This document provides an overview of various gynaecological procedures including: 1. Thin prep liquid based cytology, colposcopy, speculums, and biopsy tools for examining the cervix and vagina. 2. Transvaginal ultrasound, sonohysterography, saline infusion sonography, and MRI for examining the uterus. 3. Hysteroscopy, the gold standard for assessing the endometrium, which allows both diagnostic and operative procedures such as removing fibroids and polyps. 4. Endometrial ablation techniques for removing the endometrium without hysterectomy, including various laser, electrosurgery, balloon, and microwave methods.

1. Gynaecological
Procedures
Khalid Sait FRCSC
Professor
Faculty of Medicine
King Abdulaziz University

8. THIN
PREP
Liquid
based
cytology

12. Colposcope
• Op:cs
• Binocular
• Focal
length
:
300
mm
• Magnifica:on
:
7.5
x
15
x
30
x
(
typically
)
• Green
Filter
• Light
source
• Teaching
aid
• Camera

15. Cusco Vaginal
Speculum
Collin Vaginal
Speculum

20. Kevorkian-Younge Biopsy Punch

21. Detailed
Colposcopic
Exam.
• Original
squamocolumnar
junc:on
• Present
squamocolumnar
junc:on
• Transforma)on
zone
• Endocervical
canal
" IS COLPOSCOPY SATISFACTORY ?

26. a
grape-­‐like
or
"sea-­‐anemone"

29. • If
abn.
Epith.
has
no
stromal
papillae
it
will
appear
only
white

36. " Arrangement
of
terminal
vessels
in
the
stroma
underlying
the
sq.
epith
.

37. Abnormal
vessels
• When
the
stroma
and
accompanied
capillaries
are
pressed
between
islands
of
sq
.
Epith.
in
con:nuous
fasion,
a
cobblestone
or
chicken–
wire
pa[ern
called
mosaic
is
appeared.

38. Abnormal
vessels
" Puncta:on
reflect
the
capillaries
in
stromal
papillae
that
are
seen
end-­‐
on
and
penetrate
the
epith.

41. The
Uterus

42. Transvaginal
Ultrasound

43. SonoHysterography

45. Saline
Infusion
Sonography
(SIS)

47. MRI
• Map
mul:ple
large
fibroids/complex
cases
• Assess
congenital
uterine
abnormali:es
• Post-­‐opera:vely
• Not
useful
in
synechiae,
small
lesions

49. HYSTEROSCOPY
• Is
the
‘Gold
Standard’
in
assessing
the
endometrium
• Makes
see-­‐and-­‐treat
hysteroscopy
possible
• Is
the
treatment
of
choice
where
fer:lity
needs
to
be
preserved
or
enhanced

50. Outpa:ent
Hysteroscopy

55. Diagnos:c
Hysteroscopy

56. OPERATIVE
HYSTEROSCOPY

57. Opera:ve
Hysteroscopy
• Indica:ons
– Removal
of
Fibroids
– Removal
of
Polyps
– Endometrium
abla:on/
resec:on
– Synechiae
division
– Uterine
septa
transec:on

58. Opera:ve
Hysteroscopy
• Removal
of
the
endometrium
without
hysterectomy
(FEATS)
– Laser
–
Goldrath
et
al,
1981,
AMJOG
– TCRE
–
DeCherney
et
al,
1983,
Obstet
Gynecol
– Rollerball
–
Vaincaille
TG,
1987,
Obstet
Gynecol

61. D&C

64. Hysterectomy

65. Second
Genera:on
Endometrial
Abla:on
Devices
(SEATs)
• Thermal
Balloon
–
ThermaChoice,
Cavatherm,
Menotreat
• Free
Circula:ng
-­‐
HydroTherm
Abla:on
• Bipolar
Electrosurgery-­‐
Novasure
• Microwave
Abla:on
-­‐
MEA
• HerOp:on
–
Cryogen
• Vesta
Radioabla:on
• Laser
–
ELITT

67. Hysteroscopic Sterilisation