Gynae surgeries

Introduction to gynae surgery for Medical students/ Post graduates

1. GYNAECOLOGIC SURGERIES








DATO DR ARUKU NAIDU
MD(UKM), FRCOG(UK), CU (JCU)
CONSULTANT O & G AND
UROGYNAECOLOGIST
www.aruku.naidu.blogspot.com

2. CONTENT
Anatomy of Pelvis
Type of surgery based on Pelvic Organ that is
involved
Mode of surgery- open/lap/vaginal/ Robotics

3. Anatomy of the pelvis
Bony pelvis
Soft tissue
Organs

4. BONY PELVIS

5. SOFT TISSUE

6. Soft Tissue
Perineal membrane Pelvic diaphragm

7. Internal organs

8. Gynaecologic surgeries
Vulva
Vagina
Cervix
Uterus
Fallopian tubes
Adnexa
Pelvic region/area
Incontinence
POProlapse

9. TYPE OF DISEASE
BENIGN AND MALIGNANCY

TYPE OF OPERATION
OPEN METHOD
LAPAROSCOPY
VAGINAL ROUTE

10. VULVA
BARTHOLIN GLAND
CYST/ABSCESS
BIOPIES
HYMENECTOMY
VULVECTOMY

11. Vulva
Bartholin abscess

12. Hymenectomy

13. Imperforated hymen

14. Rigid Hymen

15. Vaginal surgeries
Anterior proplase
surgery
Posterior prolapse
surgery
Vault support surgery
Vaginal hysterectomy
Manchester repair

16. LARGE U-V PROLAPSE

17. PELVIC RECONSTRUCTION
•VAGINAL
HYSTERECTOMY + Mc
CALL CULDOPLASTY
•ANTERIOR DSR + MESH
•POSTERIOR DSR
•PERINEAL BODY
RESTORATION
•SUS

18. cervix
Biposy
Colposcopy and
LEEP
cervical cerclage

19. Uterus
• Fibroid
• Endometriosis
• Adenomyiosis
• Endometrial ca
• PID
• Others
EPROC/molar

20. GESTATIONAL
TROPHOBLASTIC DISEASE

21. GESTATIONAL
TROPHOBLASTIC DISEASE
Symptoms/signs
Uterus > dates (50%)
Increased pregnancy symptoms – hyperemesis,
severe PE, hyperthroidism
PV bleeding
Passing vesicles vaginally

22. GESTATIONAL
TROPHOBLASTIC DISEASE

23. GESTATIONAL
TROPHOBLASTIC DISEASE
Managements
General Assessment
Suction evacuatn under GA
Suction currettage to evacuate all molar tissue
Transfuse blood if necessary
Oxytocin drip 20 lU
In older patients- Hystrectomy is an option
Before Discharge
Counsel on contraception ( Barrier method, OCP)

24. FIBROIDS
Symptoms (50% - asymptomatic )
Menorrhagia or intermenstrual bleed
Rarely pain – due to red degeneratn
Urinary symptoms – frequency or retention
P/E
Solid mass – unable to go below
Mulitple fibroids cause irregular knobbly
enlargement
Pallor – due to severe bleeding

25. FIBROIDS

26. FIBROIDS
Management
Conservative – small,
asymptomatic fibroids
Medical
Tranexamic acids
GnRH
Surgical
Hysteroscopic
Myomectomy
Hysterectomy

27. SURGICAL TECNIQUES FOR
Urodynamic Stress Incontinence PROCEDURE MEAN ( % )
FIRST
PROCEDURE
MEAN ( % )
RECURRENT
INCONTINENCE
BLADDER BUTTRESS 67.8 NA
MARSHALL-
MARCHETTI KRANTZ
89.5 NA
BURCH
COLPOSUSPENSION
89.8 82.5
BLADDER
NECK SUSPENSION
86.7 86.4
SLINGS 93.9 86.1
INJECTABLES 45.5 57.8


Jarvis meta-analysis 1994

28. Retropubic & transobturator
pathways

29. SPARC AND MONARC
PLACEMENTS IN A CADAVER
RETROPUBIC
TOT

30. Laparoscopic Gynaecological surgery

31. Robotic gynaecological surgeries

32. Conclusion
Many gynaecological surgeries
Benign vs canser surgeries
Simple to difficult
Knowledge on surgery important
Preparation for surgery important
All for good of patients
Need to master new tecnology
Reduce morbidity and mortality

33. THANK YOU