Minimaly Invasive Procedure Dub

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    A.KAVITHA

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    Hystrectomy-100% success rate

    Disadvantages

    the diseased organ is only

    endometrium

    Long term complications urinary

    dysfunction, cvs problems

    So better choice is MIS

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    An alternative to hysterectomy when medical

    management fail

    The idea for this procedures evolved from

    pathology that happens in Ashermannsyndrome leading to amenorrhea

    The basic principle is ablation of

    endometrium

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    MIS

    I GENERATION

    II GENERATION

    NdYAG LASERELECROSURGERY

    TCRE

    ROLLER BALL

    THERMAL BALOON

    NOVASURE

    CRYOPROBE

    HYDROTHERMAL

    RADIOFREQUENCY

    III GENERATION

    MICROWAVE

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    I DIC I S

    Intractable uterine

    bleeding

    Coagulopathies-risk

    for hysterectomy

    ge >40yrs

    (completed family)

    ot willing for

    hysterectomy

    C I DIC I S

    Uterine size>12wks

    ny pathology in uterus

    Pregnancy

    cute pelvic

    inflammation

    Scarred uterus

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    PREREQUISITE

    preoperative thinning of endometrium

    danazol 200 mg tds -6 wks,

    Gnrh analogues 3 months

    Immediate Post menstrual period endometrial thickness < 3 cm

    PRE OPERATIVEPREPARATION:

    Evaluate completely and rule out CI

    INTRA OPERATIVE:

    Anaesthesia GA or regional Position dorsal lithotomy

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    Under

    HYS SC P

    Distension medium-

    irrigate1st eneration

    BJ CIV of blation is to cause thermal

    damage to the basalis layer of endmetrium

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    Distension-saline

    5mm destroyed

    SUCCESS RATE-95%

    ADVANTAGE

    More precise

    Lesser complication

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    TC

    U shaped loop3-5mm myometrium resected

    SUCC SS TE

    50% menorrhoea

    96%Hypomenorrhea

    DV TAGE

    Cheap,sampling,low failure

    rate

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    TRANSCERVICAL ENDOMETRIAL

    RESECTION

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    ROLLER BALL

    ENDOMETRIAL

    ABLATION

    2-4MM

    ball/barrel/ovoid

    Uniform vapourisationFAILURE RATE 5-10%

    ADVANTAGE

    Low rate of

    perforation

    Short time

    ROLLER BALL

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    ROLLER BALL ENDOMETRIAL

    ABLATION

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    Perforation

    Haemorrhage

    Gas embolism

    Infection

    Damage to vessels,bowels,urinary bladder

    Fliud absorbtion-lead toHT,Hyponatremia,neurologicalsymptoms,haemolysis and even death

    Hence,fluid input/output should be monitored

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    2ndGeneration

    o hysteroscope

    o distention media

    isk of 1st generation techminimised

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    Central computer system with disposable silicon

    balloon catheter 5mm

    Insert

    Inflate balloon- 5%dextrose+watercirculate

    Heat-87deg for 8min and deflate

    ADVANTAGE

    Low complications No special skill

    Effective and safe 85% success rate

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    THERMOCHOICE

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    Disposable 3D fan shaped fabric like

    expandable with metallic skeleton is

    used

    Outer sheath removed

    With high frequency electro

    generator electrocoagulation is

    done

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    NOVASURE

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    3rdGeneration

    No HYSTROSCOPE

    Even no distention

    media

    Only probe is used

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    Magnetic energy-9.2GHz

    8mm applicator

    Temp 80 deg -3min6mm destroyed

    ADVANTAGE

    No bleed,no fluid load

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    MICROWAVE ENDOMETRIAL

    ABLATION

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    CRYOABLATION

    RADIOFREQUENCYINDUCED THERMAL

    ABLATION

    HYDROTHERMAL

    ELITT-Endmetrial LASERIntrauterineThermotherapy

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    HYDROABLATION

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    Rapid recovery

    Normal dietMay be bleeding slighty-

    serosanguinus discharge-profuse

    watery discharge

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    THANK YOU