Comprehensive Manuals of Surgical Specialties

Richard H. Egdahl, editor

Byron J. Masterson

anual of Gynecologic Surgery With contributions by Kermit E. Krantz, William J. Cameron, James W. Daly, Jamil A. Fayez, and Ernest W. Franklin III

Includes 192 color illustrations

Springer-Verlag New York Heidelberg Berlin

Comprehensive Manuals of Surgical Specialties, Volume 4

SERIES EDITOR

Richard H. Egdahl, M.D., Ph.D., Professor of Surgery, Boston University Medical Center, Boston, Massachusetts 02118

AUTHOR

Byron J. Masterson, M.D., Professor, Department of Obstetrics and Gynecology, University of Kansas Medical Center, College of Health Sciences and Hospital, Kansas City, Kansas 66103

CONTRIBUTORS

William J. Cameron, M.D., Professor and Vice-Chairman, Department of Obstet­rics and Gynecology, University of Kansas Medical Center, College of Health Sciences and Hospital, Kansas City, Kansas 66103

James W. Daly, M.D., Professor, Department of Obstetrics and Gynecology, Uni­versity of Florida College of Medicine, Gainesville, Florida 32610

Jamil A. Fayez, M.D., Professor, Department of Obstetrics and Gynecology, Uni­versity of Missouri-Kansas City School of Medicine, Kansas City, Missouri 64108

Ernest W. Franklin III, M.D., Director, Foundation for Gynecologic Oncology, Atlanta, Georgia 30342

Kermit E. Krantz, M.D., Professor and Chairman, Department of Obstetrics and Gynecology, University of Kansas Medical Center, College of Health Sciences and Hospital, Kansas City, Kansas 66103

MEDICAL ILLUSTRATOR

Deanne McKeown, Design and Illustration Section, Learning Resources Divi­sion, University of Kansas Medical Center, College of Health Sciences and Hos­pital, Kansas City, Kansas 66103

Library of Congress Cataloging in Publication Data

Main entry under title: Manual of gynecologic surgery.

(Comprehensive manuals of surgical specialties; v. 4) Includes bibliographies and index. I. Gynecology, Operative. I. Masterson, Byron J.

[DNLM: I. Genital diseases, Female-Surgery-Handbooks. WP660 M421 m] RGI04.M34 618 78-32118

All rights reserved.

No part of this book may be translated or reproduced in any form without written permission from Springer-Verlag.

© 1979 by Springer-Verlag New York Inc.

Softcover reprint of the hardcover 1 st edition 1979

9 8 7 6 543 2 I

The use of general descriptive names, trade names, trademarks, etc., in this publi­cation, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act. may accordingly be used freely by anyone.

ISBN-13: 978-1-4684-0075-5 DOl: 1 O.l 007/978-1-4684-0073-1

e-ISBN-13: 978-1-4684-0073-1

This book is dedicated to my family.

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Editor' s Note

Comprehensive Manuals of Surgical Specialties is a series of surgical manuals designed to present current operative techniques and to explore various aspects of diagnosis and treatment. The series features a unique format with emphasis on large, detailed, full-color illustrations, schematic charts and photographs to demonstrate integral steps in surgical proce­dures.

Each manual focuses on a specific region or topic and describes surgical anatomy, physiology, pathology, diagnosis and operative treat­ment. Operative techniques and stratagems for dealing with surgically cor­rectable disorders are described in detail. Illustrations are primarily depicted from the surgeon's viewpoint to enhance clarity and compre­hension.

Other volumes in preparation:

Manual of Lower Gastrointestinal Surgery Manual of Urologic Surgery Manual of Vascular Surgery Manual of Cardiac Surgery Manual of Liver Surgery Manual of Soft Tissue Tumor Surgery Manual of Orthopaedic Surgery Manual of Upper Gastrointestinal Surgery Manual of Plastic Surgery Manual of Ambulatory Surgery

Richard H. Egdahl

Preface

The Mallila/ qf Gyn('c%Ric SurRery is a comprehensive guide for opera­tive decision-making and technique in female pelvic surgery. For a wide array of problems requiring surgical intervention, this volume examines the anatomy, preoperative evaluation, surgical strategy, details of tech­nique, postoperative management, and anticipated results. The manage­ment of operative complications and injuries to bowel, urinary system, and pelvic vessels is discussed.

This volume is divided into three sections: ambulatory, vaginal, and abdominal surgery. The ambulatory section will be particularly useful to the family physician. The abdominal section explains complication man­agement for the gynecologist whose surgical background may not include gastrointestinal or urinary tract surgery.. The section on ovarian surgery contains additional data for the general surgeon who may encounter unexpected ovarian lesions. Although the book should be most useful to gynecologic residents-in-training and practicing gynecologists, it will also be of use to general surgeons who perform gynecologic operations and to all physicians who perform ambulatory gynecologic procedures.

The operative techniques depicted are currently used procedures based on the newer concepts of wound healing and suturing, utilizing mod­ern surgical instrumentation. When several techniques are available, the author's personal preference is described.

This book, which was produced by the project manager system, rep­resents the efforts of 21 persons in three cities. Christine G. Williamson managed the project with drive, understanding, and skill. She was responsi­ble also for coordinating information retrieval, organizing the chapters, and editing the text.

To maintain artistic uniformity, Deanne McKeown illustrated the en­tire book. The preliminary sketches were prepared from notes and sketches made in the operating room during actual performance of the techniques described. After thorough graphic and anatomic research, they were reviewed by the author, then skillfully rendered in color. The final transparent watercolor plates present visual communication of the es­sence of the surgical procedures included here.

A full-time research staff comprised of Dr. William Hamilton, Scott Smith, and David Wright, reference librarian, abstracted references from

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Preface

Vin

the medical literature for the last 10 years on each topic. This large amount of data was narrowed to as few references as possible, consistent with the intent of each chapter. These efforts contributed to the constant reviewing and updating of the text during its 15 months of preparation.

My three fellows, Drs. Tom Snyder, Tom Sullivan, and Javier Ma­grina, were helpful in correlating, reviewing, and retrieving valuable infor­mation. In addition, their contribution to the improved level of surgical care on the gynecologic surgical service is appreciated.

My Section Manager, Felicia Weiner, successfully coordinated my various clinic and operating room schedules, speaking engagements, and university and other obligations to provide me the time necessary for the writing of this book. The advice and encouragement of A. J. Yarmat, Ph.D., Director of Communications for the University of Kansas, also contributed to the development of this book.

Byron J. Masterson

Acknowledgments

My medical career has been encouraged at every turn by my two principal surgical teachers, Dr. Kermit E. Krantz and Dr. Felix Rutledge. They have supported me at each step of my career and in every endeavor. I trust this book merits that confidence.

I am indebted to Dr. Hugh Stephenson, who interested me as a medi­cal student in experimental vascular surgery and showed me how crucial the finer points of technique were in the success of a surgical procedure: to Drs. Carl Moore and Herbert Goldberg, who showed me the pleasure in an academic pursuit: and to Ors. Glover Copher, Eugene Bricker, John Spratt, Ernesto Ego-Aguirre, Bill Spanos, Harold Gainey, Vernon Col­pitts, Joe Lucci, Bill Peterson, Sam Montello, Tom McGuire, Bill Jewell, John Weigel, and all the other surgeons with whom I have scrubbed and learned during my surgical experience.

I wish to thank Dr. Richard Egdahl, who first suggested that the pub­lisher and I get together for this volume, and Dr. Hugh Barber, who en­couraged me to use a straightforward writing format. Thanks also to Dr. Dick Mattingly, who suggested that the manual concept was worthwhile, and to John Lewis for guidance in the initial stage of this work. I also wish to thank Ron Pfost and Bernard Brown who consistently encouraged me when the task seemed impossible. Finally, my thanks to Springer-Verlag for their superb staff and wise counsel during the production of this book.

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Contents

1 Ambulatory Surgery 1 Vulvar Ambulatory Surgery I Vaginal Ambulatory Surgery 6 Cervical Ambulatory Surgery 7 Uterine Ambulatory Surgery 13 Appendix: Standard Surgical Instruments 17 References 18 Selected Bibliography 19

2 Laparoscopy (William J. Cameron) 20 Preoperative Preparation 21 Operative Technique 21 References 27 Selected Bibliography 27

I Vaginal Surgery

3 Wound Healing in Gynecologic Surgery 31 Response to Injury 31 Suture 34 Surgical Instruments 36 Appendix: Instrument List 39 References 40 Selected Bibliography 41

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Contents

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4 Cervical Conization 42 Preoperative Evaluation 42 Operative Technique 43 Postoperative Management 44 Results 45 References 45

5 Vaginal Hysterectomy 47 Preoperative Evaluation 47 Preoperative Preparation 49 Operative Technique 50 Postoperative Management and Complications 57 References 59

6 Pelvic Relaxation and Associated Conditions: Enterocele Repair 60 Preoperative Evaluation 60 Operative Technique 62 Postoperative Management and Results 66 References 67

7 Repair of Rectocele and Perineum 68 Anatomy 68 Preoperative Evaluation 68 Operative Technique 69 Postoperative Management 72 References 72

8 Anterior Colporraphy 73 Anatomy 73 Preoperative Evaluation 73 Operative Technique 75 Postoperative Management and Results 75 References 77

9 Vaginal Prolapse 78 Anatomy 78 Preoperative Evaluation 78 Operative Technique 79 Postoperative Management and Results 81 References 84

1 0 Rectovaginal Fistula and Anal Incontinence 85 Anatomy 85 Pathology 86 Preoperative Evaluation 86 Operative Technique 87 Postoperative Management and Results 90 References 91

11 Vesicovaginal Fistula (Kermit E. Krantz) 92 Preoperative Evaluation 92 Operative Technique 93 References 98

12 Surgery of the Vulva (Ernest W. Fanklin III) 99 Anatomy 99 Preoperative Evaluation 100 Operative Strategy 100 Invasive Carcinoma of the Vulva 104 References 118 Selected Bibliography 118

II Abdominal Surgery

13 Total Abdominal Hysterectomy 123 Blood Supply 123 Nerves 126 Ligaments 126 Spaces 127 Preoperative Evaluation 129 Operative Strategy 130 Operative Technique 130 Wound Healing 144 Postoperative Management 147 Postoperative Complications 147 References 148

Contents

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Contents

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14 Radical Hysterectomy (James W. Daly) 150 Preoperative Evaluation 151 Operative Technique 151 Postoperative Management 164 Results 165 References 165

15 Myomectomy 167 Pathology 167 Preoperative Evaluation 168 Operative Technique 169 Postoperative Management and Results 169 References 171

16 Infertility Surgery of the Fallopian Tube (Jamil A. Fayez) 172 Anatomy and Physiology 173 Preoperative Evaluation 173 Operative Strategy 174 Postoperative Management 176 Macroscopic versus Microscopic Tuboplasty 176 Operative Technique 176 Results 182 Surgery for Fertility Control 183 References 185 Selected Bibliography 186

17 Ectopic Pregnancy 187 Preoperative Evaluation 188 Operative Strategy 189 Postoperative Management 190 References 191

18 Surgery of the Ovary 193 Surgical Anatomy 193 Preoperative Evaluation 194 Operative Technique 195 Postoperative Management and Results 211 References 212 Selected Bibliography 214

19 Management of Bowel Injuries in Gynecologic Surgery 215 Operative Injuries 215 Surgery for Obstruction 222 Gastrointestinal Complications of Carcinoma of the

Ovary 223 Surgery for Radiation Injury 228 References 228

20 Incidental Appendectomy 230 References 23 1

21 Marshall-Marchetti-Krantz Procedure (Kermit E. Krantz) 232 Physiology 232 Preoperative Evaluation 233 Operative Strategy 234 Postoperative Management 235 References 237 Selected Bibliography 237

22 Ureteral Injury 239 Technical Considerations 240 Repair of Injury 242 Postoperative Management 246 References 247 Selected Bibliography 247

Selected Bibliography 248

Index 249

Contents

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