By Geoffrey W. Cundiff MD FACOG FACS FRCPSC, Ricardo Azziz MD MPH MBA, Robert E Bristow MD MBA FACS
Because the box of gynecologic surgical procedure evolves at a fast velocity, remain prior to the gang with Te Linde’s Atlas of Gynecologic surgical procedure, your finest advisor to pelvic anatomy and surgical applied sciences. ideal for either gynecologists-in-training and veteran physicians, this tome of knowledge imparts the newest novel concepts that may hold your perform at the industry’s innovative. no matter if you’re simply getting begun, trying to hone your surgical suggestions, or just trying to find a great advisor to maintain your reminiscence fresh—this textual content may help you achieve mastery of the newest advancements in gynecologic surgical procedure.
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Extra info for Te Linde’s Atlas of Gynecologic Surgery
Example text
The patient may be positioned in the dorsal low-lithotomy (perineolithotomy) position using Allen® Universal Stirrups (Allen Medical Systems, Cleveland, OH) or supine on the operating table. The low-lithotomy position is preferable, as it permits intraoperative bimanual examination to accurately assess distorted pelvic anatomy and allows access to the perineum for colpotomy and cystoscopy. Abdominal entry and exposure can be achieved through either a transverse or vertical incision, depending on clinical factors or the anticipated scope of the operation.
26 SECTION I GYNECOLOGY Typically, a vaginal hysterectomy is feasible if the uterine size does not exceed the size of a 12-week gravid uterus. Consideration should be given to the use of a GnRH analogue preoperatively if the uterine size can be reduced enough to make the vaginal approach feasible. A very narrow (less than 90°) pubic arch can make a vaginal approach challenging. The shape of the uterus should also be assessed. If the uterus is enlarged due to the presence of a pedunculated subserosal fibroid floating above it, a vaginal hysterectomy may be feasible.
A complete physical examination should be performed preoperatively and blood work, a chest X-ray and electrocardiogram, as well as other investigations should be ordered depending on patient-specific health concerns. The patient should be assessed for preoperative anemia, especially if the reason for hysterectomy is abnormal uterine bleeding. If anemia is present, iron supplements or GnRH analogue are helpful to correct anemia prior to surgery. In cases of severe anemia, preoperative blood transfusion should be considered.