hysteroscopy - world laparoscopy hospital
TRANSCRIPT
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Hysteroscopy
Prof. R. K. Mishra
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Definition
Hysteroscopy is a procedure used to view the inside of the uterus through a telescope-like device called a hysteroscope
The hysteroscope is placed in the vagina and introduced into the uterus through the cervix
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
History
First hysteroscope with
Cystoscope of Desormeaux
by Pantaleoni 1869
First hysteroscope with built
in lens to magnify the
image
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Surgical Team and Patient Position
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Hysteroscopic Anatomy
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Indication
1. Evaluation of unexplained uterine bleeding in pre or post-
menopausal patients
2. Diagnosis & hysteroscopic removal of suspected submucous
leiomyoma or endometrial polyp
3. Location and retrieval of ‘lost IUD’ or other foreign body
4. Exploration of endocervical canal, internal cervical os, and uterine
cavity in patients with repeated miscarriages.
5. Evaluation of patients with failed first trimester elective abortion
6. Trans-cervical division of small uterine septae
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Operating room setup
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
O.T Setup
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Procedure
Inside of the uterus is a potential cavity, like a collapsed airdome, it is necessary to fill (distend) it with either a liquid or a gas (carbon dioxide) in order to see.
Diagnostic hysteroscopy and simple operative hysteroscopy can usually be done in an office setting.
More complex operative hysteroscopy procedures are done in an operating room setting.
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Access
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Equipment
Hysteroscope
Microhysteroscope
Unit magnification- Panoramic view
20 magnification- Panoramic view
60 magnification- Contact Microscopic view depth 80microns
150 magnification- Contact microscopic view shows nuclei and cytoplasm
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Distending media
Carbon dioxide
Dextran 70
Low viscosity media like
normal saline, 5%
Dextrose, 10% Dextrose,
Dextran 4%.
Most of the surgeon uses
normal saline for Diagnostic
Hysteroscopy & Glycine for
Operative Hysteroscopy
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Property of Glycine
Do not react
Natural Amino Acid
Prevents Clot Formation
Inhibits Ionization by Monopolar current
Only Side effect is Hyponitremia after
intravasation
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Diagnostic
Hysteroscopy
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Diagnostic Hysteroscopy for
abnormal uterine bleeding
Endometrial Polyp
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Atypical adenomatous
endometrial hyperplasia
Diagnostic Hysteroscopy for
abnormal uterine bleeding
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Endometrial Carcinoma
Diagnostic Hysteroscopy for
abnormal uterine bleeding
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Submucous
Myoma
Diagnostic Hysteroscopy for
abnormal uterine bleeding
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Hysteroscopy in cases of
Infertility
Septate uterus
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Hysteroscopy in cases of
Infertility
Submucous Myoma
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Hysteroscopy in cases of
Infertility
Endometrial Polyp
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Hysteroscopy in cases of
Infertility
Forgotten IUD
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Hysteroscopy in cases of
Infertility
Intrauterine Adhesion
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Asherman's syndrome
Asherman Syndrome typically occur
as a result of scar formation after
uterine surgery, especially after a
dilatation and curettage (D&C). The
adhesions may cause amenorrhea
(lack of menstrual periods) and/or
infertility.
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Hysteroscopic Adhesiolysis
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Tubal Cause of Infertility
Combined effort of Laparoscopy,
Hysteroscopy & Falloposcopy
can be used to rule out all the
Uterine & Tubal Cause of
Infertility
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Hysteroscopy in malignancy
Endometrial carcinoma
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Hysteroscopy correlation in
Diagnosis
Bicornuate Uterus
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Myoma
Hysteroscopic
correlation & Diagnosis
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Hysteroscopy correlation in
Diagnosis
Submucous Myoma
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Hysteroscopy correlation in
Diagnosis
Endometrial Carcinoma
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Operative
Hysteroscopy
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Therapeutic role of
Hysteroscopy
In many situations, operative hysteroscopy may offer an alternative
to hysterectomy.
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Anatomy of Endometrium
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Resectoscope
The resectoscope
has been used for
male prostate
surgery for over 50
years.
The resectoscope
with a built in wire
loop or other shape
device, uses high-
frequency electrical
current.
TCRE
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Myomectomy
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Grades of Submucous Myoma
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Diagnosis
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Diagnosis
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Resection of Submucous Myoma
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Resection of Myoma
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Myomectomy
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Plasma Sect and V Samples
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Hysteroscopy for
Septet Uterus
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Principle
Cutting
Current
Is
Used
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Resection of the Uterine Septum
121
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Resection of Septum
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Therapeutic role of
Hysteroscopy
Hysteroscopic Metroplasty
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Hysteroscopic Sterilization
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Complications
Trauma Cervical laceration
Uterine perforation
Injury to Intra-abdominal Viscera-Rectum, Bladder, Intestine
Intravasation – Predisposing factors for venous intravasation of distending media: Uterine Tuberculosis, Submucous tumour,
Hypoplastic uterus, Recently traumatised uterine cavity, Proximal tubal obstruction, Excessive Pressure of Instillation
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Complications contd…
Infection Exacerbate latent salpingitis
PID
Febrile reaction
Bleeding
Mortality Peritonitis
Very high instillation pressure and flow rate
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Contraindications
Absolute
Adnexal and endometrial infection
Relative
Menstruation
Pregnancy (Rarely used)
Cone Biopsy of Cervix
Pelvic irradiation
Cardiac and Pulmonary diseases
Recently Scarred Uterus and adhesions
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World Laparoscopy Hospital Essentials of Laparoscopic Surgery
Thank you
Advance Batch February 2005