Culdoscopy
Culdoscopy, also known as flexible culdoscopy, is a minimally invasive surgical procedure utilized to visualize the female pelvic organs through an endoscope. The procedure involves inserting a rigid viewing tube through the vagina into the rectouterine pouch, allowing healthcare providers to examine the pelvic organs and collect tissue samples for diagnostic purposes. Culdoscopy is particularly useful in diagnosing conditions such as cancer of the uterus, ovaries, or Fallopian tubes, as well as assessing infertility and endometriosis.
The procedure typically requires minimal discomfort and can often be performed with varying levels of anesthesia, from local to general, depending on patient needs. Following the procedure, patients are monitored for any complications, such as bleeding or infection, and are advised to avoid certain activities for a period of time. Although culdoscopy's popularity has declined in favor of laparoscopy since the 1970s, it has seen a resurgence in the 21st century due to its comparative effectiveness and lack of abdominal incisions. Overall, culdoscopy remains a valuable tool in the field of gynecological diagnostics and treatment.
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Culdoscopy
ALSO KNOWN AS: Flexible culdoscopy
DEFINITION: A culdoscopy is a minimally invasive surgical procedure for visualizing the female pelvic organs through an endoscope (or culdoscope). The endoscope, a rigid viewing tube, is passed through the vagina into the cul-de-sac or rectouterine pouch (the pouch of Douglas), the part of the peritoneal cavity between the rectum and the uterus. The procedure can be used for the diagnosis of diseases such as cancer or the diagnosis of other conditions such as infertility or endometriosis.
Cancers diagnosed: Cancer of the uterus, ovaries, or Fallopian tubes
Why performed: Culdoscopy allows examination of the female pelvic organs and collection of a biopsy (tissue sample) for diagnosing cancer, with minimal discomfort for the patient. Culdoscopy can also be used to assess female fertility and for tubal ligation.
Patient preparation: The procedure is minimally invasive and is usually a hospital procedure with a short stay. Gas distension may be required for visualization, but it may not be necessary if the procedure is done in the knee-to-chest position. Anesthesia required for the procedure may vary from local or regional to general anesthesia, depending on various factors. If a flexible tube is used, the patient may stay awake during the procedure. The patient is informed of the risks involved, as well as the benefits of this type of diagnostic procedure.
Steps of the procedure: The patient can be positioned in the knee-to-chest position or lying down (lithotomy) for this procedure. The endoscope, or culdoscope, is inserted into the female pelvic cavity via a small incision or puncture in the top of the posterior (back) vaginal wall. After the surgeon visualizes the pelvic cavity, a tissue sample may be taken and sent to the laboratory to determine the presence of cancer.
After the procedure: The patient may be positioned on her abdomen to help expel any air used in the procedure. The patient is assessed and monitored for bleeding from the vagina. The patient should abstain from sexual intercourse, tampon use, or douches for at least two weeks or until cleared through her health care provider.
Risks: Bowel injury and sepsis are possible risks of culdoscopy. Complications are estimated at 2 percent of patients and include bleeding at the puncture site, infection or peritonitis, or hypersensitivity or allergic reaction to the anesthetic used in the surgery.
Results: Though culdoscopy is still used as a diagnostic tool, many healthcare providers have replaced it with laparoscopy. Its use in the United States began to fade after the 1970s, although it experienced a resurgence in the twenty-first century. Some medical professionals prefer culdoscopy since no abdominal incision is required, as with laparoscopy. The procedure is still performed because the findings of culdoscopy are often comparable to those of laparoscopy.
Bibliography
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Decker, Albert, and Thomas Cherry. "Culdoscopy: A New Method in the Diagnosis of Pelvic Disease—Preliminary Report." American Journal of Surgery, vol. 64.1, 1944, pp. 40–44.
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Lafans, Kathryn. “Culdocentesis - StatPearls.” NCBI, 24 Oct. 2022, www.ncbi.nlm.nih.gov/books/NBK564360. Accessed 22 June 2024.
Litynski, Grzegorz S. "Hans Frangenheim - Culdoscopy Vs. Laparoscopy, the First Book on Gynecological Endoscopy, and 'Cold Light.'" JSLS : Journal of the Society of Laparoendoscopic Surgeons, vol. 1, no. 4, 1997, pp. 357-361, www.ncbi.nlm.nih.gov/pmc/articles/PMC3016753/. Accessed 22 June 2024.
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