Culdoscopy

Culdoscopy (pelviscopy) - type of peritoneoscopy, an examination of the internal female sex organs endoscope, introduced in premonicion-uterine deepening of the abdominal cavity (Douglas pocket) through the incision posterior vaginal fornix. Culdoscopy is with the purpose of differential diagnostics of tumors of the uterus and ovaries, inflammatory formations of the uterus and extragenital tumors, as well as with difficulties in the diagnosis of ectopic pregnancy, genital TB and endometriosis.
Culdoscopy contraindicated in inflammatory and adhesive processes in the lower abdomen, with a fixed bend of the uterus backwards, with large tumors located in dopasowa space, with long narrow vagina, virgins.
The research is conducted in the hospital. Training - as described above. After emptying the bladder patient is laid on the examination table. External genitals, vagina, cervix treated with alcohol and alcoholic iodine solution. Vagina impose elaboate mirror and lift the back lip of the cervix take a bullet forceps. After a local anesthetic solution of Novocain through an incision in the back arch (0,3-0,5 cm) insert the endoscope. To impose pneumoperitoneum is not necessary, as at the moment of extraction of the stiletto and replace it with an optical system air spontaneously absorbed into the abdominal cavity through the endoscope. When viewed clearly visible in the rear surface of the uterus, ovaries and less well - fallopian tubes. After the inspection and removal of the optical system, the patient should take a deep breath, then exhale and potorytsia that the air from the abdominal cavity out the tube of the endoscope. After moldoscopie need bed rest at least one day.
The study usually easily tolerated. Complications are very rare.

Methods and equipment of moldoscopie. The night before and the morning of moldoscopie ill do a cleansing enema and not give there. 15 minutes before the examination under the skin type 1 ml 2% solution of morphine. Immediately before the study empty the bladder.
Culdoscopy produced in small operating on regular gynecological chair. External genitals, vagina, and cervix carefully treated with alcohol and iodine tincture. Vagina impose elaboate mirror and a lift. Rear lip of the cervix capture bullet forceps and produce paracervical anesthesia 0.5% novokaina solution in 20 ml on each side. In the rear and front of the vault of the vagina impose on 5 ml of the same solution. After numbing the mirror and pull the backrest lowered slightly below the horizontal level. The patient was transferred to the knee-chest position. Crotch divert mirror maximum up. Rear lip of the cervix bullet forceps to bring down.
Posterior vaginal vault in the middle pierce long thick needle to get the feeling of dropping" needles. Thus the air with a characteristic hiss sucked into the abdominal cavity is formed spontaneous pneumoperitoneum, the conditions for examination of small pelvis organs. The needle narrow scalpel vertically make the cut posterior vaginal fornix length 0,3-0,5 cm (back colpotomy), which then expand the trocar. After extract the stiletto in the tube trocar insert the endoscope with side optics and produce examination of small pelvis organs.
If moldoscopie clearly visible in the rear surface of the uterus and ovaries, less clearly visible fallopian tube (Fig. 4). For better orientation during the inspection is recommended to shift the uterus, sipping her bullet forceps imposed on the neck, or the left hand, pressing on the anterior abdominal wall sick, to bring this or that body in the field of view of the endoscope.
After the examination, offer the patient after a deep breath, exhale, and potorytsia, with the air of abdominal cavity comes out. Tools extract and on the wound of the vagina (colpotomy hole) impose kathoey seam. After moldoscopie the patient must stay in bed for at least 24 hours.

culdoscopy
Fig. 4. Culdoscopy (schematically). Right there in the corner - a view of internal genital organs of the female when moldoscopie: 1 - fallopian tube; 2 - ovary; 3 - uterus.