Gynecological Surgery

Operative Gynecology

Surgical procedures have become very safe today, because of improved anaesthesia, availability of blood transfusion, antibiotics as well as good preoperative and postoperative care of the woman. Advanced surgical technologies have also contributed to reduced surgical morbidities and operation-related complications.

It is therefore important to pay due attention to pre-operative and postoperative management of a woman undergoing surgery.

Preoperative Investigations: Prior to the submission of the patient to any major gynae­cological surgery, it is necessary to evaluate her fitness for it. The preoperative investigations include the following:

Complete blood count. This includes haemoglobin assess­ment and total and differential leucocyte count.

Urinalysis. This includes routine and microscopy urinalysis. Culture examination is requisitioned if microscopy reveals significant number of pus cells (more than five) or history of urinary tract infection (UTI), especially in women with cystocele, urinary complaints and fistula.

Fasting and post-prandial blood sugar estimations.

Kidney function tests. Blood urea, serum creatinine and uric acid.

Liver function tests. Particularly in women giving a his­tory of jaundice and in all women undergoing cancer surgery.

Blood tests for VDRL. Australia antigen and HIV-I and II.

Serum electrolytes. Na, K, Cl and HCO3.

Examination besides blood pressure. Pap smear is taken as required.

Postoperative Care: Postoperative care is important if surgical complications are to be avoided.

Immediate Care (24 H)

Vital signs such as

Pulse, temperature, BP and respiration chart to be main­tained.

The patient needs intravenous fluid for 24 h. Following a minor surgery, oral fluids are allowed 4 h after the sur­gery, and soft diet is given on the day of surgery.

The average patient needs 2 L of fluid intravenously for 24 h. This comprises 1 L of 5% glucose, 1/2 L of glucose saline and 1/2 L of Ringer’s lactate to maintain electrolyte balance. If the woman vomits, extra fluid is required to make up for the loss.

Surgical Procedures: Dilatation of the Cervix and Endometrial Curettage (D&C)

D&C is a minor gynaecological procedure of dilatating the cervix and curetting (scraping) the endometrial tissue from the uterine cavity.

It is mainly a diagnostic procedure, rarely done for thera­peutic purpose (mainly obstetric).

Dilatation of the cervix alone is required in the following conditions:

Ø  Prior to curettage (commonest).

Ø  For cervical stenosis.

Ø  To prevent cervical stenosis following Manchester opera­tion for prolapse of the uterus.

Ø  To prevent postoperative cervical stenosis in cauteriza­tion of cervical erosion and conization.

Ø  To drain haematometra.

Ø  To drain pyometra.

Prior to insertion of radium into the uterine cavity in cancer of the cervix and endometrial cancer.

Prior to removal of embedded intrauterine contraceptive device (IUCD).

Prior to breaking uterine adhesions in Asherman syndrome.

Prior to endocervical curettage for endocervical cancer.

Prior to hysteroscopy.

Anesthetic Considerations for Complicated Pregnancies:

Substance abuse: has crossed social, economic, and geographic borders, and throughout the world, it remains one of the major problems facing society. The prevalence of substance abuse in young adults (including women) has increased markedly over the past 20 years. Almost 90% of drug-abusing women are of childbearing age.139-144 Substance abuse is “self-administration of various drugs that deviates from medically or socially accepted use, which if prolonged, can lead to the development of physical and psychological dependence.”

Related conferences:

Thyroid 2018, Conference on September 03-04, 2018 Auckland, New Zealand

Diabetes 2018, Conference on September 28-29, 2018 Montreal, Canada

Endocrinology Summit 2018, October 01-02, 2018 Osaka, Japan

Euro Endocrinology 2018, Meeting on November 26-27, 2018 Dublin, Ireland

Surgeons-2018, Symposium onNovember 22-24, 2018 Romania

Robotic Surgery 2018, Meeting on May 21-22, 2018 Tokyo, Japan

Anesthesiology-2018, Conference on November 15-16, 2018 Dubai, UAE

Surgery Asia Pacific 2018, Meeting on November 27-28, 2018 Singapore

Gynecology and Obstetrics Pathology 2018, Symposium on March 30-31, 2018 Orlando, USA

Gynecology Congress 2018, on August 22-23, 2018 Tokyo, Japan