Office-Based Gynecologic Surgical Procedures
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1 Office-Based Gynecologic Surgical Procedures
2
3 Jonathan D. Emery Marie Fidela R. Paraiso Editors Office-Based Gynecologic Surgical Procedures
4 Editors Jonathan D. Emery, M.D. Department of Obstetrics and Gynecology Cleveland Clinic Willoughby Hills, OH, USA Marie Fidela R. Paraiso, M.D. Cleveland Clinic Lerner College of Medicine at Case Western Reserve University Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology and Women s Health Institute Cleveland Clinic Glickman Urological and Kidney Institute Cleveland Clinic ISBN ISBN (ebook) DOI / Springer New York Heidelberg Dordrecht London Library of Congress Control Number: # Springer Science+Business Media New York 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (
5 Preface Recent trends in medicine have begun to allow for advances in surgical procedures: what were previously surgical procedures performed in the operating room have been transitioned to the ambulatory surgery center and ultimately to the office setting. This movement has been driven by several forces: improvements in technology with smaller caliber instruments; patient s desire for lesser invasive procedures; rising health care costs with the ability to decrease expenses by performing procedures in less resourceintensive settings. National organizations such as the Advisory Board Company and the American Hospital Association have noted this shift away from inpatient to outpatient surgery. Since the late 1990s, greater than 60 % of surgical procedures in the United States were being performed in the outpatient setting. With this shift in the provision of surgical care in this country, our specialty of gynecology has been fortunate to be a leader in outpatient surgery. In the past 10 years, however, the shift has continued to evolve to the office setting. Gynecologists have been performing office-based procedures for years: colposcopy with cervical biopsy, endometrial biopsy, vulvar biopsy and excision to name a few. Improved technology, however, has allowed for further transition to the office-based setting for more diagnostic and even therapeutic procedures. Hysteroscopic sterilization is a perfect example of this trend. The recent growth in office-based gynecologic surgeries cannot be accomplished without a clear vision for patient safety. In the United States, governmental agencies and national specialty societies, including the American Congress of Obstetrics and Gynecology, have made patient safety a top priority. Clearly, the transition to office-based gynecologic surgeries must be achieved with patient safety as a primary focus; patient satisfaction is a secondary focus when developing an office-based surgical program. This book has two chapters which address these concerns. Identifying the appropriate patient for an office surgery and then putting in place policies and protocols that emphasize and mandate safe practices will ensure continued success and further advancement of office-based surgery. Also included are chapters ranging from long-standing procedures as well as newer techniques adapted to the office. Each chapter contains advice and some tips and tricks that will allow gynecologists and women s health specialists to successfully establish these procedures in their offices. v
6 vi Preface A number of excellent and well-regarded texts of gynecologic surgery as well as office gynecology are currently available. There are not, however, texts that deal with the specifics of office-based gynecologic surgery: that is what makes this book unique. Our goal for this textbook is to provide gynecologists and women s health specialists the specifics needed to begin to perform both basic and advanced gynecologic surgeries in the office from start to finish. As gynecologists, we have the distinctive opportunity to continue to advance minimally invasive procedures that can make a significant impact on a women s health, all the while done in the safe and comforting environment of our offices. Our patients deserve the best care from us and we hope this text will continue to allow gynecologists to put Patients First. Willoughby Hills, OH, USA Jonathan D. Emery, M.D. Marie Fidela R. Paraiso, M.D.
7 Contents 1 Pre-procedure Patient Evaluation and Management... 1 May Hsieh Blanchard 2 Getting Started in Office-Based Gynecologic Procedures: Office Set-up, Procedural Implications and Ensuring Patient Safety... 9 Natalie A. Bowersox and Jonathan D. Emery 3 Informed Consent Ruth M. Farrell and Cristie M. Cole 4 Anesthesia and Analgesia for Office Gynecological Procedures Nicholas Marcanthony, Sharon Marcanthony, and Englok Yap 5 Basic Gynecologic Procedures M. Jean Uy-Kroh 6 Saline Infusion Sonohysterography Jamie Stanhiser and Rebecca Flyckt 7 Office Diagnostic Hysteroscopy Jonathan D. Emery 8 Hysteroscopic Tubal Sterilization Jonathan D. Emery 9 Office Operative Hysteroscopy: Polyp and Submucosal Fibroid Removal Mona E. Orady and Rakshanda Aslanova 10 Office-Based Global Endometrial Ablation Margaret L. McKenzie and Monique Yoder 11 Cystoscopy Audra Jolyn Hill and Marie Fidela R. Paraiso 12 Urodynamic Testing Nathan Kow and Marie Fidela R. Paraiso 13 Peri-urethral Injections Megan E. Tarr vii
8 viii Contents 14 Trigger Point Injections for Pelvic Pain Jeannine M. Miranne and Amy J. Park 15 Colposcopy Robert J. Kim 16 Loop Electro-Excision Procedure (LEEP) Kimberly L. Levinson and Chad M. Michener 17 Vulvar Biopsy and Excision/Ablation Sarah Goodrich and Mehdi Kebria Index
9 Contributors May Hsieh Blanchard, M.D., F.A.C.O.G. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA Natalie A. Bowersox, M.D. Department of Obstetrics and Gynecology, Fairview Hospital, Brunswick, OH, USA Cristie M. Cole, J.D. Department of Bioethics, Cleveland Clinic, Jonathan D. Emery, M.D. Department of Obstetrics and Gynecology & Women s Health Institute, Cleveland Clinic, Willoughby Hills, OH, USA Ruth M. Farrell, M.D., M.A. Departments of Obstetrics & Gynecology and Bioethics, Cleveland Clinic, Rebecca Flyckt, M.D. Department of Obstetrics and Gynecology & Women s Health Institute, Cleveland Clinic, Sarah Goodrich, M.D. Department of Gynecologic Oncology, Cleveland Clinic, Audra Jolyn Hill, M.D. Department of Obstetrics and Gynecology & Women s Health Institute, Cleveland Clinic, Mehdi Kebria, M.D. Department of Obstetrics and Gynecology, Cleveland Clinic, Robert J. Kim, M.D. Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA Nathan Kow, M.D. Department of Obstetrics and Gynecology & Women s Health Institute, Cleveland Clinic, Kimberly L. Levinson, M.D., M.P.H. Department of Obstetrics and Gynecology & Women s Health Institute, The Cleveland Clinic, Cleveland, OH, USA Nicholas Marcanthony, M.D. Department of Anesthesiology, Cleveland Clinic, Anesthesiology Institute, Cleveland Clinic Wooster, Cleveland Clinic, ix
10 x Contributors Sharon Marcanthony, M.D. Department of Obstetrics and Gynecology & Women s Health Institute, Cleveland Clinic, Wooster, OH, USA Margaret L. McKenzie, M.D., M.S. Department of Obstetrics and Gynecology & Women s Health Institute, Cleveland Clinic, Chad M. Michener, M.D. Department of Obstetrics and Gynecology & Women s Health Institute, Cleveland Clinic, Jeannine M. Miranne, M.D. Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC, USA Mona E. Orady, M.D. Department of Obstetrics and Gynecology & Women s Health Institute, Cleveland Clinic, Rakshanda Aslanova, M.D. Department of Obstetrics and Gynecology, Faculty of Medicine, Trakya University, Cleveland, Edirne, Turkey Marie Fidela R. Paraiso, M.D. Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology, and Women s Health Institute, Cleveland Clinic, Cleveland, OH, USA Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA Amy J. Park, M.D. Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC, USA Department of Urology, Section of Female Pelvic Medicine & Reconstructive Surgery, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC, USA Jamie Stanhiser, M.D. Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Megan E. Tarr, M.D. Department of Obstetrics and Gynecology, Cleveland Clinic, M. Jean Uy-Kroh, M.D. Department of Obstetrics and Gynecology, Cleveland Clinic, Englok Yap, M.D. Cleveland Pain Management and Acupuncture LLC, Beachwood, OH, USA Monique Yoder, M.D. Women s Health Institute, Cleveland Clinic Foundation,
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