3. Common Investigations and Procedures Flashcards
Name the imaging modality of choice for pelvic structures (1)
transabdominal or transvaginal U/S
Between transabdominal and transvaginal U/S, what’s better to provide better resolution of uterus and adnexal structures? (3)
- transvaginal U/S
- detects early pregnancy if β-hCG ≥1500 (β-hCG must be ≥6500 for transabdominal U/S)
Name pelvic pathologies identifiable on ultrasound (5)
- identify pelvic pathology
- identify ectopic pregnancy, intrauterine pregnancy
- assess uterine, adnexal, cul-de-sac, and ovarian masses (e.g. solid or cystic)
- determine endometrial thickness, locate/characterize fibroids
- monitor follicles during assisted reproduction
- assess endometrial lining in postmenopausal women
Every woman of childbearing age presenting to ER with abdominal or pelvic pain should have what? (1)
have β-hCG measured
Define: Endometrial Biopsy (2)
- performed in the office using an endometrial suction curette (pipelle) guided through the cervix to aspirate fragments of endometrium
- pre-treatment with misoprostol (Cytotec®) is optional
- more invasive procedure (i.e. D&C) may be done in the office or operating room ± hysteroscopy. This may be required if endometrial biopsy is not possible in the office setting or if there is suspicion for an endometrial polyp
Name indications: Endometrial Biopsy (5)
- Abnormal uterine bleeding (AUB)/Post-menopausal bleeding (PMB)
- age >40
- risk factors for or history of endometrial cancer
- failure of medical treatment
- significant intermenstrual bleeding
- consider in women with infrequent menses suggesting anovulatory cycles
Name indications: Hysterectomy (6)
- uterine fibroids
- endometriosis, adenomyosis
- uterine prolapse
- pelvic pain
- Abnormal uterine bleeding (AUB)
- cancer (endometrium, ovaries, fallopian tubes, cervix)
Name complications: Hysterectomy (5)
- general anesthetic
- bleeding
- infection
- injury to other organs (ureter, bladder, rectum)
- loss of ovarian function (if ovaries removed, iatrogenic menopause)
Name approaches: Hysterectomy (2)
- Open (abdominal approach): uterus removed via transverse (Pfannenstiel) or midline laparotomy
- Minimally invasive approaches
- vaginal hysterectomy
- laparoscopic-assisted vaginal hysterectomy
- total laparoscopic hysterectomy
- robotic
Describe: vaginal hysterectomy (2)
- entire procedure performed through the vagina.
- No abdominal incisions
Describe: laparoscopic-assisted vaginal hysterectomy (1)
vascular pedicles are divided by a combination of laparoscopic and vaginal approaches
Describe: total laparoscopic hysterectomy (1)
all vascular pedicles including the colpotomy approached laparoscopically and removed through the vagina
Describe: Robocic hysterectomy (3)
- a type of laparoscopic approach.
- May be advantageous in high BMI patients.
- More costly
Describe: Hysterectomy for Benign Gynaecological Indications (5)
- Hysterectomy should be approached by either vaginal, laparoscopic, or open routes
- Correction of preoperative anemia (hemoglobin <120 g/L), preoperative antibiotic prophylaxis, and measures to decrease risk of venous thromboembolism are recommended
- In patients with endometriosis, full excision of local endometriosis should be performed concurrently
- Opportunistic salpingectomy can be considered at the time of hysterectomy, but the planned surgical approach should not be changed for this sole purpose
- Urinary tract injury is a known complication of hysterectomy and there should be a low threshold for further investigation in cases where injury is suspected- consider routine cystoscopy
Describe: Subtotal Hysterectomy
- Tissues removed
- Indications
- Tissues removed: Uterus
- Indications:
- Inaccessible cervix (e.g. adhesions)
- Patient choice/preference
- Severe endometriosis
