Hysterectomy and hysteroscopy

Question 1

Keys facts about hysterectomy

Answer 1

• Ensure alternatives are explained eg Mirena for endometriosis
• Pt should know she will be infertile
• Impact on sexual function, bladder function and psychology
• Stops bleeding but not necessarily pelvic pain

Question 2

Frequent risks

Answer 2

• Pain
• Wound infection
• Numbness/ tingling around the scar
• UTI
• Ovarian failure

Question 3

Serious risks of hysterectomy

Answer 3

• Bleeding, needing tx- 23/1000 common
• Pelvic abscess 2:1000
• Serious complications 4:100
• Damage to bladder/ureter 7:1000, uncommon
• Bowel injury- rare
• Return to theatre, 7:1000 uncommon
• VTE/PET 4:1000, uncommon
• Death in 6w rare

Question 4

Other consent for hysterectomy

Answer 4

• Subtotal hyst
• Oopherectomy- incase abnormal or bleeding
• Repair of injuries

Question 5

OP hysteroscopy setting

Answer 5

• Not in theatre
• Well equiped
• Trained staff
• Private changing facilities

Question 6

Pre OP hysteroscopy

Answer 6

• Consent
• Leaflet

Question 7

Analgesia OP hysteroscopy

Answer 7

• NSAIDS 1h before if not allergic
• Dont use opioids
• Do not use routine cervical prep/conscious sedation

Question 8

OP hysteroscopy steps

Answer 8

• 2.7mm scope with 3-3.5mm sheath
• Degree of scope- up to operator
• Saline/CO2 distension
• Saline - better views and can use bipolar
• Dilate if needed
• Local anaesthetic if dilation or tenaculum is needed