Gynecologic and Obstetric Surgery. Challenges and Management Options

Description

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.

Contents

Contributors
Preface
List of Abbreviations
PART I: GENERAL PRE-, INTRA-, and POST-OPERATIVE CHALLENGES

SECTION 1: PRE-OPERATIVE CARE
Phil Moore and Arri Coomarasamy
1 Patient with poor ASA score
Phil Moore
2 Patient on medication
Arri Coomarasamy
3 Patient with ischaemic heart disease
Sohail Khan and Jonathan Townend
4 Patient with Arrhythmias
Sanoj Chacko and Joseph de Bono
5 Patient with a pace-maker or implantable defibrillator
Howard Marshall
6 Patient with complex congenital heart disease (a Fontan Circulation)
Yaso Emmanuel and Sara Thorne
7 Hypertensive patient
Catherine Nelson-Piercy and Aarthi Mohan
8 Patient with respiratory disease
Heinke Kunst
9 Patient with diabetes
Arri Coomarasamy and Dukaydah van der Berg
10 Patient with thyroid disease
Ramy Labib and Shiao Chan
11 Patient with renal disease
Khalid Hasan
12 Patient with liver disease
Joanna Dowman and Phil Newsome
13 Patient with rheumatologic diseases
Amita Mahendru and Justin Chu
14 Patient with hematologic disorders
Chieh Lin (Kathy) Fu
15 Patient at high risk of venous thrombosis
Ian Greer
16 Patient on anti-coagulant therapy
Sophie Lee and Will Lester
17 Patient on steroid therapy
Shaista Nazir and John Ayuk
18 Patient with epilepsy
Danita Jones and Virgil Salanga
19 Patient with a psychiatric condition
Idnan Yunas
20 Patient with organ transplant
Sarah Winfield
21 Patient with Hep B or Hep C
Firas Al-Rshoud and Arri Coomarasamy
22 Patient with HIV
Firas Al-Rshoud and Arri Coomarasamy
23 Obese patient
Phil Moore
24 Patient with poor nutritional status
Phil Moore
25 Pregnant patient requiring non-obstetric surgery
Arri Coomarasamy

SECTION 2: INTRA-OPERATIVE CARE
Arri Coomarasamy and Mahmood Shafi
26 Transverse incision on the abdomen inadequate for surgery
Arri Coomarasamy
27 Patient with multiple abdominal scars
Mohammed Khairy and Arri Coomarasamy
28 Patient with previous mesh incisional hernia repair requiring a laparotomy
Chris Keh and Christopher Smart
29 Patient with previous mesh incisional hernia repair requiring a laparoscopy
Emanuele Lo Menzo, Samuel Szomstein and Raul Rosenthal
30 Unexpected pathology: ovarian cyst
Mohan Kumar
31 Unexpected pathology: abnormal appearance of the uterus
Arri Coomarasamy
32 Unexpected pathology: severe pelvic adhesions
Stephen Zimberg and Michael Sprague
33 Unexpected pathology: abnormal appearance of bowel
Olivia Will and Justin Davies
34 Unexpected pathology: retro-peritoneal mass
Mohamed Mehasseb
35 Bladder injury
Arri Coomarasamy and Richard Popert
36 Ureteric injury
Arri Coomarasamy and Richard Popert
37 Small and large bowel injury
Howard Joy
38 Inferior epigastric vessel injury
M Chakrabarti and Sudha Sundar
38 Inferior epigastric vessel injury
M Chakrabarti and Sudha Sundar
39 Bleeding from retracted pedicular (pelvic sidewall) vessels
Michael Sprague and Stephen Zimberg
40 Massive haemorrhage
KL Moores, Will Parry-Smith and Martin Underwood
41 Broken needle
J Ritchie, A Radotra and Martin Underwood
42 Lost swab, needle or instrument
J Ritchie, A Radotra and Martin Underwood

SECTION 3: POST-OPERATIVE CARE
Arri Coomarasamy and Janesh Gupta
43 Post-operative care
Janesh Gupta, Robbert Soeters and Aaron Nhdluni
44 Excessive nausea and vomiting after surgery
Phil Moore
45 Excessive abdominal pain after surgery
Manjeet Shehmar
45 Excessive abdominal pain after surgery
Manjeet Shehmar
46 Bowel damage: postoperative presentation
Ketankumar Gajjar and Mahmood Shafi
47 Wound infection
Pallavi Latthe and James Gray
48 Wound dehiscence
Justin Clark
49 Late wound failure: incisional hernia
Saloney Nazeer
50 Necrotising fasciitis
Tariq Ahmad
51 Surgical drains
Ahmed M El-Sharkawy and Sherif Awad
52 Shocked patient
Manjeet Shehmar
53 Breathless patient: post-operative pulmonary complications
Christopher Primus and Heinke Kunst
53 Breathless patient: post-opertaive pulmonary complications
Heinke Kunst
54 Confused post-operative patient
Idnan Yunas
55 Patient with poor urine output
Amelia Davison and Jackie Ross
56 Electrolyte imbalance
Manjeet Shehmar and Arri Coomarasamy
57 The swollen leg
Edwin Stephen, Indrani Sen and Tim Lees
58 Cardiorespiratory arrest
Jennie Kerr
PART II: OPERATIONS and CHALLENGES

SECTION 4: GENERAL and MINIMAL ACCESS GYNECOLOGY
Justin Clark, Kiong K. Chan and Arri Coomarasamy
59 Difficulty in dilating a cervix: Cervical stenosis and cervical closure
Arri Coomarasamy
60 Uterine perforation
Arri Coomarasamy
61 Surgical uterine evacuation: excessive bleeding
Rajesh Varma
62 Surgical uterine evacuation in a woman with multiple fibroids
Rajesh Varma
63 Use of excessive distension media at hysteroscopy
Arri Coomarasamy
64 Hysteroscopy: endometrial resection and ablation in the abnormal uterine cavity
lessandro Conforti and Adam Magos
65 Laparoscopy in a pediatric patient
Suketu Mansuria, Cara King and Arri Coomarasamy
66 Safe laparoscopic entry in a thin patient
Janesh Gupta and Justin Chu
67 Laparoscopy: unable to gain entry
Mohamed Mehasseb
68 Surgical emphysema
Arri Coomarasamy
69 Venous Air Embolism
Anneke Chu and Jennie Kerr
70 Laparoscopy: problems with monopolar diathermy
Thomas Lang and Resad Pasic
71 Laparoscopy: problems with bipolar diathermy
Thomas Lang and Resad Pasic
72 Laparoscopy: bladder injury
Peter Rosenblatt
73 Laparoscopy: ureteric injury
Peter Rosenblatt
74 Bowel injury during laparoscopy: intraoperative presentation
Alan Lam
75 Bowel injury after laparoscopy: late presentation
Alan Lam
76 Blood vessel injury at laparoscopy
Liza Ball
77 Laparoscopy for large ovarian cyst
Justin Clark
78 Laparoscopy for an ovarian cyst in pregnancy
Justin Clark
79 Laparoscopic removal of recto-vaginal endometriosis
Alan Lam
80 Laparoscopic myomectomy
Ertan Saridogan
81 Total laparoscopic hysterectomy
Alan Farthing
82 Laparoscopic hysterectomy for a large fibroid uterus
Alan Lam
83 Laparoscopy: difficulty in tissue retrieval
Su Yen Khong and Alan Lam
84 Surgery for cornual or interstitial pregnancy
Ayesha Mahmud and Yousri Afifi
85 Surgery for cervical ectopic pregnancy
Bassel Wattar and Yousri Afifi
86 Surgery for caesarean scar pregnancy
Justin Clark
87 Surgery for adnexal torsion
Mohamed Otify and Jackie Ross
88 Laparoscopic appendicectomy
Edward Rawstorne, Chris Keh and Christopher Smart
89 Laparoscopic surgery: When to convert to laparotomy?
Mohamed Mehasseb
90 Laparoscopy: late complication – Port site herniation
Ayesha Mahmud and Yousri Afifi

SECTION 5: REPRODUCTIVE SURGERY
Arri Coomarasamy and Mahmood Shafi
91 Uterine septum division
Basim Abu-Rafea and Khaldoun Sharif
92 Surgery for intrauterine adhesions
Mohan Kumar
93 Myomectomy: breach of the endometrial cavity
Masoud Afnan
94 Myomectomy: multiple large fibroids
Justin Chu and Arri Coomarasamy
95 Myomectomy: massive intraoperative haemorrhage
Neelam Potdar and Arri Coomarasamy
96 Vaginal myomectomy
Adam Magos
97 Surgery for proximal tubal blockage
Spyros Papaiannou
98 Surgery for distal tubal blockage
Lynne Robinson, Hemant Vakharia and Yousri Afifi
99 Reversal of female sterilization
Hemant Vakharia, Lynne Robinson and Yousri Afifi
100 Surgery for congenital abnormalities of the genital tract
Naomi Crouch
101 Surgical sperm retrieval
David Muthuveloe and Zaki Almallah

SECTION 6: UROGYNECOLOGIC SURGERY
Pallavi Latthe and Willy Davila
102 Sling procedures: bladder injury
Fidan Bayli and Philip Toozs-Hobson
103 Sling procedures: urethral injury
Gamal Ghoniem
104 Sling procedures: retropubic haematoma
Fidan Bayli and Philip Toozs-Hobson
105 Sling procedures: bowel injury
Fidan Bayli and Philip Toozs-Hobson
106 Sling procedures: voiding dysfunction after stress urinary incontinence surgery
Margarita Aponte and Victor Nitti
107 Sling procedures: tape erosion into bladder
Samuel Grimsley and Zaki Almallah
108 Sling procedures: sexual dysfunction
Swati Jha and Ranee Thakar
109 Sling procedures: persistent urine leakage
Luis Espaillat-Rijo and Willy Davila
110 Difficult vaginal hysterectomy
Shirish Sheth and Seth Finkelstein
111 Vaginal hysterectomy: difficulty in entering the posterior pouch
Alfredo Jijon and Willy Davila
112 Salpingo-oopherectomy at the time of vaginal hysterectomy
Alfredo Jijon and Willy Davila
113 Bladder injury during anterior vaginal repair or vaginal hysterectomy
Pallavi Latthe, Suneetha Rachaneni and Mohammed Belal
113 Bladder injury at anterior repair
Pallavi Latthe
113 Bladder injury at anterior repair
Pallavi Latthe
113 Bladder injury at anterior repair
Pallavi Latthe
113 Bladder injury at anterior repair
Pallavi Latthe
113 Bladder injury at anterior repair
Pallavi Latthe
114 Difficult sacrocolpopexy Orfhlaith
O'Sullivan and Barry O'Reilly
115 Difficult sacrospinous fixation
Smita Rajshekhar and Rohna Kearney
116 Recurrent pelvic organ prolapse
Monika Vij and Bob Freeman
117 Colpocleisis
Kalaivani Ramalingam and Ash Monga
118 Uterine suspension procedures: Laparoscopic hysteropexy
Natalia Price and Simon Jackson
119 Mesh tape exposure following tension free vaginal tape (TVT)
Helen Bolton and Mark Slack
120 Vaginal vault evisceration
Swati Jha
121 Complications in laparoscopic pelvic floor surgery
Nir Haya and Chris Maher
122 Robotic urogynecology procedures
Orfhlaith O'Sulivan and Barry O'Reilly
123 Complications in robotic pelvic floor surgery
Amie Kawasaki
124 Neovagina
Lynsey Hayward and Willy Davila
125 Vaginal stricture after pelvic organ prolapse surgery
Willy Davila, Ted Roth and Rodney Meeks
126 Urethral diverticula and other periurethral masses
Bhavin Patel and Kathleen Kobashi
127 Vesico-vaginal fistulae
Karolynn Echols, Tamara Toidze and Edward Stanford
128 Urethro-vaginal fistulae
Suzy Elneil
129 Recto-vaginal fistulae
Claire Burton and Simon Radley
130 Secondary anal sphincter repair
Steven Wexner and Emanuele Silva

SECTION 7: GYNECOLOGIC ONCOLOGY
Kavita Singh, Mahmood Shafi and Kiong K. Chan
131 Large loop excision of the transformation zone (LLETZ)
Mahmood Shafi
132 Knife cone biopsy
Najum Qureshi
133 Staging procedures: examination under anaesthesia, cystoscopy, sigmoidoscopy and biopsy techniques
Mahmood Shafi
134 Radicality of surgery for cervical cancer
Mahmood Shafi
135 Pelvic and para-aortic lymphadenectomy in gynecologic cancers
Kavita Singh and Rami Fares
136 Trachelectomy for treatment of cervical cancer
Kavita Singh and Janos Balega
137 Laparoscopic radical surgery for cervical cancer
Mohamed Mehasseb
138 Groin and retroperitoneal lymphocele
David Luesley
139 Laparotomy for a pelvic mass of uncertain nature
Mahmood Shafi
140 Gynecologic cancer extending to the bowel
Kiong K Chan
141 Omental procedures: supracolic omentectomy, infracolic omentectomy, omental biopsy
Kiong K Chan
142 Diaphragmatic surgery in advanced ovarian cancer
Ariella Jakobsen-Setton and Kavita Singh
143 Fine needle aspiration; biopsy of superficial groin lymph node
Moji Balogun
144 Vulval surgery: wide local excision and vulvectomy
Mahmood Shafi
145 Sentinel node biopsy in gynecologic cancer
Kavita Singh
146 Groin lymphadenectomy
Ketan Gajjar
147 Plastic surgical techniques used in vulval or perineal procedures
Mahmood Shafi
148 Vaginectomy
Janos Balega and Kavita Singh
149 Urinary diversion
John Parkin
150 Pelvic exenteration
Kavita Singh
151 Gynecologic cancer and concurrent pregnancy
Nirmala Rai Talapadi and Sudha Sundar

SECTION 8: OBSTETRIC SURGERY
Pallavi Latthe, Kiong K. Chan and Arri Coomarasamy
152 Ovarian cyst identified at caesarean section
Kiong K Chan and Ioannis Gallos
153 Laparoscopy in pregnancy
Kevin Stepp and Anjana Nair
154 Cervical cerclage
Ayesha Mahmud and Yousri Afifi
155 Caesarean section in a woman with fibroids
Andrew Prentice
156 Caesarean section at the limits of viability
Catherine Aiken and Jeremy Brockelsby
157 Difficult delivery of the fetal head during caesarean section
Parveen Abedin
158 Surgical management of massive obstetric haemorrhage from the uterus, cervix or vagina
Phil Steer
159 Surgical management of placenta praevia
Vibha Giri and Mohan Kumar
160 Surgical management of placenta accrete
Vibha Giri and Mohan Kumar
161 Surgical management options for shoulder dystocia: Zavanelli maneuver, abdominal rescue, symphsiotomy and cleidotomy
Syeda Batool Mazhar and Asia Nazir
162 Uterine inversion
Phil Steer
163 Episiotomy and second degree tear
Khaled Ismail and Sara Webb
164 Obstetric anal sphincter tear
Natalie Nunes, Helen Stevenson and Matthew Parsons
165 Pregnancy and female genital mutilation
Naomi Low-Beer and Gubby Ayida
166 Destructive operations on a dead fetus
Hany Abdelaleem
166 Destructive operations on the fetus
Hany Abdelaleem
167 Setting up of a basic obstetric theatre facility in a low-resource setting
Zahida Qureshi and Alfred Murage

SECTION 9: MISCELLANEOUS
Mahmood Shafi and Arri Coomarasamy
168 Enhanced recovery
Manjeet Shehmar
169 Major surgery in a Jehovah’s Witness patient
Martin Underwood and Will Parry-Smith
170 Termination of pregnancy at advanced gestation
Rohan Chodankar and Janesh Gupta
171 Cervical fibroids: techniques for myomectomy and hysterectomy
Debby Karp
172 Hysterectomy for broad ligament fibroids
Kiong K Chan
173 Hysterectomy for a double uterus
Kiong K Chan
174 Cervical stump excision
Kiong K Chan
175 Surgery for ovarian remnant
Kiong K Chan and Arri Coomarasamy
176 Surgery for a missing intrauterine contraceptive device
Toh Lick Tan
177 Management of imperforate hymen, transverse and other vaginal septa
Jane Macdougall
178 Benign lesions in the groin and vulva
Jennifer Byrom
179 Cystic structure in the upper vagina
Ted Roth and Rodney Meeks
180 Adnexal masses in infants and children
Rachel Miller and KrisAnn Schultz
181 Nerve injuries associated with gynecologic and obstetric surgery
Djavid Alleemudder
182 Consent challenges
Will Parry-Smith and Martin Underwood
183 Dealing with complaints
Mahmood Shafi
184 Dealing with litigation
Rebekah Ley and Mahmood Shafi

Index