Hysteroscopy and Hysterectomy

Hysterectomy

The flexible hystersocpe can be used as an out patient procedure as its fairly simple…but is only diagnostic and not therapeurtiv as the rigid one..because in the rigid one, you can put in instruments as well and do procedures. But the rigid you have to get the orientation of the uterus correct or it can lead to perforation. Rigid has better resolution as well. 1. orintation and can perforate 2 better resolutio 3 needs anesthsia (cause need cervical dilatation) 4 can do both diagnostic and operative.

Get abnormal uterine bleeding endometrial aspiration is enough but if you're suspecting malignancy then better to do what a hysteroscopy and biospy as well or d and c if bleeding and stuff

If there is a lot of scarring it is called ashermans syndrome where adhesions is a typical feature

The polypcan be an can either an endometrioid Polyp or a fibroid polyp either endometrial or a muscle

To septate uterus can also be bicornuate uterus and the only way to differentiate the two is by seeing the fundus whether its dipping or not and it can be done by either MRI or ultrasound but also you can combine hysterecopy with laparoscopy

Sometimes it's difficult to differentiate between a submucous polyp/ fribroid and endometroid polyp but it can be done by seeing features like friability and a feeding vessel but definitive diagnosis is done by HPE. So theres names for the different procedures involved like myomectomy and polypectomy but final diagnosis is by HPE so HPE can even cause a name change to the surgery that was done!! (fleshy, friaiity vs feeding vessel sign)

Ahdesionolysis can be done you say a caustery which can reduce bleeding because both taking out and stopping bleeding is done by the same instrument

When IUCDS get stuck inside with thread missing then it can be taken out by other methods like using a special instruments are trying to take it out but if that fails can use a hysterectomy

Endometrial ablation is done when medical methods have failed and if the woman doesn't want surgical methods and wants to preserve uterus

Cervical procedures can be tough when theres adhesions and previous procedures done but theres cervica priming agents that can be applied to prime the cervix

Perforation of the uterus can be done if gone too deep and if the angle was wrong that is why it is important to do an abdominals examination before introducing instruments in to determine theangle and also when using cauteriser and cutting septum can go into tape and that is bye now a days they prefer to do it with ultrasound or laposcopic guidance

Complications of air embolism is very very rare but any procedure where you put instruments and scopes can lead to air embolism

Hysteroscopy doesnt need a new general anesthesia and can be done only with IV sedation but if there is problem with the cervix then you can use priming agents and stuff and for that you can do a para cervical block for some patients can be uneasy so anesthesia can be done y case to case basis

Carbon dioxide is used as an distension agent for laparoscopy but is not used in his hysterecopy because it can leak to the abdomen through the tubes an cause shoulder and abdominal cramps and difficult to stop bleeding if there is bleeding

and and dextran isn’t used because can lead to anaphylactic reactions and high viscosity so makes it difficult to put in and out.

can lead to fluid overload by leaking into the uterine muscle layers and getting into the blood vesselss and also leaking to the abdomen though through the tubes at way so can extravsate and lead to other problens as wel

glycine is more clearer than saline because when sailine gets mixed with blood it can get hazy for a moment but lysine doesn't mix with blood so its much clearer

the advantage of saline is that it doesn’t cause fluid overload as much as glycine but the disad is that only bipolar can be used and unipolar cannot

but nowadays more and more instruments are made that can be used with saline

fluid overload can happen if you use high oressure or glycine or for long time

hysterectomy is a major surgery with so many complications so shouldn’t be taken lightly ..if its benign cause then don’t and move away from it…but for malignant causes then okay as long it meats the stage wise treatment protocols.

Also its seen that it leads to ovarian failure in a few years so for benign and for younger women we shouldn’t do it. Use other surgery treatment methods instead.

Uterus spairing treatment vs fertiit sparing treatment

not only for fertility but to avoid menapausal symptoms!

Laposcopy requires general aneesthesia but the other desont…\..adbominal route doesn’t?

If obese can lead to more anetshia complication so laposcopy isn’t preferre….also isn’t preferred because harer to insert laposcope in obese people …abdominal isn’t preferred but vaginal route is

Vaginal route and lapsocpic route is similar and they have similar problems…but important differene is that vaginal route is preferred in obese patients and vaginal has less ueteric injury risk

Usually lap and vaginal is preferred and lap is preferred when the surgeon is skilled..its a clean and non malignant surgery and the uterus is small in szoe and case selection is good and its not a complicated surgery but otherwise abdominal is preferred => complicated, large, malignancy

There is types of hysterectomy and routes o hysterectomy which is two separate things..for example total and subtotal are two types of hysterectomy that can be done in either routes . its independent and the types can be done I different routes

In patients with cardiac compromise lap is C/I because in lap the abdomen is distended and that can press on the vena cava and the diaprhragm leading to more load on the heart and that caan precipitate heart failure.

For haem unstable patients we prefer laparotomy over laposocpy because laposcopy takes time putting the hole and stuff and putting instrumnets in

Nowadays rarely we do subtotal or supracervical hysterectomy…because why keep the cervix?

Whether or not to remove the pvaries depend on the age…like for post menapusal then can remove the ovaries but before that keep it? To prevent premature menapause

Don’t resort to hysterectomy if it’s a benign disease. And don’t remove ovaires if its young..but if malignant then can remove ovaries.for 40 to 50 years it dpends on case by case basis.

The ture ligaments are the ligaments that are found between bones..these ligaments are just concentrations of connective tissue and the broad ligemants is nothing but a fold of peritoneum that has dragged by and the fallopian tube lies on top

The cardinal ligaments and the uterine sacral ligaments are at the same level and the must know the three ligaments at the cirnu and their relationships…the fallopian tube, the ovarian ligaments and the round ligament. The infundipulopelvic ligaments is found in the other side. And broad ligament is the surrounding sheeths of perionuem.

The uterine arteries runs along the uetero scral ligaments and the ovarian arteries runs along the infuncidbulopelvic ligaments….

If you want to spare the ovaries must clamp at the ovarian ligaments, otherwise must clamp the infundipulo ligament which has a risk of uetrnine injuries as well

Can identify the ureter from a an artery by the characteristic feel and the artery pulsate

Bowel injuries are very very rare but can happen in complicated surgeries with many adhesions

Bladder injuries can happen because the peritoneum folds in front of the uterus…so need to dissect and pull that part out..so if surgeon is not skilled or so many adhesions can lead to bladder injuries

To prevent ureter inuries clamp and cut as close to the uterus as possible which is not possible for radical hystercetomies as need to dissect further apart and even the parametrium is cut

In radical hysterectomies the ligaments are taken out as well as cut further away from the uterus but in simple its cut close to the uterus and the ligaments are sparred and kept inside.

In radical hysteretomies must identify the ureter and then spare the ureter.in complicated surgeries this is difficult so urological surgeon can be called to identify the ureter and to repair any damage caused and can put stents to identify the ureter so can spare it.