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Endoscopy In Gynecology PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Endoscopy in Gynecology” by Dr. Yashodhara Pradeep.

This medical PowerPoint presentation tells how endoscopy can be used for diagnostic and therapeutic purposes in gynecology. There are two types of endoscopy commonly used in gynecology: hysteroscopy and laparoscopy.

Hysteroscopy is a procedure that involves the insertion of a small camera called a hysteroscope through the vagina and cervix to examine the inside of the uterus. This technique can be used to diagnose and treat various gynecological conditions such as uterine fibroids, polyps, and endometrial hyperplasia. It can also be used to perform procedures such as endometrial ablation and removal of small fibroids or polyps.

Laparoscopy, on the other hand, is a minimally invasive surgical technique that involves the insertion of a laparoscope, a thin tube with a camera, through a small incision in the abdomen. Laparoscopy is used in gynecology to diagnose and treat conditions such as endometriosis, ovarian cysts, and pelvic adhesions. It can also be used to perform procedures such as tubal ligation and removal of the uterus (hysterectomy).

Both hysteroscopy and laparoscopy have advantages over traditional open surgery. They are less invasive, require smaller incisions, and result in less pain and scarring. They also have shorter recovery times and lower complication rates. However, not all gynecological conditions can be treated with endoscopy, and in some cases, open surgery may be necessary.

It is important to discuss the risks and benefits of endoscopy with your gynecologist to determine if it is the right treatment option for you.

Tags : Endoscopy in Gynecology, hysteroscopy, laparoscopy, vagina, cervix, uterus, Obstetrics and Gynecology, Obstetrics and Gynecology PowerPoint presentation

Published on : Jun 20, 2023 | Views : 1689 | Downloads : 4

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Endoscopy in Gynecology Dr. Yashodhara Pradeep Prof. ObGyn King George Medical University
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Endoscopy in Gynecology Laparoscopy Hysteroscopy Colposcopy
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Laparoscopy--Indications Diagnostic Laparoscopy Therapeutic or (Operative )Laparoscopy
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Indication Diagnostic Laparoscopy To Visualize pelvic structure uterus , right and left adnexa , structures in right and left iliac fossa and pouch of Douglas, To know the tubal patency (chrome pertubation) Ovarian biobsy Second look surgery
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Advantages of Laparoscopy Shorter hospital stay Less postoperative pain Faster return to daily activity Small incision Less adhesions Uterine Surgery Myomectomy Hysterectomy
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Therapeutic Indication Tubal surgery: Tubal ligation Salpingectomy in case of Ectopic Pregnancy Salpingostomy in Fimbrial block Ovarian Surgery: Oopherectomy Cystectomy Ovarian drilling
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Therapeutic procedures Infertility procedures: Fimbrioplasty Salpingostomy Adhesiolysis Endometriosis Endometrioma cystectomy plus adhesiolysis Pelvic Floor repair Culdoplasty Enterocele repair Vault suspension Paravaginal repair etc
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Patient Preparation & Counseling Counseling about the procedure & expected outcome Bowel Preparation to facilitate the visualization of operative area & reduced chances of bowel injury
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Limitation of Laparoscopy Reduced exposure of operating field Skilled person Expensive Instruments Cost is high Prolonged operating time Prolong anaesthesia Increased risk of complication in less skilled person
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Equipment & Technique Patient positioning Operating room organization Peritoneal access Visualization Manipulation of tissue & fluid Cutting, haemostasis, &tissue fastening Tissue extraction Incision management
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Laparoscopic Procedure Midline infra umbilical incision Lifting of Abdominal wall Insertion of Insufflation needle or (Varies needle) Creation of pneumoperitoneum with CO2 Check the needle position in peritoneal cavity Intraperitoneal Pressure for placement of trocar &canula 20-25 mm then reduced to 10-12 mm Insertion of Laproscope with camera after white balancing Creation of ancillary ports Maintaining peritoneal distension
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Insertion site of Insufflation needle and primary canula
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Disposable Trocar’s of Various sizes 12mmto 2.7mm
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Reusable Devices Trocar and canula
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Laparoscope odegree2,5,10 mm
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Graspers Curved Straight and manipulators
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Insufflation Needle
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Uterine manipulator
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Radio frequency electrosurgical generator
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Ligating cutting and shearing device
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Insulator Defect Direct contact coupling
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Laparoscopic Cutting devices
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Specimen removal bag
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Electromechanical Morcellator
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Complications Anaesthesia Complications: Hypoventilation Esophageal intubation Gastro esophageal reflux Broncho spasm Hypotension < venous return sec. to high intraperitoneal pressure Narcotic overdose Carbon dioxide embolus Cardiac Arrhythmias dt hypercarbia & acidemia Cardiac Arrest
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Complication Extra peritoneal Insufflation Emphysema Electrosurgical complications : thermal visceral injury ¤t diversions Hemorrhagic complications – Great vessels : aorta, common iliac, int.&ext. iliac vessels & their branches Abdominal wall vessels : superficial circumflex iliac vessels, superficial inferior epigastric vessels(SIEV), Deep inferior epigasrric iliac vessels;(DIE IV) ,deep circumflex iliac vessels (DCI V )
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Complications Gastro Intestinal Injury: Stomach , Small Bowel, & the Colon Urologic Injury: Bladder Ureter Neurological Injuries: Due to poor positioning , pressure or surgical dissection Infection Incisional hernia Wound dehiscence
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Hysteroscopy
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Causes of AUB Post pregnancy Metrorrhagia Endometrial hyperplasia Sub mucous Fibroid or fibroid at other site Endometrial Polyp Foreign body Lost IUCD Endometrial Atrophy Endometrial cancer
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Indication for Hysteroscopy Unexplained abnormal uterine bleeding Reproductive age group Premenopausal Postmenopausal 2. Selected infertility cases Abnormal hysterography or transvaginal ultrasonography Unexplained infertility Asherman’s syndrome Recurrent spontaneous abortion Congenital uterine abnormality a Bicornuate uterus, Subseptate, Septate uterus, uterus didelphous
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Operative procedures Endometrial biopsy site specific Foreign body removal Dissection of septum Endometrial polyp removal Myomectomy of sub mucous fibroid Endometrial ablation Trans cervical tubal catheterisation Sterilization Adhesiolysis in Uterine synechia
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Contraindication Infection Pregnancy Malignancy Bleeding Cardiopumonary Disorder Cervical Stenosis
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Intra operative Complications Trauma Hemorrhage Complications related to distension media Infection Thermal damage caused by the electric current Cervical or uterine perforation 1-9%
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Equipment and Technique Patient positioning and cervical exposure Anesthesia Cervical dilation Uterine distention Imaging Intrauterine manipulation
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Distension media Carbondioxide Dextran 70 Low viscosity fluids 1.5 %Glycine 3 % Sorbitol 5 % manitol
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Cervical Canal Papillary structure
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Submucous Fibroid Pedunculated Myoma
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Vascularisation of Submucous Fibroid
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Endometrial Ablation Introduction : Introduced in1980, for destroying the endometrium in women with abnormal uterine bleeding with the aim of reducing or totally eliminating the bleeding Abnormal uterine bleeding is common gynecological problem Medical treatment often has transitory effect
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Indication Abnormal uterine bleeding not responding to medical management, & the case is neither premalignant or malignant Recurrent endometrial hyperplasia without Atypia Although in selected cases of above category can be done It can be done under local anaesthesia
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Preoperative Preparation To ensure complete ablation of the mucosa a homogeneous &thin endmt. must be achieved by GnRH analogs or danazol for 2-3 months Aspiration of the endmt or curettage Prophylactic antibiotic tt
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Technique Chemical & Radioactive substances abandoned dt poor results Cryo surgery proposed but didn’t work High frequency radio waves Resectoscope
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Resectoscope Instrument: Telescope & continuous flow sheath system allowing for simultaneous in & out flow of the distension liquid used in the cavity to distend the ut. Cavity Sorbitol / mannitol/glycine solution as continuous flow irrigation pump to have clear field Resection & Coagulation Endometrial slices of 3-5 mm thickness is resected 50-100W unipolar electrosurgical generator can be connected to Resectoscope The terminal portion has U shaped loop for endoscopy-guided resection
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Endometrial ablation Technique Entire endometrium must be ablated; small islands of remaining endometrium may otherwise give rise to widespread recolonization of this epithelium The entire endometrial thickness must be ablated but should not be deep enough to myometrium Normally the epithelium in the isthmus region is spared in order to prevent a total Asherman’s syndrome It would be ideal to maintain the possibility of inspect the uterine cavity for the follow up Hysteroscopic guided techniques are preferable over blind methods bcz > effective, can detect other intra uterine pathology
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Technique Roller Bar Coagulation: Variation of previous method Terminal loop is replaced by roller bar The roller bar electrode consist of a metal ball or bar connected to unipolar electro surgical generator & is used for systemic coagulation of the entire endometrium Advantage: Technically this method is easier as there is no risk of penetrating too deep into the myometrium Disadvantage : endmt . Can not be collected for H/P exam. Ideally It can be used along with U loop specially to assess the corners of tubes
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Neodymium Technique YAG Laser Coagulation: Similar to electrosurgical coagulation but performed with Laser Thermal Ablation Technique: Balloon Thermal Ablation
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Endometrial Ablation Results: Symptoms Remission: 90- 95% 90-95% SUCCESS RATE
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Causes of Failure Most common presence of Adenomyosis 89% Uterine dimensions : hysterometry >12cm increases the failure rate Curettage immediately prior to surgery worsens the results of ablation itself The surgeon ‘s skill The correct pharmacological preparation with analogs or with danozol significantly improves the result
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COLPOSCOPY
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Was introduced by Dr. Hans Hinselman in 1925. The word “colposcope” is derived from the greek words kolpos (fold or hollow) and skope (examine). Method of examining the cervix, vagina and vulva in vivo using a microscope (colposcope) and an external white light source. Objective –to detect intraepithelial and early neoplasia of cervix, vagina and vulva COLPOSCOPY- INTRODUCTION
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Evaluation of women with- Pap smear reporting of epithelial cell abnormality, with no gross lesion on the cervix or vagina Presence of inflammatory cells despite adequate treatment Presence of keratinized cells Positive visual screening tests-VIA or VILI Positive high risk HPV DNA test Post coital bleeding & post menopausal bleeding “Unhealthy cervix or vagina” on naked eye examination Exposure to DES in utero Anogenital condylomas and subclinical HPV infection VAIN or VIN Also used for monitoring of women treated for CIN and preop evaluation of women diagnosed having cancer cervix stage 1 (to rule out involvement of vagina) INDICATIONS
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The epithelium and stroma have a reciprocal relationship. Epithelium acts like a filter through which redness of stroma is transmitted. The image is dependent upon the ratio of absorbed light and reflected light and depends upon: The thickness of the epithelium The morphology and organization of the epithelium The vascularity and nature of the underlying stroma Tissue chromophores Red blood cell hemoglobin Tissue basis of colposcopy
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Patient laid down in lithotomy position Bivalve self retaining vaginal (Cusco’s) speculum is introduced After saline wash, any gross lesion,vascular details and opacity of the epithelium noted. Green filter- to evaluate vascular details. Green filter absorbs red colour & blood vessels stand out as black streak against translucent epithelium. Steps of colposcopy
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II Abnormal colposcopic findings: Flat acetowhite epithelium Dense acetowhite epithelium* Fine mosaic Coarse mosaic * Fine punctation Coarse punctation * Iodine partial positivity Iodine negativity * Atypical vessels * * Major changes International Federation for Cervical Pathology and Colposcopy (IFCPC)Colposcopic Classification (2002)
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Take home Message Hysteroscopy is an important procedure to evaluate uterine cavity, cervix &vagina It can be used as diagnostic & therapeutic The role of hysteroscopy in perimenopausal & post menopausal bleeding is invaluable It permits to take the biopsy under direct visualization than blindly by D/C Endometrial ablation is good alternative in women who are neither willing to continue medical tt nor wants to go for hysterectomy. The case selection& the skill of the operator is hallmark to achieve good results & less failure rates
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Indications Abnormal Pap smear Abnormal VIC Abnormal VIA Abnormal VIL
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Hysteroscopy in Peri-menopausal Bleeding Abnormal uterine bleeding is most common problem in a women >40 yrs of age Various diagnostic techniques ( D/C, EB, Vabra suction curettage, Challenge test, HSG, TVS ) has been proposed Hysteroscopy as an out patient procedure in combination with endometrial biopsy has demonstrated its great potential as a method of 1st choice in the management of Abnormal bleeding
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Colposcopic Findings Acetowhite epithrlium Leukoplakia dt Keratin producing cells Atypical vascular pattern- invasive cx ca Mosaic or punctate Irregular surface contour with loss of surface epithelium Color tone change yellow orange Cx Biopsy
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