GYNECOLOGISTS FOCUS ON THE FEMALE REPRODUCTIVE SYSTEM……. .

GYNECOLOGIC SURGERY

ANATOMY

INTERNAL FEMALE ORGANS:VAGINAUTERUSCERVIXFALLOPIAN TUBESOVARIES

**Situated in the “lesser pelvis”These organs are protected by the bones of

“bony pelvis” and supported by the muscularity of the pelvic floor.

SUPPORT STRUCTURES OF THE FEMALE PELVIS

“Pelvic Girdle”

Consists of:Iliac crestIschiapubic bonessacrum

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Pelvic Sagittal Plane

Pelvic “Floor” Consists of:

Levator ani muscles and its 3 components

1. Iliococcygeal2. Pubococcygeal3. Puborectalis

PELVIS

Two distinct cavities :

1. “false pelvis”2. “true pelvis”

“FALSE PELVIS”

Little significance to gynecology and obstetrics

Prominent attachment for pelvic musculature.

Varies widely is size

“True Pelvis”

Inlets = round

Outlets = transversely oval- aids in the process of fetal delivery.

Pelvic Ligaments

CardinalRoundInfundibulopelvic

Loose configurations of :Areolar tissueBlood vesselsMuscle fibers

“MOORINGS” (Anchors)

Connective tissue are not static, they change with age, nutritional status, amount of exercise and hormonal fluctuations……

EXTERNAL GENITALIA“VULVA”

Mons PubisLabia MajoraLabia MinoraClitorisBartholins GlandsFourchettePerineum

No NOT a Volvo!!!

“EXTERNAL GENITALIA” CONTINUED…

External genitalia are vascularized and innervated by the clitoral, perineal and inferior hemorrhoidal branches of the pudendal artery and nerve.

“VESTIBULE”

Cavity between the labia minoraContains the urethral meatusInferior to the clitoris as well as the orifices

of the vestibular glands (Bartholins glands)

“PERINEUM”

Area between the inferior vaginal opening and anus

SensitiveBranches of the pudendal nerve; 2nd , 3rd and

4th sacral portions of the spinal canal.

“VAGINA”

Fibromuscular tubeIncrease in diameter in its internal projectionWidest at its deepest regionAcidic environmentAscends posterosuperiorlyBladder and urethra anteriorly; annular recess

created by the cervical vaginal junction called the fornix

Rectum and anal canal posteriorlyRich vascular supply derived from vaginal, uterine,

internal pudendal and middle rectal branches of the internal iliac arteries

ANATOMICAL PELVIC PLANES----CROSS SECTION, SAGITTAL

“UTERUS”

Hollow, thick walled and pear-shaped Between bladder and rectum Uterine appendages: (adnexa) - Fallopian tubes - Ovaries Superior 2/3 (corpus uteri) or body which narrows to a

cylindrical lower section called uterine (cervix) Internal OS - At the junction between corpus uteri External OS - Where the cervix opens into the vagina Lined with endometrium Ligaments that extend to the pelvic walls suspend the uterus

“LIGAMENTS”

LATERALLY = BROAD ANTERIORLY = CARDINALPOSTERIORLY = PUBICINFERIORLY = SACRAL

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Uterine and Uterine Appendages

“BROAD LIGAMENT

Result of peritoneal foldsContains fallopian tubes

“ROUND LIGAMENT”

Consists of ovarian ligaments Various blood vesselsNerves and lymphatics

The round ligament passes through the inguinal ring to the skin and connective tissue of the labia majora.

Arterial supply: is derived from the uterine branch of the paired internal iliac arteries

“FALLOPIAN TUBES” (uterine tubes)

4 PORTIONS:1. Fimbria2. Ampulla3. Isthmus4. Intramural region: Situated in the upper margin of the broad

ligament Vascularity achieved by the ovarian and

uterine arteries

“OVARIES”

Paired, almond-shapedLie on either side of uterusProduction and expulsion of oocytes (eggs)Release of hormones (estrogen, and progesterone)Ovarian cycle stimulated by the release of LH &

FSH from putuitary glandSupported at either end by suspensory ligament

(suspensory)Ovarian ligament, lying in broad ligament,

support the bulk of the ovariesOvarian arteries, branching from the aorta

COMMON SURGICAL PROCEDURES

Hysterectomy with or without BSO

-Vaginal -Abdominal

Laparoscopy

D & C D & E

A&P repair

C-section

GENERAL OBSTETRIC AND GYNECOLOGICAL INSTRUMENTS

•Heaney needle holders•Jorgenson scissors•Episiotomy scissors (bandage scissors)•Heaney-Ballantine clamps•Tissue forceps with teeth

OPERATING ROOM SET-UP, PT POSITIONING AND DRAPING

•Standard OR table -foot drop capabilities -sockets/brackets for leg holders -candy cane stirrups -Allen stirrups

•Lithotomy (most common) •Mayostand-abdominal approach•Backtable –vaginal approach•Suction devices•Kick buckets•ESU•Sterile handpieces

•Draping•Under buttocks•Leggings•4 towels and a lap sheet

Drugs – Oxytocin (pitocin, synotocin) used to induce labor. Carboprost (Hemabate) – oxytocic drug available in parenteral form, used to cause abortion; contracting uterus.

Positioning and Draping? Equipment? Mayostand vs. Backtable Suction Devices, ESU

Special Considerations

•Cervical and intrauterine instrumentation

1. Goodell uterine dialator2. Bozeman (many uses) uterine dressing forceps3. Uterine sound4. Uterine tenaculum5. Hegar uterine dialators6. Uterine curettes

•Abdominal and perineal retractors

1. Deaver 2” blade2. Deaver 1” blade3. Dee Lee universal retractor4. Gelpi perineal ret.5. O’sullivan O’Connor abdominal ret6. Franz abdominal ret

Hegar Uterine Dialators

Sims Uterine curettes

Bozeman Uterine Dressing Forceps

Abdominal Perineal Retractors

Franz Abdominal

Retractor

DeLee Universal Retractor