GYN Surgery Review

List the four uterine ligaments in the order they will be divided during a T.A.H. List them in the order they will be divided during a T.V.H.

TAH - broad, round, uterosacral, cardinal TVH - cardinal, uterosacral, round, broad

List four of the uterine ligaments.

broad, round, uterosacral, cardinal

This procedure provides visualization of the interior of the uterus. What might this procedure be done to treat?

hysteroscopy abnormal uterine bleeding, IUD removal, diagnosis, endometrial polyp, removal of uterine septum

How is methylene blue used in tuboplasty for infertility?

injected in cervix testing for blockage - patency of tubes hysteroscopy

Explain what you will do with the pieces of placenta handed to you during a Cesarean section and why you need to do this.

keep all placenta pieces and piece them together like a puzzle to make sure all the placenta has been removed because if not the patient can suffer from bleeding because the uterus won't be able to shrink to a smaller size

LAVH

laparoscopically assisted vaginal hysterectomy

For what do the letters "LLETZ" stand?

large loop excision of the transformational zone

Define LLETZ and LAVH.

large loop excision of the transformational zone laparoscopic assisted vaginal hysterectomy

Name two retractors that would be classified as lateral vaginal wall retractors. Name a posterior wall retractor.

lateral - Heaney, Heaney-simon, doyen posterior - auvard

list three indications for a caesarean section

maternal - eclampsia, placenta previa, failed induction fetal - fetal distress, breech presentation, complications from multiples

Removal of the entire uterus

Hysterectomy

Surgical procedure to view the inside of the uterus with a scope

Hysteroscopy

What is the flared distal portion of the fallopian tube called?

Infundibulum

This instrument is used during a TAH to cut the vaginal cuff.

Jorgensen scissors

Name a common type of vesicourethral abdominal suspension.

MMK marshal marchetie krantz and Burch

What instrument might be used to grasp the anterior lip of the cervix just prior to dissection of the cervix from the vaginal cuff?

TAA, tenaculum Sponge forceps for a Shirodkar procedure Tenaculum or Oschner for TAH

Before the skin incision is made for an LAVH, this is placed on the cervix.

Hulka

Place the following instruments in the order you would expect them to be used to perform a TAH by selecting the appropriate number (1 is first, 2 is second, etc.). Long curved Mayo sciss O'Connor O'Sullivan #10 Blade on #3 handle Zeppelin clamps (x2) Jorgensen scissors Isolation basin

#10 Blade on #3 handle O'Connor O'Sullivan Zeppelin clamps (x2) Long curved Mayo sciss Jorgensen scissors Isolation basin

Place the following instruments in the order you would expect them to be used to perform a Caesarean section by selecting the appropriate number (1 is first, 2 is second, etc.). DeLee retractor #20 Blade on #4 handle Controlled suction 2-0 Vicryl SH Cord clamp Bandage scissors

#20 Blade on #4 handle DeLee retractor Bandage scissors Controlled suction Cord clamp 2-0 Vicryl SH

This procedure is done for benign tumors of the myometrium when preserving fertility is desired.

Abdominal myomectomy

This instrument is used during Cesarean section to extend the incision made in the uterus.

Bandage scissors

Surgical procedure to correct a defect in the vaginal wall

Colporrhaphy

An instrument setup for this type of case will include several sizes of sterile cannulas.

D&C - dilation and curettage

what is a DeLee retractor used for during a C-section? How about bandage scissors?

DeLee retractor - bladder retractor Bandage scissors - cut uterine incision - incision in uterus to keep from hurting the baby

An incision made during normal labor to facilitate delivery with less trauma to the mother is called a/an

Episiotomy - perineotomy

The finger-like projections at the end of the fallopian tube are called:

Fimbriae

List the five structures labeled on this diagram (A first, then B, C, D, and E).

Fundus or Myometrium Ampulla Ovary Round ligament Cervix or Fornix

Surgical formation of a pouch to treat a cyst

Marsupialization

Removal of an ovary

Oophrectomy

Term that describes the extensive bacterial infection of the pelvic organs.

Pelvic inflammatory disease

List the three layers of the uterine wall and the type of tissue each is composed of.

Perimetrium - serous, myometrium - muscular, endometrial - mucosal PasS MoM EM

This drug is used to stimulate uterine contractions.

Pitocin

Define "Tubal Ligation"

Procedure in which the patient's fallopian tubes are blocked or clamped Fallopian tubes are cut, tied, or blocked this prevents future pregnancy (permanently)

What is the function of the ovary?

Produce estrogen, progesterone, and ova

Define "Myomectomy"

Removal of a tumor of the muscle layer in the uterus

Define "Pelvic Exenteration".

Removal of the contents of the pelvis surgical removal of all organs from the pelvic (lower abdominal) cavity

Define "vulvectomy"

Removal of the female external genetalia surgical removal of the vulva (outer part of the female genitals - includes mons pubis, labia majora and minor, clitoris, and vestibule) Can have a simple vulvectomy, radical, etc

Which structures will be removed during a pelvic exenteration?

Reproductive organs - ovaries, Fallopian tubes, uterus, cervix, vagina Lymph nodes in pelvis bladder, colon, and probably rectum

label picture

Round Ligament or Internal Ring, Urinary Bladder, Fundus of Uterus, Rectum or Posterior cul de sac, Ampulla of Fallopian Tube

Which of these would you hand the surgeon to grasp the uterus during a TAH?

Schroeder

This instrument is also called a Tulip clamp and is used to grasp the uterus.

Somer

Briefly explain how the surgeon will identify the ureter during a TAH.

Stimulate it with a blunt object (e.g. sponge stick) and watch for peristalsis

Define "Condyloma Ablation"

The use of heat to destroy genital warts

How is a radical hysterectomy different from a Werthheim procedure?

There is no difference. Werthheim is a technique for a radical hysterectomy.

Why is a Foley catheter placed just prior to a hysterectomy?

To reduce the size of the bladder and get it out of the way

How is a Wertheim procedure different from a total abdominal hysterectomy?

Total - just taking the uterus and cervix werthheim - ovaries, tubes, nodes, 1/3 of the vaginal wall/vault

What is the function of the Fallopian tubes?

Transport ova to the uterus

This condition will result in the leakage of urine into the vagina.

Vesicovaginal fistula

Removal of the uterus, tubes, ovaries, upper 1/3 of the vaginal vault and lymph nodes

Wertheim procedure

Where can extrauterine pregnancies occur?

anywhere (ectopic pregnancy) - (tubal ectopic) fallopian tubes, cervix (cervical), Ovary (ovaric), abdomen (abdominal), myometrial

The fallopian tube is typically grasped with what instrument?

babcock

How is a sterile Mayo tray used during vaginal procedures.

becomes a lap tray (in surgeons lap because they are sitting)

A hernial protrusion of the bladder that causes a downward bulge in the anterior wall of the vagina is called a ______. What is a similar protrusion of the rectum through the posterior vaginal wall called?

cystocele - bladder, rectocele - rectum

Briefly describe the instrumentation for a cervical conization and how each instrument would be used.

electrocautery loop and long angled number 3 knife. you use the electrocautery loop to scoop out a cone on the cervix while burning the tissue. the knife is used to cut out a cone of tissue without cautery

This is the correct term for cauterization of the endometrium.

endometrial ablation

Herniation of the cul-de-sac of Douglas containing a loop of bowel is a/an:

enterocele

This is the most common type of ovarian cyst.

follicular

List the three common types of ovarian cysts. Which is the most common?

follicular cyst (most common), chocolate cyst (from endimetriosis), Dermoid cyst (egg that's developing starts to grow without fertilization. Can just be teeth, hair, etc)

The portion of the uterus above the level of the tubes is called the

fundus

The ovary is attached to the uterus by the

ovarian ligament

A procedure whose ultimate goal is abdominal, perineal, and groin dissection is a:

pelvic exenteration

Properly padding a stirrup is done to prevent damage to this structure. How must a patient's legs be placed into and taken out of stirrups? Why?

peroneal nerve both legs should be elevated and flexed at the hip simultaneously to prevent hip dislocation or postoperative back and hip pain

Why does the circulator temporarily place a "red rubber" catheter in the bladder of a TAH patient before surgery?

reduce the chance of injuring the bladder

Which of the uterine ligaments passes through the inguinal canal?

round ligament

Removal of the Fallopian tube

salpingectomy

Describe marsupialization of a Bartholin duct cyst/abscess.

same as pilonidal cyst - find all sinus tracts, suture it open, pack it

In which procedure would you anticipate having a Deschamp ligature passer loaded with 5mm tape?

shirodkar procedure permanent stitch around cervix (c-section will be needed to deliver baby later)

Name three types of tenacula.

single tooth, double tooth, lahey

why is it important that the entire placenta be accounted for after a baby is delivered?

to allow the uterus to return to its normal size. if not removed, mother could have bad bleeding

During a TAH, what structure must the surgeon AVOID as she/he divides the broad ligament?

ureter