1. Gynecologists focus on the female reproductive system……..
GYNECOLOGIC SURGERY
Gynecologists focus on the female reproductive system……..

2. 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.

3. SUPPORT STRUCTURES OF THE FEMALE PELVIS

4. “Pelvic Girdle”
Consists of:
Iliac crest
Ischia
pubic bones
sacrum

5. Pelvic Sagittal Plane

6. Pelvic “Floor” Consists of:
Levator ani muscles and its 3 components
Iliococcygeal
Pubococcygeal
Puborectalis

7. PELVIS
Two distinct cavities :
“false pelvis”
“true pelvis”

8. “FALSE PELVIS” Little significance to gynecology and obstetrics
Prominent attachment for pelvic musculature.
Varies widely is size

9. “True Pelvis” Inlets = round
Outlets = transversely oval- aids in the process of fetal delivery.

10. Pelvic Ligaments Cardinal Round Infundibulopelvic
Loose configurations of :
Areolar tissue
Blood vessels
Muscle fibers

11. “MOORINGS” (Anchors)
Connective tissue are not static, they change with age, nutritional status, amount of exercise and hormonal fluctuations……

12. EXTERNAL GENITALIA “VULVA”
No NOT a Volvo!!!
Mons Pubis
Labia Majora
Labia Minora
Clitoris
Bartholins Glands
Fourchette
Perineum

13. “EXTERNAL GENITALIA” CONTINUED…
External genitalia are vascularized and innervated by the clitoral, perineal and inferior hemorrhoidal branches of the pudendal artery and nerve.

14. “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)

15. “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.

16. “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

17. ANATOMICAL PELVIC PLANES----CROSS SECTION, SAGITTAL

18. “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

19. “LIGAMENTS” LATERALLY = BROAD ANTERIORLY = CARDINAL
POSTERIORLY = PUBIC
INFERIORLY = SACRAL

20. Uterine and Uterine Appendages

21. “BROAD LIGAMENT
Result of peritoneal folds
Contains fallopian tubes

22. “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

23. “FALLOPIAN TUBES” (uterine tubes)
4 PORTIONS:
Fimbria
Ampulla
Isthmus
Intramural region:
Situated in the upper margin of the broad ligament
Vascularity achieved by the ovarian and uterine arteries

24. “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

25. COMMON SURGICAL PROCEDURES
Laparoscopy
Hysterectomy with or without BSO
-Vaginal
-Abdominal
D & C
D & E
A&P repair
C-section

26. 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)
Mayostand-abdominal approach
Backtable –vaginal approach
Suction devices
Kick buckets
ESU
Sterile handpieces
Draping
Under buttocks
Leggings
4 towels and a lap sheet

27. Positioning and Draping? Equipment? Mayostand vs. Backtable
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

28. Cervical and intrauterine instrumentation
Goodell uterine dialator
Bozeman (many uses) uterine dressing forceps
Uterine sound
Uterine tenaculum
Hegar uterine dialators
Uterine curettes
Abdominal and perineal retractors
Deaver 2” blade
Deaver 1” blade
Dee Lee universal retractor
Gelpi perineal ret.
O’sullivan O’Connor abdominal ret
Franz abdominal ret

29. Hegar Uterine Dialators

30. Bozeman Uterine Dressing Forceps
Sims Uterine curettes
Bozeman Uterine Dressing
Forceps

31. Abdominal Perineal Retractors
Franz Abdominal
Retractor
DeLee Universal
Retractor