Anesthesia for Hysteroscopy - 03/09/11
Résumé |
Hysteroscopy is not in itself a new technique; visualization of the uterine cavity was first described by Pantaleoni as long ago as 1869.54 In recent years, however, the use of hysteroscopy, both as a diagnostic and in particular as a therapeutic tool, has taken off as surgical equipment has improved along with a general drive toward minimally invasive techniques in all the surgical specialties. In this respect, diagnostic hysteroscopy, which generally can be performed as an outpatient procedure without the need for general anesthesia, is replacing dilatation and curettage in the diagnosis of abnormal uterine bleeding.24 Other diagnostic indications include investigation of recurrent miscarriage, primary or secondary infertility, and location and retrieval of fractured or embedded intrauterine contraceptive devices. The hysteroscopic technique of therapeutic endometrial ablation now offers a minimally invasive alternative to hysterectomy in the surgical management of menorrhagia,35 with reduced hospital stay and early recovery period55 and lower postoperative morbidity20 compared with the abdominal procedure. In selected patients, symptomatic submucous fibroids can be resected hysteroscopically, again avoiding the need for an intraabdominal procedure.52 Hysteroscopic techniques can also be used in the treatment of the septate uterus and lysis of uterine adhesions.60
As with other minimally invasive surgical techniques, improvements in equipment, greater experience, and familiarity with techniques have ensured that complication rates remain extremely low. Nevertheless, the infrequent but potentially disastrous nature of these complications makes it imperative for all those involved with the surgery to remain vigilant. In the provision of anesthesia for these techniques, therefore, the anesthesiologist must be aware of the potential hazards associated with the procedures and is often best placed for their early detection and prompt treatment.
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| Address reprint requests to Tong J. Gan, Department of Anesthesiology, Duke University Medical Center, Erwin Road, Box 3094, Durham, NC 27710 |
Vol 19 - N° 1
P. 125-140 - mars 2001 Retour au numéro
Article précédent
- Surgical Aspects and Future Developments of Laparoscopy
- Stephanie B. Jones, Daniel B. Jones
- Physiologic Changes During Thoracoscopy
- Brian Fredman
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