Obstetric and gynecologic surgery is a craft that requires sound knowledge and skills. The knowledge and skills will need to be applied to the specifics of each surgical patient to enable the best surgical management and minimize complications. This resource book offers insightful management options to many of the challenges a gynecologic or obstetric surgeon may face before, during or after an operation. Designed to guide the surgeon to safe practice throughout all stages of surgical management, it offers case studies, management options with tips and tricks, and ideas for prevention of complications. Key points and summaries are provided at the end of each chapter for elevator reading , i.e., quick brushing up of facts on the way to facing a
challenge.
Divided into two sections the book first covers general pre, intra and post–operative challenges and, second, specific operative procedures within the specialist areas in obstetrics and gynecology.
Contents
PART I: GENERAL PRE, INTRA, and POST OPERATIVE CHALLENGES
SECTION 1: PRE–OPERATIVE CARE
1 Patient with poor ASA score
2 Patient on medication
3 Patient with ischaemic heart disease
4 Patient with Arrhythmias
5 Patient with a pace–maker or implantable defibrillator
6 Patient with complex congenital heart disease (a Fontan Circulation)
7 Hypertensive patient
8 Patient with respiratory disease
9 Patient with diabetes
10 Patient with thyroid disease
11 Patient with renal disease
12 Patient with liver disease
13 Patient with rheumatologic diseases
14 Patient with hematologic disorders
15 Patient at high risk of venous thrombosis
16 Patient on anti–coagulant therapy
17 Patient on steroid therapy
18 Patient with epilepsy
19 Patient with a psychiatric condition
20 Patient with organ transplant
21 Patient with Hep B or Hep C
22 Patient with HIV
23 Obese patient
24 Patient with poor nutritional status
25 Pregnant patient requiring non–obstetric surgery
SECTION 2: INTRA–OPERATIVE CARE
26 Transverse incision on the abdomen inadequate for surgery
27 Patient with multiple abdominal scars
28 Patient with previous mesh incisional hernia repair requiring a laparotomy
29 Patient with previous mesh incisional hernia repair requiring a laparoscopy
30 Unexpected pathology: ovarian cyst
31 Unexpected pathology: abnormal appearance of the uterus
32 Unexpected pathology: severe pelvic adhesions
33 Unexpected pathology: abnormal appearance of bowel
34 Unexpected pathology: retro–peritoneal mass
35 Bladder injury
36 Ureteric injury
37 Small and large bowel injury
38 Inferior epigastric vessel injury
38 Inferior epigastric vessel injury
39 Bleeding from retracted pedicular (pelvic sidewall) vessels
40 Massive haemorrhage
41 Broken needle
42 Lost swab, needle or instrument
SECTION 3: POST–OPERATIVE CARE
43 Post–operative care
44 Excessive nausea and vomiting after surgery
45 Excessive abdominal pain after surgery
45 Excessive abdominal pain after surgery
46 Bowel damage: postoperative presentation
47 Wound infection
48 Wound dehiscence
49 Late wound failure: incisional hernia
50 Necrotising fasciitis
51 Surgical drains
52 Shocked patient
53 Breathless patient: post–operative pulmonary complications
53 Breathless patient: post–opertaive pulmonary complications
54 Confused post–operative patient
55 Patient with poor urine output
56 Electrolyte imbalance
57 The swollen leg
58 Cardiorespiratory arrest
PART II: OPERATIONS and CHALLENGES
SECTION 4: GENERAL and MINIMAL ACCESS GYNECOLOGY
59 Difficulty in dilating a cervix: Cervical stenosis and cervical closure
60 Uterine perforation
61 Surgical uterine evacuation: excessive bleeding
62 Surgical uterine evacuation in a woman with multiple fibroids
63 Use of excessive distension media at hysteroscopy
64 Hysteroscopy: endometrial resection and ablation in the abnormal uterine cavity
65 Laparoscopy in a pediatric patient
66 Safe laparoscopic entry in a thin patient
67 Laparoscopy: unable to gain entry
68 Surgical emphysema
69 Venous Air Embolism
70 Laparoscopy: problems with monopolar diathermy
71 Laparoscopy: problems with bipolar diathermy
72 Laparoscopy: bladder injury
73 Laparoscopy: ureteric injury
74 Bowel injury during laparoscopy: intraoperative presentation
75 Bowel injury after laparoscopy: late presentation
76 Blood vessel injury at laparoscopy
77 Laparoscopy for large ovarian cyst
78 Laparoscopy for an ovarian cyst in pregnancy
79 Laparoscopic removal of recto–vaginal endometriosis
80 Laparoscopic myomectomy
81 Total laparoscopic hysterectomy
82 Laparoscopic hysterectomy for a large fibroid uterus
83 Laparoscopy: difficulty in tissue retrieval
84 Surgery for cornual or interstitial pregnancy
85 Surgery for cervical ectopic pregnancy
86 Surgery for caesarean scar pregnancy
87 Surgery for adnexal torsion
88 Laparoscopic appendicectomy
89 Laparoscopic surgery: When to convert to laparotomy?
90 Laparoscopy: late complication Port site herniation
SECTION 5: REPRODUCTIVE SURGERY
91 Uterine septum division
92 Surgery for intrauterine adhesions
93 Myomectomy: breach of the endometrial cavity
94 Myomectomy: multiple large fibroids
95 Myomectomy: massive intraoperative haemorrhage
96 Vaginal myomectomy
97 Surgery for proximal tubal blockage
98 Surgery for distal tubal blockage
99 Reversal of female sterilisation
100 Surgery for congenital abnormalities of the genital tract
101 Surgical sperm retrieval
SECTION 6: UROGYNECOLOGIC SURGERY
102 Sling procedures: bladder injury
103 Sling procedures: urethral injury
104 Sling procedures: retropubic haematoma
105 Sling procedures: bowel injury
106 Sling procedures: voiding dysfunction after stress urinary incontinence surgery
107 Sling procedures: tape erosion into bladder
108 Sling procedures: sexual dysfunction
109 Sling procedures: persistent urine leakage
110 Difficult vaginal hysterectomy
111 Vaginal hysterectomy: difficulty in entering the posterior pouch
112 Salpingo–oopherectomy at the time of vaginal hysterectomy
113 Bladder injury during anterior vaginal repair or vaginal hysterectomy
113 Bladder injury at anterior repair
113 Bladder injury at anterior repair
113 Bladder injury at anterior repair
113 Bladder injury at anterior repair
113 Bladder injury at anterior repair
114 Difficult sacrocolpopexy
115 Difficult sacrospinous fixation
116 Recurrent pelvic organ prolapse
117 Colpocleisis
118 Uterine suspension procedures: Laparoscopic hysteropexy
119 Mesh tape exposure following tension free vaginal tape (TVT)
120 Vaginal vault evisceration
121 Complications in laparoscopic pelvic floor surgery
122 Robotic urogynecology procedures
123 Complications in robotic pelvic floor surgery
124 Neovagina
125 Vaginal stricture after pelvic organ prolapse surgery
126 Urethral diverticula and other periurethral masses
127 Vesico–vaginal fistulae
128 Urethro–vaginal fistulae
129 Recto–vaginal fistulae
130 Secondary anal sphincter repair
SECTION 7: GYNECOLOGIC ONCOLOGY
131 Large loop excision of the transformation zone (LLETZ)
132 Knife cone biopsy
133 Staging procedures: examination under anaesthesia, cystoscopy, sigmoidoscopy and biopsy techniques
134 Radicality of surgery for cervical cancer
135 Pelvic and para–aortic lymphadenectomy in gynecologic cancers
136 Trachelectomy for treatment of cervical cancer
137 Laparoscopic radical surgery for cervical cancer
138 Groin and retroperitoneal lymphocele
139 Laparotomy for a pelvic mass of uncertain nature
140 Gynecologic cancer extending to the bowel
141 Omental procedures: supracolic omentectomy, infracolic omentectomy, omental biopsy
142 Diaphragmatic surgery in advanced ovarian cancer
143 Fine needle aspiration; biopsy of superficial groin lymph node
144 Vulval surgery: wide local excision and vulvectomy
145 Sentinel node biopsy in gynecologic cancer
146 Groin lymphadenectomy
147 Plastic surgical techniques used in vulval or perineal procedures
148 Vaginectomy
149 Urinary diversion
150 Pelvic exenteration
151 Gynecologic cancer and concurrent pregnancy
SECTION 8: OBSTETRIC SURGERY
152 Ovarian cyst identified at caesarean section
153 Laparoscopy in pregnancy
154 Cervical cerclage
155 Caesarean section in a woman with fibroids
156 Caesarean section at the limits of viability
157 Difficult delivery of the fetal head during caesarean section
158 Surgical management of massive obstetric haemorrhage from the uterus, cervix or vagina
159 Surgical management of placenta praevia
160 Surgical management of placenta accreta
161 Surgical management options for shoulder dystocia: Zavanelli maneuver, abdominal rescue, symphsiotomy and cleidotomy
162 Uterine inversion
163 Episiotomy and second degree tear
164 Obstetric anal sphincter tear
165 Pregnancy and female genital mutilation
166 Destructive operations on a dead fetus
166 Destructive operations on the fetus
167 Setting up of a basic obstetric theatre facility in a low–resource setting
SECTION 9: MISCELLANEOUS
168 Enhanced recovery
169 Major surgery in a Jehovah s Witness patient
170 Termination of pregnancy at advanced gestation
171 Cervical fibroids: techniques for myomectomy and hysterectomy
172 Hysterectomy for broad ligament fibroids
173 Hysterectomy for a double uterus
174 Cervical stump excision
175 Surgery for ovarian remnant
176 Surgery for a missing intrauterine contraceptive device
177 Management of imperforate hymen, transverse and other vaginal septa
178 Benign lesions in the groin and vulva
179 Cystic structure in the upper vagina
180 Adnexal masses in infants and children
181 Nerve injuries associated with gynecologic and obstetric surgery
182 Consent challenges
183 Dealing with complaints
184 Dealing with litigation
