Gynaecological Endoscopy

Max Brinsmead MB BS PhD

May 2015
Gynaecological Endoscopy:

• Laparoscopy

• Hysteroscopy

• Colposcopy
 Indications for Laparoscopy
• Diagnostic
– For pelvic pain
• Endometriosis
• PID
• Adhesions
• Pelvic congestion etc.
– Infertility
• With tubal insufflation

– Pelvic Mass
• Uterine eg Fibroids
• Ovarian – benign or malignant
• Other
 Indications for Laparoscopy 2
• For Intervention
– Assisted conception (OPU and GIFT)

– Diathermy to endometriosis

– Sterilisation (Clips, Loops or Diathermy)

– Biopsy of ovary or tumours

– Division of adhesions

– Ectopic pregnancy, cysts, oophorectomy

– Advanced surgery – all operations!

 Techniques in Laparoscopy
• Creating the Pneumoperitoneum
– Verres needle
– Direct trochar insertion
– Hassan open technique
– Abdominal wall elevation
– CO2, N2 or other gas
• Reusable or Disposable Equipment
• Direct vision or camera
• Surgical Aids
– Unipolar or Bipolar diathermy
– Laser
– Loops
– Clips
– Long instruments
 Complications of Laparoscopy
• Failure
• Injury to:
– Major blood vessels
– Ureter, Bladder or Bowel
– Uterine perforation from elevator
– Need laparotomy 1:500
• Wound infection
• Gas embolism
• Surgical misadventure
– Inadvertent diathermy perforation
– Peritonitis
• Death
• 1:500,000
 Indications for Hysteroscopy
• Abnormal uterine bleeding
– Post menopausal
– Pre menopausal

• Infertility
– Congenital abnormality
– Adhesions
– Polyps etc.

• Surgical Interventions
– Sterilisation (Essure)
– Division of adhesions
– Removal of benign tumours
– Endometrial ablation
 Techniques in Hysteroscopy
• Distension with:
– Nothing = contact hysteroscopy
– Gas CO2
– Saline
– Glycine

• Blind Entry or Entry under vision

• Hysteroscopic instruments

• Endometrial ablation
– Laser
– Resectoscope
– Roller ball
– Now overtaken with blind thermal or radio HF ablation
Complications of Hysteroscopy:
• Failure
• Cervical Injury

• Uterine perforation
• Fluid overload

• Infection
 Colposcopy
• Indications:
– Evaluation of CIN
– Biopsy target
– Vaginal and vulval examination
– DES exposure

• Techniques:
– Acetic acid
– Schiller’s iodine

• Intervention:
– Outpatient treatment of CIN e.g. Laser
 Any Questions or
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