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