Gynaecological EndoscopyGynaecological Endoscopy

Max Brinsmead MB BS PhDMax Brinsmead MB BS PhDMay 2015May 2015

Gynaecological Endoscopy:Gynaecological Endoscopy:

• LaparoscopyLaparoscopy

• HysteroscopyHysteroscopy

• ColposcopyColposcopy

Indications for LaparoscopyIndications for Laparoscopy• DiagnosticDiagnostic

– For pelvic painFor pelvic pain•EndometriosisEndometriosis•PIDPID•AdhesionsAdhesions•Pelvic congestion etc.Pelvic congestion etc.

– InfertilityInfertility•With tubal insufflationWith tubal insufflation

– Pelvic MassPelvic Mass•Uterine eg FibroidsUterine eg Fibroids•Ovarian – benign or malignantOvarian – benign or malignant•OtherOther

Indications for Laparoscopy 2Indications for Laparoscopy 2

• For InterventionFor Intervention

– Assisted conception (OPU and GIFT)Assisted conception (OPU and GIFT)

– Diathermy to endometriosisDiathermy to endometriosis

– Sterilisation (Clips, Loops or Diathermy)Sterilisation (Clips, Loops or Diathermy)

– Biopsy of ovary or tumoursBiopsy of ovary or tumours

– Division of adhesionsDivision of adhesions

– Ectopic pregnancy, cysts, oophorectomyEctopic pregnancy, cysts, oophorectomy

– Advanced surgery – all operations!Advanced surgery – all operations!

Techniques in LaparoscopyTechniques in Laparoscopy• Creating the PneumoperitoneumCreating the Pneumoperitoneum

– Verres needleVerres needle– Direct trochar insertionDirect trochar insertion– Hassan open techniqueHassan open technique– Abdominal wall elevationAbdominal wall elevation– COCO2, 2, NN2 2 or other gasor other gas

• Reusable or Disposable EquipmentReusable or Disposable Equipment• Direct vision or cameraDirect vision or camera• Surgical AidsSurgical Aids

– Unipolar or Bipolar diathermyUnipolar or Bipolar diathermy– LaserLaser– LoopsLoops– ClipsClips– Long instrumentsLong instruments

Complications of Complications of LaparoscopyLaparoscopy

• FailureFailure• Injury to:Injury to:

– Major blood vesselsMajor blood vessels– Ureter, Bladder or BowelUreter, Bladder or Bowel– Uterine perforation from elevatorUterine perforation from elevator– Need laparotomy 1:500Need laparotomy 1:500

• Wound infectionWound infection• Gas embolismGas embolism• Surgical misadventureSurgical misadventure

– Inadvertent diathermy perforationInadvertent diathermy perforation– PeritonitisPeritonitis

• DeathDeath• 1:500,0001:500,000

Indications for HysteroscopyIndications for Hysteroscopy

• Abnormal uterine bleedingAbnormal uterine bleeding– Post menopausalPost menopausal– Pre menopausalPre menopausal

• InfertilityInfertility– Congenital abnormalityCongenital abnormality– AdhesionsAdhesions– Polyps etc.Polyps etc.

• Surgical InterventionsSurgical Interventions– Sterilisation (Essure)Sterilisation (Essure)– Division of adhesionsDivision of adhesions– Removal of benign tumoursRemoval of benign tumours– Endometrial ablationEndometrial ablation

Techniques in HysteroscopyTechniques in Hysteroscopy• Distension with:Distension with:

– Nothing = contact hysteroscopyNothing = contact hysteroscopy– Gas COGas CO22

– SalineSaline– GlycineGlycine

• Blind Entry or Entry under visionBlind Entry or Entry under vision

• Hysteroscopic instrumentsHysteroscopic instruments

• Endometrial ablationEndometrial ablation– LaserLaser– ResectoscopeResectoscope– Roller ballRoller ball– Now overtaken with blind thermal or radio HF ablationNow overtaken with blind thermal or radio HF ablation

Complications of Complications of Hysteroscopy:Hysteroscopy:• FailureFailure

• Cervical InjuryCervical Injury

• Uterine perforationUterine perforation

• Fluid overloadFluid overload

• InfectionInfection

ColposcopyColposcopy

• Indications:Indications:– Evaluation of CINEvaluation of CIN– Biopsy targetBiopsy target– Vaginal and vulval examinationVaginal and vulval examination– DES exposureDES exposure

• Techniques:Techniques:– Acetic acidAcetic acid– Schiller’s iodineSchiller’s iodine

• Intervention:Intervention:– Outpatient treatment of CIN e.g. LaserOutpatient treatment of CIN e.g. Laser

Any Questions or Any Questions or Comments?Comments?

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