1. Introduction to GYN Surgeries

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

3. FEMALE ANATOMY
Fallopian tubes are open to the abdomen=problem with venereal disease/can wreak havoc

5. Pathology Benign Malignant Other 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) -
Benign
Cysts
Polyps (pedunculated lesion)
Fistulas
Dysplasia= abnormal tissue growth
Leiomyoma/Myoma/Fibroid - smooth muscle tumor
Fibroma - connective tissue tumor
Cystocele= herniation of bladder into vagina, Rectocele= herniation of rectum into vagina; Enterocele=herniation of cul-de-sac of Douglas/includes loops of intestines into vagina; myoma=smooth muscle; Dysplasia=abnormal tissue growth

6. (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.

7. Endometriosis

8. Ectopic Pregnancy

9. Pedunculated Myoma

10. Prolapsed Uterus

11. Rectocele

12. Gynecological Procedures
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)
Colposcopy viewing cervix/biopsies. A & P repair-reconstruction vagina, pelvic floor, muascles, fascia, of rectum, urethra, bladder, perimneum to cystocele and rectocele to restore bladder and rectum to normal position. Le Fort corrects uterine prolapse (elderly).

13. Bartholin Gland Cyst

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

15. 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) pp

16. 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

17. 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

18. 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

19. 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

20. 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)
Any time that insufflation or fluids are involved you need to be aware of mediums, maximum volumes, settings, flow rate and outflow rate

21. Laparoscopic Procedure Continued
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

22. 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

23. 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

24. Hysteroscopy Procedure
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

25. 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

26. 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

27. 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
Missed-conception parts of non-living and in uterus more than 2 months. Incomplete-products of conception retained in uterus. Imminent- about to abort. Spontaneous- abortion occurs without being induced.

28. 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

29. D&C Procedure 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

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

31. 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

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