5 Pathology Benign Malignant Other Vulvar Vaginal Cervical Uterine OvarianOtherEndometriosis - the presence and growth of functioning endometrial tissue in places other than the uterus that often results in severe painCystocele - herniation of bladder into vaginaRectocele (posterior colporrhaphy) - herniation of rectum into vaginaEnterocele - herniation of cul-de-sac of Douglas/includes loops of intestines into vaginaEctopic Pregnancy - The implantation and subsequent development of a fertilized egg outside the uterusIncompetent Cervix (cerclage) -BenignCystsPolyps (pedunculated lesion)FistulasDysplasia= abnormal tissue growthLeiomyoma/Myoma/Fibroid - smooth muscle tumorFibroma - connective tissue tumorCystocele= 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.
12 Gynecological Procedures ColposcopyHysteroscopyD & CD & ELaparoscopyHysterectomy Oophorectomy SalpingectomyAbdominal Hysterectomysubtotaltotalradical (Wertheim)VaginalLAVHA & 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 positionBartholin’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).
18 LaparoscopyDefinition-Visualization of the peritoneal cavity through the anterior abdominal wall(For optimal visualization must have pneumoperitoneum)Procedures-Diagnosis, Evaluation, InterventionLaser and Electrosurgery may be used
19 Laparoscopy Continued Instruments:Verres NeedleSilastic Tubing with connectorTrocar and Sleeve x 2Laparoscope Laparoscopic scissorsLight Cord Laparoscopic graspersCamera Bipolar forceps (Kleppinger)Biopsy forceps Ball and Loop Electrodes
20 Laparoscopy Procedure Small incision at umbilicusAbdominal 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 graspersItems 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 thicknessSteri-strips may be used and Bandaids are applied to the incision sitesA peri-pad is placed for the patientKeep 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 HysteroscopyDefinition-Endoscopic visualization of the uterine cavity and openings or orifices to the fallopian tubesIntroduced vaginallyUsed for diagnosis and interventionDiagnosis/Intervention: abnormal bleeding, endometriosis, IUD removal, infertility evaluation, polyps, sterilization, and adhesionsLaser/electrosurgery may be usedBiopsy 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 forwardDepth of cavity may be measured with a uterine sound or modified grasper with soundCervix may be dilated with Pratt, Hanks, or Hegar dilatorsScope/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 telfaIf 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 dextroseGlycineSorbitolAbove may all be used with laser or cauteryHyskon (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 AbortionsMissed - parts of non-living conception and in uterus more than 2 monthsIncomplete - products of conception retained in uterusImminent - about to abortSpontaneous - abortion occurs without being inducedVoluntaryMissed-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 therapeuticDiagnostic: dysmenorrhea, endometriosis, rule out pregnacy before sterilization, infertilityTherapeutic: 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 awakeCervix is grasped with tenaculum and dilated with Pratt, Hanks, or Hegar dilatorsUterine sound may be used to determine depth of the uterine cavitySmooth, sharp, or Heany uterine curettes will be used to clean out the uterine cavitySuction may be used in conjuction or soloTissue may be sent for culture place it on a piece of telfaPeri-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 miscarriagesProcedure: Speculum, tenaculum, dilators, suction apparatus, curettes may be needed, peri-pad placed
32 Summary Female Anatomy Pathology Miscellaneous Procedure Overview Instrumentation ReviewLaparoscopy(diagnostic or operative)HysteroscopyD & C (dilation & curettage)D & E (dilation & evacuation)Suction Curettage