Science topic

Gynaecological Surgery - Science topic

Explore the latest questions and answers in Gynaecological Surgery, and find Gynaecological Surgery experts.
Questions related to Gynaecological Surgery
  • asked a question related to Gynaecological Surgery
Question
4 answers
We have recently seen a pregnant lady presented ln last trimester with cyanosis and breadthlesness for the first time and latter found to have pulmonary arteriovenous fistula.. 
Relevant answer
Answer
Pregnancy is a hazardous period for women with PAVMs. There are incresed risks of pulmonary emboli and myocardial infarction with normal coronary arteries.
You can also follow this link.. Pulmonary Arteriovenous Malformations
  • asked a question related to Gynaecological Surgery
Question
5 answers
Surgeons who treat patients with vulvar malignancy should be aware of the serious defect (Fig) following radical vulvectomy, which need immediate reconstruction.
Numerous vascularized flaps have been designed and validated for obliterating the dead space and closing the vulvoperineal skin defect. But the reconstructive surgery with flaps is somewhat like a way that rob Peter to pay Paul.
I had systematically searched the relevant articles in Pubmed with the search strategy and selection criteria “vulvar malignancies”; “vulva”, “vulvar”, “vulval”;“vulvectomy” ; “vulvar reconstruction” combined with“vulvovaginal reconstruction”; “quality of life”, no paper regarding the procedure of vulvar transplantation was found.
Is it possible to perform allogeneic vulvar transplantation with anastomosis of the internal pudendal artery aiming at recovering an acceptable cosmetic appearance.
Thank you for your attention.
Relevant answer
Answer
Hamid Asmouki Dear Dr. Hamid Asmouki, Many thanks for your comment, I agree with your suggestion. As the skin defect is close to anus opening, colostomy should be considered before reconstructive surgery or vulvar transplantation for avoiding the postoperative infection.
  • asked a question related to Gynaecological Surgery
Question
5 answers
There is a uterine prolapse (Last degree) and there is an ulcer. The Q is how can the patient apply the cream prescribed for the ulcer along with the antiseptic and Gauze (Also Vaseline is prescribed).
Is the cream (Mebo cream aids in healing) applied on the ulcer only?, and we impregnate the gauze with the antiseptic (Betadine) and apply it on the cervix and the vagina only, or apply it on the entire prolapsed uterus, and if so, how? Because as we previously applied the cream on the ulcer, so there will be overlapping of two ingredients (Mebo and Betadine) ? And finally how we raise the uterus with the Gauze?
I downloaded the image for illustration.
Relevant answer
Answer
Recommended treatment. For decubitus ulcer includes
1. Reduction
2. Ring pessary
3. Estrogen cream
Without pesaary there will be no improvement due to persistent cause which is tiusse necrosis.
  • asked a question related to Gynaecological Surgery
  • asked a question related to Gynaecological Surgery
Question
1 answer
Dear Friends,
A 7 years old boy with left testis hypotrophy was presented to me. Sonography – left testis 8 mm length, spare perfusion on Doppler; right testis 15 mm length, gut perfusion. At 4 years of age – surgery for left testicular torsion of an undiagnosed retained testis.
The question is – should the hypotroph testis be removed or to be left until puberty?
Relevant answer
Answer
Yes it must be immediately removed without any hesitations for its harmful effect on its contralateral peer.
1- Zakaria O, Shono T, Imajima T, Suita S. Fertility and histological studies in a unilateral cryptorchid rat model during early and late adulthood. Br J Urol 1998;82:404–7.
  • asked a question related to Gynaecological Surgery
Question
4 answers
In all published literature available to me it is stated that in 1848, Henry Hancock, President of the Medical Society of London, presented a paper to that society describing the treatment of a 30-year-old female eight months pregnant in the Charing Cross Hospital in London [Hancock H. Disease of the appendix caeci cured by operation. Lancet. 1848;2:380–2.].
In only one book (published in 1899) it is written that François Mestivier, in 1759, incised an abscess in the right groin, in a woman eight months pregnant, and on autopsy found at the bottom of the abscess, the appendix vermiformis perforated by a pin [Mestivier FF. Observation sur une tumeur, située proche à la région ombilicale, du côté droit, occasionée par une grosse épingle trouvée dans l'appendice vermiculaire du cécum. J Méd Chir Pharmacol. 1759;10:441-2.].
I cannot reach the full-text of that article to confirm that this is the first published case. In all texts that mention Mestivier's article, a male patient is described and there is no mention of pregnancy (of course).
Please if someone has the full-text of that article send it to me or if anyone has the knowledge of some earlier descriptions of appendectomy during pregnancy or postpartum inform me.
Relevant answer
Answer
Kelly's book cited here is available at: https://archive.org/details/appendicitisand00kellgoog
 just like many other old books, maybe Stumpf's work is also somewhere here. Kelly also didn't make a proper reference to Stumpf in his book (page 427) and I guess that is the reason Maes et al. also missed to reference him. All in all, blame Howard Kelly, I guess he wouldn't be able to publish this way today (haha).
  • asked a question related to Gynaecological Surgery
Question
20 answers
A 35 years old lady, a known case of Psoriasis is on Homeopathic treatment. She has been married for the last 2 years and has now reported for evaluation for infertility. She has normal menstrual periods. Her general, systemic and pelvic examinations are within normal limits except for psoriatic patches. Laboratory investigations are normal. On pelvic USG, uterus is normal size and endomyomtrial echotexture is normal. There are 2 small subserous fibroids, one small cyst in right adnexa adjacent to ovary (? parovarian cyst) and an endometrial polyp of 13 x 8 mm size. Planning for hysteroscopic polypectomy. Can one go ahead with laparohysteroscpic evaluation in this case along with polypectomy?
Relevant answer
I would carry out a hyeteroscopic polypectomy in the first instance. Laparoscopic evaluation will be done only if no success even after polypectomy. The question I often ask myself is "what is the size of a polyp that can have an effect thus needs removal?"
  • asked a question related to Gynaecological Surgery
Question
13 answers
A 23 years old girl has been having recurrent vaginitis for the last one year.She has been in relationship for the last few years. Barrier contraception is being used with the present partner. She used to have unprotected intercourse with the previous partner. The clinical picture is that of fungal vaginitis. Local antifungal agent, Clotrimazole (at times along with Clindamycin) have been administered few times. She was put on once a week Flucanozole tablet for 6 weeks. The couple had taken combination of Azithromycin, Flucanozole and Secnidazole few months back. GTT done recently is WNL. HIV and VDRL were done in February and repeated few days back. They are non reactive. High vaginal swab has been taken for culture. Vaginal secretions have been collected for cytology. Report is awaited. How to manage this case?
Relevant answer
Answer
The screening process has been methodical with extensive screening for STI's , Diabetes and  immune compromise undertaken. Repeat antifungals x 6 administered. Barriers are in use: Penis-vaginal transmission ruled out.
Is there another source for the vaginitis? gut and oral sources come to mind. Any information on whether cunnilingus and /or fellatio is practiced. Source/pool Identification
Suggest a medication break, diet change -try yogurt alternate day as a meal item or snack , avoid antibiotic use. How about some pro-biotics?  
  • asked a question related to Gynaecological Surgery
Question
13 answers
   For 90 year old women, uterine prolapse can be a daily struggle, but surgery is not worth the risk,  pessaries are not comfortable and result in putrid discharge sometimes.    In a woman who is no longer having intercourse, why not sew up the lips to keep the uterus in?    Has anyone tried this? 
Relevant answer
Answer
Ok. I have to explain. 
  • asked a question related to Gynaecological Surgery
Question
4 answers
B-lynch in conservative management of PPH
Relevant answer
Answer
 Thanks Nematain but i cant get access to the full text
  • asked a question related to Gynaecological Surgery
Question
14 answers
Is there a place of leaving the placenta in-situ without removal or any other conservative measures
Relevant answer
Answer
what is Pent-rose tourniquet?  DR. Gihad Shabib
  • asked a question related to Gynaecological Surgery
Question
5 answers
Example: Please see attachment
Relevant answer
Answer
What exactly is your aim, what is the purpose of the analysis?
Statistical analyses are tools that serve some purpose, to help you achieve some aim. The summarization of your 600 observations as percentages is already a statistical analysis with the purpose to see the relative contribution of the different groups in your sample. You may show these graphically in some diagram (a pie chart, a dot chart, a column chart, ...).
If you want to give some indication of the statistical precision of your estimates you can calculate the standard errors as sqrt(p/(1-p) * 1/n) where p is the proportion (0<p<1) and n is the sample size. It is preferred to provide confidence intervals instead. There are online-tools available to calculate them, like here: http://vassarstats.net/prop1.html
If you have some idea about the frequency distribution (e.g. from some reference population) and if you are interested in the significance of the deviation of your data from that reference distribution then you can use a chi² test. Even this can be done online, e.g. here: http://www.quantpsy.org/chisq/chisq.htm
You may have different questions. Without clearly formulating your questions it is not very sensible to advise any statistical analysis. That's like advising to take the bus at 3 o'clock from the main station when you don't specify to which destination you want to go (if you are in your office and your destination is the toilet, the advice to take the bus might be quite unreasonable...).
  • asked a question related to Gynaecological Surgery
Question
8 answers
We are trying to organize a fertility preservation program for prepubertal girls
Relevant answer
Answer
We are working on cryopreservation of ovaring tissue but most of the tissue come from the women at the age above 35y/o.
  • asked a question related to Gynaecological Surgery
Question
12 answers
After diagnosing umbilical cord prolapse, in order to remove compression of the presenting part (the head) the doctor elevated the presented part with the hand in the vagina. After several minutes he changed the hand with the midwife. Do you consider this acceptable? In what situations the hand should not be removed or changed?
Relevant answer
Answer
In my institution the protocol  is: trun patient to a knee chest position. Push the presenting part upward by a hand in the vagina, give oxygen & code 333 for a stat C section. If the person who is holding the hand feels tired then someone else can take over with very rapid exchange of hands  
  • asked a question related to Gynaecological Surgery
Question
54 answers
Direct trocar insertion through Palmer's point with 10 mm trocar OR Veress needle insufflation prior to trocar entry through Palmer's point? Which one is preferable or practiced?
Relevant answer
Answer
I think that everyone should use the technique that he is familiar with and there are no major concern in experienced hands. We should always keep in mind that in previously operated patient, if you encounter a problem with veress or direct insertion it is then so difficult to justify your approach legally. The use of the hasson technique is safer and should be advocated in these cases. 
  • asked a question related to Gynaecological Surgery
Question
20 answers
Two different obstetrical cases were observed in female camels. In both cases, severing straining of mothers resulted in prolapse of the (uterus???) or (vagina??). Meanwhile with continuous straining, this prolapsed part was teared with appearance of the fetal parts. In the second case, the intestines were dislocated after fetal removal.
The questions are:
1. Is this prolapsed/teared part vagina or uterus? I suggest it is uterus, it seem very similar to the endometrium.
2. What is the pathogensis? How did this part come to outside during parturition? Is this the non-pregnant horn?
We would like to understand both cases.
Thank you    
Relevant answer
Answer
Here, I re-attached the pictures with some labels,  Question was for (A and B) and C is only for comparison.
  • asked a question related to Gynaecological Surgery
Question
4 answers
Does anyone still use Voluven, a colloid in a pressure bag during spinal anesthesia administration to decrease incidence of spinal hypotension ? If not what are your alternatives to reduce hypotension incidence in C-section ?
Relevant answer
Answer
No,
  • asked a question related to Gynaecological Surgery
Question
5 answers
I mean: in order to have clear margins at extemporaneous pathological examination. You stick to preoperative design of removal? Use intra-operative ultrasound? Aim larger margins?...
Relevant answer
Answer
The best recipe to have negative margins when removing a breast lesion of uncertain nature  is the incision  1 cm 
  • asked a question related to Gynaecological Surgery
Question
9 answers
A 18-year-old girl with primary amenorrhoea having well developed secondary sexual characters and lower one third of vagina consulted me for pain and swelling of lower abdomen for last two months. The pain is dragging and not happening monthly. It was a hard mass with smooth surface moving side to side. The mass was freely moving above-downward on per-rectal examination. USG features were suggestive of a fibroid but did not reveal any cervix. What would be the differential diagnosis? I did laparoscopy and MRI and finally removed the mass. 
Relevant answer
Answer
I have collected all the articles since its first reporting in index journal. Thanks for the reference. I did not remove it laparoscopically. 
  • asked a question related to Gynaecological Surgery
Question
4 answers
We have isolated a pure culture of Bifidobacterium in a endocervical and endometrial swab collected during a surgical process from a woman who has endometritis postpartum.
Is it possible that this "commensal" has caused the infection?
All the other exams are negative for all the microorganism we could test.
Thank you.
Relevant answer
Answer
Wow, thank you.
That's an interesting reading.
Greetings,
Ramona.
  • asked a question related to Gynaecological Surgery
Question
13 answers
In the third cesarean section, should uterine incision be performed above the former uterine incision or under the former uterine incision or in situ of the former uterine incision?
Relevant answer
Answer
In my hospital we only allow 3 CS for any one person but very rarely do we encounter a 4th CS. I recommend above the scar because of the space available for extension of the incision and I personal tear up and down on a horizontal incision (publication attached ) so the extended tear usually extend upwards on either side, like a "smile". this is because of the alignment of the muscle fibers. since we only allow 3 CS, incision on the upper segment is not a issue because Bilateral Tubal ligation is done with the patients approval.
  • asked a question related to Gynaecological Surgery
Question
11 answers
Is there laparoscopic training box especially for laparoscopic Gynaecology now? and do you think that is it useful?
Relevant answer
Answer
Here in Chile we give every year Laparoscopic Courses for Gynecologist basic and advanced (www.eieschile.cl ) from 2007. EIES (www.eiesonline.com) give these courses from 2003 uo today in Latinamerica and another countries.
We use pelvic training models called "Evas" from Prodelphus: www.prodelphus.com.br from Brasil. Look at the website and you will found a lot of accesories to put into evas for training in diferent tipes of disections and sutures. Dr. Marcos Lyra the owner of Prodelphus is a Gyn who knows about laparoscopy and Hysteroscopy and he is a very Smart designer of these models for endoscopic surgery training
  • asked a question related to Gynaecological Surgery
Question
56 answers
.
Relevant answer
Answer
3/11/2014
Vaginal hysterectomy with anterior and posterior repair.
With all due respect the Manchester (-Fothergill) procedure is outdated.
Kind regards,
Johan (JT) Nel.
  • asked a question related to Gynaecological Surgery
Question
10 answers
Could someone help me with the case of a patient who underwent surgery of Wertheim-Meigs for cervical cancer for 15 days ago, and has been showing urinary retention. She referred to feel of bladder fullness but can't urinate. We are making intermittent catheterization.
Relevant answer
Answer
in my opinion good urine microscopic examination and culture sensitivity to rule out any infection. micturating cystourethrogram to rule out any injury.some time Bladder atonicity can occure because of denervation, so ratherthan intermittent catheteraisation i feel catheterise the patient and investigate and treat the cause accordingly. 
  • asked a question related to Gynaecological Surgery
Question
7 answers
What are some reports in the literature about what the risk factors are for the recurrence for POP surgery? What is the most recurrent area in POP surgery? Little about ideal procedure for recurrent POP surgery.
Relevant answer
Answer
The most recurrent area in POP is the vault. The most effective and most studied procedure is abdominal sacrocolpopexy (lap or robotic por open)
  • asked a question related to Gynaecological Surgery
Question
7 answers
14 year old (24kg) phenotypic female operated 8 days back for 28 wks size torsion of solid (mostly) ovarian tumor in emergency. She also had large cliteromegaly. Clinical diagnosis was dysgerminoma. LDH was very high. Alpha fetoprotein came next day was very high. 'Y' chromosome could not be assessed prop as it was taking at-least 10-15 days. Clitoral reduction was planned but laparotomy had lot of adhesions and most probably she would require another surgery to remove another gonad. Uterus was present with b/l fallopian tubes. Vagina is narrow with separate opening for urethra. Other side gonad was looking streak with a mount on one side. HPR came yesterday - Malignant Mixed germ cell tumor (Dysgerminoma with Yolk sac tumor) and biopsy from other gonad as seminiferous tubule. Surgical stage was Ic. She is planned for chemo followed by clitoral reduction. Karyotype still awaited. 17 Hydroxyprogesterone and testosterone was normal.
Relevant answer
Answer
46 XY
  • asked a question related to Gynaecological Surgery
Question
32 answers
There seems to be an rising incidence of prolapse of the vaginal vault following vaginal hysterectomy in the area I practice presumably because the primary procedures are mainly performed by practitioners with inadequate experience in conducting vaginal hysterectomy; and also because of wrong choice of treatment method in cases of procidentia
Relevant answer
Answer
The ideal procedure is sacrocolpopexy . Vaginal hysterecotmy is no longer indicated in procedentia treatment.
  • asked a question related to Gynaecological Surgery
Question
19 answers
Many women with pelvic organ prolapse detected during pelvic examination do not have complaints related to it. Should repair surgeries be done on them?
What is the opinion regarding site specific repair of vaginal wall prolapse? Some gynaecological operative books do not mention it, especially for posterior vaginal wall prolapses. If site specific repair is followed, then anterior and posterior colpoperineorrhaphy should go into oblivion. Is there any role of approximating levator ani for rectocele? Does the latter procedure cause stress urinary incontinence in some women?
Relevant answer
Answer
Surgical repair is indicated only in symptomatic patients. Rectocele repair does not cause stress urinary incontinence. Even with levator ani approximation, the condition has a tendency to recur, probably because stools are not always kept soft. Mesh insertion has too many serious complications. If a vaginal hysterectomy is done for menorrhagia, the vaginal vault should be sutured to the uterosacral ligaments, to prevent the occurence of an enterocele. This can be simply done by keeping the sutures on the uterosacral ligaments and then, after vaginal hysterectomy tying them together.
  • asked a question related to Gynaecological Surgery
Question
9 answers
During tubal reanastomosis one cannot achieve exact apposition between mucosal layers of both sides of fallopian tube. Methylene blue is introduced to assess the success of the tubal anastomosis. In case there is no spillage through the fimbrial end, does it always mean that the surgery has not been successful? Is there is any role for repeat surgery in the same sitting in such cases? Are guide wire/ probes encouraged during tubal recanalisation? What postoperative management can be carried out in order to retain tubal patency? Some surgeons advocate hydrotubation to increase the success of the surgery. I would like to see if there are references with regard to this or any other method that helps during and after such kind of surgery.
Relevant answer
Answer
12 March 2014
Dear Veena,
Thanks for your interesting question !
Exact oppostion can be accomplished between mucosal layers of both sides of the fallopian tube. I have proved this by scanning electron microsopy. We are so overloaded with clinical work in South Africa, that I must still publish this in a reputable medical journal. However, my results have been published in a book I wrote: "Core Obstetrics & Gynaecology with Examination Guidelines for M.B.Ch.B." I have more than 40 years experince of microsurgial tubal anastomosis via a new method micro-laparotomy and using an operating microscope - the proof of results should be live births of healthy babies, which in my experience is more than 90% in isthmus- isthmus tubal anasthomosis. There should be spillage of methylene blue through the fimbrial end of the tube, unless you are experienced enough to realise that you have done a good anastomises, despite leaking of methylene blue at the site of the anastomosis. A guide wire is not necessay for an experienced microsurgeon, with the exception of interstial anastomosis - the fallopian tubes are so narrow here that I a have used prolene 0 as a guideline to ensure proper and accurate anastomisis. The gudeline wire can easily be removed via hysteroscopy, before the woman leaves the hospital. This has greatly inproved results in these cases, in my experience. I only came to this conclusion after repeating operations, which I no longer find necessary.
With proper operative technique postoperative managemet should consist of that usually practised, with the exception of hysteroscopy as I mentioned. Although not properly researched, post-operative antibiotics should be given, since tubal structure is so delicate, that even a minor infection can destroy the operation (tubal cilia and microvilli).
In my experience there is no place for postoperative hydrotubation and little place for post-operative laporosopy/ post-operative hysterosalpinography. It is a waste of time and money, since better observations can be made by pre-operative laparoscopy and hysteroscopy and in exeptional cases post-operative laporoscopy, if the patient is not pregnant after a year. Obviously ovulation should be evaluated by temperature charts, etc., as well as male infertilty/impotence.
Laporoscopic anastomosis has many disadvantages as compared to minmal access minmal invasive microsurgery.
Likewise IVF should not be used for operable cases, since the results are much poorer when expressed as the birth of live healtty babies. Unfortunatelely IVF specialists persist in reporting their results as pregnancies per cycle, meaning a positive beta -HCG. However the vast majority of patients with a positive beta- HCG abort.
This is only a short answer to a vast subject - I will gladly answer more questions.
Prof J T Nel.