Gynecologic and obstetric surgery is a craft that requires sound knowledge and skills. The specifics of each individual case must be understood to enable the best surgical management approach and to minimize complications. This resource book offers insightful management options to many of the challenges a gynecologic or obstetric surgeon may face before, during and after an operation.
Divided into two sections, the book first covers general preoperative, intraoperative and postoperative challenges and, second, specific surgical procedures. It provides advice on both general gynecologic and obstetric operations, as well as subspecialist areas such as reproductive surgery, urogynecology and gynecologic oncology.
The chapters are concise, beginning with illustrative case histories followed by background, management options, and any preventative approaches. Designed to guide the surgeon to safe practice throughout all stages, they offer practical and step-by-step help.
Table of Contents
Contributors, x
Preface, xv
List of Abbreviations, xvi
Part I: General Preoperative, Intraoperative, and Postoperative Challenges
Section 1: Preoperative Care
Editors: Phil Moore and Arri Coomarasamy
1 Patient with Poor ASA Score, 3
Phil Moore
2 Patient on Medication, 6
Arri Coomarasamy
3 Patient with Ischemic Heart Disease, 9
Sohail Q. Khan and Jonathan N. Townend
4 Patient with Arrhythmias, 13
Sanoj Chacko and Joseph de Bono
5 Patient with a Pacemaker or Implantable Defibrillator, 17
Howard Marshall
6 Patient with Complex Congenital Heart Disease (Fontan Circulation), 20
Yaso Emmanuel and Sara A. Thorne
7 Hypertensive Patient, 22
Aarthi R. Mohan and Catherine Nelson-Piercy
8 Patient with Respiratory Disease, 25
Heinke Kunst
9 Patient with Diabetes, 28
Arri Coomarasamy and Dukaydah van der Berg
10 Patient with Thyroid Disease, 30
Ramy Labib and Shiao-yng Chan
11 Patient with Renal Disease, 33
Khalid Hasan
12 Patient with Liver Disease, 35
Joanna K. Dowman and Philip N. Newsome
13 Patient with Rheumatologic Diseases, 38
Amita A. Mahendru and Justin Chu
14 Patient with Hematologic Disorders, 41
Chieh Lin Fu
15 Patient at High Risk of Venous Thrombosis, 44
Ian A. Greer
16 Patient on Anticoagulant Therapy, 47
Sophie Lee and Will Lester
17 Patient on Steroid Therapy, 50
Shaista Nazir and John Ayuk
18 Patient with Epilepsy, 54
Danita Jones and Virgilio Salanga
19 Patient with a Psychiatric Condition, 56
Idnan Yunas
20 Patient with Organ Transplant, 59
Sarah Winfield
21 Patient with Hepatitis B or C, 61
Firas Al-Rshoud and Arri Coomarasamy
22 Patient with HIV, 64
Firas Al-Rshoud and Arri Coomarasamy
23 Obese Patient, 67
Phil Moore
24 Patient with Poor Nutritional Status, 69
Phil Moore
25 Pregnant Patient Requiring Non-obstetric Surgery, 71
Arri Coomarasamy
Section 2: Intraoperative Care
Editors: Arri Coomarasamy and Mahmood I. Shafi
26 Transverse Incision on the Abdomen Inadequate for Surgery, 77
Arri Coomarasamy
27 Previous Multiple Abdominal Scars, 79
Mohammed Khairy and Arri Coomarasamy
28 Patient with Previous Mesh Incisional Hernia Repair Requiring a Laparotomy, 83
Christopher Smart and Chris Keh
29 Patient with Previous Mesh Incisional Hernia Repair Requiring a Laparoscopy, 86
Emanuele Lo Menzo, Samuel Szomstein, and Raul J. Rosenthal
30 Unexpected Pathology: Ovarian Cyst, 89
Mohan Kumar
31 Unexpected Pathology: Abnormal Appearance of the Uterus, 92
Arri Coomarasamy
32 Unexpected Pathology: Severe Pelvic Adhesions, 94
Stephen E. Zimberg and Michael L. Sprague
33 Unexpected Pathology: Abnormal Appearance of Bowel, 97
Olivia Will and Justin Davies
34 Unexpected Pathology: Retroperitoneal Mass, 100
Mohamed Mehasseb
35 Bladder Injury, 103
Arri Coomarasamy and Richard Popert
36 Ureteric Injury, 106
Arri Coomarasamy and Richard Popert
37 Small and Large Bowel Injury, 111
Howard Joy
38 Inferior Epigastric Vessel Injury, 116
Manas Chakrabarti and Sudha Sundar
39 Bleeding from Retracted Pedicular (Pelvic Sidewall) Vessels, 119
Michael L. Sprague and Stephen E. Zimberg
40 Massive Hemorrhage, 121
Karen Louise Moores, William Parry-Smith, and Martyn Underwood
41 Broken Needle, 125
Joanne Kathleen Ritchie, Anuradha Radotra, and Martyn Underwood
42 Lost Swab, Needle or Instrument, 127
Joanne Kathleen Ritchie, Martyn Underwood, and William Parry-Smith
Section 3: Postoperative Care
Editors: Arri Coomarasamy and Janesh Gupta
43 Postoperative Care, 131
Janesh Gupta, Robbert Soeters, and Aaron Ndhluni
44 Excessive Nausea and Vomiting after Surgery, 133
Phil Moore
45 Excessive Abdominal Pain after Surgery, 136
Manjeet Shehmar
46 Bowel Damage: Postoperative Presentation, 139
Ketan Gajjar and Mahmood I. Shafi
47 Wound Infection, 142
Pallavi Latthe and James Gray
48 Wound Dehiscence, 147
T. Justin Clark
49 Late Wound Failure: Incisional Hernia, 150
Saloney Nazeer
50 Necrotizing Fasciitis, 153
Tariq Ahmad
51 Management of Surgical Drains, 156
Ahmed M. El-Sharkawy and Sherif Awad
52 Shocked Patient, 159
Manjeet Shehmar
53 Breathless Patient: Postoperative Pulmonary Complications, 162
Heinke Kunst
54 Confused Postoperative Patient, 165
Idnan Yunas
55 Patient with Poor Urine Output, 167
Amelia Davison and Jackie A. Ross
56 Electrolyte Imbalance, 170
Manjeet Shehmar and Arri Coomarasamy
57 Swollen Leg, 174
Edwin Stephen, Indrani Sen, and Tim Lees
58 Cardiorespiratory Arrest, 177
Jennie Kerr
PART II: Operations and Challenges
Section 4: General and Minimal Access Gynecology
Editors: T. Justin Clark, Kiong K. Chan, and Arri Coomarasamy
59 Difficulty in Dilating the Cervix: Cervical Stenosis and Cervical Closure, 183
Arri Coomarasamy
60 Uterine Perforation, 186
Arri Coomarasamy
61 Surgical Uterine Evacuation: Excessive Bleeding, 189
Rajesh Varma
62 Surgical Uterine Evacuation in a Woman with Multiple Fibroids, 191
Rajesh Varma
63 Use of Excessive Distension Media at Hysteroscopy, 194
Arri Coomarasamy
64 Hysteroscopy: Endometrial Resection and Ablation in the Abnormal Uterine Cavity, 197
Alessandro Conforti and Adam Magos
65 Laparoscopy in a Pediatric Patient, 199
Suketu M. Mansuria, Cara R. King, and Arri Coomarasamy
66 Safe Laparoscopic Entry in a Thin Patient, 202
Janesh Gupta and Justin Chu
67 Laparoscopy: Unable to Gain Entry, 205
Mohamed Mehasseb
68 Surgical Emphysema, 208
Arri Coomarasamy
69 Venous Air Embolism, 210
Anneke Chu and Jennie Kerr
70 Laparoscopy: Problems with Monopolar Diathermy, 213
Thomas G. Lang and Resad Pasic
71 Laparoscopy: Problems with Bipolar Diathermy, 216
Thomas G. Lang and Resad Pasic
72 Laparoscopy: Bladder Injury, 218
Peter L. Rosenblatt
73 Laparoscopy: Ureteric Injury, 221
Peter L. Rosenblatt
74 Bowel Injury During Laparoscopy: Intraoperative Presentation, 224
Alan Lam
75 Bowel Injury After Laparoscopy: Late Presentation, 227
Alan Lam
76 Blood Vessel Injury at Laparoscopy, 230
Elizabeth Ball
77 Laparoscopy for Large Ovarian Cyst, 233
T. Justin Clark
78 Laparoscopy for an Ovarian Cyst in Pregnancy, 235
T. Justin Clark
79 Laparoscopic Removal of Rectovaginal Endometriosis, 238
Alan Lam
80 Laparoscopic Myomectomy, 242
Ertan Saridogan
81 Total Laparoscopic Hysterectomy, 245
Alan Farthing
82 Laparoscopic Hysterectomy for a Large Fibroid Uterus, 247
Alan Lam
83 Laparoscopy: Difficulty in Tissue Retrieval, 250
Su-Yen Khong and Alan Lam
84 Surgery for Cornual or Interstitial Pregnancy, 253
Ayesha Mahmud and Yousri Afifi
85 Surgery for Cervical Ectopic Pregnancy, 256
Bassel H. Al Wattar and Yousri Afifi
86 Surgery for Cesarean Scar Pregnancy, 259
T. Justin Clark
87 Surgery for Adnexal Torsion, 262
Mohamed Otify and Jackie A. Ross
88 Laparoscopic Appendectomy, 264
Edward Rawstorne, Christopher Smart, and Chris Keh
89 Laparoscopic Surgery: When to Convert to Laparotomy?, 267
Mohamed Mehasseb
90 Laparoscopy: Port-site Herniation, 269
Ayesha Mahmud and Yousri Afifi
Section 5: Reproductive Surgery
Editors: Arri Coomarasamy and Mahmood I. Shafi
91 Uterine Septum, 275
Basim Abu-Rafea and Khaldoun Sharif
92 Surgery for Intrauterine Adhesions, 278
Mohan Kumar
93 Myomectomy: Breach of the Endometrial Cavity, 280
Masoud Afnan and Arri Coomarasamy
94 Myomectomy: Multiple Large Fibroids, 282
Justin Chu and Arri Coomarasamy
95 Myomectomy: Massive Intraoperative Hemorrhage, 284
Neelam Potdar and Arri Coomarasamy
96 Vaginal Myomectomy, 287
Adam Magos
97 Surgery for Proximal Tubal Blockage, 289
Spyros Papaioannou
98 Surgery for Distal Tubal Disease, 292
Lynne Robinson, Hemant N. Vakharia, and Yousri Afifi
99 Reversal of Sterilization, 295
Hemant N. Vakharia, Lynne Robinson, and Yousri Afifi
100 Surgery for Congenital Abnormalities of the Genital Tract, 299
Naomi S. Crouch
101 Surgical Sperm Retrieval, 304
David Muthuveloe and Y. Zaki Almallah
Section 6: Urogynecologic Surgery
Editors: Pallavi Latthe and G. Willy Davila
102 Sling Procedures: Bladder Injury, 309
Fidan Israfil-Bayli and Philip Toozs-Hobson
103 Sling Procedures: Urethral Injury, 311
Gamal M. Ghoniem
104 Sling Procedures: Retropubic Hematoma, 314
Fidan Israfil-Bayli and Philip Toozs-Hobson
105 Sling Procedures: Bowel Injury, 316
Fidan Israfil-Bayli and Philip Toozs-Hobson
106 Sling Procedures: Voiding Dysfunction after Stress Urinary Incontinence Surgery, 318
Margarita M. Aponte and Victor W. Nitti
107 Sling Procedures: Tape Erosion into the Bladder, 321
Samuel J.S. Grimsley and Y. Zaki Almallah
108 Sling Procedures: Sexual Dysfunction, 323
Swati Jha and Ranee Thakar
109 Sling Procedures: Persistent Urine Leakage, 325
Luis Manuel Espaillat-Rijo and G. Willy Davila
110 Difficult Vaginal Hysterectomy, 329
G. Willy Davila
111 Vaginal Hysterectomy: Difficulty in Entering the Posterior Pouch, 332
Alfredo Jijon and G. Willy Davila
112 Salpingo-oophorectomy at the Time of Vaginal Hysterectomy, 335
Alfredo Jijon and G. Willy Davila
113 Bladder Injury During Anterior Vaginal Repair or Vaginal Hysterectomy, 338
Pallavi Latthe, Suneetha Rachaneni, and Mohammed Belal
114 Difficult Sacrocolpopexy, 341
Orfhlaith E. O’Sullivan and Barry A. O’Reilly
115 Difficult Sacrospinous Fixation, 345
Smita Rajshekhar and Rohna Kearney
116 Recurrent Pelvic Organ Prolapse, 348
Monika Vij and Robert Freeman
117 Colpocleisis, 351
Kalaivani Ramalingam and Ash Monga
118 Uterine Suspension Procedures: Laparoscopic Hysteropexy, 353
Natalia Price and Simon Jackson
119 Mesh Tape Exposure Following Tension-free Vaginal Tape, 356
Helen Bolton and Mark Slack
120 Vaginal Vault Evisceration, 360
Swati Jha
121 Complications in Laparoscopic Pelvic Floor Surgery, 362
Nir Haya and Christopher Maher
122 Robotic Urogynecology Procedures, 367
Orfhlaith E. O’Sullivan and Barry A. O’Reilly
123 Complications in Robotic Pelvic Floor Surgery, 370
Amie Kawasaki
124 Neovagina, 372
Lynsey Hayward and G. Willy Davila
125 Vaginal Stricture After Pelvic Organ Prolapse Surgery, 375
Ted M. Roth, G. Rodney Meeks and G. Willy Davila
126 Urethral Diverticula and Other Periurethral Masses, 378
Bhavin Patel and Kathleen C. Kobashi
127 Vesicovaginal Fistulae, 382
Karolynn T. Echols,Tamara V. Toidze, and Edward Stanford
128 Urethrovaginal Fistulae, 386
Sohier Elneil
129 Rectovaginal Fistulae, 389
Claire Burton and Simon Radley
130 Secondary Anal Sphincter Repair, 392
Steven D. Wexner and Emanuela Silva
Section 7: Gynecologic Oncology
Editors: Kavita Singh, Mahmood I. Shafi, and Kiong K. Chan
131 Large Loop Excision of the Transformation Zone, 399
Mahmood I. Shafi
132 Knife Cone Biopsy, 401
Najum Qureshi
133 Staging Procedures: Examination Under Anesthesia, Cystoscopy, Sigmoidoscopy, and Biopsy Techniques, 403
Mahmood I. Shafi
134 Radicality of Surgery for Cervical Cancer, 406
Mahmood I. Shafi
135 Pelvic and Para-aortic Lymphadenectomy in Gynecologic Cancers, 408
Kavita Singh and Rami Fares
136 Trachelectomy for Treatment of Cervical Cancer, 412
Kavita Singh and Janos Balega
137 Laparoscopic Radical Surgery for Cervical Cancer, 414
Mohamed Mehasseb
138 Groin and Retroperitoneal Lymphocele, 416
David M. Luesley
139 Laparotomy for a Pelvic Mass of Uncertain Nature, 418
Mahmood I. Shafi
140 Gynecologic Cancer Extending to the Bowel, 420
Kiong K. Chan
141 Omental Procedures: Supracolic Omentectomy, Infracolic Omentectomy, and Omental Biopsy, 423
Kiong K. Chan
142 Diaphragmatic Surgery in Advanced Ovarian Cancer, 425
Ariella Jakobson-Setton and Kavita Singh
143 Fine-needle Aspiration Biopsy of Superficial Groin Lymph Node, 428
Moji Balogun
144 Vulval Surgery: Wide Local Excision and Vulvectomy, 431
Mahmood I. Shafi
145 Sentinel Node Biopsy in Gynecologic Cancer, 433
Kavita Singh
146 Groin Lymphadenectomy, 435
Ketan Gajjar
147 Plastic Surgical Techniques in Vulval or Perineal Procedures, 438
Mahmood I. Shafi
148 Vaginectomy, 441
Janos Balega and Kavita Singh
149 Urinary Diversion, 443
John Parkin
150 Pelvic Exenteration, 446
Kavita Singh
151 Gynecologic Cancer and Concurrent Pregnancy, 449
Nirmala Rai Talapadi and Sudha Sundar
Section 8: Obstetric Surgery
Editors: Pallavi Latthe, Kiong K. Chan, and Arri Coomarasamy
152 Ovarian Cyst Identified at Cesarean Section, 455
Kiong K. Chan and Ioannis Gallos
153 Laparoscopy in Pregnancy, 457
Kevin J.E. Stepp and Anjana Nair
154 Cervical Cerclage, 459
Ayesha Mahmud and Yousri Afifi
155 Cesarean Section in a Woman with Fibroids, 463
Andrew Prentice
156 Cesarean Section at the Limits of Viability, 465
Catherine Aiken and Jeremy Brockelsby
157 Difficult Delivery of the Fetal Head During Cesarean Section, 468
Parveen Abedin
158 Surgical Management of Massive Obstetric Hemorrhage from the Uterus, Cervix, or Vagina, 470
Phil Steer
159 Surgical Management of Placenta Praevia, 475
Vibha Giri and Mohan Kumar
160 Surgical Management of Placenta Accreta, 479
Vibha Giri and Mohan Kumar
161 Surgical Management Options for Shoulder Dystocia: Zavanelli Maneuver, Abdominal Rescue, Symphysiotomy, and Cleidotomy, 482
Syeda Batool Mazhar and Asia Nazir
162 Uterine Inversion, 485
Phil Steer
163 Episiotomy and Second-degree Tear, 488
Khaled M.K. Ismail and Sara S. Webb
164 Obstetric Anal Sphincter Tear, 490
Natalie P. Nunes, Helen Stevenson, and Matthew Parsons
165 Pregnancy and Female Genital Mutilation, 493
Naomi Low-Beer and Gubby Ayida
166 Destructive Operations on a Dead Fetus, 496
Hany Abdel-Aleem
167 Development of a Basic Obstetric Theater Facility in a Low-resource Setting, 499
Zahida Qureshi and Alfred Murage
Section 9: Miscellaneous
Editors: Mahmood I. Shafi and Arri Coomarasamy
168 Enhanced Recovery, 505
Manjeet Shehmar
169 Major Surgery in a Jehovah’s Witness Patient, 507
Martyn Underwood and William Parry-Smith
170 Termination of Pregnancy at Advanced Gestation, 509
Rohan Chodankar and Janesh Gupta
171 Cervical Fibroids: Techniques for Myomectomy and Hysterectomy, 511
Deborah R. Karp
172 Hysterectomy for Broad Ligament Fibroids, 514
Kiong K. Chan
173 Hysterectomy for a Double Uterus, 516
Kiong K. Chan
174 Cervical Stump Excision, 518
Kiong K. Chan
175 Surgery for Ovarian Remnant, 520
Kiong K. Chan and Arri Coomarasamy
176 Surgery for Missing Intrauterine Contraceptive Device, 522
Toh Lick Tan
177 Management of Imperforate Hymen, Transverse and other Vaginal Septa, 525
Jane MacDougall
178 Benign Lesions in the Groin and Vulva, 528
Jennifer Byrom
179 Cystic Structure in the Upper Vagina, 531
Ted M. Roth and G. Rodney Meeks
180 Adnexal Masses in Infants and Children, 533
Rachel J. Miller and Kris Ann P. Schultz
181 Nerve Injuries Associated with Gynecologic and Obstetric Surgery, 536
Djavid Alleemudder
182 Consent Challenges, 540
William Parry-Smith and Martyn Underwood
183 Dealing with Complaints, 542
Mahmood I. Shafi
184 Dealing with Litigation, 544
Rebekah Ley and Mahmood I. Shafi
Index, 547
