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OBGYN > 8: LAPAROSCOPIC PROCEDURES > Flashcards

8: LAPAROSCOPIC PROCEDURES Flashcards

1
Q

% adhesion formation of omentum

A

68%

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2
Q

% adhesion formation of small intestine

A

67%

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3
Q

% adhesion formation of colon

A

41%

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4
Q

Dissecting avascular adhesions

A

Blunt traction/countertraction
Sharp

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5
Q

What has the greatest thermal spread out of monopolar, bipolar, ultrasonic?

A

Bipolar > Monopolar > Ultrasonic

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6
Q

% of ectopics in fallopian tube

A

90%

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7
Q

RFs ectopic

A

Previous ectopic
Fallopian tube damage
Prior tubal surgery
Prior pelvic surgery
ART
Smoking
1/2 have no RFs

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8
Q

Indications for salpingectomy over salpingostomy for ectopic

A

Salpingectomy preferred if:
Tubal damage or extensive bleeding from tube
Appropriate if desired future fertility and LSC evidence of healthy contralateral fallopian tube

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9
Q

Indications for salpingostomy over salpingectomy for ectopic

A

Salpingostomy preferred if:
Desire future fertility or evidence of damage to contralateral fallopian tube/someone who would require ART if salpingectomy is performed

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10
Q

Residual trophoblastic disease after salpingostomy may be as high as __%

A

20%

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11
Q

How to decrease risk of residual trophoblastic tissue after salpingostomy

A

Consider MTX prior

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12
Q

Difference in recurrent ectopic rate after salpingectomy vs salpingostomy?

A

RCT shows no difference in recurrent ectopics or IUP rates when comparing the two

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13
Q

Post-op care after salpingostomy

A

Follow bhcg to 0 (even if path shows trophoblastic tissue)

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14
Q

Indications for ovarian cystectomy

A

Benign
Intact technique to leave functional ovary in place

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15
Q

Do you need to reconstruct ovary after cystectomy?

A

Not unless needed for hemostasis (it will heal by secondary intention)

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16
Q

Hemostatic options for ovary

A

Minor bleeding - hemostatic agents (ex: topical thrombin, fibrin sealant)
Moderate bleeding - suture ligation, electrosurgery
Severe uncontrolled bleeding - consider oophorectomy

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17
Q

Oophorectomy infications

A

Benign ovarian neoplasm not amenable to cystectomy
Risk-reducing surgery (ex: ovarian or breast cancer)
Ovarian torsion or non-viable ovary
TOA refractory to conservative management
Cancer
Gender dysphoria with no desire for future fertiility

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18
Q

RFs ovarian torsion

A

Reproductive age
Ovarian mass >5cm
Pregnancy (especially between 11-17w)
Ovulation induction
Prior torsion

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19
Q

Sensitivity of US for ovarian torsion

A

40-75%

20
Q

When to do oophorectomy after torsion

A

If obvious necrosis
If ovary is black with gelatinous/friable tissue
In post-menopausal to prevent recurrence
If malignancy is suggested, salpingoophorectomy is recommended

21
Q

Prevention of ovarian torsion recurrence

A

Ovarian cyst suppression (hormonal)
Oophoropexy or shortening of uteroovarian ligament (consider if recurrent torsion, torsion of normal ovaries, or if ovary is greatly enlarged but without discrete mass

22
Q

Fibroids are reason for ___ of hysterectomies

A

1/3

23
Q

Benefits of LSC myomectomy over open

A

Reduced pain
Decreased fever
Shorter hospitalization

24
Q

Difference in pregnancy rates, recurrence rates, and uterine rupture rates for LSC vs open myomectomy

A

Unchanged

25
Q

Most common complication of minimally-invasive myomectomy

A

Hemorrhage

26
Q

Average blood loss for LSC myomectomy

A

20-80cc

27
Q

Upper limit % of transfusion rate for LSC myomectomy

A

28%

28
Q

Hysterectomy rate during LSC myomectomy

A

4%

29
Q

Meds to decrease risk of LSC myomectomy

A

Misoprostol, dilute vasopressin, GnRH agonist

30
Q

RFs for adhesive disease with LSC myomectomy

A

Removal of posterior fibroid
Larger incision size
Longer surgical time
Higher # of surgical knots
Higher # of fibroids removed/larger size

31
Q

How to decrease risk of adhesive disease during LSC myomectomy

A

Gently handling tissues
Avoid tissue drying
Adequate hemostasis
Running

32
Q

Incidence of urinary tract injury for pelvic surgery

A

1%

33
Q

Incidence of ureter injury

A

0.3-1.5%

34
Q

Gyn surgery % responsible for iatrogenic ureteral injuries d/t close proximity of the ureters

A

75%

35
Q

% of ureteral injuries at vaginal cuff

A

71%

36
Q

% of ureteral injuries at pelvic brim

A

29%

37
Q

Contraindications to supracervical hysterectomy

A

Malignancy of the cervix or uterus
History of cervical dysplasia (d/t risk of occult malignancy)
History of endometrial hyperplasia

38
Q

Post-op supracervical risks

A

Persistent cyclic bleeding (2/2 residual LUS endometrial remaining in cervical stump)
Persistent pain (up to 38% of women)
Need for additional surgery (ex: women with endo are more likely to have persistent bleeding/pain after supracervical)

39
Q

Trachelectomy needed in ___ of women after supracervical hysterectomy

A

1/4

40
Q

Supracervical benefits over total

A

Decreased operative time
Decreased blood loss
No risk of cuff dehiscence

41
Q

Difference in prolapse, urinary incontinence, sexual satisfaction, and surgical risk or supracervical vs regular hysterectomy?

A

NO DIFFERENCE

42
Q

Indications for operative management for endometrioma

A

Pain associated with cyst
Optimize fertility for ART
Enlarging size

43
Q

Expectant management for endometrioma

A

Will not resolve with expectant/medical management
Can consider if small or asymptomatic

44
Q

Recurrence rate of endometrioma if drained

A

80-100%

45
Q

Preferred surgical intervention for endometrioma

A

Cystectomy

46
Q

Post-operative management of endometriomas

A

COCPs (cyclic and continuous)
GnRH Agonist
GnRH Antagonist
Progestins
LNG IUD

OBGYN (16 decks)

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