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WACS > HYSTEROSCOPY IN GYNAECOLOGY > Flashcards

HYSTEROSCOPY IN GYNAECOLOGY Flashcards

1
Q

Definition and types of hysteroscopy

A

Endoscopic visualization of the cervical canal and the uterine cavity

Diagnostic and therapeutic

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2
Q

T/F: Hysteroscopy is considered the ‘gold standard’ procedure for the diagnosis and management of women with intrauterine pathology

A

T

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3
Q

T/F: Routine use of Hysteroscopy as a screening tool in the general population of subfertile women with normal USS or HSG in the basic infertility work-up for improving reproductive success rate – No high-quality evidence

A

T

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4
Q

T/F: Outpatient hysteroscopy before in vitro fertilisation treatment in women with normal ultrasound of the uterine cavity and a history of two to four failed in vitro fertilisation treatment cycles does not improve live birth rate

A

T

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5
Q

5 advantages of diagnostic hysteroscopy

A
  1. Confirm the presence of the lesion.
  2. Identify the location of the
    lesion.
  3. Identify the nature of the lesion.
  4. Plan and undertake treatment
    measures at a later date.
  5. “See and treat”
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6
Q

5 advantages of operative hysteroscopy

A
  1. Increases the precision of
    surgery
  2. Minimizes trauma to the
    endometrial lining
  3. Preclude major surgical
    intervention.
  4. MIS
  5. Shorter hospital stay and
    recovery time.
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7
Q

T/F: There is no reason to avoid diagnostic hysteroscopy before surgery in patients with endometrial cancer especially in early stages

A

T

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8
Q

T/F: No evidence to support an association between preoperative hysteroscopy and a worse prognosis in endometrial cancer

A

T

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9
Q

Levels of pain management in hysteroscopy

A

Level 1 to level 5
Level 3 divided into a and b

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10
Q

3 settings for hysteroscopy

A

Office
Outpatient clinic
Operating room

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11
Q

2 approaches of hysteroscopy

A

Vaginoscopy and speculum assisted

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12
Q

5 models of care in hysteroscopy

A

Office
Outpatient
Ambulatory
Extended recovery
Inpatient

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13
Q

3 indications for diagnostic hysteroscopy

A
  1. Abnormal uterine bleeding
  2. Infertility:
    IUA (Asherman’s syndrome)
    Submucous fibroids
    Endometrial polyps
    Uterine malformations (e.g
    Uterine Septum)
    Fetal bone
  3. Recurrent miscarriages
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14
Q

11 indications for therapeutic hysteroscopy

A
  1. Adhesiolysis
  2. Myomectomy
  3. Polypectomy
  4. Septum resection
  5. Removal of foreign body & IUD
  6. Fallopian tubal cannulation
  7. Placement of intratubal device
    for sterilization
  8. Evacuation of RPOC
  9. Removal of Cornual ectopic
    pregnancy after MTX
  10. Treatment of caesarean scar
    pregnancy
  11. Treatment of Focal
    adenomyosis
  12. Haemangioma and A-V
    malformation
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15
Q

Pattern of findings in hysteroscopy depends on 5 factors:

A

Geographical location
Group of patients
Age
Comorbidity
Drug use e.g Tamoxifen

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16
Q

2 absolute contraindications for hysteroscopy

A

Active uterine/pelvic infection
Cervical Cancer

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17
Q

5 relative contraindications to hysteroscopy

A

Severe systemic illness (Cardiopulmonary disease)
Pregnancy
Heavy uterine bleeding!
Inexperienced Surgeon
Unstable patient

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18
Q

Classification of operative hysteroscopy (RCOG)

A

Level 1
Level 2
Level 3

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19
Q

Level 1 hysteroscopy involves –, – and –

A
  1. Diagnostic hysteroscopy with
    target biopsy
  2. Removal of simple polyps
  3. Removal of IUCD
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20
Q

3 procedures in level 2 hysteroscopy

A
  1. Proximal fallopian tube
    cannulation
  2. Minor Asherman’s syndrome
  3. Removal of pedunculated fibroid
    (Type 0) or large polyp
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21
Q

5 procedures in level 3 hysteroscopy

A
  1. Division/resection of uterine
    septum
  2. Major Asherman’s syndrome
  3. Endometrial resection or
    ablation
  4. Resection of submucous fibroid
    (Type 1 & 2)
  5. Repeat endometrial ablation or
    resection
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22
Q

5 components of patient evaluation for hysteroscopy

A

History
Physical examination
Investigation
Timing of the procedure
Consent

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23
Q

The ideal patient positioning for hysteroscopy

A

Modified lithotomy position

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24
Q

Anaesthesia for level 1 hysteroscopy

A

No medication or the use oral non-sedative medication

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25
Q

Anaesthesia for level 2 hysteroscopy

A

Local anaesthetic to the genital tract

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26
Q

T/F: Conscious sedation for level 3 hysteroscopy

A

T

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27
Q

Anaesthesia for level 3a hysteroscopy

A

Oral or inhalational medications with a sedative effect

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28
Q

Anaesthesia for level 3b hysteroscopy

A

Parenteral medications with a sedative effect

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29
Q

Anaesthesia for pain level 4 hysteroscopy

A

Regional anaesthesia

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30
Q

Anaesthesia for level 5 hysteroscopy

A

General anaesthesia

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31
Q

14 instruments required for hysteroscopy

A

Troley
Monitor (LED)
Camera unit
Light source (LED, Xenon, Halogen)
Light source cable
Telescopes (0, 12, 30 degrees)
Distension media
Infusion pumps (Manual/Automated)
Hysteroscope
Accessory instruments
Electrosurgical generator
Monopolar and bipolar resectoscopes
Electrodes
Advanced tissue removal systems

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32
Q

The 3 degrees of telescopes used for hysteroscopy

A

0, 12 and 20 degrees

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33
Q

3 types of light source used for hysteroscopy

A

LED
Xenon
Halogen

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34
Q

Wattage of the different light sources

A

Halogen - 200w
Xenon - 300w
LED - 150 to 175w

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35
Q

The material for the different light sources

A

Halogen - tungsten
Xenon - Silica quartz
LED - semiconductors mainly gallium

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36
Q

Colour temperature of the various light sources

A

Halogen - 5000 to 5600K
Xenon - 6000 to 6400K
LED - up to 6500K

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37
Q

Heat generated by the light sources

A

Halogen - High
Xenon - High
LED - Less

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38
Q

Life (hours) of the light sources

A

Halogen - 1000 to 2000
Xenon - 2000
LED - 30,000

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39
Q

Colour of light from the light sources

A

Halogen - white with yellowish tint

Xenon - white with bluish tint. More natural compared to halogen

LED - White

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40
Q

Cost comparison of the different light sources

A

Halogen - inexpensive
Xenon - expensive
LED - economical and energy efficient

41
Q

Diameter of rigid telescopes

A

1 - 5mm

42
Q

Diameter of flexible telescopes

A

2.7 - 5mm

43
Q

T/F: Distention media for hysteroscopy can be fluid or gas

A

T

44
Q

2 classes of low viscosity fluids for hysteroscopy

A
  1. Electrolyte/Ionic:
    (N/Saline/Ringer’s lactate)
  2. Non-electrolyte/Non-ionic:
    (Glycine 1.5%, Sorbitol 3%, Mannitol 5%, Dextrose/water 5%)
45
Q

High viscosity fluid for hysteroscopy

A

(Dextran 70, Hyskon{32% Dextran-70 in 10% Glucose})

46
Q

IUP for hysteroscopy

A

below MAP (70 – 150mmHg)

47
Q

Methods of fluid delivery for hysteroscopy

A

(a)Gravity

(b)Infusion pumps
Manual
Electronic

48
Q

The 2 types of hysteroscopic sheath

A

Single channel and dual-channel

49
Q

T/F: the single channel hysteroscopic sheaths are for diagnostic hysteroscopy only

A

T

50
Q

T/F: the dual channel hysteroscopic sheaths are for both diagnostic and operative hysteroscopy

A

T

51
Q

5 accessory instruments in hysteroscopy

A

Scissors
Grasping forceps
Biopsy forceps
Morcellators
Myoma screw

52
Q

2 types of resectoscopes

A

Monopolar and bipolar

53
Q

The 3 basic electrodes of the resectoscopes

A

Roller ball
Collins knife
Cutting loop

54
Q

T/F: Compared to resectoscopes, Truclear/Myosure tissue removal system has shorter operative time and higher likelihood of complete lesion removal

A

T

55
Q

T/F: Truclear/Myosure tissue removal system is more expensive compared to resectoscopes

A

T

56
Q

T/F: The use of antibiotics appears not to be beneficial to prevent infection after hysteroscopy

A

T

57
Q

During hysteroscopy in the absence of an automated fluid monitor, how often do you calculate the fluid deficit

A

Calculate deficit every 5 to 10minutes in the absence of fluid monitor

58
Q

Predetermined limit to TERMINATE the procedure IN HEALTHY FIT WOMEN for fluid deficit

A

300 to 500ml – Dextran
1000ml – Hypotonic (Glycine)
2500ml – Isotonic (N/Saline)
10mmol/L Dec. Serum Na

59
Q

How do you prevent intrauterine adhesions with hysteroscopy

A
  1. Pre-hysteroscopic treatment
    Oestrogen
    GnRH analogue
    SPRM
  2. Barrier methods
    IUD
    Intrauterine Balloon catheter
    Foley catheter
    Malecot catheter
    Cross-linked HA Gels
    Anti-adhesive barrier
  3. Delicate surgical techniques
    Surgical instruments
    Cold scissors
    Electrosurgery
60
Q

T/F: Rate of complication with hysteroscopy is <1%, 2.7%

A

T

61
Q

Complication rate for diagnostic hysteroscopy

A

0.13%

62
Q

Complication rate for operative hysteroscopy

A

0.96%

63
Q

Strongest predictor of complications with hysteroscopy is

A

type of procedure performed.
Adhesiolysis (4.5%)
Endometrial resection (0.8%)
Myomectomy (0.8%)
Polypectomy (0.4%)

64
Q

Complication rate with hysteroscopic adhesiolysis

A

4.5%

65
Q

Complication rate of hysteroscopic endometrial resection

A

0.8%

66
Q

Complication rate of hysteroscopic myomectomy

A

0.8%

67
Q

Complication rate of hysteroscopic polypectomy

A

0.4%

68
Q

T/F: Postoperative complications of hysteroscopy can be early or late

A

T

69
Q

2 early complications of hysteroscopy

A

Infection
Post operative bleeding

70
Q

3 late complications of hysteroscopy

A

Intrauterine adhesions
Haematometria
Uterine rupture during pregnancy

71
Q

2 neurological complications that usually manifest immediately after hysteroscopy

A

Acute compartment syndrome.
Femoral neuropathy

72
Q

2 manifestations of neurological complications following hysteroscopy

A

Foot drop
Lower extremity paresthesia

73
Q

6 risk factors for neurological complication with hysteroscopy

A

Patient malpositioning
Excessive hip flexion, abduction and ext rotation
Excessive pressure over the fibula head
Prolonged operation time
Nerve compression
Assistant surgeons resting on the patient legs

74
Q

4 examples of anaesthetic complications seen in hysteroscopy

A
  1. Inadvertent systemic injection of
    LA
  2. Palpitation & Anxiety from
    vasoconstrictors (Adrenaline)
  3. Complications of regional
    anaesthesia
    Hypotension
    Spinal headaches
    Infection
  4. Complications of GA
75
Q

5 complications of absorption of non-ionic distension medium used with monopolar resection/ablation

A

Hyponatraemia
Pulmonary oedema
Cerebral oedema
Seizures
Death

76
Q

8 types fluid used as of distension media

A
  1. N/S
  2. 5% glucose
  3. 1.5% glycine
  4. 5% DW
  5. 5% Mannitol
  6. 3% Sorbitol
  7. Mannitol/sorbitol (purisol)
  8. 32% Dextran 70 (hyskon)
77
Q

The only hypertonic fluid used for liquid distension

A

32% Dextran 70 (Hyskon)

78
Q

The 2 isotonic fluids used for distension

A

N/S and 5% mannitol

79
Q

T/F: Apart from N/S, 5% mannitol and 32% Dextran all the other fluids used for distension are hypotonic

A

T

80
Q

The only distension fluid that contains physiologic electrolytes is

A

N/S

81
Q

The only distension fluid that has high viscosity is

A

32% Dextran (hyskon)

82
Q

Normal serum level of Na

A

135 - 145

83
Q

At what serum Na level will the patient become restless and what is the treatment

A

120 -135
Oxygen
IV Frusemide 40 – 60mg
0.9% Normal saline

84
Q

At serum Na levels of 110 - 120 what 4 symptoms will the patient have and how will you treat the patient

A

Nausea, Headache, Confusion, Cardiac irregularities

Ventilator support if PE
IV Frusemide 1mg/Kg 4 to 6hrs.
3% hypertonic saline

85
Q

At what serum sodium level will the patient have arrhythmias, Convulsions, Severe hypotension. Coma,

A

<110

86
Q

6 complications of complicated access to the uterine cavity

A

Failed procedure (<2%)
Cervical laceration
Uterine perforation
Avulsion of the endometrium
False passage
Haemorrhage

87
Q

10 risk factors for complicated access to the uterine cavity

A

Nulliparity
Menopausal state
Uterine synechiae
Cervical stenosis
Retroverted uterus
Uterine malformation
Excessive traction
Forceful dilatation
Cervical hypoplasia
Endometrial malignancy

88
Q

Uterine perforation usually occurs during these 3 parts of the procedure

A

Dilatation of the cervix
Insertion of hysteroscope
Resectoscope use

89
Q

3 risk factors of uterine perforation

A

Poor entry technique
Retroverted uterus
Cervical stenosis

90
Q

8 ways of preventing complications arising from difficult access to the uterine cavity

A

Osmotic dilators
PG Gel or Tablet
Preoperative GnRHa
Estrogen prep
Vasopressin (0.05 – 0.1U/ml at 4’ & 8’)
Adhesiolysis with Scissors
Small diameter hysteroscope
Ultrasound/Laparoscopic guidance

91
Q

5 electrosurgical complications

A

Prolonged operation time
Myoma chips removal
Fluid absorption
Fluid overload
Electrolyte derangement

92
Q

T/F: Infection is a commonly seen early complication of hysteroscopy.

A

F. Rare

93
Q

2 risk factors for infection as an early post operative complication of hysteroscopy

A

History of PID
Endometritis

Use antibiotics prophylaxis

94
Q

T/F: Hematometria is a late post operative complication of hysteroscopy

A

T

95
Q

2 ways of preventing hematometria as a late post operative complication of hysteroscopy

A

Avoid the isthmus and cervical canal during resection.

Use of Foley catheter

96
Q

2 causes of intrauterine adhesions as a late postoperative complication of hysteroscopy

A

Excessive resection
Endometrial avulsion

97
Q

3 ways of preventing intrauterine adhesions as a postoperative complication of hysteroscopy

A

Endometrial regeneration (Cyclical Hormonal tablets)

Intrauterine device/balloon catheter

Cross-linked HA gel

98
Q

T/F: Uterine rupture and placenta accreta are late postoperative complications of hysteroscopy

A

T
Prevent by preventing intrauterine adhesions

WACS (19 decks)

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