Minimaly Invasive Procedure Dub

8/9/2019 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

Minimaly Invasive Procedure Dub

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