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.

1. Endoscopy in Gynecology and Obstetric
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By : Ekhlass Ramadan Haji

2. Endoscopic procedures use a narrow telescope, an
“endoscope” to view the interior of a viscus or
preformed space.
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3. types of endoscopic surgery in obstetrics and
gynecology:
1.laparoscopy
2.hysteroscopy
3.Salpingoscopy
4.Colposcopy
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4. Laparoscopy
Laparoscopy allows visualization of the peritoneal cavity
Today, laparoscopy is one of the most common surgical
procedures performed in many parts of the world
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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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8. Indications
Diagnostic
1.Pelvic pain (acute or chronic )
2.Ectopic pregnancy
3.Endometriosis
4.Determination of tubal patency
5.Infertility
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9. Left tubal ectopic pregnancy
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10. Endometriosis
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11. Tubal patency test
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12. Therapeutic
1. Tubal Sterilization
2.Salpingotomy or salpingectomy
3.Ovarian cystectomy
4.Myomectomy
5.Hysterectomy
6.Endometriosis
7.Lysis of adhesion
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13. Contraindications
Absolute contraindications
1.Hemodynamic instability/shock
2.Acute intestinal obstruction with dilated bowel
loops
3.Increased intracranial pressure
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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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17. Patient positioning
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18. Operating room organization
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19. Peritoneal access
Site of access
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20. Insufflation needle
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21. trocar cannula
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22. Visualization
Laparoscope Laparoscope tower and camera
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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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24. Laparoscopic instrument for grasping and
manipulating tissue
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25. Specimen removal bag
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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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33. Contraindications
1.Viable intrauterine pregnancy
2.Female genital tract malignancy ( cervical,pelvic )
3.Active pelvic infection
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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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