Gynecological EndoscopyGynecological Endoscopy

Done by:

essa tawfeeQ Nawal akbar

mohammed jawaD Mohammed dhamen

Supervised by: Dr. Majda

Done by:

essa tawfeeQ Nawal akbar

mohammed jawaD Mohammed dhamen

Supervised by: Dr. Majda

Operative LaparoscopyOperative LaparoscopyOperative LaparoscopyOperative Laparoscopy

Successful operative Successful operative laparoscopy requires three laparoscopy requires three essential ingredients:essential ingredients:

1. Surgical skill;2. A well designed and

equipped Operating Room;3. A surgical team.

Successful operative Successful operative laparoscopy requires three laparoscopy requires three essential ingredients:essential ingredients:

1. Surgical skill;2. A well designed and

equipped Operating Room;3. A surgical team.

Gynecological EndoscopyGynecological Endoscopy

Endoscopy in obstetrics and gynaecology has many branches:

Laparoscopy Hysteroscopy. Colposcopy Falloposcopy Fetoscopy

Endoscopy in obstetrics and gynaecology has many branches:

Laparoscopy Hysteroscopy. Colposcopy Falloposcopy Fetoscopy

OutlineOutline

Laparoscopy

Definition Instruments The Procedures Indications and contraindications Complications

Laparoscopy

Definition Instruments The Procedures Indications and contraindications Complications

LaparoscopyLaparoscopy

Definition:

It is a technique which allows viewing (Diagnostic) and surgical maneuvers (Therapeutic) to be performed in abdominal organs through a surgical incision of < 1cm with help of pneumoperitoneum.

Definition:

It is a technique which allows viewing (Diagnostic) and surgical maneuvers (Therapeutic) to be performed in abdominal organs through a surgical incision of < 1cm with help of pneumoperitoneum.

InstrumentsInstruments

1. Verres needle:

used to inflate air to the peritoneal cavity (pneumoperitoneum) through the umbilicus where there is the thinnest abdominal wall.

1. Verres needle:

used to inflate air to the peritoneal cavity (pneumoperitoneum) through the umbilicus where there is the thinnest abdominal wall.

2. Electronic laparoflator:

Used to insufflate through the verres needle.

Maintains constant intra-abdominal pressure without exceeding the safety limit.

Some types have heating system to prevent lowering the patient body temperature.

2. Electronic laparoflator:

Used to insufflate through the verres needle.

Maintains constant intra-abdominal pressure without exceeding the safety limit.

Some types have heating system to prevent lowering the patient body temperature.

3. Trocars:

Permit access to the intraperitoneal cavity in which other instruments can pass.

The trocar used should be adapted to the diameter of the telescope selected.

3. Trocars:

Permit access to the intraperitoneal cavity in which other instruments can pass.

The trocar used should be adapted to the diameter of the telescope selected.

4. Telescope:

There are different sizes each with a different use.

They are used to visualize the peritoneal cavity.

4. Telescope:

There are different sizes each with a different use.

They are used to visualize the peritoneal cavity.

5. Camera 5. Camera equipment.equipment.

6. Light source.6. Light source.

5. Camera 5. Camera equipment.equipment.

6. Light source.6. Light source.

There are two types:- Disposable - Reusable

They can be either atraumatic or grasping foreceps.

There are two types:- Disposable - Reusable

They can be either atraumatic or grasping foreceps.

7. Forceps and scissors7. Forceps and scissors::7. Forceps and scissors7. Forceps and scissors::

8. Bipolar elecrtosurgey.9. Unipolar electrosurgery.10. Laser.11. Ultrasound system.12. Suction and irrigation system.13. Suture.14. Laparoscopic bag.15. Tissue morcellator: used to remove large specimens

like myomas or an entire uterus in small pieces.16. Uterine manipulator: used to mobilize or stabilize the

uterus and adnexa.

8. Bipolar elecrtosurgey.9. Unipolar electrosurgery.10. Laser.11. Ultrasound system.12. Suction and irrigation system.13. Suture.14. Laparoscopic bag.15. Tissue morcellator: used to remove large specimens

like myomas or an entire uterus in small pieces.16. Uterine manipulator: used to mobilize or stabilize the

uterus and adnexa.

InstrumentsInstrumentsInstrumentsInstruments

1.1. Preparation of the patient:Preparation of the patient:

Inform the patient about the Inform the patient about the therapeutic benefits and potential risks therapeutic benefits and potential risks (informed consent).(informed consent).

Intestinal preparation: Simple Intestinal preparation: Simple intestinal emptying, for better viewing intestinal emptying, for better viewing and preventing injuries.and preventing injuries.

Place the patient in the dorsolithotomy Place the patient in the dorsolithotomy position.position.

1.1. Preparation of the patient:Preparation of the patient:

Inform the patient about the Inform the patient about the therapeutic benefits and potential risks therapeutic benefits and potential risks (informed consent).(informed consent).

Intestinal preparation: Simple Intestinal preparation: Simple intestinal emptying, for better viewing intestinal emptying, for better viewing and preventing injuries.and preventing injuries.

Place the patient in the dorsolithotomy Place the patient in the dorsolithotomy position.position.

ProcedureProcedureProcedureProcedure

a. The abdominal wall is lifted by hand or by grasping forcepsb. Pnemoperitoneum is created by verres needle introduced to the

umbilical area (less subcutaneous and preperitoneul tissue). c. The needle is inserted in an oblique angle toward the uterine

fundusd. The negative pressure will allow the underlying structures to fall

away.e. After making sure that the needle is in correct position, air flow

can be increased to 2.5 liters per minute till a pressure of 15mmHg

a. The abdominal wall is lifted by hand or by grasping forcepsb. Pnemoperitoneum is created by verres needle introduced to the

umbilical area (less subcutaneous and preperitoneul tissue). c. The needle is inserted in an oblique angle toward the uterine

fundusd. The negative pressure will allow the underlying structures to fall

away.e. After making sure that the needle is in correct position, air flow

can be increased to 2.5 liters per minute till a pressure of 15mmHg

2. Creation of pneumoperitoneum:2. Creation of pneumoperitoneum:2. Creation of pneumoperitoneum:2. Creation of pneumoperitoneum:

a. Once the intra-abdominal pressure reaches 15 mmHg the main trocar is introduced after removal of veress needle.

b. The position of the trocar must be verified by inserting the laparoscope and viewing the pelvic cavity.

a. Once the intra-abdominal pressure reaches 15 mmHg the main trocar is introduced after removal of veress needle.

b. The position of the trocar must be verified by inserting the laparoscope and viewing the pelvic cavity.

3. Trocar introduction3. Trocar introduction

A. The omentum, bowel and bifurcation of pelvic vessels should be evaluated to avoid injuries caused during the introduction of Verres needle or trocar.

B. The site of introduction of other trocars should be verified by finger palpation and transillumination of abdominal wall to avoid injury to epigastric vessels.

C. Identify if there is any bleeding

A. The omentum, bowel and bifurcation of pelvic vessels should be evaluated to avoid injuries caused during the introduction of Verres needle or trocar.

B. The site of introduction of other trocars should be verified by finger palpation and transillumination of abdominal wall to avoid injury to epigastric vessels.

C. Identify if there is any bleeding

4. Viewing the peritoneal cavity:4. Viewing the peritoneal cavity:

After the procedure After the procedure COCO2 2 gas must be gas must be evacuated completely evacuated completely to reduce post-operative to reduce post-operative painpain

In operative procedures:In operative procedures:- 1 or 2 bottles of Ringer’s lactate are - 1 or 2 bottles of Ringer’s lactate are used to wash the peritoneal cavity after used to wash the peritoneal cavity after laparoscopy.laparoscopy.- Leave 500/1000 cc of ringer’s lactate to - Leave 500/1000 cc of ringer’s lactate to reduce the incidence of post operative reduce the incidence of post operative pain.pain.

After the procedure After the procedure COCO2 2 gas must be gas must be evacuated completely evacuated completely to reduce post-operative to reduce post-operative painpain

In operative procedures:In operative procedures:- 1 or 2 bottles of Ringer’s lactate are - 1 or 2 bottles of Ringer’s lactate are used to wash the peritoneal cavity after used to wash the peritoneal cavity after laparoscopy.laparoscopy.- Leave 500/1000 cc of ringer’s lactate to - Leave 500/1000 cc of ringer’s lactate to reduce the incidence of post operative reduce the incidence of post operative pain.pain.

Used as a diagnostic toolUsed as a diagnostic tool

Infertility: status of the fallopian tube (morphology and Infertility: status of the fallopian tube (morphology and functionality) and any pathological condition e.g. functionality) and any pathological condition e.g. adhesions.adhesions.

Ovarian cysts or tumors.Ovarian cysts or tumors. Ectopic pregnancy.Ectopic pregnancy. PID: tubal abscess or adhesions.PID: tubal abscess or adhesions. Endometriosis: define the sites of implants and Endometriosis: define the sites of implants and

endometrial cysts.endometrial cysts.

Used as a diagnostic toolUsed as a diagnostic tool

Infertility: status of the fallopian tube (morphology and Infertility: status of the fallopian tube (morphology and functionality) and any pathological condition e.g. functionality) and any pathological condition e.g. adhesions.adhesions.

Ovarian cysts or tumors.Ovarian cysts or tumors. Ectopic pregnancy.Ectopic pregnancy. PID: tubal abscess or adhesions.PID: tubal abscess or adhesions. Endometriosis: define the sites of implants and Endometriosis: define the sites of implants and

endometrial cysts.endometrial cysts.

IndicationsIndicationsIndicationsIndications

Ovarian CystOvarian Cyst

Adhesions Adhesions between the between the

omentum and omentum and uterusuterus

Ectopic pregnancy

- Management of ovarian cyst by:- Management of ovarian cyst by:

- Drainage.- Drainage.

- Ovarian cystectomy.- Ovarian cystectomy.

- Ovarian drilling of the cortex and stroma to - Ovarian drilling of the cortex and stroma to decrease androgens in the ovariesdecrease androgens in the ovaries

- Correcting ovarian torsion.- Correcting ovarian torsion.

- As a treatment of endometriosis- As a treatment of endometriosis

- By removal of the endometrial cyst, - By removal of the endometrial cyst,

cauterization of endometrial spots and cauterization of endometrial spots and adhesiolysisadhesiolysis

- Management of ovarian cyst by:- Management of ovarian cyst by:

- Drainage.- Drainage.

- Ovarian cystectomy.- Ovarian cystectomy.

- Ovarian drilling of the cortex and stroma to - Ovarian drilling of the cortex and stroma to decrease androgens in the ovariesdecrease androgens in the ovaries

- Correcting ovarian torsion.- Correcting ovarian torsion.

- As a treatment of endometriosis- As a treatment of endometriosis

- By removal of the endometrial cyst, - By removal of the endometrial cyst,

cauterization of endometrial spots and cauterization of endometrial spots and adhesiolysisadhesiolysis

As a therapeutic toolAs a therapeutic toolAs a therapeutic toolAs a therapeutic tool

MovieMovie

Management of infertility:Management of infertility:

- Adhesiolysis- Adhesiolysis

- Treat the cause (endometriosis, - Treat the cause (endometriosis, PCOS)PCOS)

Myomectomy for fibroids: used for subserosal and Myomectomy for fibroids: used for subserosal and intramural fibroids only, not used for submucosal fibroids. intramural fibroids only, not used for submucosal fibroids.

Management of PID: by draining tubal abscess and Management of PID: by draining tubal abscess and adhesiolysis.adhesiolysis.

Management of infertility:Management of infertility:

- Adhesiolysis- Adhesiolysis

- Treat the cause (endometriosis, - Treat the cause (endometriosis, PCOS)PCOS)

Myomectomy for fibroids: used for subserosal and Myomectomy for fibroids: used for subserosal and intramural fibroids only, not used for submucosal fibroids. intramural fibroids only, not used for submucosal fibroids.

Management of PID: by draining tubal abscess and Management of PID: by draining tubal abscess and adhesiolysis.adhesiolysis.

As a therapeutic toolAs a therapeutic toolAs a therapeutic toolAs a therapeutic tool

AdhesiolysisAdhesiolysisAdhesiolysisAdhesiolysis

MyomectomyMyomectomy

Salpingotomy Salpingotomy

Used to preserve the tubes for desired Used to preserve the tubes for desired reproductivity.reproductivity.

Done if the patient is hemodynamicaly Done if the patient is hemodynamicaly stablestable

If size < 5 cmIf size < 5 cm Location must be ampullary, infundibular Location must be ampullary, infundibular

or isthmic. or isthmic. Contralateral tube either normal or absent.Contralateral tube either normal or absent.

Salpingotomy Salpingotomy

Used to preserve the tubes for desired Used to preserve the tubes for desired reproductivity.reproductivity.

Done if the patient is hemodynamicaly Done if the patient is hemodynamicaly stablestable

If size < 5 cmIf size < 5 cm Location must be ampullary, infundibular Location must be ampullary, infundibular

or isthmic. or isthmic. Contralateral tube either normal or absent.Contralateral tube either normal or absent.

Management of ectopic pregnancy:Management of ectopic pregnancy:Management of ectopic pregnancy:Management of ectopic pregnancy:

SalpingotomySalpingotomy

- Salpingectomy (it is the standard for ectopic pregnancy)

- Ruptured tube

- Multiple recurrence of ectopic pregnancy.

- Size of ectopic > 5 cm

- Salpingectomy (it is the standard for ectopic pregnancy)

- Ruptured tube

- Multiple recurrence of ectopic pregnancy.

- Size of ectopic > 5 cm

IndicationsIndicationsIndicationsIndications

- Tubal sterilization by:

- Bipolar coagulation.

- Clips (filshie clips) and rings

- Before doing this you should consult the patient about three things

- Chance of irreversibility

- Failure rate 1/200

- Bleeding may occur and we may shift to

laparatomy.

- Laparoscopic hysterectomy.

- Tubal sterilization by:

- Bipolar coagulation.

- Clips (filshie clips) and rings

- Before doing this you should consult the patient about three things

- Chance of irreversibility

- Failure rate 1/200

- Bleeding may occur and we may shift to

laparatomy.

- Laparoscopic hysterectomy.

IndicationsIndicationsIndicationsIndications

Ring sterilizationRing sterilization

ContraindicationsContraindicationsContraindicationsContraindications

1.1. Generalized peritonitisGeneralized peritonitis

2.2. Hypovolemic shockHypovolemic shock

3.3. Severe cardiac diseaseSevere cardiac disease

4.4. Hemoglobin less than 7 g/dLHemoglobin less than 7 g/dL

5.5. Uterine size > 12 wks.Uterine size > 12 wks.

6.6. Multiple previous abdominal proceduresMultiple previous abdominal procedures

7.7. Extreme body weightExtreme body weight

1.1. Generalized peritonitisGeneralized peritonitis

2.2. Hypovolemic shockHypovolemic shock

3.3. Severe cardiac diseaseSevere cardiac disease

4.4. Hemoglobin less than 7 g/dLHemoglobin less than 7 g/dL

5.5. Uterine size > 12 wks.Uterine size > 12 wks.

6.6. Multiple previous abdominal proceduresMultiple previous abdominal procedures

7.7. Extreme body weightExtreme body weight

- Pneumoperitoneum:- Extraperitonel emphysema due to failure of

introducing verres needle correctly into the peritoneal cavity and not checking the negative pressure on the machine.

- Gas may extend to the mediastinum and compromise cardiac function

- Pneumoomentum: and put the patient on the trendlenberg

- Injury to abdominal organs- GI: if the intestine is distended or adherent to the

abdominal wall (prevented by good intestinal preparation) and putting the patient on the telendelenburg position.

- Bladder injury: prevented by emptying the bladder.

- Pneumoperitoneum:- Extraperitonel emphysema due to failure of

introducing verres needle correctly into the peritoneal cavity and not checking the negative pressure on the machine.

- Gas may extend to the mediastinum and compromise cardiac function

- Pneumoomentum: and put the patient on the trendlenberg

- Injury to abdominal organs- GI: if the intestine is distended or adherent to the

abdominal wall (prevented by good intestinal preparation) and putting the patient on the telendelenburg position.

- Bladder injury: prevented by emptying the bladder.

ComplicationsComplicationsComplicationsComplications

Blood vessel injury:Blood vessel injury:

- Pelvic, omental and mesentricPelvic, omental and mesentric- Prevented by introducing the verres needle in Prevented by introducing the verres needle in

an angle.an angle.- In obese patients you can insert the needle in In obese patients you can insert the needle in

straight manner because of the thick fatty layer.straight manner because of the thick fatty layer.

Blood vessel injury:Blood vessel injury:

- Pelvic, omental and mesentricPelvic, omental and mesentric- Prevented by introducing the verres needle in Prevented by introducing the verres needle in

an angle.an angle.- In obese patients you can insert the needle in In obese patients you can insert the needle in

straight manner because of the thick fatty layer.straight manner because of the thick fatty layer.

ComplicationsComplicationsComplicationsComplications

HysteroscopyHysteroscopyHysteroscopyHysteroscopy

DefinitionDefinition Instruments Instruments The ProceduresThe Procedures Indications and contraindicationsIndications and contraindications ComplicationsComplications

DefinitionDefinition Instruments Instruments The ProceduresThe Procedures Indications and contraindicationsIndications and contraindications ComplicationsComplications

HysteroscopyHysteroscopy

DefinitionDefinition::

It is a technique which allows viewing and surgical It is a technique which allows viewing and surgical maneuvers to be performed in the uterine cavity.maneuvers to be performed in the uterine cavity.

It has many advantages that made it wide spread It has many advantages that made it wide spread and fundamental diagnostic method in daily and fundamental diagnostic method in daily

gynecological practice.gynecological practice.

DefinitionDefinition::

It is a technique which allows viewing and surgical It is a technique which allows viewing and surgical maneuvers to be performed in the uterine cavity.maneuvers to be performed in the uterine cavity.

It has many advantages that made it wide spread It has many advantages that made it wide spread and fundamental diagnostic method in daily and fundamental diagnostic method in daily

gynecological practice.gynecological practice.

InstrumentsInstruments

1. Distention media of the uterine cavity (CO2 distention)

2. Light source.xenon light source gives the best image quality

1. Distention media of the uterine cavity (CO2 distention)

2. Light source.xenon light source gives the best image quality

3. Camera Equipment

4. Endoscopeflexible: high cost and fragile cannot be autoclaved.rigid: gives different direction of the view.

- 0°, 12°, 30° (best for diagnostic purpose).

3. Camera Equipment

4. Endoscopeflexible: high cost and fragile cannot be autoclaved.rigid: gives different direction of the view.

- 0°, 12°, 30° (best for diagnostic purpose).

5. Hysteroscope:5. Hysteroscope:

There are 2 types of hysteroscopes:There are 2 types of hysteroscopes:DiagnosticDiagnosticTherapeuticTherapeutic

1.1. Preparation of the patient:Preparation of the patient:

Detailed history and complete physical examinationDetailed history and complete physical examination It is preferable to do the procedure in the first part of the It is preferable to do the procedure in the first part of the

menstrual cycle, because there is less mucus (better viewing) menstrual cycle, because there is less mucus (better viewing) and no chance of encountering early pregnancyand no chance of encountering early pregnancy

Informed consentInformed consent Patient is placed in lithotomy positionPatient is placed in lithotomy position Accurate bimanual examination to asses the uterine (position, Accurate bimanual examination to asses the uterine (position,

morphology, volume).morphology, volume).

1.1. Preparation of the patient:Preparation of the patient:

Detailed history and complete physical examinationDetailed history and complete physical examination It is preferable to do the procedure in the first part of the It is preferable to do the procedure in the first part of the

menstrual cycle, because there is less mucus (better viewing) menstrual cycle, because there is less mucus (better viewing) and no chance of encountering early pregnancyand no chance of encountering early pregnancy

Informed consentInformed consent Patient is placed in lithotomy positionPatient is placed in lithotomy position Accurate bimanual examination to asses the uterine (position, Accurate bimanual examination to asses the uterine (position,

morphology, volume).morphology, volume).

ProcedureProcedure

2. Technique:2. Technique:

Clean cervix with antisepticsClean cervix with antiseptics Cervical forceps is placed on the front labiaCervical forceps is placed on the front labia Light source & CO2 gas supply are connected to the Light source & CO2 gas supply are connected to the

instrumentinstrument Insert hysteroscope into the cervical canal, which Insert hysteroscope into the cervical canal, which

dilates from the gas pressure.dilates from the gas pressure.

2. Technique:2. Technique:

Clean cervix with antisepticsClean cervix with antiseptics Cervical forceps is placed on the front labiaCervical forceps is placed on the front labia Light source & CO2 gas supply are connected to the Light source & CO2 gas supply are connected to the

instrumentinstrument Insert hysteroscope into the cervical canal, which Insert hysteroscope into the cervical canal, which

dilates from the gas pressure.dilates from the gas pressure.

ProcedureProcedure

Used as a diagnostic tool:

- Abnormal uterine bleeding caused by: - submucous and intramural myoma. - endometrial polyps. - endometrial atrophy.

- Endometrial tumors.- Infertility related to:

- Intrauterine adhesions (Asherman’s syndrome)- Submucous fibroids. - Endometrial polyps.

- Uterine malformation (it cannot differentiate between sepatate and bicorneate uterus)<- this can be done by laparoscopy.

Used as a diagnostic tool:

- Abnormal uterine bleeding caused by: - submucous and intramural myoma. - endometrial polyps. - endometrial atrophy.

- Endometrial tumors.- Infertility related to:

- Intrauterine adhesions (Asherman’s syndrome)- Submucous fibroids. - Endometrial polyps.

- Uterine malformation (it cannot differentiate between sepatate and bicorneate uterus)<- this can be done by laparoscopy.

IndicationsIndicationsIndicationsIndications

Used as a therapeutic toolUsed as a therapeutic toolEndometrial ablation (using laser):Endometrial ablation (using laser): Abnormal uterine bleeding but we should role Abnormal uterine bleeding but we should role

out cancerous or pre cancerous cause of out cancerous or pre cancerous cause of bleeding.bleeding.

Also used in patients with high risk for Also used in patients with high risk for hysterectomy or the patient does not want to hysterectomy or the patient does not want to do the surgery.do the surgery.steroscopic Surgeries and steroscopic Surgeries and Endometrial PolypectomyEndometrial Polypectomy

Used as a therapeutic toolUsed as a therapeutic toolEndometrial ablation (using laser):Endometrial ablation (using laser): Abnormal uterine bleeding but we should role Abnormal uterine bleeding but we should role

out cancerous or pre cancerous cause of out cancerous or pre cancerous cause of bleeding.bleeding.

Also used in patients with high risk for Also used in patients with high risk for hysterectomy or the patient does not want to hysterectomy or the patient does not want to do the surgery.do the surgery.steroscopic Surgeries and steroscopic Surgeries and Endometrial PolypectomyEndometrial Polypectomy

IndicationsIndicationsIndicationsIndications

Correct uterine malformation like septate uterus by resection of the septum. (bicorneate uterus is corrected by laparotomy using metroplasty).

Polypectomy. Intrauterine adhesions. Myomectomy: The main indication for hysteroscopic

myomectomy is AUB caused by submucous myomas in infertile patients

Correct uterine malformation like septate uterus by resection of the septum. (bicorneate uterus is corrected by laparotomy using metroplasty).

Polypectomy. Intrauterine adhesions. Myomectomy: The main indication for hysteroscopic

myomectomy is AUB caused by submucous myomas in infertile patients

IndicationsIndicationsIndicationsIndications

Hysteroscopic Surgeries and Hysteroscopic Surgeries and Endometrial PolypectomyEndometrial Polypectomy

Hysteroscopic Surgeries and Hysteroscopic Surgeries and Endometrial PolypectomyEndometrial Polypectomy

Used as a therapeutic tool- Removal of foreign bodies and IUCD.

- Fallopian tube catheterization

- to canalize the tube.

- to place intra tubal device for reversible

sterilization.

Used as a therapeutic tool- Removal of foreign bodies and IUCD.

- Fallopian tube catheterization

- to canalize the tube.

- to place intra tubal device for reversible

sterilization.

IndicationsIndicationsIndicationsIndications

Uterine polypUterine polyp

Uterine anomalyUterine anomaly

Intrauterine AdhesionsIntrauterine Adhesions

Endometrial Ca.Endometrial Ca.

ContraindicationsContraindicationsContraindicationsContraindications

Pregnancy.Pregnancy. Current or recent pelvic infection.Current or recent pelvic infection. Current vaginitis, cervicitis and Current vaginitis, cervicitis and

endometritisendometritis.. Recent uterine perforation.Recent uterine perforation. Active Bleeding.Active Bleeding.

Pregnancy.Pregnancy. Current or recent pelvic infection.Current or recent pelvic infection. Current vaginitis, cervicitis and Current vaginitis, cervicitis and

endometritisendometritis.. Recent uterine perforation.Recent uterine perforation. Active Bleeding.Active Bleeding.

- Complications related to distention media:- due to CO2 insufflation:

- Cardiac arrhythmia due to excessive absorption.- Gas embolism.- We use hysteroflator that insufflate pressure of 100-120 mmHg

constantly without exceeding the safety limit.

- due to fluid:

- HMW (dextran)- Anaphylactic reaction- Pulmonary edema- Adult RDS

- Complications related to distention media:- due to CO2 insufflation:

- Cardiac arrhythmia due to excessive absorption.- Gas embolism.- We use hysteroflator that insufflate pressure of 100-120 mmHg

constantly without exceeding the safety limit.

- due to fluid:

- HMW (dextran)- Anaphylactic reaction- Pulmonary edema- Adult RDS

ComplicationsComplicationsComplicationsComplications

- LMW (saline)- Fluid overload: prevented by keeping the operating

time to minimum.

- Avoid entering vascular channels.- Close monitoring of fluid balance. - If you exceed 1000 ml of infused fluid stop the

procedure.

- Intraoperative complications:- Uterine perforation (<1%)- Hemorrhage either from:

- Perforation- Tenaculum used to hold the cervix.

-Trauma.- Thermal damage.

- LMW (saline)- Fluid overload: prevented by keeping the operating

time to minimum.

- Avoid entering vascular channels.- Close monitoring of fluid balance. - If you exceed 1000 ml of infused fluid stop the

procedure.

- Intraoperative complications:- Uterine perforation (<1%)- Hemorrhage either from:

- Perforation- Tenaculum used to hold the cervix.

-Trauma.- Thermal damage.

ComplicationsComplicationsComplicationsComplications

- Late onset:

- Infections: like acute PID, so we give prophylactic antibiotics.- Vaginal discharge: common after ablative procedures and it is self

limiting.

- Adhesion formation:

- Common after myomectomy when 2 fibroids are located opposite to each other in the uterine wall.

- To prevent the adhesions it is better to remove the fibroids in stages, and give estrogen (to build up the endometrial) therapy directly after resection. And also we can use IUCD.

- Late onset:

- Infections: like acute PID, so we give prophylactic antibiotics.- Vaginal discharge: common after ablative procedures and it is self

limiting.

- Adhesion formation:

- Common after myomectomy when 2 fibroids are located opposite to each other in the uterine wall.

- To prevent the adhesions it is better to remove the fibroids in stages, and give estrogen (to build up the endometrial) therapy directly after resection. And also we can use IUCD.

ComplicationsComplicationsComplicationsComplications

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MovieMovie

Wait !!Wait !!

Asherman Syndrome: It is defined as intrauterine adhesions Cause can be iatrogenic (after hysteroscopic

myomectomy) and can due to infection. It can be treated by hysteroscopic adhesiolysis

followed by inserting IUCD to make the uterine walls apart from each other. We can also use estrogen after adhesiolysis and this wall cause the emdometrium to build up and prevent adhesions to reoccur

Asherman Syndrome: It is defined as intrauterine adhesions Cause can be iatrogenic (after hysteroscopic

myomectomy) and can due to infection. It can be treated by hysteroscopic adhesiolysis

followed by inserting IUCD to make the uterine walls apart from each other. We can also use estrogen after adhesiolysis and this wall cause the emdometrium to build up and prevent adhesions to reoccur