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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
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