Endoscopy in gynecology uses narrow telescopes (endoscopes) to view the interior of organs and spaces. There are several types including laparoscopy, hysteroscopy, salpingoscopy, and colposcopy. Laparoscopy allows visualization of the abdominal cavity and is commonly used for diagnostic and therapeutic procedures like tubal ligation with advantages over open surgery like less pain and faster recovery. Hysteroscopy involves passing an endoscope through the cervix to inspect the uterine cavity and can be used for procedures like polyp removal. Both procedures have risks of perforation, bleeding, and infection that require proper patient preparation and counseling.
6. Advantages Minimal access surgery over
traditional open surgery
1.Less post operative pain
2.Shorter hospitalization
3.Faster return to normal activity
4.Less post operative adhesion formation
5.Less blood loss
6.Better cosmetics
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7. Limitations
1. Reduced exposure of operating field
2. Skilled person
3.Expensive Instruments
4. Cost is high
5.Prolonged operating time
6.Prolong anaesthesia
7. Increased risk of complication in less skilled person
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14. Relative contraindications
1.Cardiopulmonary failure
2.Pregnancy/large pelvic masses
3.Soft tissue infection at port sites
4.Expected (extensive) adhesions from a previous
abdominal surgery
5.Abdominal aortic aneurysm (may be associated with
increased risk of vascular rupture)
6.Multiple abdominal incision
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15. Patient preparation and communication
The patient considering laparoscopic surgery should
be properly counseled regarding the potential
outcomes, including adverse outcomes, and the risk
of conversion to laparotomy
Procedure usually under general anesthesia
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16. Equipment and technique
To facilitate the discussion of laparoscopic equipment, supplies, and
techniques, it is useful to divide procedures into “core
competencies,” which are as follows:
1. Patient positioning
2. Operating room organization
3. Peritoneal access
4. Visualization
5. Manipulation of tissue and fluid
6. Cutting, hemostasis, and tissue fastening
7. Tissue extraction
8. Incision management
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23. The majority of instruments used for
diagnostic laparoscopy are 5 mm in diameter, and 10
mm instruments are used for operative laparoscopy.
More recently, a 2 mm laparoscope has become
available.
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27. Complications
1.Anesthetic and cardiopulmonary complication
2.Extraperitoneal insufflation
3.Hemorrhagic complication
4.GI complications
5.Urologic injury
6.Neurological injury
7.Incisional hernia and wound dehiscence
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28. Hysteroscopy
involves passing a small-diameter telescope, through
the cervix to directly inspect the uterine cavity.
Excellent images can be obtained
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29. Types of hysteroscopy
1. A flexible hysteroscope may be used in the
outpatient setting, with carbon dioxide as a filling
medium.
2. Rigid instruments employ circulating fluids and
therefore can be used to visualize the uterine cavity
even if the woman is bleeding.
The procedure can be performed under local, regional
or general anaesthesia.
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30. Indication
Diagnostic
1.Unexplained abnormal uterine bleeding (AUB)
Pre menopausal
Post menopausal
2. Selected Infertility cases
Abnormal hysterography or TVUS
Unexplained infertility
“Second look” evaluation following selected uterine surgery cases
3. Recurrent pregnancy loss (RPL).
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31. Operative Hysteroscopy
A number of intrauterine procedures can be performed under endoscopic
direction, including
1.sterilization,
2.transection of a uterine septum
3.resection of leiomyomas and polyps
4.removal of retained products of conception
5.Adhenolysis
6.endometrial destruction through Nd:YAG laser vaporization ,desiccation, or
vaporization.
7.Hysteroscopy may be used to direct the removal of foreign bodies including
embedded intrauterine contraceptive devices
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34. Complications
The most significant risks of operative hysteroscopy are
1.perforation of the uterus
2.excessive bleeding
3.distention medium hazards (e.g., gas embolism, fluid
overload, anaphylactic shock).
Much less frequent and less serious complications include
1.infections (e.g., endometritis, pelvic inflammatory disease)
2.traumatic cervical lacerations
3. postoperative cervical stenosis.
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35. References
1.Berek & Novak’s Gynecology
2.Essentials of obstetric and gynecology
3.Gynecology by Ten Teachers
4.Medscape
5.Amboss.com
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Today, laparoscopy is one of the most common surgical procedures performed in many parts of the world
1.Most common indication
2.Ectopic pregnancy removal of tubal pregnancy that don’t meet the criteria of medical therapy
4.Contoversial bcoz smaller leiomyomas can be removed , but more than 6cm not be removed
6.Laser coagulation,thermal vaporization,excision of endometriosis
1.
1.In the last few years was contraindicated
head-down (Trendelenburg) position that allows the bowel to move out of the pelvis to facilitate visualization after the cannulas have been placed.
The thighs are usually kept in the neutral position to preserve the sacroiliac angle, reducing the tendency of bowel to slide into the peritoneal cavity.
The site of initial or primary access is generally through the umbilicus. However, there are a number of circumstances where this may not be appropriate or even
safe. Such circumstances include pregnancy, the presence of a very large pelvic mass, or when previous surgery has been performed in the lower or mid abdomen. In such instances alternate sites such as the left upper quadrant may be more appropriate
Make the primary incision at the base of the umbilicus
Insert the veress needle through the base of the umbilicus, sensing a double click
Insert 2-3 ml of saline through the veress needle; it should run in freely
Aspirate back; nothing should be aspirated Fill with co2 to 25mmhg
Insert the primary trocar
1.Hypoventilation , bronchospasm , hypotension , arrythmia,cardiac arrest
Co2 embolus signs sudden unexplained hypotension,arrythmia,cyanosis , heart murmer
2.Subcutaneous emphysema
3.
4.Great vessels injury : aorta and vena cava , common iliac vessels and their branches , internal and external iliac vessels
5.
6.bladder, ureteral
6. Peripheral nerve injury
A flexible hysteroscope may be used in the outpatient setting. Rigid instruments employ circulating fluids and therefore can be used to visualize the uterine cavity even if the woman is bleeding