Active Ingredients: Doxycycline
Several diagnostic systems such as small diameter rigid and flexible scopes, as well as operative systems, including monopolar loop cautery, bipolar systems, microscissors or graspers, and hysteroscopic morcellators, are currently available, which are utilized based on the complexity of the proposed hysteroscopic surgery.
After sterile surgical prepping of the vagina, hysteroscopy is carried out by the grasping of the anterior lip of the cervix with a tenaculum, followed by cervical dilation to the required diameter of the hysteroscope, insertion of hysteroscope, and distention of the uterine cavity with the distension media.
Other atraumatic hysteroscopic techniques such as the vaginoscopic approach have also been introduced. Antibiotic Prophylaxis As with any surgical intervention, hysteroscopy carries risk of infection, given the abundance of lower genital tract flora, this risk is small, that is, ranging between 0.
In one retrospective cohort study of 200 patients undergoing operative hysteroscopy without antibiotic prophylaxis, the investigators reported 3 1. All patients with postsurgical infections had a prior history of PID.
Of these infections, 18 0. Regarding endometritis, sixteen cases were early-onset and vaginal cultures in this group grew Streptococcus D and Staphylococcus aureus 2 cases each.
Six patients did not have vaginal cultures performed and no pathogens were isolated in the remaining 6 patients. In the 2 cases of late-onset endometritis, vaginal cultures showed Streptococcus D in one case and polymicrobial flora in the other case.
All patients with endometritis were treated with antibiotics. A prospective study has investigated the efficacy of amoxicillin and clavulanate antibiotic prophylaxis in preventing bacteremia during hysteroscopy.
In this study of 166 patients, the investigators randomized 55 patients to receive 1.
Despite these differences in bacteremia, no difference in the incidence of postoperative infection was noted. In their randomized trial of 631 women undergoing diagnostic hysteroscopy with or without antibiotic prophylaxis, Kasius et al.
Similarly, in a randomized control trial of 364 women by Gregoriou et al.
In a multicenter, double-blinded, randomized, placebo-controlled study of 1046 patients undergoing hysteroscopy, Nappi et al.
Patients were randomized to receive 1 gram of intramuscular cefazolin or placebo preoperatively. The investigators found an overall infection rate of 1.
Based on these published studies, most professional societies recommend against routine antibiotic prophylaxis for hysteroscopy in the general patient population. Laparoscopy 5. Brief Technique In current clinical practice, a laparoscopy is usually performed for the definitive diagnosis of endometriosis before pursuing ART.
In many cases, laparoscopy with excision of hydrosalpinges is performed to improve ART treatment success.
Diagnostic laparoscopy generally begins with placing the patient in dorsal lithotomy position, surgical prepping, and draping, followed by the insertion of a Foley catheter.
Open entry of the fascia at the level of the umbilicus or closed entry using a Veress needle in the umbilicus or left upper quadrant of the abdomen is performed next. Accessory instruments through the other 5 mm ports are used as needed. Antibiotic Prophylaxis Over the past decade, laparoscopy has grown in popularity among gynecologists due to its improved cosmesis and postoperative recovery times when compared to laparotomy.
In comparison to conventional laparotomy for benign gynecologic conditions, laparoscopic surgery carries a low postoperative infection rate. Laparoscopic procedures can be divided into clean or clean-contaminated involving entry into the uterine cavity or vagina procedures.
In, a placebo-controlled, randomized trial of 450 women undergoing laparoscopy was randomly assigned to receive a single dose of a first generation cephalosporin prior to surgery or placebo.