This document discusses various types of gynecological surgeries. It begins with an overview of pelvic anatomy and describes different surgical approaches including open, laparoscopic, vaginal, and robotic. Specific procedures covered include vulva surgeries like Bartholin cyst removal, hymenectomy, and vulvectomy. Vaginal procedures like anterior and posterior prolapse repair and vaginal hysterectomy are also outlined. The document then discusses cervical biopsies, colposcopies, and cerclage. Uterine conditions like fibroids, endometriosis, and cancers are reviewed along with their surgical management. Urinary incontinence procedures such as Burch colposuspension, slings, and inject

1. GYNAECOLOGIC SURGERIES
DATO DR ARUKU NAIDU
MD(UKM), FRCOG(UK), CU (JCU)
CONSULTANT O & G AND
UROGYNAECOLOGIST
www.aruku.naidu.blogspot.com

2. CONTENT
 Anatomy of Pelvis
 Type of surgery based on Pelvic Organ that is
involved
 Mode of surgery- open/lap/vaginal/ Robotics

3. Anatomy of the pelvis
 Bony pelvis
 Soft tissue
 Organs

4. BONY PELVIS

5. SOFT TISSUE

6. Soft Tissue
Perineal membrane Pelvic diaphragm

7. Internal organs

8. Gynaecologic surgeries
 Vulva
 Vagina
 Cervix
 Uterus
 Fallopian tubes
 Adnexa
 Pelvic region/area
 Incontinence
 POProlapse

9. TYPE OF DISEASE
 BENIGN AND MALIGNANCY
TYPE OF OPERATION
OPEN METHOD
LAPAROSCOPY
VAGINAL ROUTE

10. VULVA
 BARTHOLIN GLAND
CYST/ABSCESS
 BIOPIES
 HYMENECTOMY
 VULVECTOMY

11. Vulva
Bartholin abscess

12. Hymenectomy

13. Imperforated hymen

14. Rigid Hymen

15. Vaginal surgeries
 Anterior proplase
surgery
 Posterior prolapse
surgery
 Vault support surgery
 Vaginal hysterectomy
 Manchester repair

16. LARGE U-V PROLAPSE

17. PELVIC RECONSTRUCTION
•VAGINAL
HYSTERECTOMY + Mc
CALL CULDOPLASTY
•ANTERIOR DSR + MESH
•POSTERIOR DSR
•PERINEAL BODY
RESTORATION
•SUS

18. cervix
 Biposy
 Colposcopy and
LEEP
 cervical cerclage

19. Uterus
• Fibroid
• Endometriosis
• Adenomyiosis
• Endometrial ca
• PID
• Others
EPROC/molar

20. GESTATIONAL
TROPHOBLASTIC DISEASE

21. GESTATIONAL
TROPHOBLASTIC DISEASE
Symptoms/signs
 Uterus > dates (50%)
 Increased pregnancy symptoms – hyperemesis,
severe PE, hyperthroidism
 PV bleeding
 Passing vesicles vaginally

22. GESTATIONAL
TROPHOBLASTIC DISEASE

23. GESTATIONAL
TROPHOBLASTIC DISEASE
 Managements
 General Assessment
 Suction evacuatn under GA
 Suction currettage to evacuate all molar tissue
 Transfuse blood if necessary
 Oxytocin drip 20 lU
 In older patients- Hystrectomy is an option
 Before Discharge
 Counsel on contraception ( Barrier method, OCP)

24. FIBROIDS
 Symptoms (50% - asymptomatic )
 Menorrhagia or intermenstrual bleed
 Rarely pain – due to red degeneratn
 Urinary symptoms – frequency or retention
 P/E
 Solid mass – unable to go below
 Mulitple fibroids cause irregular knobbly
enlargement
 Pallor – due to severe bleeding

25. FIBROIDS

26. FIBROIDS
Management
 Conservative – small,
asymptomatic fibroids
 Medical
 Tranexamic acids
 GnRH
 Surgical
 Hysteroscopic
 Myomectomy
 Hysterectomy

27. SURGICAL TECNIQUES FOR
Urodynamic Stress Incontinence
PROCEDURE MEAN ( % )
FIRST
PROCEDURE
MEAN ( % )
RECURRENT
INCONTINENCE
BLADDER BUTTRESS 67.8 NA
MARSHALL-
MARCHETTI KRANTZ
89.5 NA
BURCH
COLPOSUSPENSION
89.8 82.5
BLADDER
NECK SUSPENSION
86.7 86.4
SLINGS 93.9 86.1
INJECTABLES 45.5 57.8
Jarvis meta-analysis 1994

28. Retropubic & transobturator
pathways

29. SPARC AND MONARC
PLACEMENTS IN A CADAVER
RETROPUBIC
TOT

30. Laparoscopic Gynaecological surgery

31. Robotic gynaecological surgeries

32. Conclusion
 Many gynaecological surgeries
 Benign vs canser surgeries
 Simple to difficult
 Knowledge on surgery important
 Preparation for surgery important
 All for good of patients
 Need to master new tecnology
 Reduce morbidity and mortality

33. THANK YOU