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Microsoft word - ablation 76-100.doc

Stenosis
Dilated canal
Lacerations
Fragile
Cervical Stenosis
False Passage & Perforation
Frequency: 1.3-3.0 %
Reasons:
Solution:
Perform diagnostic hysteroscopy to chart the endocervical canal Open Speculum
Cervical Dilators
Stenosis of the Cervix
Operative Hysteroscopy
22 – 26 F (7-9 mm)
Global Ablations
15-24 F (5-8 mm)
Cervix Dilatation
Diameter
Novasure
Her Option
ThermaChoice
Inability to Dilate the Cervix -
Stenosis
Laminaria
Misoprostol (Cytotec)
Vasopressin
Inability to Dilate the Cervix –
Cytotec (Misoprostol)
200-400 mcg
Oral or vaginal
3-24 hours prior to procedure
Tmax: 12mins
Time reduced: 40 vs 120 sec
Cytotec (Misoprostol)
Side Effects
Nausea
Diarrhea
Uterine cramps
Bleeding
Inability to Dilate the Cervix -
Vasopressin
Vasopressin 20 mL
(4U of 0.05 U/ml in 80mL of NS)
Intracervically 4 & 8 o’clock positions
• Decreased force from 37 to 20 lbs
• Complications: MI, cardiac arrest
Excessive Cervical Patency
Complication:
-Loss of a seal
Solutions:
-2 tenaculums
-Gimpelson tenaculum
-EndoLoop
-Use ThemaChoice, Her Option, Microsulis
Office Setting Recommended
Anesthesia and Pain Management1
Pre - Procedure
NSAID: Toradol 10 mg, (Ibuprofen 800mg
(Ponstel 250mg, Cataflam® 50mg, Celebrex® ) – Anxiolytic: Ativan 1 mg, (Diazepam 10mg)
Opiate analgesic: Lortab 10/500, (Vicodin® 2
***All are taken at home 1 -2 hours pre procedure. NSAIDs are also
taken the night before
Toradol® 30 mg IM (peripheral PG blocker) +
Atropine 0.4mg IM (prevents vaso-vagal) 30 min
pre procedure

1Author’s experience and recommendation Local Anesthesia
Potocky® Needle
Local Anesthesia
Toxic Dose Lidocaine
¾1% Lidocaine Without Epi =
300mg (30cc)
Uterine Pathology
Endometrial hyperplasia
Atypical endometrial hyperplasia
Adenomyosis
Polyps
Fibroids
Anticoagulated Patients
Need to stop anticoagulation?
Need to alter procedure?
Is there a best method?
Contraindications:
Prior Surgical
Classical C-section
Myomectomy
Metroplasty
Repeat Ablations
Was failure delayed or immediate?
If immediate, what is the reason for
failure:
¾ Technical problems
¾ Uterine deformity
¾ Adenomyosis
¾ New pathology: carcinoma, fibroids,
Adenomyosis
Repeat Ablations
Pre operatively, repeat studies
including biopsy and labs
What method should be used for repeat
ablation?
Depends on the reason for failure

Source: http://www.neogs.org/Syllabus/Ablation%2076-100.pdf

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