April 2009 · Vol. 21, No. 04UPDATE: MINIMALLY INVASIVE SURGERY
When a problematic cervix or distorted anatomy makes it impossible to enter the uterus for hysteroscopy or other office procedures, a few good tools and techniques can help.
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Fast Track
The vaginal route of misoprostol administration has fewer side effects than the oral route—plus longer duration and three times the bioavailability
The recommended protocol for intravaginal misoprostol is 400 μg about 12 hours before the scheduled procedure
Lidocaine 1% has a rapid onset of action, reaching peak effectiveness in just a few minutes, with a duration of approximately 60 minutes
The small flexible hysteroscope may help identify obstruction when the cervical canal is distorted
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Amy
Garcia,
MDDr. Garcia is Director of the Center for Women’s Surgery and Assistant Professor, Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM. She serves on the OBG Management Board of Editors.
Dr. Garcia reports that she is a consultant to Conceptus and Ethicon Women’s Health and Urology and a speaker for Conceptus.
Cervical stenosis and difficult uterine and vaginal anatomy pose a challenge for the gynecologist who needs access to the cervix and uterus to evaluate pathology. Overcoming this hurdle requires a careful, considered approach to avoid the complications of dilation, such as laceration, creation of a false passage, uterine perforation, and failed procedures. Care and consideration also ensure a successful and comfortable procedure; save the patient a great deal of time and the higher expense of the operating room (OR); and avert the need for general anesthesia.
In this first Update on Minimally Invasive Surgery, I will:
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