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34 Cards in this Set
- Front
- Back
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Objectives:
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Enumerate indications and contraindications
Understand open vs. closed technique and potential complications Discuss distention media and common potential complications Enumerate the laparoscopic options for sterilization Discuss hysteroscopic sterilization and timing of confirmation for tubal closure |
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What are indications for Laparoscopy?
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Sterilization
Evaluation for Chronic pelvic pain and endometriosis Hysterectomy Ectopic pregnancy Expanding with minimally invasive surgery. |
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What are contraindications for laparoscopy?
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Intestinal obstruction
Hemodynamic instability Morbid obesity???***** Extensive intra-abdominal scarring |
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What artery must you be very careful of when performing laproscopic procedures?
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Inferior epigastric artery******
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What are the positions of the 4 holes we make for laparoscopic ports?
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A: midline umbilical port
B: - 2 of these, 5mm trocar just above the anterior iliac crest bilateral C: 11mm trocar 10cm medial and cephalad to the lower iliac crest port nearest the primary surgeon |
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What is OPEN technique?
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OPEN: uses open dissection and Hassan trocar
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What is CLOSED technique?
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CLOSED: uses veres needle and optical ports
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What should the pressure be for CLOSED technique?
EXAM****** |
Entry pressure <8 mmHg*****
Max pressure <14-16 mmHg |
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Is open or closed better for avoiding injury?
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Neither superior over the other in avoiding injury
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What is Insufflation?
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CO2 Gas to achieve pneumoperitoneum
Nitric Oxide: Pain mapping (awake) Avoids build up of carbonic acid |
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What is a Harmonic tool?
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HARMONIC: less thermal spread - steep learning curve but more versatile
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What is a Bipolar tool?
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BIPOLAR: more thermal spread - easier to use
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What can a bowel injury cause?
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Early
or Late Late: usually results in necrosis and bowel perforation |
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What can bladder injury cause
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Uroma formation
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What can Ureter injury cause?
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Direct
Kinking scan Hydronephrosis Renal failure ****EXAM |
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Not sure but....know there are different views of laproscopic scopes
What is the best view and angle for the broad ligament? |
45 degree scope
uterus to left right broad ligament view optimal |
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How do you tell where the ureter is?
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Remember water under the bridge
Ureter passes BELOW the Urinary artery |
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Why are we using DaVinci robots?
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Role for converting open hysterectomy to laparoscopic
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What is so great about robotics?
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SINGLE INCISION
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What is a Hysteroscopy?
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Direct visualization of the endometrial cavity using and endoscope and light source.
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What are indications for hysteroscopy?
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Repetitive abnormal uterine bleeding
Recurrent pregnancy loss Uterine synechiae Removal of IUD Ablation of the endometrium Sterilization Polypectomy or myomectomy Incision of uterine septum |
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What is the main contraindication for hysteroscopy he told us to know?
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Inability to dilate the cervix*****
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What are some distention media we have?
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Crystalloids
D5 water Hyskon (dextram) Mannitol CO2 gas hyskon and mannitol are specific designed electrolytes media for LONG Sx |
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What are complications of Hysteroscopy?
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Fluid overload
Electrolyte disturbances Infection Bleeding Asherman’s syndrome Perforation |
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How can you tell if perforation is prior?
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prior to perforation
uterine serosa is visible through the myometrium just above and behind the rollerball |
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What is ESSURE?
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Sterilization
Hysteroscopic sterilization |
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Is Essure as effective as post-partum sterilization?
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Yes
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If you do an ESSURE what else must you include?
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Requires 3 months back up contraception****EXAM
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What does the FDA require with ESSURE?
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FDA requires 3 month post op HSG to confirm tubal blockage
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Where is ESSURE done?
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Can be done in the office
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What is ADIANA?
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uses heat to fuse the fallopian tubes
hysteroscopic technique |
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What are more Laparoscopic techniques?
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YOON
FILSHIE CLIPS CAUTERY - MONOPOLAR & BIPOLAR Failure < 1% |
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Which Cautery is LEAST effective
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Bipolar cautery is least effective
compared to monopolar |
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What is the Failure rate of cautery laproscopic?
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<1%
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