Obstetric and Gynecologic Surgery CHAPTER 15 Obstetric and Gynecologic Surgery

Objectives After studying this chapter, you will be able to: Recognize the relevant anatomy and physiology of the female reproductive system Summarize the pathology of the female reproductive system that prompts surgical intervention and the related terminology Determine any special preoperative obstetric and gynecologic diagnostic procedures/tests

Objectives (cont’d.) Determine any special preoperative preparation procedures related to obstetric/gynecologic procedures Indicate the names and uses of obstetric and gynecologic instruments, supplies, and drugs Indicate the names and uses of special equipment related to obstetric/gynecologic surgery

Objectives (cont’d.) Determine the intraoperative preparations of the patient undergoing an obstetric or gynecologic procedure Summarize the surgical steps of obstetric/gynecologic procedures Interpret the purpose and expected outcomes of the obstetric/gynecologic procedure Recognize the immediate postoperative care and possible complications of the obstetric/gynecologic procedure

Objectives (cont’d.) Assess any specific variations related to the preoperative, intraoperative, and postoperative care of the obstetric/gynecologic patient

Introduction to Obstetric and Gynecologic Surgery Focuses on females after the beginning of menstruation Obstetricians Focus on pregnant patient and issues concerned with fertility Gynecologists Focus on female reproductive system and related problems outside pregnancy

Instrumentation, Equipment, and Supplies in Obstetric and Gynecologic Surgery Obstetric surgery and cesarean section: same as for general surgery Obstetrics: require unique instruments Basic instrument sets: refer to Table 15-1

Equipment and Supplies Obstetric and gynecologic equipment Special beds Fetal monitors and warmer Stirrups and leg holders Lasers Supplies Most of the supplies are the same as those used in general surgery Refer to Figure 15-1 – 15-5

Patient Positioning, Draping, and/or Setup Abdominal cases: supine Vaginal and combination procedures: lithotomy Obstetric and gynecologic procedures Require a standard operating table with Trendelenburg and foot-drop capability OR should be arranged with provider positioning in mind

Surgical Procedures: Obstetrics Obstetric patient Exhibits a normal condition: pregnancy Common features of obstetric examination Routine obstetric visit Refer to Table 15-2 Vaginal delivery Key terms in labor and delivery Refer to Table 15-3

Labor Labor process stages Sample labor and delivery monitoring board Normal labor: refer to Table 15-4 Length of each stage is highly variable under normal conditions Sample labor and delivery monitoring board Refer to Table 15-5

Normal Role of Surgical Technologist in Delivery Most deliveries occur in a natural and normative pattern Surgical technologist is part of the team Assists the obstetrician, supports the mother, and prepares for developing problems Most common surgical interventions in vaginal birth Episiotomy and repair of perineal lacerations Refer to Table 15-6

Episiotomy and Perineal Lacerations Intentional midline surgical incision in the vulva Eases the birth process or protects the mother from uncontrolled perineal lacerations Classified according to the depth Refer to Table 15-6 Closed using absorbable sutures Refer to Figure 15-7

Procedures Specific procedures covered in the text Cervical cerclage Cesarean section Refer to Table 15-7 Tubal sterilization Tuboplasty Laparoscopic resection of unruptured tubal pregnancy

Surgical Procedures: Gynecologic Procedures Gynecologic surgery Surgery on the female reproductive system Common features of the gynecologic examination Refer to Table 15-9 Select gynecologic conditions, symptoms, and diagnostic tests Refer to Table 15-10

Surgical Procedures: Gynecologic Procedures (cont’d.) Summary information: procedures in gynecologic surgery Refer to Table 15-11 Abdominal incisions for gynecologic surgery Categories: transverse, vertical, and oblique Refer to Table 15-12

Surgical Procedures: Gynecologic Procedures (cont’d.) Diagnostic procedures Basic laparoscopy Hysteroscopy External procedures Marsupialization of Bartholin’s gland cyst Simple vulvectomy and ablation of condylomata Labioplasty De-epithelialization technique

Surgical Procedures: Gynecologic Procedures (cont’d.) Cervical surgical procedures Dilation and curettage Ovarian, fallopian tube, and uterine surgical procedures Oophorectomy Total salpingectomy Endometrial ablation Myomectomy (abdominal approach) Total abdominal hysterectomy (TAH)

Surgical Procedures: Gynecologic Procedures (cont’d.) Vaginal hysterectomy Laparoscopically assisted vaginal hysterectomy (LAVH) Robot-assisted hysterectomy Uterine radiation seeding Radical hysterectomy (Wertheim procedure) Pelvic exenteration Anterior (cystocele) and posterior (rectocele) colporrhaphy

Summary This chapter reviewed: Anatomy and physiology of the female reproductive system Pathology of the female reproductive system that prompts surgical intervention Obstetric and gynecologic diagnostic procedures and tests Surgical steps of obstetric and gynecologic procedures