Dilation and curettage (D&C)
- Indications. Diagnostic (postmenopausal bleeding) and therapeutic (dysfunctional uterine bleeding – DUB).
- Technique. The cervix is placed on traction and the cervical canal progressively dilated until the internal os is wide enough to admit the curette. The uterine cavity is then circumferentially scraped with a sharp curette.
- Complications. Creating a false tract for patients with cervical stenosis, bleeding, infection, uterine perforation.
Hysteroscopy (see also Chapter 4)
- Indications. Diagnosis of uterine anomalies, resection of submucous fibroids, endometrial ablation, numerous others.
- Technique. The hysteroscope is inserted after dilation of the cervical canal and the uterine cavity is distended with fluid (glycine, saline). A variety of instruments (rollerball coagulator, scissors, resectoscope) may be passed through the operative sheath to perform the procedure.
- Complications. Same as D&C, extravasation of hypotonic fluid into the circulation may cause acute hyponatremia and seizures.
Minimally invasive surgery
- There has been a revolution in the range of surgical procedures performed with laparoscopy due to advances in equipment and surgeon experience.
- Very recently, the daVinci robotic system has further expanded these options.
- Results in a shorter hospital stay, less postoperative discomfort, and a quicker return to work.
Laparoscopy (Figure 17.1)
- Indications. Tubal ligation, ectopic pregnancy, salpingo-oophorectomy, total laparoscopic hysterectomy, pelvic and para-aortic node dissection, sacrocolpopexy, tubal reanastomosis, myomectomy, and numerous others.
- Technique.
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