Gynae Surgery Flashcards
What is total hysterectomy?
Removal of uterus and cervix
What is sub-total hysterectomy?
Removal of body of uterus only, leaving cervix behind (will need smears)
What is total hysterectomy and bilateral salpingo-oophorectomy?
Removal of uterus, cervix, fallopian tubes and ovaries
What is radical hysterectomy?
Removal of uterus, cervix, parametric, vaignal cuff, part of or whole fallopian tubes
Ovaries may be removed or left behind depending on age
What are the approaches to hysterectomy?
Abdominal -via incision in abdomen
Vagina - via incision in the superior vagina
Laparoscopic - via small incisions in the abdomen and using laparoscopes
What advice after hysterectomy?
Mobilisation as soon as possible
What are indications for hysterectomy?
Heavy menstrual bleeding Pelvic pain Uterine prolpase Gynae malignancy Risk reduction - BRCA1, BRCA2, Lynch syndrome
What are complications fo hysterectomy?
Bleeding
Infection
Pain
Damage to bladder and/or ureter Damage to bowel Haemorrhage requiring transfusion Wound dehiscence Pelvic abscess VTE/PE Scarring Early menopause if ovaries retained due to sharing of blood supply with uterine arteries
When is hysterocopy used?
Diagnosis of abnormal uterine bleeding
Curette is used after removal of hysteroscope to take endometrial biopsies
Transcervical removal of fibroids
Shave off submucosal fibroids or polyps
Risks:
Bleeding, infection, perforation of uterus, damage to cervix, injury to surrounding organs
What is endometrial ablation?
Endometrium is destroyed by diathermy, microwave, electrical or thermal balloon
Reduces bleeding by destruction of the endometrium down to the basalts layer
Commonly performed with hystersscopy immediately prior
What are indications for endometrial ablation?
Heavy periods (menorrhagia)
Can only be offered to women who have completed their family
Reliable contraception is required following the procedure
Pregnancy is associated with life-threatening complications - placenta praevia and/or placenta accreta
What are contraindications to endometrial ablation?
Women who would like to retain their fertility or who have a diagnosis of endometrial hyperplasia or malignancy
What are risks of endometrial ablation?
Bleeding Infection Uterine perforation Failed procedure Scarring Haematometra
What is colporrhaphy?
Lack of support from anterior or posterior vaginal wall in cases of prolapse is rectified by excising redundant mucosa and doing a fascial repair
Does not correct urinary incontinence
Risks: Bleeding Infection Injury to bladder, bowel, urethras Dyspareunia Recurrence VTE
Describe surgical management of miscarriage
Prostaglandin administered PV prior to procedure to reduce the risk of cervical or uterine trauma
Cervix is grapes and dilated to 2cm
Curettes is used to remove products of contraception under suction
Risks: Bleeding Infection Perforation Uterus Retained products of conception Intrauterine adhesions Cervical tears
