Gynecological Endoscopy

Diagnostic

• For pelvic pain
• Endometriosis
• PID
• Adhesions
• Pelvic congestion etc.

• Infertility
• With tubal insufflation

• Pelvic Mass
• Uterine e.g. Fibroids
• Ovarian – benign or malignant
• Other

For Intervention

• Assisted conception (OPU and GIFT), not commonly used anymore.
• Diathermy to endometriosis
• Sterilisation (Clips, Loops or Diathermy)
• Biopsy of ovary or tumours
• Division of adhesions
• Ectopic pregnancy, cysts, oophorectomy
• Advanced surgery – all operations!

Creating the Pneumoperitoneum

• Verres needle
• Direct trochar insertion
• Hassan open technique
• Abdominal wall elevation
• CO₂ , N₂ or other gas

Reusable or Disposable Equipment

Direct vision or camera

Surgical Aids

• Unipolar or Bipolar diathermy
• Laser
• Loops
• Clips
• Long instruments

Failure

Injury to:

• Major blood vessels
• Ureter, Bladder or Bowel
• Uterine perforation from elevator
• Need laparotomy 1:500

Wound infection

Gas embolism

Surgical misadventure

• Inadvertent diathermy perforation
• Peritonitis

Death

• 1:500,000

Abnormal uterine bleeding

• Post-menopausal
• Pre-menopausal

Infertility

• Congenital abnormality
• Adhesions
• Polyps etc.

Surgical Interventions

• Sterilisation (Essure)
• Division of adhesions
• Removal of benign tumours
• Endometrial ablation

Distension with:

• Nothing = contact hysteroscopy
• Gas CO₂
• Saline
• Glycine

Blind Entry or Entry under vision

Hysteroscopic instruments

Endometrial ablation

• Laser
• Resectoscope
• Roller ball
• Now overtaken with blind thermal or radio HF ablation

Failure

Cervical Injury

Uterine perforation

Fluid overload

Infection