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Laparoscopy and hysteroscopy (hysteroscopy (Complications (Distant…
Laparoscopy and hysteroscopy
hysteroscopy
endoscopic visualization of uterine cavity, and managmenet within it localized lesions
Media used to expand the uterus:
Gas-CO2 - only diagnostic hysteroscopy, the presence of mucus, blood, fluid in the uterine cavity formed gas bubbles which influences the visualization
Liquid: 1.5% glycine solution, 5% sorbitol solution, 5% mannitol solution, saline, Ringer's
Diagnostic and therapeutic procedure should be performed in the first phase of the cycle, preferably the 11th day of the cycle.
indications
Abnormal uterine bleeding
Suspected lesions in the uterine cavity-endometrial polyp, submucosal myoma, intrauterine adhesions (Asherman syndrome)
Suspected abnormal endometrial growth
Congenital anomalies of the uterus uterus (septum)
Removal of foreign body from the uterine cavity
Diagnosis of infertility and recurrent miscarriage
Contraindications
Inflammation of the female genital tract
Very extensive uterine bleeding
Cervical Cancer
pregnancy
surgical histeroscopy
Removal of submucosal fibroids
Removal of polyps of the endometrium
Removal of the uterine septum
Removal of intrauterine adhesions
Resection of the endometrium
Complications
<1%
Damage to the uterine wall - while expanding the cervical canal, invasive procedures – i.e. intrauterine adhesions removal, evacuation of foreign body from the uterine cavity
Bleeding intra-and postoperative-the greatest risk during the release of intrauterine adhesions, myomectomy, septum excision
prevention - assumption filled Foley catheter into the uterine cavity after surgery
Infection-inflammation of the lining of the uterine cavity, the greatest risk after surgery of releasing intrauterine adhesions
CO2 overdose, arrhythmias, -insufflation is recommended to use the maximum flow of 40-60 ml / min and pressure not exceeding 100 mm Hg
Overhydration and hyponetremia when applying solutions hypotonic (mannitol, sorbitol, dextran, glycine) - risk 6% - Do not exceed the pressure in the uterine cavity over 75-80 mm Hg, slightly shorten treatment time
Allergic reaction and disseminated intravascular coagulation-dextran
Distant complications
intrauterine adhesions -there is no clearly effective method of preventing the formation of adhesions
The risk of spread of cancer from the uterine cavity into the peritoneal cavity – not clear, to avoid use lower pression
Rupture of the uterus during pregnancy
Laparoscopy
Diagnostic
Surgical
Chronic pelvic pain
Diagnosis of endometriosis
Infertility-ineffective stimulation of ovulation, unexplained cause of infertility, abnormal permeability-HSG, suspected periadnexal adhesions
Diagnosis of genital malformations-only in case of doubt after the MRI-not as a test of recognition / confirming the defect
Diagnostic
Evaluation of pelvic and abdominal organs
Biopsy from the ovaries, other places suspected of having the disease process in the abdominal cavity
bacterial smears in patients with recurrent inflammation of the adnexa
Permeability of the fallopian tubes in the diagnosis of infertility
Surgical
Operations on the fallopian tubes
Ectopic pregnancy - fallopian tube, ovary, in the corner of the uterus, in the residual corner
plstic urgery of abdominal end of the fallopian tube
Release of the adhesions
removal of the periovarian cyst.
Uterine fibroids - fibroplasty, endometrial amputation, uterine removal
Operations on the ovaries:
removal of ovarian tumors
cone ovary resection, biopsy
Electrocauterisation of the ovaries
Endometriosis
Genital neoplasms
- prolaps of the genitals
Treatment of endometrial cysts
laparoscopic cyst wall debridement (stripping) gives better results than cyst drainage and cyst wall ablation with electrical energy
Ablation of cyst wall with electrical energy - Risk of thermal injury to remaining ovarian tissue and consequently decrease of ovarian reserve
Sewing and closure of the ovary after removal of the endometrial cyst - increases the risk of adhesions
Surgery of the uterus
Enucleation of uterine fibroids-necessary assumption hemostatic sutures in layers as the prevention of uterine rupture during pregnancy
removal of subserous fibroid
Amputation of the uterus
Total hysterectomy
The removal of pelvic and paraaortal lymph nodes
Ectopic pregnancy
Surgical conservative treatment - no additional treatment required in over 90% of cases
fallopian tube permeability index, intrauterine pregnancy and susequent ectopic pregnancy similar to laparoscopic and laparotomy procedures
Risk of persistent ectopic pregnancy after laparoscopic conservative treatment 5%, after laparotomy 4.8% after tissue extrusion - 15%
Contraindications
Lack of patient consent
Spilled peritonitis
Severe blood coagulation disorders
Condition after extensive oncological surgery in the area of the stomach and intestines
Hypertension III and IV according to WHO, cardiovascular failure, history of heart failure, unstable coronary artery disease, cardiac arrhythmia
Obesity, Big tumors, Abdominal surgery, Old age , Peritoneal pelvic inflammation
Complications
Subcutaneous emphysema and pneumomediastinum
Thermal damage to the intestine
Damage to the sigmoid surface
Cardiovascular complications associated with increased intra-abdominal pressure
Thromboembolic complications of pelvic veins