Culdoscopy
Norm of Culdoscopy
Normal structure and arrangement of the pelvic organs; absence of inflammatory processes, lesions, adhesions, or ectopic pregnancy; and patent fallopian tubes.
Usage of Culdoscopy
Aids in the diagnosis of endometriosis, pelvic adhesions, and pelvic abnormalities not diagnosable by palpation. Exploratory procedure for adhesions or tubal blockage causing sterility or for suspected salpingitis, ectopic pregnancy, pelvic pain, or pelvic inflammatory disease. Technique for tubal sterilization.
Description of Culdoscopy
The direct visualization of the pelvic organs through a culdoscope inserted through the cul-de-sac (rectovaginal septum) of the vagina into the pelvis. The culdoscope, or pelvic endoscope, is a surgical instrument (flexible type available) with a fiberoptic light source, lens, and light hood. Although visualization of the pelvic organs is more difficult with culdoscopy than with laparoscopy, the procedure poses less risk to the woman.
Professional Considerations of Culdoscopy
Consent form IS required.
Risks
Inadvertent amniocentesis, pain.
Contraindications
In instances of cul-de-sac mass, fixed uterine retrodisplacement, acute gynecologic infections, thickened nodular uterosacral ligaments, and in clients who are unable to maintain a knee-chest position.
Preparation
- Pain medication may be prescribed.
- The client should void just before the procedure and disrobe below the waist or wear a gown.
- Obtain an antiseptic solution, a culdoscope, a cannula and a trocar, sterile water in a warmer, perineal retractor, a speculum, a tenaculum, a local anesthetic, two needles, two syringes, indigo carmine dye, a pillow, and an absorbable suture material.
- The culdoscope is prewarmed in a sterile solution.
- Insert an indwelling urinary catheter to prevent bladder distension from urine.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
Procedure
- The client is placed facedown in the knee-chest position with her thighs perpendicular to the examination table and her shoulders supported with shoulder rests.
- A perineal retractor is inserted to expose the vaginal vault, and the area is cleansed with an antiseptic solution.
- A speculum is inserted through the vagina to elevate the perineum, and a tenaculum is used to pull the cervix toward the symphysis pubis, thus exposing the cul-de-sac.
- The rectovaginal septum is injected with local anesthetic in several places.
- The trocar is inserted through a cannula and pushed through the vaginal wall at the cul-de-sac and then removed. Upon removal, pneumoperitoneum occurs, aided by the knee-chest position, as air rushes into the peritoneal cavity.
- The culdoscope is connected to the fiberoptic light cord and inserted through the cannula into the peritoneal cavity, and the angled lens system is manipulated to methodically inspect the pelvic organs. Organs and structures inspected include the posterior uterine surface, fallopian tubes and ovaries, uterosacral ligaments, pelvic peritoneum, appendix, rectum, and sigmoid colon.
- Dye may be injected into the uterus through the cervix, and the fallopian tubes are inspected for patency.
- The culdoscope is removed, and the woman is assisted into a prone position with a pillow under the abdomen to force air out of the abdominal cavity. The cannula is removed, and the cul-de-sac is sutured with absorbable sutures.
Postprocedure Care
- Notify the physician for more than a small amount of bleeding or for fever, chills, or an increase in abdominal pain.
Client and Family Teaching
- You may experience abdominal cramping for several days after the procedure, until the air dissipates.
Factors That Affect Results
- The value of this procedure depends on the skill of the operator.
Other Data
- Microsurgical repair of adnexal structures is sometimes performed with culdoscopy.
