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    Operative Gynecology

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    Amal Firdaus
    The document discusses various gynecological procedures including dilatation and curettage, anterior and posterior colporrhaphy, Fothergill's operation, myomectomy, and hysterectomy. It provides indications, steps, and complications for each procedure. Types of hysterectomy include abdominal, vaginal, laparoscopic, subtotal, total, pan, radical, and cesarean hysterectomy. Steps of abdominal hysterectomy involve dividing and ligating ligaments and blood vessels to remove the uterus.

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    Operative Gynecology

    Uploaded by

    Amal Firdaus
    136 views24 pages
    The document discusses various gynecological procedures including dilatation and curettage, anterior and posterior colporrhaphy, Fothergill's operation, myomectomy, and hysterectomy. It provides indications, steps, and complications for each procedure. Types of hysterectomy include abdominal, vaginal, laparoscopic, subtotal, total, pan, radical, and cesarean hysterectomy. Steps of abdominal hysterectomy involve dividing and ligating ligaments and blood vessels to remove the uterus.

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    Operative Gyne

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    The document discusses various gynecological procedures including dilatation and curettage, anterior and posterior colporrhaphy, Fothergill's operation, myomectomy, and hysterectomy. It provides indications, steps, and complications for each procedure. Types of hysterectomy include abdominal, vaginal, laparoscopic, subtotal, total, pan, radical, and cesarean hysterectomy. Steps of abdominal hysterectomy involve dividing and ligating ligaments and blood vessels to remove the uterus.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    136 views24 pages

    Operative Gynecology

    Uploaded by

    Amal Firdaus
    The document discusses various gynecological procedures including dilatation and curettage, anterior and posterior colporrhaphy, Fothergill's operation, myomectomy, and hysterectomy. It provides indications, steps, and complications for each procedure. Types of hysterectomy include abdominal, vaginal, laparoscopic, subtotal, total, pan, radical, and cesarean hysterectomy. Steps of abdominal hysterectomy involve dividing and ligating ligaments and blood vessels to remove the uterus.

    Copyright:

    © All Rights Reserved
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    Download as pdf or txt
    of 24

    Operative Gynecology

    Prof. Dr. AHMED T. SULAIMAN


    DILATATION & CURETTAGE

    • Indications
    • A. Dilatation of the cervix
    • 1.A preliminary to curettage
    • 2.Prior to hysteroscopy
    • 3.As a step of other operations e.g. cervical
    amputation or Fothergill repair
    • 4. Insertion of IUD in stenotic cervix 5.
    Introduction of intracervical or intrauterine
    radium 6. Cervical stenosis 7. Spasmodic
    dysmenorrhea 8. Drainage of pyometra or
    haematometra
    • B. Curettage of the uterine cavity
    • 1.Diagnosis & treatment of abnormal uterine bleeding
    • 2.Diagnosis of endometrial cancer
    • 3.Diagnosis & treatment of endometrial hyperplasia,
    endometrial polypi & submucous myoma
    • 4.To detect ovulation & its defects in infertility
    • 5.Removal of IUCD
    • 6. Fractional curettage
    • 7. Endocervical curettage
    • 8. In pregnancy:
    • Abortion: therapeutic, missed, incomplete,
    inevitable, septic
    • Molar pregnancy
    • Postabortive or postpartum bleeding
    • Technique
    • 1.Evacuate the bladder
    • 2.Anesthesia
    • 3.Vaginal speculum & grasp the cervix
    • 4.Sounding
    • 5.Dilate the cervix
    • 6.Curette
    • Complications
    • 1.Cervical laceration
    • 2.Cervical incompetence
    • 3.Perforation of the uterus
    • 4.Spread of infection
    • 5. Asherman syndrome
    • 6.Persistence of bleeding: missing of an endometrial
    polyp or remnants of conception
    • Perforation of the uterus Diagnosis: Sound,
    dilator or curette is passed beyond the
    pre-determined length of the uterus.
    Management:
    • 1.Avoid the part where perforation occurred (no
    necessarily to stop)
    • 2.Observation: hemorrhage, peritonitis
    • 3.Laparotomy: intestine is exposed for possible
    injury, uterine wound is sutured, peritoneal
    • ANTERIOR COLPORRHAPHY
    • Indications:
    • Cystocele Steps:
    • 1. Anterior vaginal wall incision
    • 2. The anterior vaginal wall is separated from the bladder &
    the bladder is pushed to its normal position as a pelvic
    organ
    • 3. Plication of the the pubovesical fascia beneath the
    bladder to form a shelf
    • 4. Redundant vaginal wall is removed
    Posterior colpoperineoraphy
    • Indication: Rectocele Steps
    • 1.Incision at the mucocutaneous junction.
    • 2.The posterior vaginal wall is separated from the
    rectum
    • 3.The 2 levator ani are approximated in front of the
    rectum
    • 4.Redundant vaginal wall is removed
    • 5.The superficial perineal muscles are approximated in
    the midline
    • 6.The vagina is closed
    • 7.The skin of the perineum is closed
    FOTHERGILLS OPERATION

    • Indication Combined vaginal & uterine prolapse


    with supravaginal elongation of the cervix Steps
    • 1.Dilatation & curettage: Dilatation to cover the
    cervical stump. Curettage to exclude uterine
    pathology
    • 2.Anterior colporrhaphy: repair cystocele
    • 3. Amputation of the cervix: restore the normal
    length of the cervix
    • 4. Shortening & approximating of the
    Mackenrodt ligaments in front of the cervix:
    elevate the uterus & pull the cervix posteriorly
    to correct the retroversion
    • 5. Posterior colpoperineoraphy: repair rectocele
    & to strengthen the lax pelvic floor to prevent
    recurrence
    MYOMECTOMY

    • Indication Symptomatizing patient who did not


    complete her family Types
    • 1.Abdominal
    • 2.Vaginal
    • 3.Hysteroscopic: submucous <5cm
    • 4.Laparoscopic: Pedunculated subserous
    HYSTERECTOMY
    • Indications
    • I.Gynecological:
    • 1.Fibroid
    • 2.Advanced endometriosis & adenomyosis
    • 3.Malignant tumors of the cervix, body, tubes or ovary
    • 4.Recurrent DUB not responding to conservative
    treatment
    • 5.Chronic pyometra
    • 6.Chronic inversion of the uterus
    • II. Obstetric indications
    • 1.Uncontrolled postpartum hemorrhage
    • 2.Rupture uterus
    • 3.Placenta accreta
    • 4.Invasive mole
    • 5.Couvelaire uterus
    Types

    • 1.Abdominal
    • 2.Vaginal
    • 3.Laparoscopic
    Types of abdominal hysterectomy

    • •Subtotal: removal of the uterus with


    preservation of the cervix
    • •Total: removal of the uterus & cervix
    • •Pan: total with bilateral salpingo-oophrectomy
    • •Radical: removal of the uterus, cervix,
    parametrial tissue, endopelvic fascia,
    uterosacral ligaments & pelvic lymph nodes
    • •Cesarean hysterectomy:
    • •removal of the uterus after C.S e.g. atonic
    postpartum hemorhage or placenta accreta.
    • •Hysterectomy-en-toto: Removal of the uterus
    with a contained dead fetus without opening
    the uterus to decrease blood loss e.g. couvelaire
    uterus
    Types

    • 1.Extrafacial: removal of the uterus with its


    fascial layer. It is the operation usually
    performed 2. Intrafascial: The outer
    (endopelvic) fascia is left attached to the
    bladder. It is used when it is difficult to dissect
    the bladder from front of the cervix e.g.
    adhesions from previous CS.
    Steps

    • 1. Division & ligation of the round ligaments 2.


    Division & Ligation of the tubes & ovarian
    ligaments if the ovaries will be left, or the
    infundibulo-pelvic ligaments if the ovaries will
    be removed. 3. Incise the peritoneum of the
    vesicouterine pouch by extending the incision in
    the anterior leaf of the broad ligament, then
    dissect the bladder downward
    • 3. Clamp the uterine arteries & divide them 4.
    Uterosacral ligaments & Mackenrodtks
    ligaments are divided & ligated. 5. The vagina is
    divided from its attachment to the cervix.

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