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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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