surgical gynaecology Flashcards
What is the standard recommended size scope for outpatient hysteroscopy?
outpatient hysteroscopy should use a 2.7mm hysteroscope
Overall Risk of serious complication for abdominal hysterectomy for benign conditions?
According to the RCOG consent advice
Overall Risk serious complication for abdominal hysterectomy for benign conditions.
4%
Risk of Haemorrhage requiring blood transfusion for abdominal hysterectomy for benign conditions?
Haemorrhage requiring blood transfusion 2.3%
Risk of Bladder and/or ureter injury and/or long-term disturbance of bladder function for abdominal hysterectomy for benign conditions?
Bladder and/or ureter injury and/or long-term disturbance of bladder function
0.7%
Risk of Return to theatre (e.g. because of bleeding/wound dehiscence etc) for abdominal hysterectomy for benign conditions?
0.7%
Risk of VTE related to abdominal hysterectomy for benign conditions?
VTE 0.4%
Risk of Pelvic abscess/infection related to abdominal hysterectomy for benign conditions?
Pelvic abscess/infection: 0.2%
Risk of bowel injury related to abdominal hysterectomy for benign conditions?
Bowel injury: 0.04% (4 in 10 000)
Risk of death within 6 weeks of abdominal hysterectomy for benign conditions?
Risk of death within 6 weeks
0.03%
According to the RCOG advice on risk
What is the equivalent numerical ratio for the term ‘very common’
1/1 to 1/10
According to the RCOG advice on risk
What is the equivalent numerical ratio for the term ‘common’
1/10 to 1/100
According to the RCOG advice on risk
What is the equivalent numerical ratio for the term ‘uncommon’
1/100 to 1/1000
According to the RCOG advice on risk
What is the equivalent numerical ratio for the term ‘rare’
1/1000 to 1/10,000
According to the RCOG advice on risk
What is the equivalent numerical ratio for the term ‘very rare’
Less than 1 / 10,000
Post-operative foot drop is most commonly due to injury of which nerve?
foot drop is most commonly the result of common peroneal nerve injury
often due to compression of the nerve as it winds around the proximal fibula
incidence of vascular injury during laparoscopy according to the Green-top guidelines is?
0.1-0.2/1000
Major vessel injury is the most important potential complication at laparoscopy.
Bowel Injury is more common - 0.4/1000
incidence of bowel injury during laparoscopy according to the Green-top guidelines is?
0.4/1000
Overall incidence of serious complication during laparoscopy according to the Green-top guidelines is?
Overall risk of ‘serous complications’ is 2/1000
Overall incidence of death related to laparoscopy according to the Green-top guidelines is?
Risk of death is 5 in 100,000
Which nerves may be injured with abdominal incision and may cause pain to the groin
Iliohypogastric and Ilioinguinal nerves
iliohypogatsric injury - pain extends from incision laterally to the inguinal and suprapubic regions.
Ilioinguinal injury - hyperesthesia or hypoesthesia of the skin along the inguinal ligament. May radiate to lower abdomen. Pain may be localised to medial groin, labia majora and inner thigh
What symptoms will injury to the femoral branch of the genitofemoral nerve cause?
hypoesthesia over anterior thigh below the inguinal ligament
What is the maximum dose of lidocaine with adrenaline
maximum dose of lidocaine with adrenaline
7mg/kg
What is the Max dose of
Lidocaine
Lidocaine Max dose is 3mg/kg
7mg/kg with adrenaline
1% lidocaine is 10mg/ml
Mode of action of lidocaine
Lidocaine Blocks fast voltage gated sodium channels
Half life of lidocaine
Lidocaine Half life
2 hours
What is the route of metabolism of lidocaine?
Hepatic metabolism
Overall incidence of significant complication during surgical evacuation of the uterus according to the Green-top guidelines is?
Surgical Evacuation of the Uterus
The overall significant complication rate
approx 6%
incidence of bleeding requiring transfusion related to surgical evacuation of the uterus according to the Green-top guidelines is?
Bleeding necessitating transfusion
uncommon 0-3 in 1000
incidence of infection related to surgical evacuation of the uterus according to the Green-top guidelines is?
Infection 4%
incidence of retained placental or feral tissue related to surgical evacuation of the uterus according to the Green-top guidelines is?
Retained placental or fetal tissue 4%
incidence of intrauterine adhesions related to surgical evacuation of the uterus according to the Green-top guidelines is?
19%
incidence of uterine perforation related to surgical evacuation of the uterus according to the Green-top guidelines is?
Uterine perforation 1 in 1000
incidence of Cervical trauma related to surgical evacuation of the uterus according to the Green-top guidelines is?
Cervical trauma <1 in 1000
1% lidocaine is how many mg/ml
1% lidocaine is 10mg/ml
Embolisation of which artery is considered by NICE as one of the 1st line surgical management options of HMB caused by fibroids?
Uterine
Uterine artery embolisation (UAE) is a treatment option for fibroids and adenomyosis
What is the absorption time of monocryl sutures in days?
90-120 days
What is the absorption time of Vicryl sutures in days?
60-90 days
What is the absorption time of Vicryl Rapide sutures in days?
7-14 days
What is the absorption time of PDS sutures in days?
180-210 days
Complications of UAE
Complications are typically late (>30 days post procedure) and include
Vaginal discharge (16% at 12months)
Expulsion fibroid material (10%)
Endometritis (0.5%)
Amenorrhoea (age dependent <1% in women under 40 years old)
Change in sexual function (worse in 10%, improved in 26%, unchanged in most)
Fir a diagnostic laparoscopy what is the appropriate pressure for gas insufflation prior to inserting the primary trocar?
20-25 mmHg
For a diagnostic laparoscopy what is the appropriate distension pressure once the trocars have been inserted?
12 - 15 mmHg
What are the reintervention rates for women undergoing UAE
1 in 3 by 5 years
For symptom recurrence or complication
significantly higher with UAE compared to surgery (only 4:100)
What is Post-embolisation syndrome?
Post-embolisation syndrome - typically an early complication of UAE.
consists of pain, nausea, fever and malaise. +/- raised inflammatory markers and white cell count.
Usually self limiting and subsides within 10 - 14 days
