEROSCOPY DR.GURURAJ DESHPANDE MS(OBG) ASSOCIATE PROFESSOR DEPT.OF.OBG KAMINENI INSTITUTE OF MEDICAL SCIENCES NARKETPALLY
  2. 2. Contents           HISTORY INDICATIONS COUNSELLING ANAESTHESIA POSITION EQUIPMENTS DISTENDING MEDIA PROCEDURE COMPLICATIONS CONCLUSION
  3. 3. HISTORY:PANTALEONI 1869 T0 1970 A LONG GAP
  4. 4. INDICATIONS DIAGNOSTIC • Unexplained abnormal uterine bleeding(AUB) • Pre and post menopausal • Selected infertility cases • Abnormal HSG • Unexplained infertility • Recurrent pregnancy loss • Should be used prudently only after other investigations
  5. 5. THERAPEUTIC INDICATIONS           IUD removal Biopsy of intrauterine lesions Hemangioma and A-V malformations Resection of uterine septum Uterine synechiae Cannulation of fallopian tubes Sterilization Uterine polyps Submucous myomas Endometrial ablation
  6. 6. PATIENT COUNSELLING  Benefits Vs Risks  Other treatment options  Realistic success rate  Informed written consent
  7. 7. ANAESTHESIA  Patient anxiety  Cervix status  Procedure  Paracervical block and IV sedation  Transcervical topical anesthesia  Spinal/epidural  GA
  8. 8. POSITION
  9. 9. EQUIPMENTS:TELESCOPES
  10. 10. VIEW
  11. 11. DIAGNOSTIC CONTINOUS FLOW HYSTEROSCOPE
  12. 12. Operative sheaths and working channel for accessory instruments
  13. 13. OFFICE HYSTEROSCOPE (BETTOCCHI HYSTEROSCOPES)
  14. 14. Unipolar resectoscope consisting of working element, 8mm resectoscope sheath,4mm telescope
  15. 15. UNIPOLAR LOOP ELECTRODE FOR END ABLATION,MYOMA,POLYP
  16. 16. UNIPOLAR ELECTRODES (LOOP,NEEDLE,ROLLER,BALL)
  17. 17. DISTENDING MEDIA  Need to distend uterus to view as uterus is      almost closed structure. Minimum 45mm of Hg for diagnostic Upto 70mm of Hg for operative If more than MAP ,more chances of overload Gaseous and liquid High and low viscosity medium
  18. 18. Carbon dioxide  Neatness  Doesn't damage instruments  Doesn't mess up office/OR  CO2 and bleeding incompatible  CO2 and blood form obscuring bubbling foam  Cannot flush debris  CO2 embolism rarely
  19. 19. CO2  Insufflation should not exceed 100ml/min  Unlike laparoscopy which are in litres/min  Use only hysteroinsufflator  Ideal for diagnostic office hysteroscopy
  20. 20. HYSKON       32 percent dextran 70 in dextrose Immiscibility with blood Excellent visualization even in active bleeding Compatible with electrosurgery and lasers Outflow less due to high viscosity Hyskon allergic reaction 0.05% treat like anaphylaxis  Pulmonary edema 0.11% due to overload as it pulls water into intravascular space.
  21. 21. HYSKON  Fibrinoplastic action leading to bleeding diathesis  Clogs instruments if instruments are not washed immediately with hot water  Remains in bloodstream for 4-6 weeks
  22. 22. LOW VISCOCITY LIQUID MEDIA MEDIUM OSMOLALITY mosm/kg of water SODIUM IN mEq/L SERUM 290 135-145 GLYCINE 1.5% 200 SORBITOL 3% 178 MANNITOL 5% 280 GLYCINE 2.2% 280 NS 308 154 RL 273 130
  23. 23. NORMAL SALINE  Safest  Instilled with 2-3 litres bag from 6-8 feet  Continuous high flow required  Cannot use monopolar cautery as it contains electrolytes, bipolar can be used.  Still overload can occur which can be treated with diuretics  Stop if deficit is 1.5 litres
  24. 24. 1.5%GLYCINE AND 3%SORBITOL     Taken from urology Hypotonic Metabolized to CO2 and free water Female brain cells cannot pump cations due to progesterone action so more prone for cerebral edema.  Check osmolality and sodium minimum pre op intra op and 4 hr post op  Stop if >500ml deficit,  Can use monopolar
  25. 25. 5%MANNITOL AND 2.2%GLYCINE  Both are safer and isoosmolar  Mannitol is diuretic also  Studies have shown that glycine2.2% is very safe upto 1000ml deficit  Can use monopolar  Keep strict inflow and outflow  Take into account the fluids infused by anesthesiologist as RL commonly given is hypoosmolar
  26. 26. CONTRAINDICATIONS  Active PID  Active profuse bleeding  Recent perforation  Pregnancy  Cancer cervix  Systemic disorders affecting fluid and electrolytes
  27. 27. PROCEDURE  Cervical priming and dilatation if needed  Per vaginal examination to know the position of uterus  Vaginoscopic technique  Systematic examination  Operations with correct use of electrosurgery and lasers
  28. 28. Panoramic view
  29. 29. Tubal ostium
  30. 30. Cu-T
  31. 31. DENSE ADHESIONS
  32. 32. SUBMUCOUS FIBROID
  33. 33. EXCISION WITH LOOP
  34. 34. EXCISION OF UTERINE SEPTUM
  35. 35. COMPLICATIONS  Due to position  Anaesthetic complications  Due to distending media  Uterine perforation  Bleeding  Bowel and bladder injury  Septicemia  Death
  36. 36. Bipolar resectoscopes
  37. 37. Hysteromat E.A.S.I
  38. 38. Intrauterine BIGATTI shaver
  39. 39. CONCLUSION  Hysteroscopy is a part of every gynecological surgeon’s armamentarium  Generally a low risk technique using natural pathway.  Supersedes laparoscopy in philosophy of MIS
  40. 40. THANK YOU

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