Gynae Surgeries Flashcards
Where does the ovarian artery emerge from?
From the aorta, below the renal arteries
Where does the uterine artery emerge from^
From the internal iliac
What are the two approaches for a hysterectomy?
Vaginal
OR
Abdominal
What are indications for abdominal hysterectomy’
- Uterus enlarged by fibroids
- Significant adhesions expected
- Remove ovaries
What are indications for vaginal hysterectomy?
Normal sized uterus
Prolapse surgery
What are disadvantages of abdominal hysterectomy?
Abdominal incision
More pain
Longer recovery period
What are disadvantages for vaginal surgery
Ovaries cannot be removed
Surgical access is limited
Adhesions can cause difficulty for intercourse
What are complications for hysterectomy?
Haemorrhage DVT New bladder symptoms (Overactive bladder, stress incontinece) Early onset of menopause Ureteric /rectal injury Fistulae
To perform a oophorectomy in someone with dysmenorrhoea, what must you do first?
3 month trial of GnRH analogue to suppress ovarian function
This will ensure that oophorectly will alleviate pain
What medications should be stopped prior to hysterectomy?
COCP, HRT
4 weeks before
What must you give if you cannot stop HRT?
Give LMWH
Where is the pfannenstiel incision done?
Two finger breadths above pubic symphysis
Below the arcuate line, so there is no posterior rectus sheath
What are advantages of pfannenstiel incision?
Strong when repaired (low herniation risk)
Not very painful
Cosmetically attractive
What are disadvantages of pfannenstiel incision?
Cannot be extended / made larger
Surgical access limited
Where is midline incision done?
From pubic symphysis to umbilicus
