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Gynaecological Endoscopy

Gynaecological Endoscopy. Max Brinsmead PhD FRANZCOG July 2012. Gynaecological Endoscopy:. Laparoscopy Hysteroscopy Colposcopy. Indications for Laparoscopy. Diagnostic For pelvic pain Endometriosis PID Adhesions Pelvic congestion etc. Infertility With tubal insufflation

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Gynaecological Endoscopy

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  1. Gynaecological Endoscopy Max Brinsmead PhD FRANZCOG July 2012

  2. Gynaecological Endoscopy: • Laparoscopy • Hysteroscopy • Colposcopy

  3. Indications for Laparoscopy • Diagnostic • For pelvic pain • Endometriosis • PID • Adhesions • Pelvic congestion etc. • Infertility • With tubal insufflation • Pelvic Mass • Uterine eg Fibroids • Ovarian – benign or malignant • Other

  4. Indications for Laparoscopy 2 • For Intervention • Assisted conception (OPU and GIFT) • Diathermy to endometriosis • Sterilisation (Clips, Loops or Diathermy) • Biopsy of ovary or tumours • Division of adhesions • Ectopic pregnancy, cysts, oophorectomy • Advanced surgery – all operations!

  5. Techniques in Laparoscopy • Creating the Pneumoperitoneum • Verres needle • Direct trochar insertion • Hassan open technique • Abdominal wall elevation • CO2, N2 or other gas • Reusable or Disposable Equipment • Direct vision or camera • Surgical Aids • Unipolar or Bipolar diathermy • Laser • Loops • Clips • Long instruments

  6. Complications of Laparoscopy • Failure • Injury to: • Major blood vessels • Ureter, Bladder or Bowel • Uterine perforation from elevator • Need laparotomy 1:500 • Wound infection • Gas embolism • Surgical misadventure • Inadvertent diathermy perforation • Peritonitis • Death • 1:500,000

  7. Indications for Hysteroscopy • Abnormal uterine bleeding • Post menopausal • Pre menopausal • Infertility • Congenital abnormality • Adhesions • Polyps etc. • Surgical Interventions • Sterilisation (Essure) • Division of adhesions • Removal of benign tumours • Endometrial ablation

  8. Techniques in Hysteroscopy • Distension with: • Nothing = contact hysteroscopy • Gas CO2 • Saline • Glycine • Blind Entry or Entry under vision • Hysteroscopic instruments • Endometrial ablation • Laser • Resectoscope • Roller ball • Now overtaken with blind thermal ablation

  9. Complications of Hysteroscopy: • Failure • Cervical Injury • Uterine perforation • Fluid overload • Infection

  10. Colposcopy • Indications: • Evaluation of CIN • Biopsy target • Vaginal and vulval examination • DES exposure • Techniques: • Acetic acid • Schiller’s iodine • Intervention: • Outpatient treatment of CIN e.g. Laser

  11. Any Questions or Comments? For a copy of this PowerPoint go to www.brinsmead.net.au and follow the Link to “For Students”

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