Special Surgical Procedures II
LESSON 2: Procedures in Gynecological and Obstetrical Surgery
|
||||||||||||
|
2-29. CULDOSCOPY
a. General. The diagnostic procedure provides visualization of pelvic structures through a tubular instrument similar to a cystoscope, which is introduced through a small incision in the posterior vaginal cul-de-sac. Direct observation of the passage of dye from the uterus through the fimbriated ends of the tube is possible with the culdoscope to help determine tubal patency, the presence of ectopic pregnancy, unexplained abdominal or pelvic pain, the nature of pelvic masses, and to evaluate normal functioning of the genital tract. This examination may enable the surgeon to avoid unnecessary pelvic surgery. Laparoscopy is the preferred procedure today.
b. Patient Preparation. The patient is prepared as for a vaginal operation (refer to paragraphs 2-12 and 2-13). A local or regional anesthetic may be used. When a general anesthetic is used, the patient is intubated. The patient is usually placed in a knee-chest position, kneeling on the footboard with a kneestrap around the thighs, the chest supported on pillows, and the arms comfortably flexed above the head.
c. Operating Room Preparation. Instruments may be placed on a table so that the surgeon may serve himself. However, there is still need for a circulator. The lens of the scope may fog if the instrument is introduced cold, so the tip is dipped in warm water and wiped dry before being used.
d. Operative Procedure (see figure. 2-8).
Figure 2-8. Culdoscope. Sagittal section showing culdoscopy viewing pelvic viscera.
|
|||||||||||
The Brookside Associates Medical Education Division develops and distributes medical information that may be useful to medical professionals and those in training to become medical professionals. This website is privately-held and not connected to any governmental agency. The views expressed here are those of the authors, and unless otherwise noted, do not necessarily reflect the views of the Brookside Associates, Ltd., or any governmental or private organizations. All writings, discussions, and publications on this website are unclassified.
© 2008 Medical Education Division, Brookside Associates, Ltd. All rights reserved