Chapter 15: Obstetric and Gynecologic Surgery; Short Answer/Discussion: Gynecological Abdominal Procedures

List three transverse incisions used for gynecological surgery. Which incision provides the best cosmetic result and is 30 times stronger? What are the disadvantages of this incision? 1) Transverse 2) Vertical 3) Oblique Transverse; Disadvantages: time-consuming, hemorrhagic, compromise nerves, limit access to the upper abdomen. What ligament provides support for the ovaries? During an oophorectomy, which is ligated first? Suspensory and ovarian ligaments; The suspensory is divided and ligated first. What does an elevated serum CA-125 test indicate? Ovarian cancer, neoplastic ovarian tumor, endometriosis Fill in the blank: Myomectomy is the excision of _________. Myomas (uterine fibroids) What should be done as warm. moist lap sponges are used to pack the bowel cephalad? Count sponges as they are placed and have circulator record the number. What structure(s) is (are) removed during a TAH? Uterus, also involves cervix, ovaries, Fallopian tubes, and other surrounding structures such as lymph nodes. Anticipation for a TAH dissection requires some modification. Describe what you will pass. Preferred hysterectomy clamps: Heaney clamps and Heaney-Ballentine clamps Identify which procedure ligates the following ligaments first. A) Uterosacral ligaments B) Round and Ovarian ligaments A) Vaginal hysterectomy B) TAH, BAH Why are the Jorgenson scissors and surrounding clamps considered contaminated? They may project into the vagina and should be isolated or removed from the field after use. What are the advantages of the LAVH approach? Visualization of the abdominal organs during procedure, less traumatic, shortens patient's hospital stay. What positioning tool is used to facilitate a low lithotomy position? Allen Stirrups Where is the robotic cart with arms positioned for a robot-assisted hysterectomy? Either alongside or between the legs of the patient without contaminating. Describe the structures removed for a Wertheim procedure. What is the alternate name for the procedure? En bloc removal of the ovaries, Fallopian tubes, uterus, and ligaments, upper 1/3 of vagina, and associated lymph nodes. Alternate name: Radical hysterectomy. During dissection for the Wertheim procedure, what structures must be properly identified to prevent injury? The ureters, iliac artery, bladder surface, and nerves. List the structures that will be removed during a total pelvic exenteration. Reproductive organs, bladder, rectum, lymph nodes in the pelvis, sometimes the anus and part of the colon.