By Mitchel S. Hoffman
Knowledge of and adventure with the elemental means of vaginal hysterectomy isn't univers al. each one doctor needs to learn how to determine and delight in the scale of person edition in anatomic findings and consequently surgical technical judgements and their execu tion from one sufferer to a different. unforeseen surgical trouble should be expected, yet eventually it really is handled retrospectively. expert practitioners needs to examine the actual sufferer and her challenge comprehensively and make allowance for such person adaptations in locate ings and technical wishes as are essential to the surgical resolution for that patient's challenge. spotting those elements, Drs. Hoffman and Spellacy have orga nized and ready a entire monograph referring to this very actual medical entity. they've got reviewed the adventure of con transitority surgeons and combined those strategies with their very own event in an invaluable compendium of surgical wisdom approximately this crucial topic. Their monograph is usually recommended now not in its place for the various different high-quality surgical texts to be had to the reader yet as a complement to the surgeon's library. it truly is for these surgeons who, having mastered the fundamental innovations, are in terested in extending the frontiers of non-public wisdom of this provocative topic and thoroughly broadening the indicators for effec tive surgical procedure and reconstruction. David H. Nichols, M.D., F.A.C.S., F.A.C.O.G.
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Additional resources for The Difficult Vaginal Hysterectomy: A Surgical Atlas
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Obesity and vaginal hysterectomy. J Reprod Med 35:945-949, 1990 Reich H, DeCapria J, McGlynn F. Laparoscopie hysterectomy. J Gynecol Surg 5:213-215, 1989 Schwartz RO. Complications of laparoscopie hysterectomy. Obstet Gynecol 81:1022-1024, 1993 Sightler SE, Boike GM, Estape RE, Averette HE. Ovarian cancer in women with prior hysterectomy: 14 year experience at the University of Miami. Obstet Gynecol 78:681-684, 1991 Speroff T, Dawson NV, Speroff L, Haber RJ. A risk-benefit analysis of Suggested Reading elective bilateral oophorectomy: effect of changes in compliance with estrogen therapy on outcome.
Surg Gynecol Obstet 170:299305, 1990 Liu CY. Laparoscopie hysterectomy: a review of 72 cases. J Reprod Med 37:351-354, 1992 Mattingly RF, Thompson JD. TeLinde's Operative Gynecology (6th ed). Lippincott, Philadelphia, 1985, pp 548-560 McCarus SD. Laparoscopically-assisted vaginal hysterectomy. Female Patient. 17:98-102, 1992 McKenzie LL. On discussion of the frequency of oophorectomy at the time of hysterectomy. Am J Obstet Gynecol 100:724-726, 1968 Mikuta JM. Unexpected ovarian tumor discovered at vaginal hysterectomy.
Starting and ending beyond the corners, the full thickness of the laceration is closed with a running stitch of 3-0 chromic suture (Fig. 4-3A). There should be B 43 4. Intraoperative Complications Figure 4·3. (A) First layer of clos ure of the bladder laceration has been completed. (B) Suture line of the first layer of clos ure is being imbricated with a second layer of suture placed in the bladder muscularis. t".. B only enough tension on the suture to approximate the edges. A second layer of 3-0 chromic or delayed absorbable interrupted or running suture is placed in the muscularis so as to imbricate the tirst layer (Fig.