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Practical Guide to Office Procedures in Gynecology and Urogynecology
Khaled Sakhel, James Chivian Lukban, Alfred Z Abuhamad
1:
Patient Safety
INTRODUCTION
ACOG RESOURCES ON PATIENT SAFETY
ACOG REPORT OF THE PRESIDENTIAL TASK FORCE ON PATIENT SAFETY IN THE OFFICE SETTING
Background
Office Medical Director
Checklists
Office Set-Up
ROOM SET-UP
Preoperative
Intraoperative
Postoperative
Mock Drills
Policy and Procedure Manual
Informed Consent
Patient Rights and Responsibilities
Anesthesia
Procedure Outcome Reporting System
Ability to Rescue Patient from Excessive Sedation, Emergency Medication, and Resuscitative Policy
Time-Outs
Credentialing, Privileging and Accreditation
Patient Safety and the Relationship with Industry
ACOG OFFICE PATIENT SAFETY ASSESSMENT TOOL
REPROCESSING OF INSTRUMENTS
Cleaning
Disinfection
Sterilization
Storage
ADDITIONAL RESOURCES
2:
Legal Issues in Office-based Procedures
INTRODUCTION
REGULATION OF OFFICE-BASED SURGERY
Accreditation and State Requirements
Organizational Guidelines and Activities
Reporting Requirements
Impact of Accreditation Requirements
PHYSICIAN QUALIFICATIONS
FACILITIES
PERSONNEL
PATIENT SELECTION
ANESTHESIA
INFORMED CONSENT
PROCEDURE DOCUMENTATION
CODING
Billing Fraud
Upcoding
Unbundling Procedures and Codes
Paracervical Block and Hysteroscopy
Place of Service
Compliance Program
Web-based Marketing
Malpractice Coverage
Corporate Structure
Conclusion
APPENDIX A: OFFICE-BASED SURGERY CONSENT
APPENDIX B: HYSTEROSCOPY
3:
Gynecological Ultrasound in the Office Settings
INTRODUCTION
EQUIPMENT
COMPONENTS OF THE PELVIC ULTRASOUND EXAMINATION
THREE-DIMENSIONAL ULTRASOUND AND MüLLERIAN DUCT ANOMALIES
SONOHYSTEROGRAPHY
CONCLUSION
4:
Office Hysteroscopy
INTRODUCTION
INDICATIONS FOR OFFICE HYSTEROSCOPY
CONTRAINDICATIONS
PATIENT SELECTION FOR THE OFFICE SETTING
COUNSELING AND INFORMED CONSENT
SPECIAL PRE-PROCEDURE PREPARATIONS
SET-UP AND INSTRUMENTATION
TECHNIQUE
COMPLICATIONS AND MANAGEMENT
5:
Colposcopy and LEEP
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS—RELATIVE
PATIENT SELECTION FOR OFFICE
COUNSELING/CONSENT
PRE-PROCEDURAL PREPARATION
SET-UP/INSTRUMENTATION
TECHNIQUE
COMPLICATIONS AND MANAGEMENT
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS
PATIENT SELECTION
COUNSELING/CONSENT
PRE-PROCEDURAL PREPARATION
SET-UP AND INSTRUMENTATION
TECHNIQUE
COMPLICATIONS
6:
Long-Acting Reversible Contraception
INTRAUTERINE CONTRACEPTION
Indications for IUD Use
Contraindications for IUD Use
IMPLANTABLE CONTRACEPTION
Indications for ENG Implant Use
Contraindications for ENG Implant Use
TECHNIQUE
Intrauterine Devices
Before Placement
How to Load and Insert the Copper T 380A IUD (ParaGard®)
How to Insert the LNG IUS (Mirena®)
How to Remove an Intrauterine Device
How to Insert the Subdermal ENG Implant (Implanon® and Nexplanon®)
Ensure use of Sterile Technique throughout the Entire Procedure
LOCATING THE DEVICE
REMOVAL PROCEDURE
7:
Transcervical Sterilization
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS
PATIENT SELECTION FOR OFFICE
COUNSELING/CONSENTING
ENDOMETRIAL PREPARATION
SET-UP/INSTRUMENTATION
TECHNIQUE
COMPLICATIONS AND MANAGEMENT
CONFIRMATORY HYSTEROSALPINGOGRAPHY
Timing
Indications
Contraindications
Preoperative Preparation
Technique
Complications
CPT CODES
8:
Endometrial Ablation
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS
PATIENT SELECTION FOR OFFICE
COUNSELING/CONSENTING
SPECIAL PRE-PROCEDURE PREPARATIONS
Endometrial Preparation
Cervical Ripening
SET-UP/INSTRUMENTATION
* Patient Preparation
Pre-Procedure Treatment
Day of Procedure Treatment
Post-procedure Treatment
Office Set-up
TECHNIQUE
THERMAL BALLOON ABLATION24–26
CRYOTHERAPY25,27
RADIOFREQUENCY ABLATION25,26,28
HYDRO THERMABLATOR (HTA)25,26,29
MICROWAVE ENDOMETRIAL ABLATION25,30
COMPLICATIONS AND MANAGEMENT
Uterine Perforation
Post-ablation Bleeding
Post-ablation Infection
Post-ablation Pain
Immediate
Delayed
Post-ablation Pregnancy
Post-ablation Endometrial Cancer
9:
Bone Mineral Density Assessment
INTRODUCTION
MEDICAL HISTORY AND PHYSICAL EXAMINATION
WHO FRACTURE ASSESSMENT RISK TOOL (FRAX®)
LABORATORY EVALUATION
Bone Formation Markers
Bone Resorption Markers
IMAGING MODALITIES
Dual Energy X-ray Absorptiometry
Limitations of DEXA
Operator Dependent Mistakes
QUANTITATIVE ULTRASOUND
ASSESSMENT OF BMD IN THE PHYSICIAN OFFICE
Space Requirements
Equipment
REVIEW
National Osteoporosis Foundation 2010 Synopsis of Major Recommendations11
10:
Intrauterine Insemination
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS
PATIENT SELECTION FOR OFFICE
COUNSELING/CONSENTING
SPECIAL PREOPERATIVE PROCEDURE PREPARATIONS
SET-UP/INSTRUMENTATION
Semen Collection and Processing
IUI
TECHNIQUE
Semen Collection
Sperm Processing
SPERM WASH TECHNIQUE
SPERM PROCESSING-DENSITY GRADIENT CENTRIFUGATION TECHNIQUE
Insemination Procedure
Technique
COMPLICATIONS AND MANAGEMENT
11:
Urodynamic Testing
INTRODUCTION
URODYNAMIC COMPONENTS
EVIDENCE REGARDING THE UTILITY OF URODYNAMIC TESTING
ORGANIZATION SPECIFIC INDICATIONS FOR URODYNAMIC TESTING
General Population
Urinary Incontinence
Voiding Dysfunction
Additional Scenarios
Specific Populations
Elderly (ICI)
Those with Neurological Abnormalities (ICI)
Those with Neurological Abnormalities and Concurrent Suggestions of Lower Urinary Tract or Other Neurologic Dysfunction (ICI)
Children (ICI)
CONTRAINDICATIONS
PATIENT SELECTION FOR THE OFFICE
COUNSELING AND CONSENTING
SPECIAL PRE-PROCEDURE PREPARATIONS
SET-UP AND INSTRUMENTATION
Transducers and Catheters (Fig. 11-1)
Flowmeters (Fig. 11-2)
Equipment (Fig. 11-3)
Recording Requirements27,33
Additional Testing Equipment27,36,37
TECHNIQUE
Uroflowmetry (Figs 11-4A to C)
Data
Normal Values
Filling Cystometry27,33,36–39 (Figs 11-5A and B)
Data
Normal Values
Pressure-Flow Study (Figs 11-6A and B)
Data (in addition to that for free uroflow):
Normal Values:
Urethral Function Tests (ALPP and Urethral Pressure Profile) (Fig. 11-7)
Data
Normal Values:27
COMPLICATIONS AND MANAGEMENT
12:
Diagnostic Cystourethroscopy
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS
PATIENT SELECTION FOR THE OFFICE
COUNSELING AND CONSENT
PRE-PROCEDURE MEDICATIONS
INSTRUMENTATION
Rigid Cystoscopy
Flexible Cystoscopy
Processing
PATIENT SET-UP
TECHNIQUE
Rigid Cystoscopy
Flexible Cystoscopy
COMPLICATIONS AND MANAGEMENT
13:
Treatment of Stress Urinary Incontinence
INTRODUCTION
TRANSURETHRAL RADIOFREQUENCY COLLAGEN DENATURATION OF THE BLADDER NECK AND PROXIMAL URETHRA (RENESSA)
Background
Indications
Contraindications
Efficacy and Safety
Counseling and Consent
Preoperative Preparation
Technique
Post-treatment Considerations
INJECTABLE BULKING AGENTS
Background
Contigen® (Bovine dermal collagen cross-linked with gluteraldehyde and dispersed in saline)
Durasphere® EXP (Pyrolytic coated graphite beads suspended in a water-based carrier gel containing betaglucan)
Coaptite (Calcium hydroxylapatite bioceramic microspheres suspended in an aqueous gel carrier)
Macroplastique® (Heat-vulcanized polydimethylsiloxane suspended in a bio-excretable polyvinylpyrrolidone carrier gel)
Indications
Contraindications
Patient Selection
Counseling and Consent
Periurethral Technique
Transurethral Technique
Complications
SINGLE-INCISION MID-URETHRAL SLING (Table 13-1)
Indications
Contraindications
Patient Selection
Counseling and Consent
Preoperative Preparation
Local Anesthesia
Technique
Complications
14:
Treatment of Overactive Bladder (Sacral Nerve Stimulation)
INTRODUCTION
INDICATIONS
CONTRAINDICATIONS2
PRECAUTIONS2
ADVERSE EVENTS (AES)3
PATIENT SELECTION FOR OFFICE EVALUATION
COUNSELING AND CONSENTING
PATIENT PREPARATION
SET-UP AND INSTRUMENTATION
TECHNIQUE
COMPLICATIONS AND MANAGEMENT
15:
Conservative Management of Pelvic Organ Prolapse
INTRODUCTION
EPIDEMIOLOGY
RISK FACTORS5,6,8
INDICATIONS5,6,8
CONTRAINDICATIONS5,6,8
PATIENT SELECTION FOR OFFICE
COUNSELING AND CONSENTING
SPECIAL PRE-PROCEDURE PREPARATIONS
SET-UP AND INSTRUMENTATION
TECHNIQUE
FOLLOW-UP
PESSARY TYPES
INCONTINENCE DISH
RING (WITH/WITHOUT SUPPORTIVE DIAPHRAGM)
SHAATZ
DONUT
GELLHORN
GEHRUNG
INFLATOBALL
CUBE
COLPEXINTM SPHERE (ADAMED LTD., WARSAW, POLAND)11,12
COMPLICATIONS AND MANAGEMENT2–4,13
16:
Office Treatment of Interstitial Cystitis/Painful Bladder Syndrome: Intravesical Instillations
INTRODUCTION
Dimethyl Sulfoxide
Lidocaine
Heparin
Steroids
Hyaluronic Acid
Oxybutynin
Chondroitin Sulfate
Pentosan Polysulfate Sodium
Cocktails
Potassium Chloride
INDICATIONS
CONTRAINDICATIONS
PATIENT SELECTION FOR THE OFFICE
COUNSELING AND CONSENTING
SPECIAL PRE-PROCEDURE PREPARATIONS
SET-UP AND INSTRUMENTATION
TECHNIQUE
COMPLICATIONS AND MANAGEMENT
17:
Treatment of Pelvic Floor Muscle Spasm
INTRODUCTION
CLINICAL ASSESSMENT OF THE PELVIC FLOOR
INDICATIONS FOR TREATMENT
CONTRAINDICATIONS
COUNSELING AND CONSENT
PELVIC FLOOR PHYSICAL THERAPY
PRE-PROCEDURE PREPARATIONS
TECHNIQUES
INJECTION THERAPY
Pre-procedure Preparations
Trigger Point Injections
Technique
Botox Injections
SET-UP AND INSTRUMENTATION
Technique
COMPLICATIONS AND MANAGEMENT
Related to the Injection Technique
Related to the Agent Injected
SUMMARY
18:
Office Cosmetic Procedures
INTRODUCTION
NONSURGICAL PROCEDURES
BOTOX AND DYSPORT THERAPY
Botox/Dysport Indications
Botox/Dysport Contraindications
Patient Selection for Office
Counseling/Consenting
Special Pre-Procedure Preparations
Set Up/Instrumentation
Technique
Complications and Management
FILLER INJECTIONS
Dermal Filler Injection Indications
Dermal Filler Injection Contraindications
Patient Selection for Office
Counseling/Consenting
Special Pre-Procedure Preparations
Set-up/Instrumentation
Technique
Complications and Management
MICRODERMABRASION
Microdermabrasion Indications
Microdermabrasion Contraindications
Patient Selection for Office
Counseling/Consenting
Special Pre-Procedure Preparations
Set-up/Instrumentation
Technique
THERMAL-BASED SKIN TREATMENTS
Thermal-Based Skin Treatment Indications
Thermal-Based Skin Treatment Contraindications
Patient Selection for Office
Counseling/Consenting
Special Pre-Procedure Preparations
Set-up/Instrumentation
Technique
Surgical Procedures
INDEX
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