GYN Procedures Guide: Colposcopy, Hysteroscopy and Endometrial Ablation
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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.
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GYN Procedures Guide: Colposcopy, Hysteroscopy and Endometrial Ablation
- 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
- 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
- 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
- 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