Presentation on theme: "Gynecologists focus on the female reproductive system…….."— Presentation transcript:
1Gynecologists focus on the female reproductive system…….. GYNECOLOGIC SURGERYGynecologists focus on the female reproductive system……..
2ANATOMY INTERNAL FEMALE ORGANS: VAGINA UTERUS CERVIX FALLOPIAN TUBES OVARIES**Situated in the “lesser pelvis”These organs are protected by the bones of “bony pelvis” and supported by the muscularity of the pelvic floor.
11“MOORINGS” (Anchors)Connective tissue are not static, they change with age, nutritional status, amount of exercise and hormonal fluctuations……
12EXTERNAL GENITALIA “VULVA” No NOT a Volvo!!!Mons PubisLabia MajoraLabia MinoraClitorisBartholins GlandsFourchettePerineum
13“EXTERNAL GENITALIA” CONTINUED… External genitalia are vascularized and innervated by the clitoral, perineal and inferior hemorrhoidal branches of the pudendal artery and nerve.
14“VESTIBULE” Cavity between the labia minora Contains the urethral meatusInferior to the clitoris as well as the orifices of the vestibular glands (Bartholins glands)
15“PERINEUM” Area between the inferior vaginal opening and anus SensitiveBranches of the pudendal nerve; 2nd , 3rd and 4th sacral portions of the spinal canal.
16“VAGINA” Fibromuscular tube Increase in diameter in its internal projectionWidest at its deepest regionAcidic environmentAscends posterosuperiorlyBladder and urethra anteriorly; annular recess created by the cervical vaginal junction called the fornixRectum and anal canal posteriorlyRich vascular supply derived from vaginal, uterine, internal pudendal and middle rectal branches of the internal iliac arteries
18“UTERUS” Hollow, thick walled and pear-shaped Between bladder and rectumUterine appendages: (adnexa)- Fallopian tubes- OvariesSuperior 2/3 (corpus uteri) or body which narrows to a cylindrical lower section called uterine (cervix)Internal OS- At the junction between corpus uteriExternal OS- Where the cervix opens into the vaginaLined with endometriumLigaments that extend to the pelvic walls suspend the uterus
21“BROAD LIGAMENTResult of peritoneal foldsContains fallopian tubes
22“ROUND LIGAMENT” Consists of ovarian ligaments Various blood vessels Nerves and lymphaticsThe round ligament passes through the inguinal ring to the skin and connective tissue of the labia majora.Arterial supply: is derived from the uterine branch of the paired internal iliac arteries
23“FALLOPIAN TUBES” (uterine tubes) 4 PORTIONS:FimbriaAmpullaIsthmusIntramural region:Situated in the upper margin of the broad ligamentVascularity achieved by the ovarian and uterine arteries
24“OVARIES” Paired, almond-shaped Lie on either side of uterus Production and expulsion of oocytes (eggs)Release of hormones (estrogen, and progesterone)Ovarian cycle stimulated by the release of LH & FSH from putuitary glandSupported at either end by suspensory ligament (suspensory)Ovarian ligament, lying in broad ligament, support the bulk of the ovariesOvarian arteries, branching from the aorta
25COMMON SURGICAL PROCEDURES LaparoscopyHysterectomy with or without BSO-Vaginal-AbdominalD & CD & EA&P repairC-section
26GENERAL OBSTETRIC AND GYNECOLOGICAL INSTRUMENTS Heaney needle holdersJorgenson scissorsEpisiotomy scissors (bandage scissors)Heaney-Ballantine clampsTissue forceps with teethOPERATING ROOM SET-UP, PT POSITIONING AND DRAPINGStandard OR table-foot drop capabilities-sockets/brackets for leg holders-candy cane stirrups-Allen stirrupsLithotomy (most common)Mayostand-abdominal approachBacktable –vaginal approachSuction devicesKick bucketsESUSterile handpiecesDrapingUnder buttocksLeggings4 towels and a lap sheet
27Positioning and Draping? Equipment? Mayostand vs. Backtable Special ConsiderationsDrugs – Oxytocin (pitocin, synotocin) used to induce labor. Carboprost (Hemabate) – oxytocic drug available in parenteral form, used to cause abortion; contracting uterus.Positioning and Draping?Equipment? Mayostand vs. BacktableSuction Devices, ESU
28Cervical and intrauterine instrumentation Goodell uterine dialatorBozeman (many uses) uterine dressing forcepsUterine soundUterine tenaculumHegar uterine dialatorsUterine curettesAbdominal and perineal retractorsDeaver 2” bladeDeaver 1” bladeDee Lee universal retractorGelpi perineal ret.O’sullivan O’Connor abdominal retFranz abdominal ret