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15 Cards in this Set
- Front
- Back
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What method of hysterectomy is most common?
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Abdominal > Vaginal > Laparoscopic
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What are the most common indications for hysterectomy?
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Uterine leiomyoma
Endometriosis Uterine proolapse |
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What are the alternatives to hysterectomy?
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Expectant management (watchful waiting)
Medical treatment Endometrial ablation Uterine artery embolization (used to decrease blood supply to uterine fibromas; due to collateral circulation, uterus will remain intact even if both uterine aa are occluded) with microbeads |
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What factors favor oophorectomy?
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Increased risks for ovarian cancer based on family hx or genetic testing (BRCA1/2)
Hormone-sensitive breast cancer B/L ovarian neoplasms Severe endometriosis PID or bilateral TOA (Tubo-Ovarian Abscess) |
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What factors favor ovarian preservation?
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Premenopausal status
Concerning impact on sexual fn, libido, and QOL in young women Premenopausal women w/osteopenia, osteoporosis or risk factors for osteoporosis |
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What is the preferred method of hysterectomy?
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Transvaginal
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What are the limiting factors of transvaginal hysterectomy?
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Undescended and immobile uterus, narrow vagina at apex
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What criteria are required for transvaginal hysterectomy?
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Pathology confined to uterus
Adequate vaginal access Uterine mobility Uterus <280 g or <12 weeks--uterine size generally not a contraindication and large uterus can be removed vaginally by morcellation |
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This ligament houses the ovarian vessels.
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Infundibulopelvic ligament
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What are the indications for laparoscopic-assisted vaginal hysterectomy?
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Management of uterine leiomyomata that complicate performance of vaginal hysterectomy
Ligation of IP ligaments to facilitate difficult ovary removal Evaluation of pelvic and abdominal cavity before hysterectomy |
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What are the advantages of a supra-cervical hysterectomy?
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Easier to perform
Potentially avoid ureteral or bladder injuries No add'l benefits on sexual fn compared to total hysterectomy |
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What are the most common intraoperative injuries of hysterectomy?
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Bladder and ureteral injury
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How are bladder/ureter injuries detected intraoperatively?
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IV Indigo carmine followed by cystoscopy
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In what areas do ureteral injuries commonly occur?
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Pelvic brim near ovarian vessels (IP ligament)
Area where ureter crosses uterine artery (MOST COMMON SITE) Area lateral to vaginal cuff (avoid taking large bite while closing vaginal cuff) |
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When does bladder injury commonly occur?
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During dissection of bladder off cervix
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