By Robert S. and Zimmerman, Carl W. Kovac
This text/DVD package deal is a step by step, completely illustrated consultant to state of the art suggestions in vaginal surgical procedure. The booklet information the newest options and applied sciences for working throughout the vagina, files the facts helping the vaginal method of so much hysterectomies, and describes vaginal reconstructive surgical procedures for correcting many anatomic defects that reason sufferer difficulties. establishing sections overview pelvic anatomy and talk about instruments for vaginal surgical procedure, together with antibiotic prophylaxis. next sections specialise in particular surgical procedures, together with hysterectomies, reconstruction of the vagina, and methods for treating urinary incontinence, colorectal difficulties, and fistulas. the ultimate part discusses attractiveness and administration of intraoperative and postoperative issues. A bound-in DVD includes electronic movies of vaginal hysterectomy, fix of the anterior vaginal phase, site-specific colpocleisis, and overall procendentia.
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Extra info for Advances in Reconstructive Vaginal Surgery
24 in the cadaver laboratory have shown that in pelvic dissections of nulliparous female cadavers there is a dense connective tissue overlying the pelvic floor that extends to the pelvic sidewalls and perineum. It is a sheet of connective tissue across the entire pelvis, attaching the muscles and viscera to the bony pelvis. This connective tissue sheath is thickest at the arcus tendineus fasciae pelvis and the uterosacral ligaments, but its course could be followed intact even in the less dense areas surrounding the urethra and vaginal tube.
This dissection requires a â€œfeel,â€• especially in patients who have had cesarean deliveries and scarring of the bladder to the lower uterine segment. However, this is not a contraindication to performing a vaginal hysterectomy. Any entry into the bladder in this location simply requires recognition and closure with two layers of absorbable suture with several days of catheter drainage of the bladder. Performance of cystoscopy is mandatory to ensure closure of the entry site and bilateral ureteral function.
In the normal female pelvis the internal genitalia, base of the bladder, and rectal wall do not descend through the genital hiatus but are supported above the levator muscle. With increased intra-abdominal pressure, these supports hold the uterus and vagina over the levator plate and are fixed to the sacrum and pelvis sidewalls. When pelvic organ prolapse occurs, the genital hiatus is usually widened, and the connective supports do not keep the pelvic organs in place, allowing them to descend caudally into the vaginal lumen or completely through the vaginal opening.
Advances in Reconstructive Vaginal Surgery by Robert S. and Zimmerman, Carl W. Kovac