Loop Electrosurgical Excision Procedure (LEEP/LLETZ) for CIN

Loop electrosurgical excision procedure (LEEP), also known as large loop excision of the transformation zone (LLETZ), is a procedure for further diagnosis and treatment of cervical intraepithelial neoplasia (CIN). CIN lesion is an abnormal growth in the cervix. The CIN lesion is usually diagnosed during a routine Pap smear (or called Thin Prep) test. LEEP is a very safe way to remove abnormal tissue from the cervix that might otherwise progress to cancer. It minimizes the amount of tissue removed in order to preserve childbearing ability.

Reason for the procedure

• Presence of CIN lesions from the colposcopy evaluation and confirmed via cervical biopsy. Some types of CIN can progress to cervical cancer if not treated. This can be used as a treatment for CIN lesions.
• Unsatisfactory colposcopic evaluation whereby the whole transformation zone cannot be visualized or the cervix appeared abnormal and requires a bigger tissue specimen for a more accurate diagnosis to exclude cancer changes.

Read moreLoop Electrosurgical Excision Procedure (LEEP/LLETZ) for CIN

Endometrial biopsy (Endometrial sampling or curettage)

Endometrial biopsy is a procedure that involves the removal of tissues from the endometrium, which is the inner lining of the uterus.

Reason for the procedure

It is done to diagnose endometrial cancer or hyperplasia (with or without atypia). Endometrial hyperplasia is a potentially precancerous condition. This procedure is indicated in a woman with abnormal uterine bleeding. This includes bleeding between menstrual periods, excessive bleeding during a menstrual period, or bleeding after menopause. It is also done to exclude endometrial cancer in post-menopausal  women with abnormal endometrial finding on ultrasound scan of the uterus.

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Vasectomy – Male contraception

Article contributed by Dr Peter Ng and Dr Beatrice Chua Yoong Ni

The aim of a vasectomy is to prevent sperm from reaching the semen by disconnecting the sperm duct. The resulting ejaculate is therefore sperm-free, eliminating the risk of pregnancy. Sort of like a cheap shark fin soup without the shark fins (sperms).

Vasectomy is the contraception of choice for 6%–8% of married couples worldwide. Vasectomy is a minor procedure that provides effective and permanent contraception. In fact, it is far more effective than many other methods of contraception, including female sterilization.

Prior to a vasectomy, it is important and both husband and wife be present together to be counseled by a specialist on the implications of the procedure. It is important that the completeness of family is ascertained and that both husband and wife had discussed beforehand and agreed that it is the husband who should undergo a vasectomy to attain permanent contraception.

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Benign ovarian cysts

The ovaries are the female reproductive organs that contain eggs and will release them on a regular basis (usually monthly in the majority of the women). It also produces female and male hormones. An ovarian cyst is abnor¬mal growth in the ovary and can be either solid or cystic. It can be divided into either a benign (non-cancerous) or malignant (cancerous) type. Benign or non-cancerous cysts do not invade neighboring tissue the way malignant cyst does. The exceptionally large ovarian cyst often turns out to be benign.

The term ovarian cyst refers to abnormal growth in the ovary that contains mainly fluid, although occasionally some solid component may be present as well.

Symptoms and signs

Read moreBenign ovarian cysts

Hysteroscopy (diagnostic and operative)

The hysteroscope is a small lighted telescope used for visual examination of the cervix and the uterus to help diagnose and treat abnormalities in the cervical canal or the uterine cavity. If it is used to look for the cause of the presenting problem, it is term as diagnostic hysteroscopy. If it involves some form of surgical procedures such as removal of growths (endometrial polyps or fibroids), removal of the lining or separation of adhesions, then it is called operative hysteroscopy. In many cases, both procedures are done concurrently – the so-called “see and treat” approach.

Reasons for the procedure

  • Evaluation and treatment of abnormal uterine bleeding.
  • To look for the displaced and removal of the intrauterine device (IUD).
  • Evaluation for infertility (difficulty in conceiving) or recurrent miscarriage.
  • Uterine polyps, fibroids or adhesions (which is called Ashermann’s syndrome).
  • Obstructed fallopian tubes.
  • Congenital malformations of the uterus

Read moreHysteroscopy (diagnostic and operative)

Anaesthesia and Analgesia in Obstetrics and Gynaecology

Dr. William Morton demonstrated the first public administration of ether anaesthesia in the operating theatre of the Massachusetts General Hospital on the 16th October 1846
That day is remembered as a milestone in anaesthesia and celebrated as World Anaesthesia Day.
From that date onward, many progresses have been made in the field of anaesthesia, and more so specifically for the practice of obstetrics and gynaecology.

On the 16th August 1897, a German surgeon by the name of Dr. August Bier administered the first spinal anaesthetic. Spinal anaesthesia becomes one of the most popular methods of administering a patient pain free from surgery of the lower limbs, lower abdomen and Caesarean sections and is still widely used.

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Suction evacuation for miscarriage

Suction & evacuation is a technique of emptying the uterus of a pregnancy. It can be used to terminate a pregnancy or to remove a fetus that has died. It involves the removal of a fetus and accompanying tissue of the pregnancy from the uterus with instrumental evacuation through the vagina and is usually performed in the first trimester of pregnancy.

Reasons for procedure

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Cervical Intraepithelial Neoplasia (CIN)

Cervical intraepithelial neoplasia (or CIN) refers to the presence of abnormal cells seen on the cervical cytology smear. These abnormal cells are obtained from the lining of the outer cervix and can range from mild to severe changes. A diagnosis of CIN changes is not cancer. However, the severe form of dysplasia can be considered a precancerous condition and may eventually progress to cancer in several years if not treated.

The cervical cytology smear was previously referred to as Pap smear. Currently, the newer cervical cancer screening uses a liquid based cytology and the commonest one used are: Thin Prep or Sure-Path. These are better and more accurate compared to the conventional Pap smear test.

Classification of CIN 

Read moreCervical Intraepithelial Neoplasia (CIN)