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Abdominal Hysterectomy

Abdominal hysterectomy is one of the most frequently performed surgical procedures in the United States. The basis for this operation is an open abdomen (laparotomy), which provides adequate exposure for isolation of the uterus and adnexa from surrounding structures to allow cutting and securing of support structures that attach the uterus to the pelvic floor and sidewalls. These supporting structures include (1) vascular pedicles together with…

Abdominal Incisions

Before performing an incision in the abdominal wall, the gynecologic surgeon should have anticipated the type(s) of surgical procedure that will be done and possible complicating aspects associated with the operation. Consideration should be given to how far cephalad from the pelvis the operative exposure will need to be. In addition, the surgeon should weigh the cosmetic desire(s) of the patient, the urgency of the surgery,…

Energy Devices

Electrosurgery—Laser—Harmonic Scalpel Energy-releasing devices have been used in the past and currently are used in pelvic surgery. The raison d’être for such tools consists of hemostasis and speed. Compared with cold knife or scissor cutting, energy devices create a greater degree of surrounding tissue damage, usually in the form of thermal injury leading to necrosis, devitalization, subsequent fibrosis, and scar formation. Because of the aforesaid events,…

Suture Material, Suturing Techniques, and Knot Tying

Suture Types Sutures are used to close wounds, to secure bleeding vessels, and to seal off visceral structures. A wide variety of suture materials are available, which vary in terms of size, material, content, and consistency. For purposes of explanation, sundry sutures can be divided into absorbable and nonabsorbable. Absorbable materials are broken down by the body’s enzyme systems and virtually disintegrate ( Fig. 5.1 ).…