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ENDOSCOPIC SURGERY IN GYNECOLOGY

Notes

LAPAROSCOPY

Indications diagnostic • evaluation of infertility, pelvic pain, small pelvic masses, congenital anomalies, small hemoperitoneum, and endometriosis therapeutic • tubal ligation • lysis of adhesions • fulguration of endometriotic implants • aspiration of small cysts • retrieval of lost IUDs • tuboplasty • lymphadenectomy • myomectomy • ectopic pregnancy removal • also increasingly used for major surgeries such as cystectomies, salpingo-oophorectomy, hysterectomy, and treatment of stress incontinence

Contraindications bowel obstruction large hemoperitoneum with hypovolemic shock

Complications insufflation of the preperitoneal abdominal wall perforation of a viscus, especially bowel; if this occurs a laparotomy may be necessary poor intra-abdominal hemostasis coagulation burns of a viscus (bowel burns may result in perforation with peritonitis) inadvertent entry of iliac vessels with trochar damage to ureters, bladder (entered, burned)

HYSTEROSCOPY

use inert medium (i.e. glycine, carbon dioxide, cystosol) to distend endometrial cavity

Indications AUB • ablation of endometrium (pre-treatment with GnRH agonist) • excision of endometrial polyps, submucous fibroids • directed endometrial biopsy infertility • division of endometrial adhesions (e.g. Asherman) • uterine septum resection

Difficulties Encountered acute and chronic upper genital tract infections profuse bleeding cervical stenosis recent uterine perforation

R E L A T E D A N A T O M Y ( m a y b e u s e f u l i n p r e p a r a t i o n f o r O R ) u t e r o s a c r a l l i a g m e n t b r o a d l i g a m e n t c a r d i n a l l i g a m e n t r o u n d l i g a m e n t i n f u n d i b u l o p e l v i c l i g a m e n t o v a r i a n a r t e r y i n f e r i o r e p i g a s t r i c a r t e r i e s l a y e r s o f t h e r e c t u s s h e a t h

Gynecology 52

MCCQE 2000 Review Notes and Lecture Series

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