1. Gynaecological Endoscopy Max Brinsmead MB BS PhD May 2015

2. Gynaecological Endoscopy: Laparoscopy Laparoscopy Hysteroscopy Hysteroscopy Colposcopy Colposcopy

3. Indications for Laparoscopy Diagnostic Diagnostic –For pelvic pain Endometriosis Endometriosis PID PID Adhesions Adhesions Pelvic congestion etc. Pelvic congestion etc. –Infertility With tubal insufflation With tubal insufflation –Pelvic Mass Uterine eg Fibroids Uterine eg Fibroids Ovarian – benign or malignant Ovarian – benign or malignant Other Other

4. Indications for Laparoscopy 2 For Intervention For Intervention –Assisted conception (OPU and GIFT) –Diathermy to endometriosis –Sterilisation (Clips, Loops or Diathermy) –Biopsy of ovary or tumours –Division of adhesions –Ectopic pregnancy, cysts, oophorectomy –Advanced surgery – all operations!

5. Techniques in Laparoscopy Creating the Pneumoperitoneum Creating the Pneumoperitoneum –Verres needle –Direct trochar insertion –Hassan open technique –Abdominal wall elevation –CO 2, N 2 or other gas Reusable or Disposable Equipment Reusable or Disposable Equipment Direct vision or camera Direct vision or camera Surgical Aids Surgical Aids –Unipolar or Bipolar diathermy –Laser –Loops –Clips –Long instruments

6. Complications of Laparoscopy Failure Failure Injury to: Injury to: –Major blood vessels –Ureter, Bladder or Bowel –Uterine perforation from elevator –Need laparotomy 1:500 Wound infection Wound infection Gas embolism Gas embolism Surgical misadventure Surgical misadventure –Inadvertent diathermy perforation –Peritonitis Death Death 1:500,000 1:500,000

7. Indications for Hysteroscopy Abnormal uterine bleeding Abnormal uterine bleeding –Post menopausal –Pre menopausal Infertility Infertility –Congenital abnormality –Adhesions –Polyps etc. Surgical Interventions Surgical Interventions –Sterilisation (Essure) –Division of adhesions –Removal of benign tumours –Endometrial ablation

8. Techniques in Hysteroscopy Distension with: Distension with: –Nothing = contact hysteroscopy –Gas CO 2 –Saline –Glycine Blind Entry or Entry under vision Blind Entry or Entry under vision Hysteroscopic instruments Hysteroscopic instruments Endometrial ablation Endometrial ablation –Laser –Resectoscope –Roller ball –Now overtaken with blind thermal or radio HF ablation

9. Complications of Hysteroscopy: Failure Failure Cervical Injury Cervical Injury Uterine perforation Uterine perforation Fluid overload Fluid overload Infection Infection

10. Colposcopy Indications: Indications: –Evaluation of CIN –Biopsy target –Vaginal and vulval examination –DES exposure Techniques: Techniques: –Acetic acid –Schiller’s iodine Intervention: Intervention: –Outpatient treatment of CIN e.g. Laser

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