GYNECOLOGIC SURGERY
GYNECOLOGISTS FOCUS ON THE FEMALE
REPRODUCTIVE SYSTEM……..
ANATOMY
INTERNAL FEMALE ORGANS:
 VAGINA
 UTERUS
 CERVIX
 FALLOPIAN TUBES
 OVARIES
**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 crest
 Ischia
 pubic bones
 sacrum
Pelvic Sagittal Plane
5
Pelvic “Floor” Consists of:
 Levator ani muscles and its 3 components
Iliococcygeal
2. Pubococcygeal
3. Puborectalis
1.
PELVIS
 Two distinct cavities :
“false pelvis”
2. “true pelvis”
1.
“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
 Cardinal
 Round
 Infundibulopelvic
Loose configurations of :
 Areolar tissue
 Blood vessels
 Muscle fibers
“MOORINGS” (Anchors)
Connective tissue are not static, they change with age,
nutritional status, amount of exercise and hormonal
fluctuations……
EXTERNAL GENITALIA
“VULVA”
 Mons Pubis
 Labia Majora
 Labia Minora
 Clitoris
 Bartholins Glands
 Fourchette
 Perineum
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 minora
 Contains the urethral meatus
 Inferior to the clitoris as well as the orifices of the
vestibular glands (Bartholins glands)
“PERINEUM”
 Area between the inferior vaginal opening and anus
 Sensitive
 Branches of the pudendal nerve; 2nd , 3rd and 4th
sacral portions of the spinal canal.
“VAGINA”
 Fibromuscular tube
 Increase in diameter in its internal projection
 Widest at its deepest region
 Acidic environment
 Ascends posterosuperiorly
 Bladder and urethra anteriorly; annular recess created by
the cervical vaginal junction called the fornix
 Rectum and anal canal posteriorly
 Rich 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 = CARDINAL
 POSTERIORLY = PUBIC
 INFERIORLY = SACRAL
Uterine and
Uterine Appendages
20
“BROAD LIGAMENT
 Result of peritoneal folds
 Contains fallopian tubes
“ROUND LIGAMENT”
 Consists of ovarian ligaments
 Various blood vessels
 Nerves 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:
Fimbria
2. Ampulla
3. Isthmus
4. Intramural region:
 Situated in the upper margin of the broad ligament
 Vascularity achieved by the ovarian and uterine
arteries
1.
“OVARIES”
 Paired, almond-shaped
 Lie on either side of uterus
 Production and expulsion of oocytes (eggs)
 Release of hormones (estrogen, and progesterone)
 Ovarian cycle stimulated by the release of LH & FSH
from putuitary gland
 Supported at either end by suspensory ligament
(suspensory)
 Ovarian ligament, lying in broad ligament, support the
bulk of the ovaries
 Ovarian arteries, branching from the aorta
COMMON SURGICAL PROCEDURES
Hysterectomy with or without BSO
-Vaginal
-Abdominal
A&P repair
Laparoscopy
D & C
D & E
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)
•Draping
•Under buttocks
•Leggings
•4 towels and a lap sheet
•Mayostand-abdominal approach
•Backtable –vaginal approach
•Suction devices
•Kick buckets
•ESU
•Sterile handpieces
Special Considerations
 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
•Cervical and intrauterine instrumentation
1.
2.
3.
4.
5.
6.
Goodell uterine dialator
Bozeman (many uses) uterine dressing forceps
Uterine sound
Uterine tenaculum
Hegar uterine dialators
Uterine curettes
•Abdominal and perineal retractors
1.
2.
3.
4.
5.
6.
Deaver 2” blade
Deaver 1” blade
Dee Lee universal retractor
Gelpi perineal ret.
O’sullivan O’Connor abdominal ret
Franz abdominal ret
Hegar Uterine Dialators
Sims
Uterine
curettes
Bozeman Uterine Dressing
Forceps
Abdominal Perineal Retractors
 Franz Abdominal
Retractor
DeLee Universal
Retractor