China
Africa
Explore chapters and articles related to this topic
Operating Room Setup and Positioning
Published in Marc A. Levitt, Pediatric Colorectal Surgery, 2023
The most used dilators to check or dilate the anoplasty after a PSARP or the colo-anal anastomosis after an HD pull-through are sizes 11–14. If Hegar dilators cannot be obtained, substitutes for the most common sizes are easy to find. Examples of substitutes include the top cap of an enema bottle, a 5 mL blood collection tube, gradated candles, a 3D printed model, and the caregiver's gloved little finger (Figure 28.11).
Cervical insufficiency
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Sonia S. Hassan, Roberto Romero, Francesca Gotsch, Lorraine Nikita, Tinnakorn Chaiworapongsa
There is no objective diagnostic test for cervical insufficiency. The diagnosis is often made in a patient in the midtrimester who presents with dilatation of the cervix and different degrees of membrane prolapse. The evaluation of the nonpregnant patient represents an unsolved challenge. Several methods have been proposed for the identification of the patient at risk for cervical insufficiency, including (i) the passage of Hegar dilators (6–8 mm) or Pratt dilators through the internal cervical os (49–51), (ii) the use of a balloon test (52), or (iii) the ability of the cervix to hold an inflated Foley catheter during hysterosalpingography (53). However, there is a paucity of scientific evidence to support the value of these tests in predicting subsequent pregnancy outcome (44).
Urology
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
This is a rigid cystoscope (Figures 9.3 through 9.5). It comes in different sizes ranging from 6 F to 27 F. Adults usually require 15 F to 25 F sizes. It is inserted into the bladder through the urethra usually under a general anaesthetic. It has a light source and a camera attached to allow for direct visualisation of the anatomical structures and any potential abnormalities. It consists of a telescope, a sheath and an obturator. The sheath consists of channels within it for the insertion of surgical instruments and passage of irrigation to distend the bladder for visual optimisation. The telescope comes with varying degrees of freedom to allow for optimised visualisation of different structures depending on anatomical locations. To minimise trauma, it is generally advised to start with the smallest cystoscope without compromise to visualisation. If clinically necessary, gradual dilatation of the urethra with Hegar dilators is performed. It offers better optical clarity over the flexible cystoscope because of the optical system and the possibility of greater irrigation flow rates.
Fertility success rates in patients with secondary infertility and symptomatic cesarean scar niche undergoing hysteroscopic niche resection
Published in Gynecological Endocrinology, 2020
Shlomo B. Cohen, Jerome Bouaziz, Alexandra Bar On, Raoul Orvieto
Only patients with myometrial thickness of more than 2 mm underwent hysteroscopic niche resection. General anesthesia using isoflurane and nitrous oxide was administered in the surgical suite. We used a 9-mm resectoscope *Versapoint system 2 to provide positive pressure (100 mm Hg) and continuous outflow suction control (0.5 bar). Cervical dilation was performed using Hegar dilators (up to size 9.5), and the anterior and posterior edges of the defect were resected with a cutting loop and pure cutting current, followed by resection of the scar tissue at the apex of the niche [14]. Scar tissue was completely removed using a resectoscopic loop until the muscular tissue below was evident. We stopped the irrigation during the procedure to decrease the pressure and to identify any bleeding in the area of the niche. This bleeding signals that the entire fibrotic part of the scar has been removed and the muscular part has been reached.
A cohort study comparing 4 mg and 10 mg daily doses of postoperative oestradiol therapy to prevent adhesion reformation after hysteroscopic adhesiolysis
Published in Human Fertility, 2019
Linlin Liu, Xiaowu Huang, Enlan Xia, Xiaoyu Zhang, Tin-Chiu Li, Yuhuan Liu
A preliminary diagnostic hysteroscopy was performed under general anaesthesia, using a 4.5 mm diameter hysteroscope without prior cervical dilatation and normal saline as the distending medium. The distension pressure was set at 90 mm Hg. Once the presence of adhesions had been confirmed and uterine anatomy assessed, the diagnostic hysteroscope was withdrawn and the cervix dilated with Hegar dilators. A 12° resectoscope with an outer sheath diameter of 9.5 mm (Olympus, Japan) was then introduced into the uterine cavity. Normal saline was used as the distension medium, at a pressure of 100 mm Hg. A bipolar loop or needle electrode was used to divide the adhesions, with cutting and coagulation power set at 310 w and 90 w, respectively. Thin adhesion bands were incised with needle diathermy whereas thick fibrotic bands were resected with loop diathermy. Usually the filmy and central adhesions were divided initially with a bipolar electrode needle, followed by the marginal and dense adhesions. The procedures were performed by one of the two experienced endoscopic surgeons guided by transabdominal ultrasonography. The occurrence of any complications was recorded.
Functioning left uterine horn with cervico-vaginal atresia and ovarian maldescent – an unclassified Müllerian anomaly treated with horn-vaginal anastomosis
Published in Journal of Obstetrics and Gynaecology, 2018
Rashmi Bagga, Tanuja Muthyala, Pradeep Kumar Saha, Jasvinder Kalra, Rimpi Singla, Aashima Arora, Tulika Singh
Three months later (November 2016), her vaginal length was 3 cm and she underwent uterine horn-vaginal anastomosis by an abdomino-perineal approach. The left-sided uterine horn and fallopian tube were well-developed and the left ovary had an 8 × 8 cm endometriotic cyst. The right uterine horn was rudimentary (1 × 1 cm) with no attached fallopian tube or ovary. The right ovary was located above the pelvic brim (maldescent) with a poorly-developed fallopian tube attached to it. A fibrous band connected the two uterine horns. The right rudimentary horn and right fallopian tube were excised followed by left ovarian cystectomy and reconstruction. The uterovesical peritoneal fold was opened and the urinary bladder was reflected inferiorly over the atretic cervix and vagina. A 1 cm transverse incision was made in the vagina over a Hegar dilator introduced vaginally and four stay sutures were placed on the vaginal edges. Another 1 cm incision was made in the lower part of left uterine horn and the haematometra was drained. An 18-Fr Foley’s catheter was introduced vaginally into the endometrial cavity, anterior to the atretic cervix and was sutured to the fundal region with chromic catgut. The edges of the uterine incision were anastomosed to the edges of the vaginal incision using the four stay sutures and another three interrupted sutures to form a neo-uterovaginal canal (Figure 1(b)). She was prescribed sequential oestrogen and progestin (estradiol valerate 2 mg for 21 days and medroxy progesterone acetate 10 mg for last seven days) every 4 weeks for three cycles. Foley’s catheter got expelled after her first menstrual period (3 weeks after surgery). She has had 10 normal menstrual cycles to-date, has no pain and sonography showed no haematometra. She is presently using a vaginal mould for few minutes daily to improve the vaginal length.