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Hysteroscopy
Rita Mhaskar
1:
Normal Anatomy
CERVIX
Isthmus
Corpus
Tubal Ostia
2:
Basic Principles of Instrumentation
OPTICAL PRINCIPLE OF ENDOSCOPE
MAGNIFICATION OF THE ENDOSCOPE
RESOLUTION
3:
Instruments
ANGLE OF VIEW
FIELD OF VIEW
PANORAMIC HYSTEROSCOPE
SPECIFICS OF TELESCOPE
SPECIFICS FOR SHEATH
LIGHT SOURCES
ENDOSCOPES
Diagnostic Purpose
Operative Hysteroscope
Hamou Microhysteroscope (4 mm Diameter)
Camera
Sterilization
Specialized Endoscopes
Contact Hysteroscope
INDICATION FOR CONTACT HYSTEROSCOPY (FIGS 3.10 TO 3.17)
CONTACT VAGINOSCOPY IN CHILDREN
AUTONOMIC PANORAMIC HYSTEROSCOPE
FOCUSING MICROHYSTEROSCOPE (HAMOU)
FLEXIBLE HYSTEROSCOPE
ADVANTAGES
RESECTOSCOPE
Indications
Active Mechanism
Passive Mechanism
4:
Selection of Equipment
5:
Distension Media
DISTENSION MEDIAS
GASES
Carbon Dioxide
LIQUIDS
Hyskon (32% Dextran)
Sorbitol (3%), Glycine (1.5%) and Dextrose in Water
Mannitol (5%)
Ringer Lactate/Saline
FLUID INSTILLATION
(a) Syringes
(b) Hydrostatic Pressure
(c) Pressure Cuff
(d) Simple Pump
(e) Pressure Controlled Pump (Fig. 5.3)
6:
Lasers and Electrosurgery
LASERS
Laser for Cutting
Laser for Coagulation
Photodynamic Therapy
Special Risks of Lasers
Electrosurgery
Current Density
Tissue Resistance
Electrosurgical Circuits
Monopolar
Bipolar
7:
Indications and Contraindications for Hysteroscopy
INDICATIONS FOR HYSTEROSCOPY
CONTRAINDICATIONS
8:
Timing of Hysteroscopy
SPECIAL CIRCUMSTANCES
9:
Operating Room Set-Up
10:
Preparation of Patient
TECHNIQUE
11:
Diagnostic Hysteroscopy
ABNORMAL UTERINE BLEEDING
LIMITATIONS
INFERTILITY
Specific Indication for Diagnostic Hysteroscopy in Infertility
Secondary Dysmenorrhea
Missing Intrauterine Contraceptive Device
Complicated Intrauterine Manipulation Related to Pregnancy
(a) For Evaluation of Intrauterine Filling Defects on HSG
ESGE Classification of Intrauterine Adhesions
Submucus Myoma
ESGE Classification
12:
Hysteroscopy in Special Abnormalities
HYPOGONADOTROPHIC HYPOGONADISM
POLYCYSTIC OVARIAN SYNDROME
TAMOXIFEN/ESTROGEN
13:
Operative Hysteroscopy
INSTRUMENTS
Extraction of Lost IUCD
Removal of Endometrial Polyp
Electrosurgical Operative Procedure
REMOVAL OF INTRAUTERINE SEPTUM
Indications
Technique
Uterine Septus Completus
Residual Septum
Results
Advantages Over Abdominal Metroplasty
INTRAUTERINE ADHESIOLYSIS
Indications
Technique
Results
SUBMUCUS MYOMA
Classification (Donnez 1995)
Technique
PRETREATMENT WITH GNRH ANALOG
Advantages of GnRH Analog
Disadvantages of GnRH Analog
Postoperative Care
Endometrial Ablation/Resection
Inclusion Criteria
Indications
Points in Counseling Patients before Endometrial Ablation and Resection
Pretreatment
Techniques
COMPARISON OF METHODS OF ABLATION AND RESECTION
Laser
Disadvantages
Advantages
ELECTROSURGERY
Resection of Endometrium
Ablation
Technique (Useful Points)
14:
Laser Endometrial Ablation
TECHNIQUES
Dragging Technique (Fig. 14.1)
Blanching Technique (Fig. 14.2)
Advantages of Blanching Technique
Postoperative Care
Result
15:
Hysteroscopic Surgery on Fallopian Tube
TUBAL OCCLUSION (STERILIZATION)
Visualization of Tubal Ostia (Fig. 15.1)
Contraindications for Hysteroscopic Tubal Sterilization
INJECTION OF SCLEROSING AGENT
Quinacrine
Complications
DESTRUCTION OF INTERSTITIAL PORTION OF THE TUBE
Complications
Occlusion Plugs
SILICONE PLUG APPLICATION FOR TUBAL STERILIZATION
Technique
Results
Endoscopic Tubal Canalization
Procedure
Complication
16:
Complications of Hysteroscopy and Its Prevention
COMPLICATIONS DUE TO INSERTION OF HYSTEROSCOPE
Traumatic
Cervical Laceration
Uterine Perforation
Prevention
Direction of View
Anatomy of Cervix and Uterus
Conditions Predisposing to Uterine Perforation
Cervical Stenosis
Distortion of Uterus
Steps to Prevent Uterine Perforation
Management
Complications Due to Uterine Distension
Excessive Absorption
Rupture of Viscus
Hypothermia
Venous Air Embolism
Prevention
Bibliography
INDEX
TOC
Index
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