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CHAPTER 15

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

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CHAPTER 15

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  1. CHAPTER 15 Obstetric and Gynecologic Surgery

  2. 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

  3. 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

  4. 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

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

  6. Introduction to Obstetric and Gynecologic Surgery • 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

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

  8. 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

  9. Patient Positioning, Draping, and/or Setup • Positioning • 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

  10. 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

  11. Labor • Labor process stages • 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

  12. 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

  13. Episiotomy and Perineal Lacerations • Episiotomy • 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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)

  19. 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

  20. 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

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