SUR 111
Introduction to GYN
Surgeries
Outline
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Female Anatomy
Pathology
Miscellaneous
Procedure Overview
Instrumentation
Review
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Laparoscopy
 (diagnostic
or
operative)
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Hysteroscopy
D & C (dilation &
curettage)
D & E (dilation &
evacuation)
Suction Curettage
FEMALE ANATOMY
Pathology
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Benign
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Cysts
Polyps (pedunculated lesion)
Fistulas
Dysplasia= abnormal tissue growth
Leiomyoma/Myoma/Fibroid - smooth
muscle tumor
Fibroma - connective tissue tumor
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Malignant
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Vulvar
Vaginal
Cervical
Uterine
Ovarian
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Other
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Endometriosis - the presence and
growth of functioning endometrial tissue
in places other than the uterus that
often results in severe pain
Cystocele - herniation of bladder into
vagina
Rectocele (posterior colporrhaphy) herniation of rectum into vagina
Enterocele - herniation of cul-de-sac of
Douglas/includes loops of intestines
into vagina
Ectopic Pregnancy - The implantation
and subsequent development of a
fertilized egg outside the uterus
Incompetent Cervix (cerclage) -
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(PID) Pelvic inflammatory
disease
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(PID)
is a general term that
refers to infection of the uterus
(womb), fallopian tubes (tubes
that carry eggs from the
ovaries to the uterus) and
other reproductive organs. It is
a common and serious
complication of some sexually
transmitted diseases (STDs),
especially Chlamydia and
Gonorrhea.
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PID can damage the fallopian
tubes and tissues in and near
the uterus and ovaries. PID
can lead to serious
consequences including
infertility, ectopic pregnancy (a
pregnancy in the fallopian tube
or elsewhere outside of the
womb), abscess formation,
and chronic pelvic pain.
Endometriosis
Ectopic Pregnancy
Pedunculated Myoma
Prolapsed Uterus
Rectocele
Gynecological Procedures
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1.
2.
3.
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Colposcopy
Hysteroscopy
D&C
D&E
Laparoscopy
Hysterectomy Oophorectomy
Salpingectomy
Abdominal Hysterectomy
subtotal
total
radical (Wertheim)
Vaginal
LAVH
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A & P Repair - repairreconstruction vagina, pelvic floor,
muscles, fascia, of rectum,
urethra, bladder, perineum to
cystocele and rectocele to restore
bladder and rectum to normal
position
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Bartholin’s Cyst (I & D)
Bartholin Gland Cyst
Instruments
Major Tray
 Abdominal-Hysterectomy Tray
 D&C Tray
 Hysteroscopy Tray
resectoscope & hysteroscope
 Laparoscopic Tray
 Camera/scope tray/scope warmer
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Specific Vaginal Instruments
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Auvard weighted speculum
Graves speculum
Sims vaginal speculum (single or double ended)
Delivery forceps
Goodell uterine dilator
Sims uterine sound
Bozeman uterine dressing forcep
Hegar uterine dilators
Heaney uterine dilators
Emmett uterine tenaculum
Sims uterine curettes (blunt/sharp)
Specific Abdominal Hysterectomy
Instruments
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Abdominal retractor tray
richardsons, deavers, malleables, Balfour
w/bladder blade
O’Sullivan-O’Connor abdominal Retractor
Franz Abdominal Retractor
Heaney Hysterectomy Forceps
Heaney-Ballentine Hysterectomy Forceps
Heaney Needleholder
Jorgenson Curved Scissors
Lister Bandage Scissors
Pennington Forceps
Specific Laparoscopy
Instruments
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Scope, Light cord (scope tray)
Camera (camera sleeve if not sterile)
Insufflation tubing (silastic tubing)
Verres Needle (insufflation needle)
Intrauterine cannula (chromotubation)
Uterine manipulator
Trocar Sleeves, Trocars
Accessory Instruments: cautery adapted, graspers,
scissors, loop applicators, suturing devices,
resectoscopes
Scope warmer
Multi-fire laparoscopic staplers
Laparoscopy
Definition-Visualization of the peritoneal
cavity through the anterior abdominal wall
(For optimal visualization must have
pneumoperitoneum)
 Procedures-Diagnosis, Evaluation,
Intervention
 Laser and Electrosurgery may be used
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Laparoscopy Continued
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Instruments:
Verres Needle
Silastic Tubing with connector
Trocar and Sleeve x 2
Laparoscope
Laparoscopic scissors
Light Cord
Laparoscopic graspers
Camera
Bipolar forceps (Kleppinger)
Biopsy forceps
Ball and Loop Electrodes
Laparoscopy Procedure
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Small incision at umbilicus
Abdominal tissue elevated with a towel clip or
pinched up and a Veres needle is inserted into
the peritoneal cavity, attach a 10ml syringe to it
with about 3ml of NS (The surgeon uses it to
determine whether he is clear of vessels or
bowel)
Silastic tubing is attached (you have thrown off
one end to hook up to the insufflator) The
peritoneum is filled with carbon dioxide or
nitrous oxide gas (separates organs for optimal
visibility)
Laparoscopic Procedure
Continued
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Veres needle withdrawn and operating laparoscope inserted
(accomodates Kleppinger or scissors)
Trocars inserted (sleeve may or may not be used) Ports established
to accommodate camera in one (umbilical incision) and other
instruments needed in the other (May reattach silastic tubing to one
of the trocar sleeves and not use a veres needle)
Procedure done (May involve two more trochars, one in LLQ and
one in RLQ)
One trochar may accommodate LR irrigation/suction
apparatus/Other may accommodate graspers
Items removed, sleeve may be left to allow gas to escape or may be
sucked out with suction
Laparoscopic Procedure
Continued
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Skin is closed with a 3-0 Vicryl PS-2 cutting
(May use a 3-0 SH Vicryl taper prior to skin
closure depending on abdominal thickness
Steri-strips may be used and Bandaids are
applied to the incision sites
A peri-pad is placed for the patient
Keep in mind that depending on the procedure
performed, there may be laser, cautery, other
suture, a knot pusher for tying, endoscopic
staplers, etc. needed
Hysteroscopy
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Definition-Endoscopic visualization of the uterine
cavity and openings or orifices to the fallopian
tubes
Introduced vaginally
Used for diagnosis and intervention
Diagnosis/Intervention: abnormal bleeding,
endometriosis, IUD removal, infertility
evaluation, polyps, sterilization, and adhesions
Laser/electrosurgery may be used
Biopsy forceps, scissors, etc. may be used
Hysteroscopy
Procedure
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Graves Speculum (other speculum) Lubrication available
(NS or K-Y)
Anterior edge of cervix is grasped with a tenaculum and
pulled forward
Depth of cavity may be measured with a uterine sound
or modified grasper with sound
Cervix may be dilated with Pratt, Hanks, or Hegar
dilators
Scope/irrigator is inserted (uterus is distended with
Sorbitol, NS, Dextran (Hyskon), or Dextose solution)
Uterine cavity is explored
Hysteroscopy Procedure
Continued
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Depending on findings or procedure, may use
biopsy forceps, cautery, scissors, resectoscope
with roller ball, laser, or tubal occlusive devices.
Biopsies will need to be collected on a piece of
telfa
If Hyskon/Dextran is used clean instruments
immediately as it will harden and make
instruments difficult to clean
Hysteroscopy Irrigation
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Hysteroscopy solutions (for uterine distention)
Dextrose 5% (D5W)
Dextran 70% in dextrose
Glycine
Sorbitol
Above may all be used with laser or cautery
Hyskon (rarely used anymore due to ↑ laser use)
No cautery or lasers may be used as would cause
systemic absorption>systemic side effects
Obstetrical Complications
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Abortions
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Missed - parts of non-living conception and in
uterus more than 2 months
Incomplete - products of conception retained in
uterus
Imminent - about to abort
Spontaneous - abortion occurs without being
induced
Voluntary
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D&C
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Definition- dilation and curettage
Use diagnostic and therapeutic
Diagnostic: dysmenorrhea, endometriosis, rule
out pregnacy before sterilization, infertility
Therapeutic: polyps, evaculate retained
placenta post-child birth, IUD retrieval,
placement of radioactive devices for treatment of
cancers, incomplete miscarriage/abortion
D&C
Procedure
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Speculum (Graves, other)
Local anesthesia may be injected if the patient is awake
Cervix is grasped with tenaculum and dilated with Pratt,
Hanks, or Hegar dilators
Uterine sound may be used to determine depth of the
uterine cavity
Smooth, sharp, or Heany uterine curettes will be used to
clean out the uterine cavity
Suction may be used in conjuction or solo
Tissue may be sent for culture place it on a piece of telfa
Peri-pad placed
D&E
Definition- D & C performed after the
thirteenth week of pregnancy
 Procedure the same as a D & C
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Suction Curettage
Definition-Suction/vacuum aspiration of
the uterus
 Used in therapeutic abortions, incomplete
abortions, or miscarriages
 Procedure: Speculum, tenaculum,
dilators, suction apparatus, curettes may
be needed, peri-pad placed
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Summary
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


Female Anatomy
Pathology
Miscellaneous
Procedure Overview
Instrumentation
Review

Laparoscopy
 (diagnostic
or
operative)




Hysteroscopy
D & C (dilation &
curettage)
D & E (dilation &
evacuation)
Suction Curettage