Gynae Operations

Question 1

What endoscopic surgeries exist?

Answer 1

Diagnostic hysteroscopy and surgery

• transcervical resection of endometrium or fibroid/polyps - reduces blood loss
• resection of uterine septum

Diagnostic laparoscopy and surgery
- sterilisation
- removal of adhesions/endometriosis/ectopic
+ better visualisation, less infection, reduced hospital stay and faster recovery

Question 2

What are indications for a hysterectomy?

Answer 2

Menstrual disorders
Fiborids
Endometriosis
Chronic PID
Prolapse
Malignancies

Question 3

What are the different types of hysterectomy?

Answer 3

Total abdominal - removal of uterus and cervix through abdo incision

• malignancy
• very large/immobile uterus
• abdo inspection
• subtotal leaves the cervix

Vaginal

• removal of cervix and uterus
• used for prolapse

Radical
- removal of parametrium, upper 1/3rd of vagina, pelvic lymph nodes

Question 4

What are complications of a hysterectomy?

Answer 4

Haemorrhage
Bladder or ureteric injury

VTE
Pain
Retention and infection of urine
Prolapse
Premature menopause

Question 5

What operations can be done for cervical intraepithelial neoplasia?

Answer 5

LLETZ
Cutting diathermy under local anaesthetic to remove CIN
Increases risk of preterm delivery

Cone biopsy
Removes transformation zone and endocervix under GA or spinal
Much increased risk of preterm delivery

Question 6

What precautions should be taken before major gynae surgery?

Answer 6

COCP stopped 4 weeks before
Stop HRT or add LMWH

Mobilise early
Stay hydrated
TED stockings