GYNAECOLOGIC

AL ENDOSCOPY

ADESIYUN A.G.
 LAPAROSCOPY
LAPAROSCOPY
A procedure used to see the inside of the
abdominal and pelvic cavity via a stainless
steel tube containing series of optical
lenses.

INDICATIONS
Diagnostic
Therapeutic/ Operative

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DIAGNOSTIC INDICATIONS

Tubo-peritoneal infertility- tubal

patency, endometriosis, pelvic adhesion.
Chronic pelvic pain
Congenital abnormality of the upper
reproductive tract
Small pelvic masses
Intersex
Ectopic pregnancy

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DIAGNOSTIC INDICATIONS
(CONTD.)

Acute PID- Fitz Hugh Curtis syndrome.

Laparoscopic classification of PID- Mild(
erythema,oedema,mobile tubes and
absence of purulent discharge).
Moderate(erythema,marked oedema,
muco-purulent discharge, fixed tubes,
fimbriae may not be visible). Severe
(presence of pyosalpinx and or abscess)
Missing IUCD

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THERAPEUTIC INDICATIONS

Retreival of translocated IUCD

Adhesiolysis
Fulguration of endometrioma
Aspiration of ovarian cyst
Tubal sterilization- electrocoagulation,
rings( Yoon, Falope), Clips( Filshie,Hulka)
LUNA(Laparoscopic uterine nerve ablation)
and Presacral neurectomy for chronic pelvic
pain.
Ovarian drilling for PCOS

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THERAPEUTIC INDICATIONS
(CONTD.)

Salpingotomy and Salpingectomy for

unruptured or slow leaking ectopic pregnancy
Tubal surgery
Oophorectomy
Ventrosuspension of the uterus
Myomectomy
LAVH
TLH
Laparoscopic colposuspension for stress
incontinence

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 CONTRAINDICATION

ABSOLUTE Mechanical and paralytic

ileus, large abdominal mass, generalize
peritonitis, cardiac failure, recent
myocardial infarction, respiratory
failure, shock, severe obstructive
airway disease.
RELATIVE Gross obesity, abdominal
wall sepsis, previous multiple abdominal
incision, hiatus hernia, coagulopathy.

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 COMPLICATIONS

Anaesthetic complications
Bowel injury perforation
Vascular injury
Anterior abdominal wall insufflations
Coagulation burns viscus

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 TECHNIQUE
Cleaning and drapping
Stab incision close to the umbilicus for Veress
needle insertion. (Alternative sites left
upper quadrant, left iliac fossa outside the
rectus muscle, POD, Uterine fundus although
contraindicated in cases of infertility, previous
myomectomy and endometriosis)
Insert a Veress needle or Tuohy needle
vertically and check for correct placement
(Irrigation and aspiration test, Hanging drop
test)

ADESIYUN A.G.
 TECHNIQUE (CONTD.)

Gas insufflations for pneumoperitoneum (CO2,

N2O, air)-2 to 4 litres required, with intra-
abdominal pressure of 15mmHg
Umblical Insertion of primary trocar and sheath.
Remove trocar and insert laparoscope
For operative laparoscopy- accessory trocars are
inserted under visual control
On completion of the procedure, remove the
laparoscope, decompress the pneumoperitoneum
through the sheath, re-insert the trocar and
remove trocar and sheath together.

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EQUIPMENT / INSTRUMENT
Veress needle
Trocar and sheath
Gas Insufflator
Endoscopes 0, 30, 45 degree
Light source and light cable
Camera/ Video endoscopy
Video monitor
Forceps and scissors

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EQUIPMENT / INSTRUMENT
(CONTD.)

High frequency electro surgery unit

unipolar , bipolar
Suction and irrigation system
Laser system
Suture technique intracorporeal,
extracorporeal(Roeder knot, Weston Knot,
Half hitch)
Extraction bag
Morcellator systems
Uterine manipulator

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MERITS OF LAPAROSCOPIC
SURGERY
Cosmesis
Decrease adhesion formation
Less post-operative pain
Early post-operative recovery
Decrease hospital stay
Low incidence of DVT and pulmonary
embolism
Early return to work

ADESIYUN A.G.
 HYSTEROSCOPY
A procedure used to view the
endocervix and endometrial
cavity
Hysteroscope may be flexible or
rigid.

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DIAGNOSTIC INDICATIONS
Infertility
Recurrent abortions
Abnormal uterine bleeding
Missing IUCD
Intra-uterine adhesions
Congenital uterine abnormality
Biopsy

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THERAPEUTIC INDICATIONS
Adhesiolysis
Resection of polyps
Retreival of embedded IUCD
Resection of submucous myoma
Resection of uterine septum

ADESIYUN A.G.
THERAPEUTIC INDICATIONS
(CONTD.)

Endometrial ablation bipolar electrode

ablation(Novasure), cryo ablation
(HerOption,Soprano), hydro thermal
ablation, thermal ablation, micro wave
endometrial ablation.
Sterilization using electrocoagulation, tubal
plugs (Hamou, P-block, Ovablock),
sclerosant (Quinacrine,
Methylcyanoacrylate), intra-tubal device
(Essure, Adiana)

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 TECHNIQUE
Cleaning and drapping
Cervical dilatation

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 TECHNIQUE (CONTD.)

Insertion of hysteroscope already

connected to the distention
medium(inflow and outflow tubing),
light source,camera. Additionally for
operative hsteroscope- resectoscope
mounted, connection to
electrosurgery energy unit.

ADESIYUN A.G.
 TECHNIQUE (CONTD.)

Distention fluid- non-electrolyte

solution(Mannitol, Purisole ) for
unipolar energy use and electrolyte
solution(nomal saline) for bipolar
energy.

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 COMPLICATIONS

Uterine perforation
Cervical laceration
Adverse reaction to distension
medium
Rupture of hydrosalpinx

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 OTHERS

Culdoscopy
Salpingoscopy
Falloposcopy

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