Hysteroscopy
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Transcript of Hysteroscopy
DR.GURURAJ DESHPANDE MS(OBG)
ASSOCIATE PROFESSOR DEPT.OF.OBGKAMINENI INSTITUTE OF MEDICAL
SCIENCES NARKETPALLY
HYSTEROSCOPY
Contents
HISTORY INDICATIONS COUNSELLING ANAESTHESIA POSITION EQUIPMENTS DISTENDING MEDIA PROCEDURE COMPLICATIONS CONCLUSION
HISTORY:PANTALEONI 1869 T0 1970 A LONG GAP
INDICATIONS
DIAGNOSTIC• Unexplained abnormal uterine
bleeding(AUB)• Pre and post menopausal• Selected infertility cases• Abnormal HSG• Unexplained infertility• Recurrent pregnancy loss• Should be used prudently only after other
investigations
THERAPEUTIC INDICATIONS
IUD removal Biopsy of intrauterine lesions Hemangioma and A-V malformations Resection of uterine septum Uterine synechiae Cannulation of fallopian tubes Sterilization Uterine polyps Submucous myomas Endometrial ablation
PATIENT COUNSELLING
Benefits Vs Risks Other treatment options Realistic success rate Informed written consent
ANAESTHESIA
Patient anxiety Cervix status Procedure Paracervical block and IV sedation Transcervical topical anesthesia Spinal/epidural GA
POSITION
EQUIPMENTS:TELESCOPES
VIEW
DIAGNOSTIC CONTINOUS FLOW HYSTEROSCOPE
Operative sheaths and working channel for accessory instruments
OFFICE HYSTEROSCOPE (BETTOCCHI HYSTEROSCOPES)
Unipolar resectoscope consisting of working element, 8mm resectoscope sheath,4mm telescope
UNIPOLAR LOOP ELECTRODE FOR END ABLATION,MYOMA,POLYP
UNIPOLAR ELECTRODES (LOOP,NEEDLE,ROLLER,BALL)
DISTENDING MEDIA
Need to distend uterus to view as uterus is almost closed structure.
Minimum 45mm of Hg for diagnostic Upto 70mm of Hg for operative If more than MAP ,more chances of
overload Gaseous and liquid High and low viscosity medium
Carbon dioxide
Neatness Doesn't damage instruments Doesn't mess up office/OR CO2 and bleeding incompatible CO2 and blood form obscuring
bubbling foam Cannot flush debris CO2 embolism rarely
CO2
Insufflation should not exceed 100ml/min
Unlike laparoscopy which are in litres/min
Use only hysteroinsufflator Ideal for diagnostic office
hysteroscopy
HYSKON
32 percent dextran 70 in dextrose Immiscibility with blood Excellent visualization even in active
bleeding Compatible with electrosurgery and lasers Outflow less due to high viscosity Hyskon allergic reaction 0.05% treat like
anaphylaxis Pulmonary edema 0.11% due to overload
as it pulls water into intravascular space.
HYSKON
Fibrinoplastic action leading to bleeding diathesis
Clogs instruments if instruments are not washed immediately with hot water
Remains in bloodstream for 4-6 weeks
LOW VISCOCITY LIQUID MEDIAMEDIUM OSMOLALITY
mosm/kg of waterSODIUM IN mEq/L
SERUM 290 135-145
GLYCINE 1.5% 200
SORBITOL 3% 178
MANNITOL 5% 280
GLYCINE 2.2% 280
NS
308 154
RL 273 130
NORMAL SALINE
Safest Instilled with 2-3 litres bag from 6-8
feet Continuous high flow required Cannot use monopolar cautery as it
contains electrolytes, bipolar can be used.
Still overload can occur which can be treated with diuretics
Stop if deficit is 1.5 litres
1.5%GLYCINE AND 3%SORBITOL Taken from urology Hypotonic Metabolized to CO2 and free water Female brain cells cannot pump cations
due to progesterone action so more prone for cerebral edema.
Check osmolality and sodium minimum pre op intra op and 4 hr post op
Stop if >500ml deficit, Can use monopolar
5%MANNITOL AND 2.2%GLYCINE Both are safer and isoosmolar Mannitol is diuretic also Studies have shown that glycine2.2%
is very safe upto 1000ml deficit Can use monopolar Keep strict inflow and outflow Take into account the fluids infused
by anesthesiologist as RL commonly given is hypoosmolar
CONTRAINDICATIONS
Active PID Active profuse bleeding Recent perforation Pregnancy Cancer cervix Systemic disorders affecting fluid
and electrolytes
PROCEDURE
Cervical priming and dilatation if needed
Per vaginal examination to know the position of uterus
Vaginoscopic technique Systematic examination Operations with correct use of
electrosurgery and lasers
Panoramic view
Tubal ostium
Cu-T
DENSE ADHESIONS
SUBMUCOUS FIBROID
EXCISION WITH LOOP
EXCISION OF UTERINE SEPTUM
COMPLICATIONS
Due to position Anaesthetic complications Due to distending media Uterine perforation Bleeding Bowel and bladder injury Septicemia Death
Bipolar resectoscopes
Hysteromat E.A.S.I
Intrauterine BIGATTI shaver
CONCLUSION
Hysteroscopy is a part of every gynecological surgeon’s armamentarium
Generally a low risk technique using natural pathway.
Supersedes laparoscopy in philosophy of MIS
THANK YOU