1Single Surgical Procedures in Obstetrics and Gynaecology–17 UTERUS DISPLACEMENTS A Colour Atlas of Manchester's Operation2
3Single Surgical Procedures in Obstetrics and Gynaecology–17 UTERUS DISPLACEMENTS A Colour Atlas of Manchester's Operation
Series Editors Arun Nagrath
MS MAMS FICOG
Professor and Head Department of Obstetrics and Gynaecology Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India
Erstwhile Professor and Head Department of Obstetrics and Gynaecology SN Medical College, Agra, Uttar Pradesh, India
Senior Clinical Training Consultant Johns Hopkins Program for International Education in Gynaecology and Obstetrics (JHPIEGO), Baltimore, USA
Narendra Malhotra
MD FICOG FICMCH
President, FOGSI 2008 Dean, ICMU 2008-2009 Director, Ian Donald School of Ultrasound Consultant and Director Malhotra Nursing and Maternity Home (P) Ltd., Agra, Uttar Pradesh, India
Apollo Pankaj Hospital (P) Ltd., Agra, Uttar Pradesh, India
Associate Editor Soniya Vishwakarma
MD
Resident Gynaecological Officer Department of Obstetrics and Gynaecology Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India
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Single Surgical Procedures in Obstetrics and Gynaecology–17: A Colour Atlas of Manchester's Operation
First Edition: 2015
9789351526117
Printed at
5Dedication
… At the lotus feet of my master Late Professor Nawal Kishore MS FICOG FACS (Rockefeller Foundation Fellow)
One of the legendry artists' surgeons of India who excelled and afforded respect to a newly formed specialization Gynaecological and Obstetrical Surgeries Famous in the 50s, 60s and 70s fondly called Teacher of Teachers. Through this great master I see a glimpse of his surgical mannerisms in my work trying to achieve surgical perfection which came so naturally to Him. Lest he be forgotten in the footprints of time a humble effort to propagate his excellence through this organization for posterity. ….lest the coming generations be starved of the magical art of gynaecological and obstetrical surgery
7Preface
Anything that simplified our medical education has always been welcomed. This book is organised into multiple volumes on all gynaecological and obstetrical surgical procedures related to the female genital organs. Special sections are dedicated to patient positioning, type of incision, their closures along with proper use of drains, suture choices, etc. We have followed the advice given to Alice when about to testify at the trial of the Knave of Hearts in Wonderland, “Begin at the beginning, keep on until you come to the end and then stop”.
In crafting the book we have attempted to follow a logical sequence by dividing it into the introduction, preoperative, intraoperative and postoperative care.
Also included in this section are chapters describing in detail both the more traditional and newer surgical procedures and discuss their place and outcomes. Where feasible, we have substantiated the choice of surgical maneuvers with good science.
The purpose of this book is to provide for residents and young gynaecological surgeons an Atlas to understand every step of surgery in detail. Though the era of surgery is since long and has been described very well in surgical books, but there is always difficulty in imagining live sequence of every step of the operation, specially for the young gynaecologists. I have endeavoured to describe every single step of surgery in much detail that one can equate oneself with the operative procedure. It is modestly hoped that graduates may on occasion also find this book of use for reference and for comparison with their own operative techniques.
Though a lot of pioneer work has been done in the field of utero-vaginal prolapse in the childbearing period especially in the Indian subcontinent where the uterovaginal prolapse continues to be a menace because of inadequate doorstep facilities available to the clients combined with the associated factors responsible.
Fothergill Manchester repair continues to be the gold standard modality in the management of utero vaginal prolapse in women who are either young or have not yet completed their family.
This volume is therefore a generous attempt to describe the technique of Manchester-Fothergill repair, with which the author considers from personal experience to be most acceptable.
The book is enhanced by full colour illustrations and photographic reproductions. Special attention has been paid to the illustrations and photographs to make them more accessible and informative. The technical description is superb and to the point.
We as editors of this Colour Atlas of Gynaecologic Single Surgical Procedures in Obstetrics and Gynaecology have set out to simplify surgery by creating a step-by-step procedural process, illustrated to emphasise those surgical steps, which are critical to the individual procedure under consideration.
We have also provided important notes in an effort to aid the surgeon in reducing blood loss, minimising complication rates and improving their surgical skills.
We hope that our efforts will provide a coherent, integrated account of the field we have attempted to cover, which will be to the satisfaction of our readers.
There is no doubt that readers will thoroughly enjoy this work as we have. Series Editor, Dr Arun Nagrath is one of the accomplished and renowned Obstetrics and gynaecology surgeon. He has gained excellence especially in nondescent vaginal hysterectomy. Based on his merits and rich expertise, John Hopkins University inducted him as a consultant.
In case, you want to give any suggestion or feedback you may contact him on the following address:
Permanent Address
4/16, Lala Lajpat Rai Road, Civil Lines
Agra – 282002 (UP), India
Present Address:
103 A, Varishtha Chikitsa Adhikari Awas
UPRIMS & R, Saifai, Etawah 206301 (UP), India
Contact Numbers: 09319112861, 09410666674
E-mail ID: arun_nagrath@rediffmail.com; arunnagrath@gmail.com
Arun Nagrath
Narendra Malhotra
Soniya Vishwakarma
8Acknowledgements
We are grateful to Director, Brig. T Prabhakar “AVSM”, who has a fixation for quality and continued progress, dedicated to his institution. He has always cajoled his staff to move forwards and do something that “makes a difference”.
This book is an attempt in this direction. All through our hours of toil he always helped us to smoothen the rough edges and this work carries the hallmark of his “quality”.
We are thankful to all the staff of the Department of Obstetrics and Gynaecology of UP Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India for their contribution in this project.
My better half, Dr (Mrs) Manju Nagrath, Department of Radiodiagnosis, UP Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India, who has stood by me, tolerating my hours of frustration and its manifestations and constantly encouraging me to “keep up” my endeavours and see this work through completion.
The preparation of the book of this magnitude involves many individuals who play an important role in its creation. I am especially proud of the quality of the photographs and it would be in place to put on record the contribution of Miss Kiran Soloman, staff nurse in charge, who has shouldered the additional responsibility of helping me in the photography and Mrs Tanveer, nursing sister in charge, for providing facilities in the “State of Art” operation theatre in the Department of Obstetrics and Gynaecology, UP Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India.
To my patients who have very kindly consented to allow the use of their operative sequences for the purpose of advancement of medical education.
Arun Nagrath
Narendra Malhotra
Soniya Vishwakarma
10All Volumes in the Series “Single Surgical Procedures in Obstetrics and Gynaecology”
This book is one of the titles in the series of Single Surgical Procedures in Obstetrics and Gynaecology, a series which will eventually have 36 volumes.
If you wish to be kept informed of new additions to the series and receive details of our other titles, please write to Jaypee Brothers Medical Publishers (P) Ltd at sujatha.jp@gmail.com.
We list below a few of the other titles in print and in preparation in the Single Surgical Procedures series. Titles already published are marked (*); those titles to be published during the coming months are marked (#).
VULVA – A
*VOL-1 | Bartholin's gland excision |
Marsupilisation of Bartholin cyst | |
Release of labial fusion | |
VOL-2 | Hymenectomy (Imperforate hymen) |
Simple vulvectomy |
VAGINA – B
VOL-3 | Anterior colporrhaphy and Kelly's plication |
Posterior colpoperineorrhaphy | |
Vaginal repair of enterocoel | |
Abdominal repair of enterocoel | |
*VOL-4 | Complete perineal tear repair |
VOL-5 | Fenton's operation |
Episiotomy | |
Schuchardt's operation |
CERVIX – C
VOL-6 | Biopsy of cervix |
Cervical conisation | |
Endocervical curettage at colposcopy | |
Conisation of cervix by LEEP | |
Electrocauterisation of cervix | |
Cervical cryocauterisation | |
VOL-7 | Trachelorrhaphy |
Abdominal excision of cervical stump | |
VOL-8 | Correction of incompetent cervix by Shirodkar's technique |
Correction of incompetent cervix by McDonald's operation | |
Correction of incompetent cervix by Lash operation |
UTERUS: ABDOMINAL HYSTERECTOMY-D1
VOL-9 | Total abdominal hysterectomy |
Total abdominal hysterectomy with bilateral salpingo-oophorectomy | |
Nagrath's minilap hysterectomy | |
VOL-10 | Abdominal subtotal hysterectomy |
Obstetrical hysterectomy |
UTERUS: VAGINAL HYSTERECTOMY-D2
VOL-11 | NDVH - Conventional approach |
NDVH - With salpingo-oophorectomy | |
NDVH - Debulking by uterine bisection | |
NDVH - Debulking by wedge excision | |
NDVH - Debulking by myomectomy | |
NDVH - Debulking by morcellation | |
NDVH - Debulking by Coring | |
NDVH - Debulking by spiral incision | |
NDVH - Debulking by cervical amputation | |
NDVH - Debulking by cervical wedge | |
*VOL-12 | Ward Mayo's hysterectomy |
Modified Ward Mayo's hysterectomy—Dr Nagrath's modification | |
Clampless vaginal hysterectomy |
UTERUS-D3
VOL-13 | Dilatation and curettage |
Suction curettage for abortion | |
Dilatation and endometrial biopsy | |
Fractional curettage | |
*VOL-14 | Upper segment caesarean section |
Lower segment caesarean section |
UTERUS: DISPLACEMENTS-D4
*VOL-15 | Cervicopexy (Purandare's) |
*VOL-16 | Supravaginal cervical amputation (Nadkarni's) |
*VOL-17 | Manchester's operation |
Fothergill's repair | |
*VOL-18 | Shirodkar's anterior sling |
Shirodkar's posterior sling | |
VOL-19 | LeFort's operation |
Gilliam's operation | |
Modified Gilliam's operation | |
William Richardson's operation | |
*VOL-20 | Ventral suspension of vaginal vault |
Abdominal sacro-colpopexy |
UTERUS: MYOMECTOMY-D5
VOL- 21 | Myomectomy for Fundal fibroid, Hood's operation |
Myomectomy for anterior wall fibroid | |
Myomectomy for isthmic fibroid | |
Myomectomy for anterior cervical fibroid | |
Myomectomy for posterior wall fibroid | |
Myomectomy for intracavitary fibroid | |
Myomectomy for fibroid polyp | |
Myomectomy for broad ligament fibroid | |
Myomectomy for round ligament fibroid | |
Myomectomy for multiple fibroids |
FALLOPIAN TUBES AND OVARIES-E1
VOL-22 | Salpingo-oophorectomy |
Wedge resection of ovary | |
Ovarian cystectomy | |
Ovariotomy | |
VOL-23 | Enucleation of broad ligament cyst |
Ectopic pregnancy |
FALLOPIAN TUBE RECONSTRUCTION-E2
VOL-24 | Salpingolysis |
Fimbriolysis | |
Salpingo-ovariolysis | |
Salpingostomy | |
Salpingectomy | |
VOL-25 | Cornual reimplantation |
Fimbrioplasty | |
Tuboplasty—Microresection and anastomosis |
FEMALE STERILISATION-E3
VOL-26 | Laparoscopic sterilisation by silastic bands |
Sterilisation by minilaparotomy technique | |
Sterilisation by Pomeroy's operation | |
Sterilisation by modified Pomeroy's operation | |
Sterilisation by Irving's method | |
Sterilisation by Uchida's method | |
Sterilisation by Madlener's method | |
Sterilisation by Parkland's method | |
Sterilisation by Aldridge method | |
Sterilisation by Kroener's method | |
Sterilisation by Oxford's method | |
Sterilisation by Shirodkar's method | |
Fimbriectomy |
ABDOMINAL WALL-F
*VOL-27 | Infra-umbilical midline laparotomy |
Paramedian abdominal incision | |
Pfannenstiel's incision | |
Kustner's incision | |
Maylard's incision | |
Cherney's incision | |
VOL-28 | Abdominal closure |
Single layer abdominal closure | |
Skin closure methods | |
Use of drains | |
Incisional hernia repair |
URINARY STRESS INCONTINENCE-G
VOL-29 | Retropubic urethropexy |
Kelly's operation | |
Marshall Marchetti Krantz operation | |
Burch suspension operation |
CONGENITAL ANOMALIES-HI
VOL-30 | Strassmenn's utriculoplasty |
Jone's utriculoplasty | |
Tompkin's utriculoplasty | |
*VOL-31 | Excision of transverse vaginal septum |
Excision of longitudinal vaginal septum | |
VOL-32 | Mc Indoe's vaginoplasty |
Modified McIndoe's vaginoplasty | |
William's vulvo-vaginoplasty | |
VOL-33# | Ileal neovagina |
FISTULA OPERATIONS
VOL-34# | Layer method of RVF |
Sim's Moir saucerisation | |
Latzko's operation | |
VOL-35 | Urethral reconstruction |
Vesicovaginal fistula | |
Vesicocervical fistula | |
Ureterivaginal fistula |
MISCELLANEOUS OPERATIONS-J
VOL-36 | Intestinal loop urinary diversion |
Urinary diversion cutaneous ureterostomy | |
Urinary diversion uretero-sigmodostomy | |
Ureterovesicle anastomosis (psoas hitch) | |
Posterior colpotomy | |
Insertion of suprapubic catheter | |
Demonstration of tubal patency via laparoscopy | |
Demonstration of tubal patency by HSG |