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SUR 111. Introduction to GYN Surgeries. Female Anatomy Pathology Miscellaneous Procedure Overview Instrumentation Review . Laparoscopy (diagnostic or operative) Hysteroscopy D & C (dilation & curettage) D & E (dilation & evacuation) Suction Curettage. Outline . FEMALE ANATOMY.

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sur 111

SUR 111

Introduction to GYN Surgeries

outline
Female Anatomy

Pathology

Miscellaneous Procedure Overview

Instrumentation Review

Laparoscopy

(diagnostic or operative)

Hysteroscopy

D & C (dilation & curettage)

D & E (dilation & evacuation)

Suction Curettage

Outline
pathology
Benign

Cysts

Polyps (pedunculated lesion)

Fistulas

Dysplasia= abnormal tissue growth

Leiomyoma/Myoma/Fibroid - smooth muscle tumor

Fibroma- connective tissue tumor

Malignant

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) -

Pathology
pid pelvic inflammatory disease
(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.
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)

Gynecological Procedures
instruments
Instruments
  • Major Tray
  • Abdominal-Hysterectomy Tray
  • D&C Tray
  • Hysteroscopy Tray

resectoscope & hysteroscope

  • Laparoscopic Tray
  • Camera/scope tray/scope warmer
specific vaginal instruments
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)
specific abdominal hysterectomy instruments
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
specific laparoscopy instruments
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
laparoscopy
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
laparoscopy continued
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
laparoscopy procedure
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)
laparoscopic procedure continued
Laparoscopic ProcedureContinued
  • 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
laparoscopic procedure continued1
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
hysteroscopy
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
hysteroscopy procedure
HysteroscopyProcedure
  • 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
hysteroscopy procedure continued
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
hysteroscopy irrigation
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
obstetrical complications
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
slide28
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
d c procedure
D&CProcedure
  • 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
slide30
D&E
  • Definition- D & C performed after the thirteenth week of pregnancy
  • Procedure the same as a D & C
suction curettage
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
summary
Female Anatomy

Pathology

Miscellaneous Procedure Overview

Instrumentation Review

Laparoscopy

(diagnostic or operative)

Hysteroscopy

D & C (dilation & curettage)

D & E (dilation & evacuation)

Suction Curettage

Summary