Microsoft word - ablation 76-100.doc
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Stenosis
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Dilated canal
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Lacerations
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Fragile
Cervical Stenosis
False Passage & Perforation
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Frequency: 1.3-3.0 %
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Reasons:
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Solution:
Perform diagnostic hysteroscopy to chart the endocervical canal
Open Speculum
Cervical Dilators
Stenosis of the Cervix
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Operative Hysteroscopy
22 – 26 F (7-9 mm)
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Global Ablations
15-24 F (5-8 mm)
Cervix Dilatation
Diameter
Novasure
Her Option
ThermaChoice
Inability to Dilate the Cervix -
Stenosis
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Laminaria
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Misoprostol (Cytotec)
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Vasopressin
Inability to Dilate the Cervix –
Cytotec (Misoprostol)
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200-400 mcg
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Oral or vaginal
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3-24 hours prior to procedure
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Tmax: 12mins
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Time reduced: 40 vs 120 sec
Cytotec (Misoprostol)
Side Effects
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Nausea
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Diarrhea
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Uterine cramps
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Bleeding
Inability to Dilate the Cervix -
Vasopressin
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Vasopressin 20 mL
(4U of 0.05 U/ml in 80mL of NS)
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Intracervically 4 & 8 o’clock positions
• Decreased force from 37 to 20 lbs
• Complications: MI, cardiac arrest
Excessive Cervical Patency
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Complication:
-Loss of a seal
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Solutions:
-2 tenaculums
-Gimpelson tenaculum
-EndoLoop
-Use ThemaChoice, Her Option, Microsulis
Office Setting Recommended
Anesthesia and Pain Management1
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Pre - Procedure
–
NSAID:
Toradol 10 mg, (Ibuprofen 800mg
(Ponstel 250mg, Cataflam® 50mg, Celebrex® )
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Anxiolytic: Ativan 1 mg, (Diazepam 10mg)
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Opiate analgesic: Lortab 10/500, (Vicodin
® 2
***All are taken at home 1 -2 hours pre procedure. NSAIDs are also
taken the night before
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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
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Toxic Dose Lidocaine
¾1%
Lidocaine Without Epi =
300mg (
30cc)
Uterine Pathology
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Endometrial hyperplasia
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Atypical endometrial hyperplasia
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Adenomyosis
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Polyps
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Fibroids
Anticoagulated Patients
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Need to stop anticoagulation?
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Need to alter procedure?
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Is there a best method?
Contraindications:
Prior Surgical
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Classical C-section
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Myomectomy
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Metroplasty
Repeat Ablations
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Was failure delayed or immediate?
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If immediate, what is the reason for
failure:
¾
Technical problems
¾
Uterine deformity
¾
Adenomyosis
¾
New pathology: carcinoma, fibroids,
Adenomyosis
Repeat Ablations
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Pre operatively, repeat studies
including biopsy and labs
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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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