Uterus Displacements: A Colour Atlas of Shirodkar’s Operations for Prolapse (Volume 18) Narendra Malhotra, Arun Nagrath, Priya Sharma
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fm1Single Surgical Procedures in Obstetrics and Gynaecology–18 UTERUS: DISPLACEMENTS A Colour Atlas of Shirodkar's Operations for Prolapse
fm2Single Surgical Procedures in Obstetrics and Gynaecology–18 UTERUS: DISPLACEMENTS A Colour Atlas of Shirodkar's Operations for Prolapse
Series Editors ArunNagrath MS MAMS FICOG Professor and Head and Department of Obstetrics and Gynaecology and Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India Erstwhile Professor and Head and Department of Obstetrics and Gynaecology and SN Medical College, Agra, Uttar Pradesh, India Senior Clinical Training Consultant and 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 and Director, Ian Donald School of Ultrasound and Consultant and Director Malhotra Nursing and Maternity Home (P) Ltd., Agra, Uttar Pradesh, India Apollo Pankaj Hospital (P) Ltd., Agra, Uttar Pradesh, India Associated Editor Priya Sharma MD Lecturer Department of Obstetrics and Gynaecology and Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India
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Single Surgical Procedures in Obstetrics and Gynaecology–18: A Colour Atlas of Shirodkar's Operations for Prolapse
First Edition: 2015
Printed at
…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
Arun Nagrathfm6
Anything that simplified our medical education has always been welcomed. This book is organized 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.
Whenever a book is written by an author it always has a purpose, to help and raise the knowledge of upcoming young gynaecologists. This book is in a form of atlas to explain every step of surgery in a way, that residents can imagine the operative procedure as being held before them. 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 uterovaginal prolapse in the childbearing period especially in the Indian subcontinent where uterovaginal prolapse continues to be a menace because of inadequate doorstep facilities available to the clients combined with the associated factors responsible. I have already described Fothergill Manchester repair in my previous volume for management of prolapse in childbearing period where sling operations are not very popular. With the era of sling operation I would like to put forth a detailed description of Shirodkar's operations, i.e. Shirodkar's extended Manchester operation (vaginal approach) and Shirodkar's operation (abdominal approach). Shirodkar's operation is a milestone in the surgery of prolapse, considered as a “gold standard”, originally described by Professor V N Shirodkar in 1959–1960. This book is therefore a generous attempt to describe the technique of Shirodkar's operations, with which the author consider from personal experience to be most acceptable.
The purpose of this book is to provide for residents and young gynecological surgeons an atlas to understand every step of surgery in detail. Though the era of surgery has begun 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 so 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.
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 Gynecologic Single Surgical Procedures in Obstetrics and Gynaecology have set out to simplify surgery by creating a step-by-step procedural process, illustrated to emphasize 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.fm8
Series Editor, Dr Arun Nagrath is one of the accomplished and renowned Obstetrics and Gynaecology surgeon. He has gained excellence especially in non-descent 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
Arun Nagrath
Narendra Malhotra
Priya Sharma
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 differen`.
This book is an attempt in this direction. All through our hours of toil he always helped us in smoothening 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
Priya Sharmafm10
fm11All 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 (#).
Bartholin's gland excision
Marsupilisation of bartholin cyst
Release of labial fusion
Hymenectomy (Imperforate hymen)
Simple vulvectomy
Anterior colporrhaphy and Kelly's plication
Posterior colpoperineorrhaphy
Vaginal repair of enterocoel
Abdominal repair of enterocoel
*Complete perineal tear repair
Fenton's operation
Schuchardt's operation
Biopsy of cervix
Cervical conisation
Endocervical curettage at colposcopy
Conisation of cervix by LEEP
Electrocauterisation of cervix
Cervical cryocauterisation
Abdominal excision of cervical stump
Correction of incompetent cervix by Shirodkar's technique
Correction of incompetent cervix by McDonald's operation
Correction of incompetent cervix by Lash operation
Total abdominal hysterectomy
Total abdominal hysterectomy with bilateral salpingo-oophorectomy
Nagrath's minilap hysterectomy
Abdominal subtotal hysterectomy
Obstetrical hysterectomy
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
Ward Mayo's hysterectomy
Modified Ward Mayo's hysterectomy–
Dr Nagrath's modification
Clampless vaginal hysterectomy
Dilatation and curettage
Suction curettage for abortion
Dilatation and endometrial biopsy
Fractional curettage
Upper segment caesarean section
Lower segment caesarean section
cervicopexy (Purandare's)
supravaginal cervical amputation (Nadkarni's)
Manchester's operation
Fothergill's repair
Shirodkar's anterior sling
Shirodkar's posterior sling
LeFort's operation
Gilliam's operation
Modified Gilliam's operation
William Richardson's operation
Ventral suspension of vaginal vault
Abdominal sacro-colpopexy
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
Wedge resection of ovary
Ovarian cystectomy
Enucleation of broad ligament cyst
Ectopic pregnancy
Cornual reimplantation
Tuboplasty–Microresection and anastomosis
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
Infra-umbilical midline laparotomy
Paramedian abdominal incision
Pfannenstiel's incision
Kustner's incision
Maylard's incision
Cherney's incision
Abdominal closure
Single layer abdominal closure
Skin closure methods
Use of drains
Incisional hernia repair
Retropubic urethropexy
Kelly's operation
Marshall Marchetti Krantz operation
Burch suspension operation
Strassmenn's utriculoplasty
Jone's utriculoplasty
Tompkin's utriculoplasty
Excision of transverse vaginal septum
Excision of longitudinal vaginal septum
Mc Indoe's vaginoplasty
Modified McIndoe's vaginoplasty
William's vulvo-vaginoplasty
Ileal neovagina
Layer method of RVF
Sim's Moir saucerisation
Latzko's operation
Urethral reconstruction
Vesicovaginal fistula
Vesicocervical fistula
Ureterivaginal fistula
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