2. Obstetric and Gynecologic Surgery
CHAPTER 15
Obstetric and Gynecologic Surgery

3. 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

4. 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

5. 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

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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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)

20. 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

21. 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