State-of-the-Art: Vaginal Surgery Shalini Rajaram, Neerja Goel, Sumita Mehta
INDEX
×
Chapter Notes

Save Clear


fm1State-of-the-Art VAGINAL SURGERYfm2
fm3State-of-the-Art VAGINAL SURGERY
Second Edition
Editors Neerja Goel MD FAMS FIMSA FICOG FFGSI Director Professor and Unit Head Department of Obstetrics and Gynecology University College of Medical Sciences and Guru Teg Bahadur Hospital Delhi, India Shalini Rajaram MD MAMS Director Professor Department of Obstetrics and Gynecology University College of Medical Sciences and Guru Teg Bahadur Hospital Delhi, India Sumita Mehta DGO DNB MAMS Specialist Department of Obstetrics and Gynecology Babu Jagjivan Ram Memorial Hospital New Delhi, India Foreword Neera Agarwal
fm4
Jaypee Brothers Medical Publishers (P) Ltd.
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd.
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Overseas Offices
J.P. Medical Ltd.
83, Victoria Street, London
SW1H 0HW (UK)
Phone: +44-2031708910
Fax: +02-03-0086180
Jaypee-Highlights Medical Publishers Inc.
City of Knowledge, Bld. 237, Clayton
Panama City, Panama
Phone: +507-301-0496
Fax: +507-301-0499
Jaypee Brothers Medical Publishers (P) Ltd.
17/1-B, Babar Road, Block-B
Shaymali, Mohammadpur
Dhaka-1207, Bangladesh
Mobile: +08801912003485
Jaypee Brothers Medical Publishers (P) Ltd.
Shorakhute
Kathmandu, Nepal
Phone: +00977-9841528578
© 2013, Jaypee Brothers Medical Publishers
All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
This book has been published in good faith that the contents provided by the contributors contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the editors specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the editors. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
State-of-the-Art: Vaginal Surgery
First Edition: 2007
Second Edition: 2013
9789350902875
Printed at
fm5Dedicated to
Students of Gynecology
and all Practising Gynecologists
Editorsfm6
fm7CONTRIBUTORS
  • AG Radhika DGO DNB MAMS
  • Senior Specialist
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • AK Sethi DA MD
  • Director Professor
  • Department of Anesthesiology and Critical Care
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Alka Kriplani MD MAMS FAMS
  • Professor and Unit Head
  • Department of Obstetrics and Gynecology
  • All India Institute of Medical Sciences
  • New Delhi, India
  • Amita Suneja MD MAMS
  • Professor
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Anshul Grover DGO DNB
  • Specialist
  • Department of Obstetrics and Gynecology
  • Babu Jagjivan Ram Memorial Hospital
  • New Delhi, India
  • Arun Gupta MS
  • Professor
  • Department of Surgery
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Asha Sharma MD DNB
  • Former Senior Resident
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Ashok Kumar Saxena MD FAMS
  • Professor
  • Department of Anesthesiology
  • and Critical Care
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Bindiya Gupta MD
  • Specialist
  • Department of Obstetrics and Gynecology
  • Lal Bahadur Shastri Hospital
  • New Delhi, India
  • Deepti Agarwal MD
  • Specialist
  • Department of Anesthesiology
  • and Critical Care
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Gayathri R MBBS
  • Former Senior Resident
  • Department of Obstetrics
  • and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Geeta Mehdiratta MD
  • Associate Consultant
  • Department of Obstetrics and Gynecology
  • Sir Ganga Ram Hospital
  • New Delhi, India
  • Geetika Trivedi MD
  • Senior Resident
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Gita Radhakrishnan MD FICMCH
  • Director Professor and Unit Head
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Gunjan Singh MD
  • Former Senior Resident
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Harsha Khullar MD FICMCH
  • Senior Consultant
  • Department of Obstetrics and Gynecology
  • Sir Ganga Ram Hospital
  • New Delhi, India
  • Harsha Sharma MD
  • Former Senior Resident
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • JB Sharma MD DNB MRCOG (London)
  • MFFP (London)
  • Associate Professor
  • Department of Obstetrics and Gynecology
  • All India Institute of Medical Sciences
  • New Delhi, India
  • K Chitrathara MD MCH (Urology)
  • Head and Senior Consultant
  • Department of Surgical and Gynecologic
  • Oncology
  • Lakeshore and Welcare Hospitals
  • Kochi, Kerala, India
  • Kanika Jain DGO DNB
  • Junior Consultant
  • Department of Obstetrics and Gynecology
  • Sir Ganga Ram Hospital
  • New Delhi, India
  • fm8Kanwal Gujral DGO MS FICOG
  • Senior Consultant
  • Department of Obstetrics and Gynecology
  • Sir Ganga Ram Hospital
  • New Delhi, India
  • KC Singh MD PhD
  • Professor and Head
  • Department of Obstetrics and Gynecology
  • Tamworth
  • Australia
  • Kiran Guleria MD DNB MAMS
  • Professor
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Kurush Paghdiwalla MD DNBE
  • Consultant Obstetrician and Gynecologist
  • Chowpatty, Medical Centre and Saifee
  • Hospital
  • Mumbai, Maharashtra, India
  • Madhu Bagaria MD
  • Former Senior Resident
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Manpreet Singh MD (Anesthesia)
  • Assistant Professor
  • Department of Anesthesiology and Intensive Care
  • Government Medical College and Hospital
  • Sector-32, Chandigarh, India
  • Medha Mohta MD (Anesthesia) MAMS
  • Reader
  • Department of Anesthesiology and Critical Care
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Namita Grover MD
  • Specialist
  • Department of Obstetrics and Gynecology
  • ESI Model Hospital
  • Baddi, Himachal Pradesh, India
  • Neerja Bhatla MD MAMS
  • Professor
  • Department of Obstetrics and Gynecology
  • All India Institute of Medical Sciences
  • New Delhi, India
  • Neerja Goel MD FAMS FIMSA FICOG FFGSI
  • Director Professor and Unit Head
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Nidhi Khera MD DNB
  • Junior Consultant
  • Department of Obstetrics and Gynecology
  • Sir Ganga Ram Hospital
  • New Delhi, India
  • Nitin Agarwal MS
  • Assistant Professor
  • Department of Surgery
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Nitin Jain MD
  • Assistant Professor
  • Department of Anesthesiology
  • and Critical Care
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Partha Basu MD DNB
  • Head
  • Department of Gynecologic Oncology
  • Chittaranjan National Cancer Institute
  • Kolkata, West Bengal, India
  • Pradeep Kumar Garg MD
  • Assistant Professor
  • Department of Obstetrics and Gynecology
  • All India Institute of Medical Sciences
  • New Delhi, India
  • Pushpanjali Rai MBBS
  • Former Junior Resident
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Rachna Agarwal MD
  • Associate Professor
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Rajni Gill MD
  • Former Senior Resident
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Raman Azad MD
  • Senior Resident
  • Department of Anesthesia
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Rashmi Khatri MD
  • Former Senior Resident
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Rashmi Malik MD
  • Specialist
  • Department of Obstetrics and Gynaecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Rema P MD
  • Assistant Professor
  • Surgical Oncology
  • Regional Cancer Centre
  • Trivandrum, Kerala, India
  • Richa Agarwal MD
  • Former Senior Resident
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital, Delhi, India
  • fm9Ritu Khatuja DNB
  • Senior Research Associate
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital
  • Delhi, India
  • Ruchika Garg MD
  • Former Senior Resident
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital, Delhi, India
  • Sandhya Jain MD DNB MAMS
  • Assistant Professor
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital, Delhi, India
  • Sanjay Gupta MS
  • Professor
  • Department of Surgery
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital, Delhi, India
  • Seema Ummat MD
  • Former Senior Resident
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital, Delhi, India
  • Shakun Tyagi MD
  • Association Professor
  • Department of Obstetrics and Gynecology
  • Maulana Azad Medical College and
  • Associated Lok Nayak Jai Prakash Narayan
  • (LNJP) Hospital
  • New Delhi, India
  • Shalini Jain MD DNB
  • Former Senior Resident
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital, Delhi, India
  • Shalini Rajaram MD MAMS
  • Director Professor
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital, Delhi, India
  • Shilpa Singla MBBS
  • Junior Resident
  • Department of Obstetrics and Gynecology
  • All India Institute of Medical Sciences
  • New Delhi, India
  • Shirish S Sheth MD FRCOG (Ad Eundem) FACS
  • Consultant Gynecologist
  • Breach Candy Hospital and
  • Sir Hurkisondas Nurrotamdas Hospital
  • Mumbai, Maharashtra, India
  • Shruthi Bhaskaran MD
  • Senior Resident
  • Department of Obstetrics and Gynecology
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital, Delhi, India
  • SK Bhandari FRCS FICS FIAMS FRCOG
  • Head and Chairperson
  • Department of Obstetrics and Gynecology
  • Sir Ganga Ram Hospital, New Delhi, India
  • Sudha Prasad MD FICMCH FICOG
  • Director Professor and Unit Head
  • Department of Obstetrics and Gynecology
  • Maulana Azad Medical College and
  • Associated Lok Nayak Jai Prakash Narayan
  • (LNJP) Hospital, New Delhi, India
  • Sumana G MD DNB
  • Senior Resident
  • Department of Obstetrics and Gynecology
  • All India Institute of Medical Sciences
  • New Delhi, India
  • Sumita Mehta DGO DNB MAMS
  • Specialist
  • Department of Obstetrics and Gynecology
  • Babu Jagjivan Ram Memorial Hospital
  • New Delhi, India
  • Sunita Samvedi
  • Senior Technical Assistant (Artist)
  • Medical Illustration Unit
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital, Delhi, India
  • Surveen Ghumman MD
  • Senior Specialist
  • Department of Obstetrics
  • and Gynecology
  • Vardhman Mahavir Medical College and
  • Safdarjung Hospital, New Delhi, India
  • Tarun Bhagchandani MD (Anesthesia)
  • Senior Resident
  • Department of Anesthesiology
  • and Critical Care
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital, Delhi, India
  • Upender Sharma MS MCH (Plastic Surgery)
  • Former Specialist
  • Department of Surgery
  • University College of Medical Sciences and
  • Guru Teg Bahadur Hospital, Delhi, India
  • Vijay Zutshi MD
  • Senior Specialist
  • Department of Obstetrics
  • and Gynecology
  • Vardhman Mahavir Medical College and
  • Safdarjung Hospital, New Delhi, India
fm10
fm11FOREWORD
It is a privilege to write the ‘Foreword’ for the second edition of State-of-the-Art: Vaginal Surgery. I have known and worked closely with the editors for more than two decades and the book is a culmination of many years of knowledge, passion and surgical expertise using the vaginal route for benign conditions.
The book would be of immense value to postgraduate students and practicing gynecologists to keep themselves abreast of the latest advances in various surgical techniques performed vaginally; some of the techniques have been innovated by the editors themselves! It is a multiauthor book and has chapters written by authors of national and international fame covering extensively various vaginal techniques along with their videos.
I wish the book a great success and I am sure it will find its way on to the shelves of the young gynecologists.
Neera Agarwal MD FAMS FICOG FICMCH
Senior Consultant Max Healthcare
New Delhi, India
Formerly Head
Department of Obstetrics and Gynecology
University College of Medical Sciences and
Guru Teg Bahadur Hospital, Delhi, Indiafm12
fm13PREFACE TO THE SECOND EDITION
This book follows the first edition of State-of-the-Art: Vaginal Surgery and has been updated with addition of several new chapters, videos and illustrations. Although enormous advances have occurred in the medical management of a number of conditions, surgical therapy continues to be vital. Surgery remains an art backed by scientific reason and thought. Vaginal surgery in particular is a skill to be learnt and mastered. Most gynecological conditions can be dealt through the vaginal route particularly disorders of pelvic floor, pelvic organ prolapse, and benign vulval, vaginal, uterine and urological conditions. Ablative and excision therapy for intraepithelial neoplasia along with radical surgeries for genital malignancies are also approached vaginally.
The need to teach surgery is a high priority but with increasing number of resident doctors and high obstetric load taking much of the time, teaching vaginal surgery is becoming increasingly difficult. In addition, all surgical procedures cannot be practically demonstrated in a short span of a resident's career. Vaginal surgery results in a faster recovery with less hospital stay, inexpensive and above all scar-less; thus, it needs to be promoted.
With this aim, we have put together 57 chapters in 9 different sections covering almost all aspects of vaginal surgery, ranging from surgical anatomy, preoperative care, anesthetic considerations, surgical techniques keeping with the advances like hysteropexy, aqua-dissection, vessel sealing systems, and volume reductive techniques at non-descent vaginal hysterectomy (NDVH) and minimally invasive surgical techniques for stress urinary incontinence (SUI).
We hope that this endeavor will reach out to postgraduate students and practicing gynecologists globally.
Neerja Goel
Shalini Rajaram
Sumita Mehtafm14
fm15PREFACE TO THE FIRST EDITION
Surgery remains an art backed by scientific reason and thought. Although enormous advances have occurred in the medical management of a number of conditions, surgical therapy continues to be vital. Most gynecological conditions can be dealt through the vaginal route particularly disorders of pelvic floor, pelvic organ prolapse, benign vulval, vaginal, uterine and urological conditions. Ablative and excision therapy for intraepithelial neoplasia along with radical surgeries for genital malignancies are also approached vaginally.
Vaginal surgery in particular is a skill to be learnt and mastered. The need to teach surgery is a high priority but with increasing number of resident doctors and high obstetric load taking much of the time, teaching vaginal surgery is becoming increasingly difficult. In addition, all surgical procedures cannot be practically demonstrated in a short span of a resident's career. Vaginal surgery results in a faster recovery with less hospital stay, is more economical and above all scarless; so it needs to be promoted.
With this aim, I and Dr Shalini Rajaram have put together 50 chapters in 9 different sections covering almost all aspects of vaginal surgery, ranging from surgical anatomy, preoperative care, anesthetic considerations, surgical techniques keeping with the advances like video demonstrations of LEEP, TVT and TVT-O, laparoscopic adnexectomy, etc. in addition to ample illustrations using color photographs and sketches.
We hope that this endeavor will reach out to postgraduate students and practicing gynecologists globally.
Neerja Goel
Shalini Rajaramfm16fm17fm18fm19fm20fm21fm22fm23