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SUR 111

SUR 111. Introduction to GYN Surgeries. Female Anatomy Pathology Miscellaneous Procedure Overview Instrumentation Review . Laparoscopy (diagnostic or operative) Hysteroscopy D & C (dilation & curettage) D & E (dilation & evacuation) Suction Curettage. Outline . FEMALE ANATOMY.

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SUR 111

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  1. SUR 111 Introduction to GYN Surgeries

  2. Female Anatomy Pathology Miscellaneous Procedure Overview Instrumentation Review Laparoscopy (diagnostic or operative) Hysteroscopy D & C (dilation & curettage) D & E (dilation & evacuation) Suction Curettage Outline

  3. FEMALE ANATOMY

  4. Benign Cysts Polyps (pedunculated lesion) Fistulas Dysplasia= abnormal tissue growth Leiomyoma/Myoma/Fibroid - smooth muscle tumor Fibroma- connective tissue tumor Malignant Vulvar Vaginal Cervical Uterine Ovarian Other Endometriosis - the presence and growth of functioning endometrial tissue in places other than the uterus that often results in severe pain Cystocele - herniation of bladder into vagina Rectocele (posterior colporrhaphy) - herniation of rectum into vagina Enterocele - herniation of cul-de-sac of Douglas/includes loops of intestines into vagina Ectopic Pregnancy - The implantation and subsequent development of a fertilized egg outside the uterus Incompetent Cervix (cerclage) - Pathology

  5. (PID) Pelvic inflammatory disease • (PID) is a general term that refers to infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus) and other reproductive organs. It is a common and serious complication of some sexually transmitted diseases (STDs), especially Chlamydia and Gonorrhea. • PID can damage the fallopian tubes and tissues in and near the uterus and ovaries. PID can lead to serious consequences including infertility, ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere outside of the womb), abscess formation, and chronic pelvic pain.

  6. Endometriosis

  7. Ectopic Pregnancy

  8. PedunculatedMyoma

  9. Prolapsed Uterus

  10. Rectocele

  11. Colposcopy Hysteroscopy D & C D & E Laparoscopy Hysterectomy Oophorectomy Salpingectomy Abdominal Hysterectomy subtotal total radical (Wertheim) Vaginal LAVH A & P Repair - repair-reconstruction vagina, pelvic floor, muscles, fascia, of rectum, urethra, bladder, perineum to cystocele and rectocele to restore bladder and rectum to normal position Bartholin’s Cyst (I & D) Gynecological Procedures

  12. Bartholin Gland Cyst

  13. Instruments • Major Tray • Abdominal-Hysterectomy Tray • D&C Tray • Hysteroscopy Tray resectoscope & hysteroscope • Laparoscopic Tray • Camera/scope tray/scope warmer

  14. Specific Vaginal Instruments • Auvard weighted speculum • Graves speculum • Sims vaginal speculum (single or double ended) • Delivery forceps • Goodell uterine dilator • Sims uterine sound • Bozeman uterine dressing forcep • Hegar uterine dilators • Heaney uterine dilators • Emmett uterine tenaculum • Sims uterine curettes (blunt/sharp)

  15. Specific Abdominal Hysterectomy Instruments • Abdominal retractor tray richardsons, deavers, malleables, Balfour w/bladder blade • O’Sullivan-O’Connor abdominal Retractor • Franz Abdominal Retractor • Heaney Hysterectomy Forceps • Heaney-Ballentine Hysterectomy Forceps • Heaney Needleholder • Jorgenson Curved Scissors • Lister Bandage Scissors • Pennington Forceps

  16. Specific Laparoscopy Instruments • Scope, Light cord (scope tray) • Camera (camera sleeve if not sterile) • Insufflation tubing (silastic tubing) • Verres Needle (insufflation needle) • Intrauterine cannula (chromotubation) • Uterine manipulator • Trocar Sleeves, Trocars • Accessory Instruments: cautery adapted, graspers, scissors, loop applicators, suturing devices, resectoscopes • Scope warmer • Multi-fire laparoscopic staplers

  17. Laparoscopy • Definition-Visualization of the peritoneal cavity through the anterior abdominal wall (For optimal visualization must have pneumoperitoneum) • Procedures-Diagnosis, Evaluation, Intervention • Laser and Electrosurgery may be used

  18. Laparoscopy Continued • Instruments: • Verres Needle • Silastic Tubing with connector • Trocar and Sleeve x 2 • Laparoscope Laparoscopic scissors • Light Cord Laparoscopic graspers • Camera Bipolar forceps (Kleppinger) • Biopsy forceps Ball and Loop Electrodes

  19. Laparoscopy Procedure • Small incision at umbilicus • Abdominal tissue elevated with a towel clip or pinched up and a Veres needle is inserted into the peritoneal cavity, attach a 10ml syringe to it with about 3ml of NS (The surgeon uses it to determine whether he is clear of vessels or bowel) • Silastic tubing is attached (you have thrown off one end to hook up to the insufflator) The peritoneum is filled with carbon dioxide or nitrous oxide gas (separates organs for optimal visibility)

  20. Laparoscopic ProcedureContinued • Veres needle withdrawn and operating laparoscope inserted (accomodates Kleppinger or scissors) • Trocars inserted (sleeve may or may not be used) Ports established to accommodate camera in one (umbilical incision) and other instruments needed in the other (May reattach silastic tubing to one of the trocar sleeves and not use a veres needle) • Procedure done (May involve two more trochars, one in LLQ and one in RLQ) • One trochar may accommodate LR irrigation/suction apparatus/Other may accommodate graspers • Items removed, sleeve may be left to allow gas to escape or may be sucked out with suction

  21. Laparoscopic Procedure Continued • Skin is closed with a 3-0 Vicryl PS-2 cutting (May use a 3-0 SH Vicryl taper prior to skin closure depending on abdominal thickness • Steri-strips may be used and Bandaids are applied to the incision sites • A peri-pad is placed for the patient • Keep in mind that depending on the procedure performed, there may be laser, cautery, other suture, a knot pusher for tying, endoscopic staplers, etc. needed

  22. Hysteroscopy • Definition-Endoscopic visualization of the uterine cavity and openings or orifices to the fallopian tubes • Introduced vaginally • Used for diagnosis and intervention • Diagnosis/Intervention: abnormal bleeding, endometriosis, IUD removal, infertility evaluation, polyps, sterilization, and adhesions • Laser/electrosurgery may be used • Biopsy forceps, scissors, etc. may be used

  23. HysteroscopyProcedure • Graves Speculum (other speculum) Lubrication available (NS or K-Y) • Anterior edge of cervix is grasped with a tenaculum and pulled forward • Depth of cavity may be measured with a uterine sound or modified grasper with sound • Cervix may be dilated with Pratt, Hanks, or Hegar dilators • Scope/irrigator is inserted (uterus is distended with Sorbitol, NS, Dextran (Hyskon), or Dextose solution) • Uterine cavity is explored

  24. Hysteroscopy Procedure Continued • Depending on findings or procedure, may use biopsy forceps, cautery, scissors, resectoscope with roller ball, laser, or tubal occlusive devices. • Biopsies will need to be collected on a piece of telfa • If Hyskon/Dextran is used clean instruments immediately as it will harden and make instruments difficult to clean

  25. Hysteroscopy Irrigation • Hysteroscopy solutions (for uterine distention) • Dextrose 5% (D5W) • Dextran 70% in dextrose • Glycine • Sorbitol • Above may all be used with laser or cautery • Hyskon (rarely used anymore due to ↑ laser use) • No cautery or lasers may be used as would cause systemic absorption>systemic side effects

  26. Obstetrical Complications • Abortions • Missed - parts of non-living conception and in uterus more than 2 months • Incomplete - products of conception retained in uterus • Imminent - about to abort • Spontaneous - abortion occurs without being induced • Voluntary

  27. D & C • Definition- dilation and curettage • Use diagnostic and therapeutic • Diagnostic: dysmenorrhea, endometriosis, rule out pregnacy before sterilization, infertility • Therapeutic: polyps, evaculate retained placenta post-child birth, IUD retrieval, placement of radioactive devices for treatment of cancers, incomplete miscarriage/abortion

  28. D&CProcedure • Speculum (Graves, other) • Local anesthesia may be injected if the patient is awake • Cervix is grasped with tenaculum and dilated with Pratt, Hanks, or Hegar dilators • Uterine sound may be used to determine depth of the uterine cavity • Smooth, sharp, or Heany uterine curettes will be used to clean out the uterine cavity • Suction may be used in conjuction or solo • Tissue may be sent for culture place it on a piece of telfa • Peri-pad placed

  29. D&E • Definition- D & C performed after the thirteenth week of pregnancy • Procedure the same as a D & C

  30. Suction Curettage • Definition-Suction/vacuum aspiration of the uterus • Used in therapeutic abortions, incomplete abortions, or miscarriages • Procedure: Speculum, tenaculum, dilators, suction apparatus, curettes may be needed, peri-pad placed

  31. Female Anatomy Pathology Miscellaneous Procedure Overview Instrumentation Review Laparoscopy (diagnostic or operative) Hysteroscopy D & C (dilation & curettage) D & E (dilation & evacuation) Suction Curettage Summary

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