Surgeries

Question 1

What are some surgeries in gynaecology?

Answer 1

• laparoscopic surgery
• myomectomy
• adhesiolysis in endometriosis
• endometrial ablation
• hysteroscopy with resection of submucosal fibroids
• hysterectomy -abdominal/laparoscopic/vaginal
• Hysterectomy and bilateral salpingo-opherectomy
• miscarriage dilation and curettage
• uterine artery embolisation
• Ovarian drilling
• Ovarian cyctectomy
• oophorectomy
• colposcopy biopsy or excision
• tension-free vaginal tape
• autologous sling procedures
• colposuspension
• intramural urethral bulking
• word catheter
• marsupialisation

Question 2

What does a myomectomy involve?

Answer 2

• involves surgically removing a fibroid via laparoscopic surgery or laparotomy (open surgery) depending on stability of patient
• only treatment known to potentially improve fertility in patients with fibroids

Question 3

What does endometrial ablation involve?

Answer 3

• involves destroying the endometrium
• second-generation non-hysteroscopic techniques are used
• an example of one of these techniques is balloon thermal ablation, where a balloon is passed into the endometrial cavity filling it with high-temp fluid that burns the endometrial lining

Question 4

What conditions can endometrial ablation be used for?

Answer 4

• fibroids
• menorrhagia -> last resort when medication fails
• adenomyosis

Question 5

What does a hysterectomy involve?

Answer 5

• involves removing the uterus.
• may be laparoscopic, laparotomy, or vaginal approach
• ovaries may be removed or left depending on patient preference, risks and benefits

Question 6

What does adhesiolysis in endometriosis involve?

Answer 6

• Laparoscopic surgery can be used to excise or ablate the ectopic endometrial tissue.
• In women where there is chronic pelvic pain due to adhesions, surgery can be used to dissect the adhesions and attempt to return the anatomy to normal -> this is called ahesiolysis

Question 7

What does uterine artery embolisation involve?

Answer 7

-radiologist inserts catheter into an artery, usually femoral artery –> catheter passed through to the uterine artery under X-ray guidance–> once in correct place, particles are injected that cause a blockage in the arterial supply to the fibroid/adenomysis

Question 8

What can uterine artery embolisation be used for?

Answer 8

• large fibroids

- adenomyosis

Question 9

What is the surgical management options for menorrhagia?

Answer 9

• endometrial ablation

- hysterectomy

Question 10

What is the surgical management options for endometriosis?

Answer 10

• laparoscopic surgery to excise or ablate endometrial tissue and adhesiolysis
• hysterectomy
• laparoscopic treatment may improve fertility

Question 11

What are the surgical management options for fibroids?

Answer 11

for smaller fibroids (<3cm):

• endometrial ablation
• resection of submucosal fibroids during hysteroscopy
• hysterectomy

for larger fibroids (>3cm)

• uterine artery embolisation
• myomectomy
• hysterectomy

-GnRH agonists, such as goserelin (Zoladex) or leuprorelin (Prostap), may be used to reduce the size of fibroids before surgery.

Question 12

What are the surgical management options for ovarian cysts?

Answer 12

• laparoscopic ovarian cystectomy
• oophorectomy
• theatre