Gynecologic and obstetric surgery: challenges and management options

Content: Machine generated contents note: PART I: GENERAL PRE, INTRA, and POST OPERATIVE CHALLENGES SECTION 1: PRE-OPERATIVE CARE 1 Patient with poor ASA score 2 Patient on medication 3 Patient with ischaemic heart disease 4 Patient with Arrhythmias 5 Patient with a pace-maker or implantable defibrillator 6 Patient with complex congenital heart disease (a Fontan Circulation) 7 Hypertensive patient 8 Patient with respiratory disease 9 Patient with diabetes 10 Patient with thyroid disease 11 Patient with renal disease 12 Patient with liver disease 13 Patient with rheumatologic diseases 14 Patient with hematologic disorders 15 Patient at high risk of venous thrombosis 16 Patient on anti-coagulant therapy 17 Patient on steroid therapy 18 Patient with epilepsy 19 Patient with a psychiatric condition 20 Patient with organ transplant 21 Patient with Hep B or Hep C 22 Patient with HIV 23 Obese patient 24 Patient with poor nutritional status 25 Pregnant patient requiring non-obstetric surgery SECTION 2: INTRA-OPERATIVE CARE 26 Transverse incision on the abdomen inadequate for surgery 27 Patient with multiple abdominal scars 28 Patient with previous mesh incisional hernia repair requiring a laparotomy 29 Patient with previous mesh incisional hernia repair requiring a laparoscopy 30 Unexpected pathology: ovarian cyst 31 Unexpected pathology: abnormal appearance of the uterus 32 Unexpected pathology: severe pelvic adhesions 33 Unexpected pathology: abnormal appearance of bowel 34 Unexpected pathology: retro-peritoneal mass 35 Bladder injury 36 Ureteric injury 37 Small and large bowel injury 38 Inferior epigastric vessel injury 38 Inferior epigastric vessel injury 39 Bleeding from retracted pedicular (pelvic sidewall) vessels 40 Massive haemorrhage 41 Broken needle 42 Lost swab, needle or instrument SECTION 3: POST-OPERATIVE CARE 43 Post-operative care 44 Excessive nausea and vomiting after surgery 45 Excessive abdominal pain after surgery 45 Excessive abdominal pain after surgery 46 Bowel damage: postoperative presentation 47 Wound infection 48 Wound dehiscence 49 Late wound failure: incisional hernia 50 Necrotising fasciitis 51 Surgical drains 52 Shocked patient 53 Breathless patient: post-operative pulmonary complications 53 Breathless patient: post-opertaive pulmonary complications 54 Confused post-operative patient 55 Patient with poor urine output 56 Electrolyte imbalance 57 The swollen leg 58 Cardiorespiratory arrest PART II: OPERATIONS and CHALLENGES SECTION 4: GENERAL and MINIMAL ACCESS GYNECOLOGY 59 Difficulty in dilating a cervix: Cervical stenosis and cervical closure 60 Uterine perforation 61 Surgical uterine evacuation: excessive bleeding 62 Surgical uterine evacuation in a woman with multiple fibroids 63 Use of excessive distension media at hysteroscopy 64 Hysteroscopy: endometrial resection and ablation in the abnormal uterine cavity 65 Laparoscopy in a pediatric patient 66 Safe laparoscopic entry in a thin patient 67 Laparoscopy: unable to gain entry 68 Surgical emphysema 69 Venous Air Embolism 70 Laparoscopy: problems with monopolar diathermy 71 Laparoscopy: problems with bipolar diathermy 72 Laparoscopy: bladder injury 73 Laparoscopy: ureteric injury 74 Bowel injury during laparoscopy: intraoperative presentation 75 Bowel injury after laparoscopy: late presentation 76 Blood vessel injury at laparoscopy 77 Laparoscopy for large ovarian cyst 78 Laparoscopy for an ovarian cyst in pregnancy 79 Laparoscopic removal of recto-vaginal endometriosis 80 Laparoscopic myomectomy 81 Total laparoscopic hysterectomy 82 Laparoscopic hysterectomy for a large fibroid uterus 83 Laparoscopy: difficulty in tissue retrieval 84 Surgery for cornual or interstitial pregnancy 85 Surgery for cervical ectopic pregnancy 86 Surgery for caesarean scar pregnancy 87 Surgery for adnexal torsion 88 Laparoscopic appendicectomy 89 Laparoscopic surgery: When to convert to laparotomy? 90 Laparoscopy: late complication --
Port site herniation SECTION 5: REPRODUCTIVE SURGERY 91 Uterine septum division 92 Surgery for intrauterine adhesions 93 Myomectomy: breach of the endometrial cavity 94 Myomectomy: multiple large fibroids 95 Myomectomy: massive intraoperative haemorrhage 96 Vaginal myomectomy 97 Surgery for proximal tubal blockage 98 Surgery for distal tubal blockage 99 Reversal of female sterilisation 100 Surgery for congenital abnormalities of the genital tract 101 Surgical sperm retrieval SECTION 6: UROGYNECOLOGIC SURGERY 102 Sling procedures: bladder injury 103 Sling procedures: urethral injury 104 Sling procedures: retropubic haematoma 105 Sling procedures: bowel injury 106 Sling procedures: voiding dysfunction after stress urinary incontinence surgery 107 Sling procedures: tape erosion into bladder 108 Sling procedures: sexual dysfunction 109 Sling procedures: persistent urine leakage 110 Difficult vaginal hysterectomy 111 Vaginal hysterectomy: difficulty in entering the posterior pouch 112 Salpingo-oopherectomy at the time of vaginal hysterectomy 113 Bladder injury during anterior vaginal repair or vaginal hysterectomy 113 Bladder injury at anterior repair 113 Bladder injury at anterior repair 113 Bladder injury at anterior repair 113 Bladder injury at anterior repair 113 Bladder injury at anterior repair 114 Difficult sacrocolpopexy 115 Difficult sacrospinous fixation 116 Recurrent pelvic organ prolapse 117 Colpocleisis 118 Uterine suspension procedures: Laparoscopic hysteropexy 119 Mesh tape exposure following tension free vaginal tape (TVT) 120 Vaginal vault evisceration 121 Complications in laparoscopic pelvic floor surgery 122 Robotic urogynecology procedures 123 Complications in robotic pelvic floor surgery 124 Neovagina 125 Vaginal stricture after pelvic organ prolapse surgery 126 Urethral diverticula and other periurethral masses 127 Vesico-vaginal fistulae 128 Urethro-vaginal fistulae 129 Recto-vaginal fistulae 130 Secondary anal sphincter repair SECTION 7: GYNECOLOGIC ONCOLOGY 131 Large loop excision of the transformation zone (LLETZ) 132 Knife cone biopsy 133 Staging procedures: examination under anaesthesia, cystoscopy, sigmoidoscopy and biopsy techniques 134 Radicality of surgery for cervical cancer 135 Pelvic and para-aortic lymphadenectomy in gynecologic cancers 136 Trachelectomy for treatment of cervical cancer 137 Laparoscopic radical surgery for cervical cancer 138 Groin and retroperitoneal lymphocele 139 Laparotomy for a pelvic mass of uncertain nature 140 Gynecologic cancer extending to the bowel 141 Omental procedures: supracolic omentectomy, infracolic omentectomy, omental biopsy 142 Diaphragmatic surgery in advanced ovarian cancer 143 Fine needle aspiration
 biopsy of superficial groin lymph node 144 Vulval surgery: wide local excision and vulvectomy 145 Sentinel node biopsy in gynecologic cancer 146 Groin lymphadenectomy 147 Plastic surgical techniques used in vulval or perineal procedures 148 Vaginectomy 149 Urinary diversion 150 Pelvic exenteration 151 Gynecologic cancer and concurrent pregnancy SECTION 8: OBSTETRIC SURGERY 152 Ovarian cyst identified at caesarean section 153 Laparoscopy in pregnancy 154 Cervical cerclage 155 Caesarean section in a woman with fibroids 156 Caesarean section at the limits of viability 157 Difficult delivery of the fetal head during caesarean section 158 Surgical management of massive obstetric haemorrhage from the uterus, cervix or vagina 159 Surgical management of placenta praevia 160 Surgical management of placenta accreta 161 Surgical management options for shoulder dystocia: Zavanelli maneuver, abdominal rescue, symphsiotomy and cleidotomy 162 Uterine inversion 163 Episiotomy and second degree tear 164 Obstetric anal sphincter tear 165 Pregnancy and female genital mutilation 166 Destructive operations on a dead fetus 166 Destructive operations on the fetus 167 Setting up of a basic obstetric theatre facility in a low-resource setting SECTION 9: MISCELLANEOUS 168 Enhanced recovery 169 Major surgery in a Jehovah's Witness patient 170 Termination of pregnancy at advanced gestation 171 Cervical fibroids: techniques for myomectomy and hysterectomy 172 Hysterectomy for broad ligament fibroids 173 Hysterectomy for a double uterus 174 Cervical stump excision 175 Surgery for ovarian remnant 176 Surgery for a missing intrauterine contraceptive device 177 Management of imperforate hymen, transverse and other vaginal septa 178 Benign lesions in the groin and vulva 179 Cystic structure in the upper vagina 180 Adnexal masses in infants and children 181 Nerve injuries associated with gynecologic and obstetric surgery 182 Consent challenges 183 Dealing with complaints 184 Dealing with litigation.