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This document discusses myomectomy, which is a common surgery to remove uterine fibroids while preserving the uterus. It describes the different surgical approaches including open, endoscopic, hysteroscopic, and laparoscopic. For each approach, it provides details on patient selection, preoperative mapping and imaging, surgical tools and techniques, tips to prevent complications, and post-operative concerns. It emphasizes the importance of adequate training to equip gynecologists with the skills to perform these minimally invasive procedures.
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- It describes the historical development of hysteroscopy from the 19th century to modern techniques.
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2) Key components of modern hysteroscopy include a telescope, light source, distention media (such as saline or CO2), and single- or multi-channel sheaths.
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1. Hysteroscopy has evolved since its beginnings in the late 19th century when instruments were first used to visualize the inside of the uterus.
2. Developments in distension media and techniques in the mid-20th century allowed hysteroscopy to become more practical as an office procedure using carbon dioxide or other media.
3. Diagnostic hysteroscopy is used to evaluate conditions like polyps, fibroids, and abnormalities like septate uteri but may sometimes require conversion to operative hysteroscopy during the same session. Care must be taken to prevent complications from inadequate visualization or improper technique.
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- Specific procedures discussed include hysteroscopic metroplasty for septate uterus, adhesiolysis for synechiae, transcervical resection of submucous myomas, and endometrial ablation.
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- Energy sources for laparoscopy including monopolar, bipolar and advanced sources like LigaSure, EnSeal and harmonic.
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2. Options for intracavitary distension including non-electrolyte and electrolyte liquid solutions, as well as methods for supplying the distension media.
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Laparoscopic Ovarian Surgery
Laparoscopic ovarian surgery can be used to manage most ovarian abnormalities. Key steps in laparoscopic ovarian cystectomy include aspirating cyst contents, stripping the cyst capsule from the ovarian cortex, and extracting the capsule. It is important to avoid injury to nearby structures like the ureter and completely remove the cyst to evaluate for early carcinoma. Outcomes are better when the ovary can be preserved through cystectomy rather than full oophorectomy. Teratomas require especially careful removal of all contents to prevent chemical peritonitis.
Sleeve leaks
PREVENTION and Treatment of Sleeve Gastrectomy Leaks
Dr Rutledge
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
Managing Complications FIRST Prevent Complications
Managing Leaks First Prevent Leaks!!
Examples of Complacency Sleeve Gastrectomy Leak
“Sleeve Gastrectomy & Risk of Leak: Systematic Analysis of 4,888 Patients”
“Risk of leak is low at 2.4%"
Surg Endosc. 2012 Jun;26(6):1509-15. Epub 2011 Dec 17. Aurora AR, Khaitan L, Saber AA. Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
Monitoring in iui
This document discusses Dr. Santosh Gupta, a consultant in reproductive medicine. It summarizes his qualifications and experience, including his medical degrees and fellowships. It also lists some of his academic achievements like awards for presentations at reproductive medicine conferences. The document then discusses various aspects of monitoring IUI treatment cycles using transvaginal ultrasound and Doppler imaging. It provides guidance on follicle size, endometrial thickness, vascularity assessments, and when to trigger ovulation with hCG to help maximize success rates of IUI.
The Role of laparoscopy in the era of ART
The advancement of new perspectives in assisted reproductive technology (ART) through the use of modern infertility evaluation technique Still clinician needs to reassess how infertility should be best treated.
Recently the focus of treatment for infertility has shifted from systematic correction of each identified factor.
health-pptx
This document provides guidelines for hCG levels during pregnancy at different gestational ages based on weeks from the last menstrual period (LMP). It also lists common ultrasound findings, differential diagnoses, and complications associated with gestational trophoblastic diseases (GTDs) like molar pregnancies. The management of benign GTDs typically involves suction evacuation. Chemotherapy may be indicated depending on factors like hCG levels after evacuation.
The Obstetric Gynaecologis - 2013 - Stavroulis - Methods for specimen remov...
This document discusses different methods for removing specimens from the peritoneal cavity after laparoscopic excision. It describes using mini laparotomy, transumbilical or ancillary port-site incisions, or posterior colpotomy. Recently, using morcellators and endoscopic bags to remove specimens laparoscopically has grown in popularity. The size, whether cystic or solid, and risk of malignancy influence the retrieval method. There is a risk of spillage, especially with suspected early malignancy, so this must be considered during excision and retrieval. In the future, natural orifice transluminal endoscopy may be an operative and retrieval route.
Fertility preservation in cancer
This document discusses fertility preservation options for cancer patients. It begins by noting that advances in cancer treatment have led to improved survival rates but also increased risks of infertility. It then discusses the field of oncofertility, which aims to provide fertility preservation options for young cancer patients. The document reviews fertility preservation guidelines and options for both female and male patients, including embryo/oocyte cryopreservation, ovarian tissue cryopreservation, and sperm cryopreservation. It stresses the importance of discussing fertility preservation with patients before starting cancer treatment.
Lap Accsses technique and complications
- Inserts a Foley catheter through the 5mm port
- Inflates the balloon in the retroperitoneum
- Compresses the bleeding vessel
- Allows controlled deflation after haemostasis
INFERIOR EPIGASTRIC ARTERY INJURY
SECONDARY TROCAR INJURIES
- Bowel injury
- Vascular injury
- Bladder injury
- Ureteric injury
Risk factors:
- Poor technique
- Adhesions
- Obesity
- Previous surgery
Management:
- Laparoscopic repair
- Conversion to laparotomy
SECONDARY TROCAR INJURIES
HAND INSTRUMENT
Ectopic pregnancy 1
This document discusses ectopic pregnancy, defined as implantation of a fertilized egg outside the uterus. It notes the rising incidence due to factors like IVF and discusses symptoms, diagnosis, and treatment options. For diagnosis, it recommends a combination of beta-hCG testing, ultrasound, and laparoscopy. Treatment depends on the situation but includes surgical options like laparoscopic salpingectomy or salpingostomy as well as medical management with methotrexate in some cases. The goal is early diagnosis and treatment to reduce risks while preserving fertility when possible.
Similar to myomectomy.pptx (20)
Presentation on Adherent placenta by Dr. Laxmi Shrikhande
Presentation on Adherent placenta by Dr. Laxmi Shrikhande
Medical management of heavy menstrual bleeding hmb
Medical management of heavy menstrual bleeding hmb
International Journal of Reproductive Medicine & Gynecology
International Journal of Reproductive Medicine & Gynecology
The Obstetric Gynaecologis - 2013 - Stavroulis - Methods for specimen remov...
The Obstetric Gynaecologis - 2013 - Stavroulis - Methods for specimen remov...
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Obstetric Haemorrhage [Autosaved].pptx
The document discusses damage control surgery (DCS) for postpartum hemorrhage (PPH). It provides:
1. DCS involves performing limited surgical interventions to control life-threatening bleeding and stabilizing the patient, then delaying definitive surgery until intensive care unit stabilization is achieved.
2. Indications for DCS include persistent bleeding, massive transfusion, hemodynamic instability, and the development of coagulopathy.
3. The key principles of DCS are rapid hemorrhage control, usually via packing, followed by resuscitation and correction of coagulopathy in the ICU before performing definitive surgery 48-72 hours later.
Controversy and consensus regarding management of recurrent pregnancy loss.pptx
This document discusses controversy and consensus regarding management of recurrent pregnancy loss. It provides definitions of miscarriage and recurrent pregnancy loss. It examines various potential causes of recurrent pregnancy loss including genetic, immunological, endocrine, anatomical, infectious, and male factors. For each factor, it discusses recommendations for investigation and management based on guidelines from various organizations. The document emphasizes taking a thorough history and investigating multiple potential causes through tests and scans to determine a tailored treatment plan aiming to prevent future miscarriages.
Stimulation protocol in ART: should we tailor it on AMH level?
Level of AMH correlated with number of antral follicles of ovary.
Therefore AMH is taken by indicator of ovarian reserve.
vvf ppt.ppt
This document summarizes the repair of vesicovaginal fistulas (VVF) performed at Chittagong Medical College from 2001-2015. It discusses that VVF most often occurs due to prolonged obstructed labor causing tissue damage. The majority of VVF cases (94%) can be treated with vaginal repair using a Martius flap with a success rate of 94% and minor complications. While stress incontinence remains an issue, repeated attempts at repair can achieve success. The document recommends that dedicated gynecologists can perform VVF repair in Bangladesh using basic techniques and postoperative care to restore dignity to women suffering from this condition.
Optimization of outcomes of .pptx
The rationale is that increasing the density of both eggs and sperm near the site of fertilization will increase the likelihood of pregnancy.
Diagnosis of PCOS MCMCTACONSESSION4.pptx
This document provides guidance on diagnosing and managing polycystic ovarian syndrome (PCOS) in adolescents. Key points include:
- Adult PCOS diagnostic criteria are not applicable to adolescents due to normal irregular periods and cystic ovaries during puberty.
- Recommended diagnostic approach involves assessing for unexplained hyperandrogenism and ovarian dysfunction after ruling out other conditions.
- Management involves lifestyle changes like weight loss, exercise and diet, as well as symptom-focused treatments like birth control pills, anti-androgens and insulin-sensitizing agents.
- The goals are to alleviate current symptoms, decrease future health risks of PCOS like infertility, metabolic syndrome and diabetes. Care must be taken to
COMPLICATIONS OF ASSISTED REPROUCTIVE TECHIQUES
Assisted reproductive techniques (ART) such as IVF and ICSI can help treat infertility but also carry several risks. A major complication is ovarian hyperstimulation syndrome (OHSS) which can range from mild to severe/critical. Prevention strategies include using the lowest effective drug doses, coasting, GnRH agonist triggering, and cryopreserving all embryos. Other risks include multiple pregnancies, preterm birth, and pregnancy complications. Careful patient selection and monitoring can help reduce risks from ART.
PCOS.pptx
1. Polycystic ovary syndrome (PCOS) is a complex clinical syndrome with unclear etiology and various risk factors including genetics, environment, and obesity.
2. PCOS is characterized by menstrual irregularities, hirsutism, acne, infertility and obesity. It can cause insulin resistance, endometrial cancer risk, and other metabolic complications.
3. Diagnosis of PCOS involves requiring two of three criteria - oligo/amenorrhea, clinical or biochemical signs of hyperandrogenism, and polycystic ovaries on ultrasound. Differential diagnoses must be excluded.
Endometriosis
1. Endometriosis can negatively impact ovarian reserve by damaging follicles through inflammation, fibrosis, and reduced vascularization caused by the disease itself or surgery to remove endometriotic cysts.
2. Anti-Mullerian hormone (AMH) levels tend to be lower in women with endometriosis, with more severe reductions seen with bilateral disease, larger cysts, more fibrosis, and longer disease duration.
3. When considering surgery or fertility treatments for endometriosis patients with low ovarian reserve, factors like the woman's age, infertility duration, pelvic pain levels, recurrence risk, and ovarian reserve markers must be evaluated individually to optimize outcomes while preserving future fertility potential.
when patient refer to ART clinic
This document discusses evaluation and treatment of infertility for both male and female patients. It provides details on:
1. Evaluating both male and female partners simultaneously, including medical history, physical exam, and laboratory tests to detect underlying causes of infertility.
2. Common causes of male infertility like varicocele, infections, genetic issues, lifestyle factors etc. Evaluation includes semen analysis, hormone levels and identifying correctable issues.
3. Age is a major factor in female fertility, with risks increasing after age 35. Evaluation focuses on menstrual/obstetric history and detecting treatable conditions.
The goal is to allow natural conception if possible by addressing correctable issues, while assisted reproduction is an option if
Fibroid presentation1
This document discusses the management of uterine fibroids. It defines fibroids as benign tumors of the myometrium. Symptoms vary and include menstrual problems, pressure symptoms, and reproductive dysfunction like infertility. Diagnosis involves imaging like ultrasound and MRI. Treatment options include expectant management for asymptomatic cases, medical treatment to relieve symptoms using drugs like progesterone or GnRH analogues, and surgical options like hysterectomy or myomectomy. Factors in surgical decision making include size and location of fibroids, desire for future fertility, and expertise of the surgeon. Myomectomy aims to preserve the uterus but carries risks of recurrence and complications in future pregnancies.
Systemic lupus erythematosus during pregnancy
This document discusses systemic lupus erythematosus (SLE) during pregnancy. It describes SLE as an autoimmune disease characterized by autoantibodies that can affect multiple organs. Pregnancy can trigger disease flares in SLE patients. The document outlines criteria for SLE diagnosis, potential adverse effects of SLE on pregnancy like abortion and preeclampsia, recommended monitoring and treatment during pregnancy including immunosuppressants, and risks for conditions in offspring like congenital heart block. Good outcomes are associated with disease remission prior to conception and treatment including hydroxychloroquine use during pregnancy.
Fertility enhancing hysteroscopic surgery
Hysteroscopic surgery can effectively treat various intrauterine pathologies that cause infertility such as polyps, fibroids, adhesions, and septums. It allows for direct visualization and removal of abnormalities, improving chances for spontaneous or assisted conception. While hysteroscopy is considered the gold standard for diagnosing intrauterine issues, less invasive methods like ultrasound and HSG are usually sufficient. Routine hysteroscopy before first IVF is not recommended as it does not improve live birth rates, but may be beneficial after repeated failures. Operative hysteroscopy can significantly enhance fertility outcomes.
1. recurrent pregnancy loss
This document discusses recurrent pregnancy loss. It defines recurrent miscarriage as three or more consecutive spontaneous abortions before 20 weeks of gestation. Evaluation and treatment should focus on common and treatable causes like uterine anomalies, endocrine abnormalities, autoimmune disorders, thrombophilia, and genetic factors. Management may include surgical correction of septate uterus, treatment of thyroid disorders, anticoagulation for antiphospholipid syndrome, and assisted reproductive technology for translocations. Unexplained recurrent loss can be managed with lifestyle changes, progesterone, low-dose aspirin, and close monitoring during subsequent pregnancies.
HOW TO OPTIMIZE ART OUTCOME
This document discusses various factors that can optimize ART (assisted reproductive technology) outcomes. It addresses:
1) Patient selection criteria like age, BMI, lifestyle factors, medical and reproductive history that can impact success rates.
2) Techniques like using biomarkers to personalize ovarian stimulation protocols, recombinant hormones, antagonist protocols, and LH supplementation that can improve yield and outcomes.
3) Laboratory best practices for media, vitrification, embryo selection through PGS/morphological grading, and single embryo transfer that can maximize success while minimizing risks.
The document provides evidence-based guidance on optimizing each step of the ART process from patient screening to embryo transfer.
Challenges - In management of infertility
Over fertility is a problem of Bangladesh.Still infertility is an issue 1 in 7 couples have difficulties to conceive.
Inability to create a desired pregnancy that culminates in the Birth of child is likely to create a life crisis for women and their partners.
Predictive Factors influencing pregnancy rate after intrauterine insemination
Intrauterine insemination (IUI) is an assisted reproduction procedure that involves the deposition of a processed semen sample in the upper uterine cavity.This is non invasive and cost effective first line therapy for infertile couple.IUI can be done easily in simple setups.
Trends of ovulation induction in PCOS
This document discusses trends in ovulation induction in patients with polycystic ovary syndrome (PCOS). It covers the hormonal mechanisms of normal ovulation and pathophysiology of PCOS. Treatment options discussed include lifestyle modification, oral ovulation induction drugs like clomiphene citrate and letrozole, insulin sensitizers, injectable gonadotropins, and ovarian drilling. The risks, benefits, and effectiveness of each approach is evaluated to determine the optimal individualized treatment strategy based on a patient's characteristics and treatment goals.
Massive Postpartum haemorrhage
Postpartum haemorrhage (PPH) is commonly defined as a blood loss of 500 ml or more within 24 hours after birth.
It affects about 5% of all women giving birth around the world.
Globally, nearly one quarter of all maternal deaths are associated with PPH. In most low-income countries, it is the main cause of maternal mortality.
Pruritus in pregnancy
Pruritus affects upto 20% of pregnant women.
There are conditions unique to pregnancy that involve pruritus as a leading symptom.
This is called dermotoses of pregnancy.
May produce risk to mother and foetus.
Approach to skin lesions in pregnancy: Pruritus related to pregnancy, Pruritus not related to pregnancy
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Controversy and consensus regarding management of recurrent pregnancy loss.pptx
Controversy and consensus regarding management of recurrent pregnancy loss.pptx
Stimulation protocol in ART: should we tailor it on AMH level?
Stimulation protocol in ART: should we tailor it on AMH level?
Predictive Factors influencing pregnancy rate after intrauterine insemination
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Emphysema is a disease condition of respiratory system.
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It is a type of chronic obstructive
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Here are some key objectives of communication with children:
Build Trust and Security:
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Encourage Expression:
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Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
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Teach Social Skills:
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Resolve Conflicts:
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Encourage Independence:
Support children in making decisions and solving problems on their own.
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Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
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Guide and Educate:
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- 2. Dr.Rokeya Begum FCPS,MS 1. Graduated from Chittagong Medical College. 2.Working as Professor and advisor of Department of Obs & Gynae, USTC, Chittagong. 3. IVF specialist & Endoscopic Surgeon, Surgiscope Fertility & Endoscopic centre, Chittagong . 4. Special interest in High risk Obstetrics, Infertility & Endoscope. 5. Author of two books: - Clinical guide to Obstetrics and Gynaecology - Problem Based Questions Answer and OSCEs in Obstetrics and Gynaecology 6. Receive Life time achievement award in 2016 for Obstetrics and Gynaecology Society of Bangladesh.
- 3. Myomectomy is a common operation but it is challenging - Relieve of symptoms - Preservation of uterus - Fertility issue
- 4. What is the route Open Endoscope Hysteroscope Laparoscope Abdomen Uterus
- 5. FIGO classification of myoma Selection of case
- 6. Tools for myoma mapping 01 USG MRI 03 SIS 02 02
- 7. USG shows
- 8. • Number • Size • Position • Distances from the endometrial cavity • Distance from serosa • Number, size ,grade, location of myoma Detailed description of the myoma
- 10. 0 and 1 submucous myoma suitable for hysteroscope. 2 and 3 difficult for hysteroscope. Hysteroscope
- 11. Good instrument Submucous myoma resection Instrument Scissors 1 2 Bipolar resectoscope 3 Mini resectoscope 4 5 Pressure bag/ Endomat pump Hysteroscopic morcellator
- 12. 6 Resectoscope - monopolar 8 7 Glycine as distension media Unipolar wire loop Good instrument
- 13. Tips Resection starts from base to tip Towards surgeon Always pulling Long strip of myoma has to resected Wire loop always visible Fluid balance monitoring
- 15. Selection of patients - Large myoma upto Xiphysternum - Multiple –Suturing difficulty Laparoscope
- 16. Prevention of haemorrhage - Vasopressin injection - Ligation of uterine artery Laparoscope vasoconstriction Dilute vasopressin 20unit in 200ml N/Saline Avoid intravascular injection Cardiovascular complications
- 17. Incision over myoma - Horizontal - Vertical Laparoscope
- 18. Enucleation of myoma - Dissection - Traction and counter traction Laparoscope
- 20. Laparoscope Bipolar cautery for hemostasis of bed Check for missing myoma
- 21. Suture material V-Loc Stratafix knotless tissue control device
- 25. 01 02 04 03 05 06 Knowledge of anatomy Knowledge of difficulties Knowledge of possible complications Knowledge of limits Knowledge of Technique Knowledge of instrument Tips
- 26. Concerns Technically feasibility Complication rates Conversions rates Long term failure
- 27. Adequate provision of structure training within the gynaecology residency programme. To equip new generation of gynaecologist with skills to perform these procedure. Prepare set benefits of minimal access surgery by avoid open surgery.
- 28. It is all about the Mind set and Training. To make possible Gynae endoscopic surgery “By all for all”