Hysteroscopy
Download as PPTX, PDF17 likes6,897 views
This document discusses hysteroscopic procedures, including their history, indications, equipment, techniques, complications, and conclusions. Hysteroscopes allow physicians to examine and treat the inside of the uterus using small cameras and surgical tools inserted through the cervix. The document outlines the various diagnostic and therapeutic indications for hysteroscopy. It also details the counseling, anesthesia, positioning, equipment, distending media, procedures, and potential complications involved. In conclusion, the author states that hysteroscopy is a valuable technique for gynecological surgeons, providing minimally invasive options through the uterus's natural pathway.
Hysteroscopy
- 1. HYSTEROSCOPY DR.GURURAJ DESHPANDE MS(OBG) ASSOCIATE PROFESSOR DEPT.OF.OBG KAMINENI INSTITUTE OF MEDICAL SCIENCES NARKETPALLY
- 3. HISTORY:PANTALEONI 1869 T0 1970 A LONG GAP
- 4. 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
- 5. 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
- 6. PATIENT COUNSELLING Benefits Vs Risks Other treatment options Realistic success rate Informed written consent
- 7. ANAESTHESIA Patient anxiety Cervix status Procedure Paracervical block and IV sedation Transcervical topical anesthesia Spinal/epidural GA
- 8. POSITION
- 10. VIEW
- 12. Operative sheaths and working channel for accessory instruments
- 14. Unipolar resectoscope consisting of working element, 8mm resectoscope sheath,4mm telescope
- 15. UNIPOLAR LOOP ELECTRODE FOR END ABLATION,MYOMA,POLYP
- 18. 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
- 19. 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
- 20. CO2 Insufflation should not exceed 100ml/min Unlike laparoscopy which are in litres/min Use only hysteroinsufflator Ideal for diagnostic office hysteroscopy
- 21. 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.
- 22. 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
- 23. LOW VISCOCITY LIQUID MEDIA MEDIUM OSMOLALITY mosm/kg of water SODIUM 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
- 24. 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
- 25. 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
- 26. 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
- 27. CONTRAINDICATIONS Active PID Active profuse bleeding Recent perforation Pregnancy Cancer cervix Systemic disorders affecting fluid and electrolytes
- 28. 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
- 30. Panoramic view
- 31. Tubal ostium
- 32. Cu-T
- 33. DENSE ADHESIONS
- 36. EXCISION OF UTERINE SEPTUM
- 37. COMPLICATIONS Due to position Anaesthetic complications Due to distending media Uterine perforation Bleeding Bowel and bladder injury Septicemia Death
- 41. 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
- 42. THANK YOU