laparoscopy, hysteroscopy,Sonohysterography,Articles 1,2,3,4, 19 Apr 01

From: KathFindlay (klfindlay@adhesions.org.uk)
Fri Apr 20 00:05:14 2001


Q. What is laparoscopy? Article 1 19/4/01

A. Laparoscopy is an out patient (one-day) surgery in which a thin telescope-like instrument is inserted into the abdominal cavity through the belly button. Using this instrument (the laparoscope), the physician is able to visualize the abdominal/pelvic contents, including the uterus, fallopian tubes, ovaries, bowel, appendix, liver and gallbladder. Additional small (5mm) incisions in the bikini line are also often necessary to help with the manipulation of internal organs. Laparoscopy can be used to treat most gynaecologic and infertility problems for which surgery is required. Such problems include the removal of pelvic adhesions, ovarian cysts, some types of uterine fibroids, swollen tubes, tubal pregnancies, treatment of endometriosis, and the documentation of tubal patency. The recovery time following laparoscopy is much less than with standard surgery (days compared to weeks). The complications of laparoscopy are the same as with all types of surgery and include, infection, injury to adjacent organs such as the bowel or bladder and blood loss that may require a blood transfusion. There is also a small risk that it will be necessary to open your belly to fix a problem that cannot be addressed through the laparoscope, but this is extremely rare. Q. What is hysteroscopy? Article 2 19/4/01

A. Hysteroscopy is an out patient (one-day) surgery in which a small telescope-like instrument is inserted into the uterine cavity through the vagina. Fluid is then used to distend the uterine cavity and abnormalities such as polyps, scar tissue and intrauterine fibroids can be visualized and treated. Hysteroscopy is often performed in the office with only mild anaesthesia. The recovery time from surgery is extremely rapid. Most patients are ready to resume normal activities the same day. The risks of hysteroscopy are the same as for any surgery and include infection, bleeding, and injury to adjacent organs such as the bowel or bladder. Hysteroscopy has the additional small risk of making a hole in the uterine wall. This complication occurs rarely and usually has no bearing on future fertility. For more information on this procedure, see our patient information sheet on hysteroscopy <http://haveababy.com/baby/hystero.asp> .

Office Hysteroscopy Article 3 19/4/01

Office Hysteroscopy is a procedure performed to evaluate the internal architecture of the uterine cavity through direct visual inspection, to remove surface lesions that protrude into the cavity (e.g., polyps, adhesions, a septum, or to pass a thin catheter through one or both fallopian tubes. Hysteroscopy is usually performed under a light Neurolept anaesthetic administered intravenously by an in-house anaesthesiologist. For patients who have had a vaginal delivery before, and for those with an easily negotiable cervical canal, it is possible to perform the hysteroscopy with only local anaesthetic. In addition, patients who have not had a vaginal delivery in the past, but who have a high pain tolerance and a low level of anxiety, may do their hysteroscopy under local anaesthetic (paracervical blockade). Hysteroscopy is usually performed on cycle day seven through 12 of a normal menstrual cycle, after all bleeding has stopped, but prior to expected ovulation. If you are on oral contraception pills or are post-menopausal, then the procedure can be performed at any time. It is important that you call the office for an appointment as soon as your menses begins. Appointments may be scheduled in advance if menstrual intervals are regular. The procedure is performed between 2 and 4 p.m. You will be issued a prescription for an antibiotic (doxycycline or tetracycline), which will help to protect against possible reproductive tract infections. Patients are expected to take doxycycline, 100 mg orally, twice a day; or tetracycline, 250 mg orally, four times a day for three days. These antibiotics should be started the day before the scheduled hysteroscopy and completed the day after the procedure. Doxycycline may be taken with food and does not interfere with most other medications. Tetracycline should also be taken with food, but should not be taken with milk products or calcium-containing medications. The most common side effect of hysteroscopy is uterine cramping similar to menstrual cramps. In anticipation of this reaction, patients are advised to take one hour prior to the procedure either * 600 mg of Motrin, * 600 mg of Advil (equivalent of three, 200 mg tablets), * Anaprox DS 550 mg, or * Ponstel 500 mg (equivalent of two, 250 mg tablets) In addition to the oral medications listed above, you will be given an intramuscularly injection of 60 mg of Toradol, which should help minimize or alleviate discomfort associated with the procedure. Prior to performing the hysteroscopy, several other minor procedures may be performed. Cervical cultures for routine pathogens and ureaplasma urealyticum, in addition to cervical swabs for DNA probes for chlamydia and gonorrhea may be obtained. The uterine position and depth will be measured using a Jones embryo catheter. A complete transvaginal pelvic ultrasound will be performed to evaluate the pelvic reproductive organs (i.e., uterus and ovaries). The hysteroscopy entails placing a speculum into the vagina and cleansing the vagina and cervix with an antibacterial solution (Zephiran). Local anaesthesia is administered in the form of a paracervical blockade using Nesacaine/lidocaine. Following this, the cervix is grasped and stabilized with an instrument (tenaculum) and the rigid carbon dioxide diagnostic hysteroscope will be carefully and gently inserted and guided through the cervical canal into the uterine cavity. At times, it may be necessary to carefully and gently dilate the cervical canal in order to allow the fiberoptic endoscope to enter into the uterine cavity. Carbon dioxide gas is used to distend the uterine cavity and allow for visual inspection. The placement of the endoscope through the cervix and the distention of the uterine cavity by the carbon dioxide gas may result in cramping. It is not uncommon for some patients to experience light vaginal bleeding and cramping for a few hours after the procedure. Patients who experience heavy bleeding, fever greater than 101°F, foul smelling vaginal discharge, chills or severe and persistent abdominal pain are advised to call the office. It is common to have spotting for one to two days after the procedure as the result of placement of the tenaculum onto the cervix, and not from intrauterine bleeding. Q. What is FUS/fluid ultrasound/Sonohysterography? Article 4 19/4/01

A. Sonohysterography (fluid ultrasound, FUS, hydrosonography) is a simple, relatively non-invasive technique for imaging the uterine cavity. The procedure is performed in the office without anaesthesia, (although 600-800mg of Ibuprofen 20 minutes prior to the exam helps to relieve cramping). A thin catheter is introduced into the uterus through the vagina. A transvaginal ultrasound is then performed while 10-20 cc of saline is injected into the uterus. The cavity is distended by the fluid, revealing the presence of intrauterine fibroids, adhesions or small polyps, which are sometimes missed on hysterosalpingogram (HSG). The distention of the uterus causes some cramping that is well-tolerated by most patients and which dissipates rapidly once the procedure is finished. Fluid noted in the pelvic cavity indicates that at least one tube is patent. Lesions detected on sonohysterography cannot be treated at the same time, but the procedure is quick, costs much less than a hysteroscopy and the majority of women will have a normal endometrial cavity. However, if abnormal pathology is suspected, it may be preferable to proceed directly to hysteroscopy.


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