gynecology 5th year, 1st & 2nd lectures (dr. abir mohidien said)
DESCRIPTION
The lecture has been given on May 9th & 11th, 2011 by Dr. Abir Mohidien Said.TRANSCRIPT
DR: Abir Mohidien Said
*
*
About 80% of all the gyn.surgeries are
elective, this means that there are other
alternative treatments to be considered, the
appropriateness of the dicision making depends
on the physician & patient on an individual
basis, prepair for operation is
important, information about
operation, risk, alternative.
*
*D&C one of the most commen minor gyn.op.
*D&C may be a diagnostic or a therapeutic procedure
*A diagnostic is performed for:
* Premenopausal irreguler menstrual bleeding
* Post menapausal bleeding
* Suspected Ca. of cervix or endometium(fractional curettage)
*Therapeutic effect with very heavy bleeding
*
*Perforation of the uterus. It is not uncommen &
occurs particulary with a retroverted uterus
*Infection ( always 2 typs
antibiotic, aerobic&nonaerobic)
*Hemorrhage
*Continuing pregnancy
*Retained products of conception
*Cervical damage
*
* A cone shaped portion of the cervix removed therapeutic &
diagnostic purposes
*Therapeutic ( cervical dysplasia or chronic cervicitis)
*Performed by using knive or loop electrosurgical excision or
by laser ( give nice scar & less bleeding)
*
*
*Is commonly used to treat condylomas of the
cervix, vagina,perinium & vulva
*To treat chronic cervicitis
*Dysplasia of the vulva
*Vaporization or coagulation of endometriosis (
laproscopic)
*
*
*Using a device called laparoscope( telescope)
*CO2 inflation ( few liters about 3-4 L)
*Laproscopy is two types:
* Diagnostic laparoscopy
*Operative Laparoscopy
*
*Unexplained infertility
*Tubal patancy testing
*Adenexal, uterin pathology congenital or
acquired
*Acute abdomen, suspected ectopic gestation
*
*Tubutomy & ectopic preg. removed
*Salpingectomy with Ectopic pregnancy
*Salpingo oophorectomy (prophylxic,ect)
*Exicesion of the ovarium cyst
*Oophorectomy exicesion
*Adhesion lysis
*Vaporization of the endometriosis
*LAVH
*Sterilisation & abdominal IUD removal
*
*Penetrating injuries from veress needle
*Perforation of the bowel
*Perforetion of the blood vessels
*Damage to bowel and bladder during diathermy
*Gas embolism
*Bleeding
*Infection
*
*Now very commen, means the visualization of the
endometrial & endocervical lining & the cavity by
using a flexible or raged telescope.
*Diagnosis or operative
*Diagnosis of any congenital ( uterin septum etc)
*Operative of uterine pathology ( endometrial
,cervical polypectomy or submucus fibroids
etc)
*
*
*
*Perforation during cevix dilitation
*Uterin perforation
*Bowel or bladder damage ( diathermy )
*Fluid absorption ( manitol , NACL )
*Bleeding
*Infection
*Air embolism
*
*Full bladder with water & induced the
cystoscop throw the urethra to the blader
*Rigid or flexible cystoscop
*Gynaecologist used only for diagnostic, after
recurrent cystitis, haematuria, suspected polyp
& to se perforation, after induced tape of
incontinence operation.( TVT, TOT)
*
*Total hysterectomy
*Subtotal/ supravaginal hysterectomy
*Radical hysterectomy( Wertheim operation)
*Total hyterectomy with bilatral/unilateral
salpingo-oophorectomy
*Vaginal hysterectomy
*LAVH (laproscopically-assisted vaginal
hysterectomy)
*
*Bleeding
*Wound infection (deep or superfacial)
*Cystitis
*Urin retention
*Embolism ( DVT, lung)
*Damage to the intestine, blader, ureter)
*Sever painfull
*Complication of GA
*
*Stress incontinens (laxity of the urethra)
TVT ( Tension -free Vaginal Tape)
TOT ( Trans Obturator Tape)
Burch operation (permanent stitches
are placed near the neck of the bladder and fixed to the
back of the pubic)
*
*Cystocele repair, large cystoceles may require
surgery to push up the bladder away from the
vagina & support it so it will stay in anormal
position
*Complication: bladder perforation,urge
incontinence,infection & bleeding
*
*Rectocele repair, occurs when rectum start to
fall to the front & pushes against the back wall
of the vagina
*Push up the rectum away from the vagina &
support it so it will stay in amore normal
position
*Complication : intestine
perforation, infection, bleeding,stenosis of
vagina & dysparunia
*
THANKS