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Delivery Room Management of a Preterm Infant

Learning Objectives Understand the basic steps of resuscitation of a newborn per Neonatal Resuscitation Program (NRP) guidelines. Anticipate the needs of a preterm infant at delivery and review the management of a preterm infant in the delivery room. List effective strategies in resuscitation of a preterm infant. Preterm delivery is defined as delivery at <37 weeks gestation. In United States, the preterm birth rate is 9.9% of…

Complications of Minimally Invasive Surgery

Minimally invasive surgery has consistently been found to reduce complications compared with open surgery. For patients undergoing a variety of gynecologic procedures, minimally invasive surgery also results in equivalent primary procedural outcomes (e.g., survival outcomes after surgical staging of endometrial cancer, risk of recurrent fibroids after myomectomy). Although minimally invasive surgery has clear benefits, it also has unique risks that surgeons must minimize, anticipate, and adeptly…

Robotic Surgery

Surgery remains the mainstay of gynecologic cancer treatment, including radical hysterectomy, trachelectomy, and ovarian cancer cytoreduction. Historically, these procedures were performed through a large abdominal incision and were associated with prolonged hospitalization and significant morbidity. With advances in minimally invasive surgery (MIS), many of these operations are now being done as outpatient procedures, with less morbidity. Perioperative and Oncologic Outcomes in Minimally Invasive Surgery With the…

Laparoscopic Approach to Gynecologic Malignancy

The use of laparoscopy has been implemented in the management of adnexal masses since the late 1970s. However, laparoscopy became more popular in gynecologic oncology after Daniel Dargent first described the use of this technique to evaluate pelvic lymph nodes in 1989. A few years later, Querleu and colleagues described the first cases of laparoscopic pelvic lymphadenectomy in patients with cervical cancer. It did not take…

Laparoendoscopic Single-Site Surgery in Gynecologic Oncology

Acknowledgment Elsevier previously published a portion of the content in this chapter (Boruta DM. Laparoendoscopic single-site surgery in gynecologic oncology: an update. Gynecol Oncol. 2016;141:616–623). Laparoscopy is the surgical approach of choice for many gynecologic oncology procedures. Reduced morbidity, shorter hospitalization, and a more rapid recovery have been associated with minimally invasive surgical approaches when compared with laparotomy. Incisional morbidity, including vascular and viscous injury, postoperative…

Complications of Radiation Oncology

Radiation therapy has been a predominant treatment option for cervical cancer since Marie Curie discovered radium. Radiation therapy is the primary treatment for locally advanced cervical cancer, vulvar carcinoma, and vaginal carcinoma. It is used in the postoperative setting to reduce the incidence of local recurrence in patients with endometrial cancer, vulvar cancer, and cervical cancer who have high risk factors. Different combinations of external beam…

Management of Vascular Complications

Acknowledgment The authors wish to thank Karen C. Broadbent and George T. Pisimisis for their great assistance on this chapter. Gynecologic malignancies remain a leading cause of cancer death in women. There are approximately 98,000 new cases and 30,000 deaths annually from gynecologic cancers (including cancers of the ovaries, fallopian tubes, uterus, cervix, vagina, and vulva) in the United States. The treatment of gynecologic cancers has…

Urinary Diversion in Gynecologic Oncology

Pelvic exenteration, the most radical of pelvic procedures, is used with curative or palliative intent in the treatment of women with primary and recurrent pelvic malignancies. In women undergoing total or anterior exenterative procedures, the choice of urinary diversion can have a great impact on functional outcome, intraoperative and postoperative complications, and overall quality of life. The importance of the reconstruction phase on the psychosocial well-being…

Pelvic Reconstruction in Gynecologic Oncology Surgery

We restore, repair and make whole those parts … Which nature has given but which fortune has taken away . Gaspar Tagliacozzi (1545–1599) The goals of pelvic and perineal reconstruction in gynecologic oncology surgery may be summarized as follows: Maximize wound healing, with adequate dead space obliteration, to hasten recovery before and after chemotherapy and radiation therapy Preserve function, including intestinal and urinary integrity, as well…

Management of Urologic Complications in Gynecologic Oncology Surgery

A fellowship-trained gynecologic oncologist is expected to be competent in performing gynecologic, gastrointestinal, urologic, and vascular procedures relevant to gynecologic malignancy management. Urologic injury is a known risk factor of pelvic and retroperitoneal surgery in general and in gynecologic surgical procedures in particular. Urologic injuries during gynecologic operations can cause significant morbidity and if not identified immediately can delay recovery and necessitate several additional procedures. The…

Management of Bowel Surgery Complications

Bowel manipulation and resection are commonly performed in gynecologic cancer surgery. The principles of bowel surgery are discussed elsewhere in this book (see Chapter 17 ). This chapter focuses on frequent complications surgeons encounter during open and minimally invasive surgery (MIS) on the small and large bowel: special anatomy, vascular hemorrhage, solid and hollow-viscous organ injury, deep organ space infections, anastomotic complications, enterocutaneous fistulas (ECFs), blind…

Small Bowel and Large Bowel Resection and Anastomosis

The field of gynecologic oncology has undergone an evolution, mirroring the growing knowledge of the pathophysiology of gynecologic malignancies and the introduction of new treatment modalities and innovative techniques. The introduction of targeted therapies, precision medicine, genomic profiling, genetic testing, and checkpoint blockade immune therapies is advancing the field rapidly and adding promising new medical treatment options for women with gynecologic cancers. Today, gynecologic oncologists are…

Complications of Pelvic Exenteration

Pelvic exenteration, the en bloc removal of the pelvic organs, is indicated for central recurrent or persistent gynecologic cancer, including cervical, endometrial, vaginal, or vulvar cancer. Even when performed in the setting of specialized centers by highly skilled surgeons, pelvic exenteration is associated with significant morbidity and mortality. Since the initial series published by Brunschwig in 1948, there has been a dramatic change in the type…

Pelvic Exenteration for Gynecologic Cancers

Pelvic exenteration (PE) is a very complex procedure, even currently. In addition to unique surgical erudition and interdisciplinary surgical team involvement, these operations require special expertise for the right candidate selection, postoperative care, and handling of complications. Because of the narrow spectrum of indications, PE is a rare procedure, and so the only solution for achieving good results is establishing a system of candidate centralization. Such…

Complications and Management of Radical Cytoreduction

Radical cytoreduction consists of complex surgical procedures that may include extended peritonectomy, diaphragmatic resections, lymphadenectomy, and multiple visceral resections. As a result, it may be difficult to determine which of these innumerable procedures contributes to a specific complication. Patients undergoing cytoreductive surgical procedures are predisposed to predictable major morbidity, and this may be accentuated by their general medical condition and comorbidities. Perioperative planning in accordance with…

Radical Pelvic and Retroperitoneal Ovarian Cancer Surgery

Pelvis In early stages, removal of the adnexa involved by tumor, a total abdominal hysterectomy with bilateral salpingo-oophorectomy, pelvic and paraaortic lymphadenectomy, and omentectomy are required as part of the surgical staging. Conservative procedures including unilateral salpingo-oophorectomy may be an alternative in young patients with early-stage disease and desire to preserve their fertility. In advanced stages, it is very common to find the internal genitalia (uterus…

Radical Upper Abdominal Surgery: Liver, Diaphragm, and Spleen

The prognostic implications associated with the resection of all visible residual disease in patients with advanced-stage ovarian cancer have been clearly established in several retrospective and nonrandomized prospective studies. In 2013, Landrum and colleagues detailed the survival outcomes of patients with no visible residual disease treated with intraperitoneal chemotherapy, reporting a median overall survival of 110 months. Several other authors have also validated these findings. Over…

Indications for Laparoscopic Assessment of Cytoreduction

Background The current standard of care for advanced epithelial ovarian cancer (AEOC) is a combination of cytoreductive surgery and paclitaxel and platinum-based chemotherapy. The size of residual disease has been repeatedly proven to be a crucial prognostic factor for affected patients, and the achievement of complete gross tumor resection is now recognized as the main goal of cytoreductive surgery. In a meta-analysis by Chang and colleagues,…