Surgical Gynecology: A Case-Based Approach

Description:

Gynecology is principally an operative specialty and the range of gynecologic procedures managed is constantly expanding due to improved instrumentation and minimally invasive techniques. Covering the entire spectrum of gynecologic surgery through a case-based, digestible format, procedures such as vaginal, transvaginal, hysteroscopic, laparoscopic, robotic, and abdominal procedures are included, as well as common surgical challenges and complications. For each case, a clinical vignette outlines the situation and the clinical context of the patient, followed by a comprehensive discussion of the evidence-based management approach and key teaching points. The decision to operate, contraindications, alternatives to surgery and preoperative counseling is discussed in detail along with the level of care needed for each case. Readers will improve their knowledge base of gynecologic surgery and gain multiple tools to overcome common surgical obstacles.

Table of Contents:

Case 1 A 45-Year-Old Woman Undergoing Hysterectomy Requests Oophorectomy

Case 2 A 40-Year-Old G0 Developmentally Delayed Woman Requires Hysterectomy

Case 3 A 45-Year-Old Woman with Possible Penicillin Allergy Scheduled for Hysterectomy

Case 4 A 50-Year-Old Woman with Prior DVT Undergoing Hysterectomy

Case 5 A 40-Year-Old Woman with Severe Anemia Scheduled for Surgery Refuses Blood Products

Case 6 A 55-Year-Old Woman Enquires about Your Institution’s Protocols for Enhanced Recovery after

Case 7 A 55-Year-Old Female with a 25-Year Smoking History and COPD Is Undergoing a Robotic Hysterec

Case 8 A 48-Year-Old with Adult-Onset Diabetes Is Undergoing a Hysterectomy for Recurrent Simple Hyp

Case 9 A 10-Year-Old Girl with a Vulvar Hematoma after Playground Injury

Case 10 A 50-Year-Old Woman with a Discrete Area of Leukoplakia That on In-Office Punch Biopsy Showe

Case 11 A 50-Year-Old Woman with Recurrent Bartholin’s Gland Cyst

Case 12 A 21-Year-Old Woman with Labial Pain During Exercise

Case 13 A 33-Year-Old Woman with Localized Vulvodynia without Vaginismus

Case 14 A 24-Year-Old Woman with Multiple Large Vulvar Condyloma

Case 15 A 70-Year-Old with Vulvar Paget’s Disease

Case 16 A 45-Year-Old Female with Multifocal VIN

Case 17 A 70-Year-Old Woman with Diabetes, Exquisitely Painful 2 cm Vulvar Ulcerative Lesion, and Su

Case 18 A 14-Year-Old Adolescent with Cyclic Pelvic Pain and Amenorrhea

Case 19 A 40-Year-Old Woman with a 3 cm Mass Prolapsing through the Cervix

Case 20 A 35-Year-Old Woman with a Fetal Demise at 20 Weeks’ Gestation

Case 21 A 25-Year-Old Woman with Intrauterine Embryonic Demise and Temperature of 39.2°C

Case 22 A 40-Year-Old G0 Woman with Endometrial Intraepithelial Neoplasia Desiring Hysterectomy

Case 23 A 35-Year-Old G3P3 Woman with a 12-Week Uterus and a Prior Cesarean Section Who Desires Vagi

Case 24 A 42-Year-Old G2P2 Woman Undergoing Vaginal Hysterectomy with Difficulty Entering the Perito

Case 25 A 28-Year-Old P0 Woman with Adenocarcinoma In Situ Has Intraoperative Bleeding during a Cold

Case 26 A 30-Year-Old G1 Woman with Suspected Uterine Perforation during Suction Dilation and Curett

Case 27 A 39-Year-Old P4 Woman with Recurrent HSIL after LEEP

Case 28 A 34-Year-Old G2P1 Woman with Elevated β-hCG (>250 000 mIU/mL) and Concern for Molar Gestat

Case 29 A 35-Year-Old G3P2 Woman with Persistent Bleeding after Suction D&C

Case 30 A 70-Year-Old G0 Woman with Postmenopausal Bleeding and Severe Vaginal Atrophy

Case 31 A 28-Year-Old G3P2 Woman Presents at Eight Weeks with a Cervical Ectopic Pregnancy

Case 32 A 45-Year-Old Woman with Leg Weakness following a Vaginal Hysterectomy

Case 33 A 45-Year-Old Woman Undergoes a Transvaginal Midurethral Sling and Is Unable to Void after t

Case 34 A 65-Year-Old Woman Presents with a Symptomatic Stage 2 Rectocele

Case 35 A 55-Year-Old Woman with Stress Urinary Incontinence without Uterine Prolapse

Case 36 A 45-Year-Old P2 Woman Undergoing Vaginal Hysterectomy Who Desires Opportunistic Salpingecto

Case 37 A 32-Year-Old G2P2 with Bleeding from a 5 cm Vaginal Laceration after Sexual Assault

Case 38 A 50-Year-Old Woman Loses Consciousness during an Office Hysteroscopy

Case 39 A 44-Year-Old Woman with Intermenstrual Spotting

Case 40 A 71-Year-Old G2P2 Woman with Postmenopausal Bleeding and Severe Cervical Stenosis

Case 41 A 34-Year-Old G2P2 Woman with a 4 cm Type 1 Submucosal Myoma Undergoing a Hysteroscopic Myom

Case 42 A 50-Year-Old Woman with a Retained IUD

Case 43 A 30-Year-Old Woman Seeking Pregnancy Who Has Intrauterine Synechiae

Case 44 A 42-Year-Old Woman with Abnormal Uterine Bleeding Who Desires In-Office Ablation

Case 45 A 55-Year-Old G1P1 Woman with New-Onset Vaginal Bleeding after Prior Endometrial Ablation

Case 46 A 22-Year-Old G3P0030 Woman with Recurrent Pregnancy Loss and Uterine Septum

Case 47 A 33-Year-Old G2P2 Woman with Persistent Irregular Vaginal Bleeding after Cesarean Delivery

Case 48 A 38-Year-Old G3P2 Woman with Pelvic Pain following Endometrial Ablation

Case 49 A 33-Year-Old Woman with Acute Hypoxia during Hysteroscopic Myomectomy

Case 50 A 40-Year-Old Woman Desires Endometrial Ablation for Heavy Menstrual Bleeding

Case 51 A 24-Year-Old G0 Woman with Suspected Endometriosis Who Has Failed Medical Management

Case 52 A 35-Year-Old G0 Woman with Chronic Pain and Multiple Prior Surgeries Undergoing Diagnostic

Case 53 A 25-Year-Old Woman with Sudden Cardiovascular Collapse after Creation of Pneumoperitoneum

Case 54 A 30-Year-Old G0 Woman with 6 cm Complex Ovarian Cyst Suspicious for Borderline Ovarian Tumo

Case 55 A 32-Year-Old G4P4 Woman with Through-and-Through Small Bowel Penetration on Placement of Um

Case 56 A 43-Year-Old G3P3 BRCA1 Carrier Desiring Risk-Reducing Salpingo-oophorectomy

Case 57 A 34-Year-Old G3P3 Is Undergoing an Interval Bilateral Salpingectomy. During Initial Trocar

Case 58 A 28-Year-Old G0 Woman with Stage IV Endometriosis and an Obliterated Posterior Cul-de-sac

Case 59 A 40-Year-Old G3P3 Woman with 20 cm Unilateral Simple Cyst

Case 60 A 16-Year-Old Female G0 Adolescent with Acute Pelvic Pain

Case 61 A 29-Year-Old G2P0 Woman with Symptomatic Ectopic Pregnancy and History of Prior Salpingecto

Case 62 A 35-Year-Old P2 Woman with Preperitoneal Insufflation at Time of Laparoscopy

Case 63 A 38-Year-Old Woman Who Desires Device Removal after Hysteroscopic Sterilization

Case 64 A 28-Year-Old Woman with a 6 cm Complex Mass Adherent to the Pelvic Sidewall

Case 65 A 21-Year-Old Woman with an 8 cm Adnexal Mass Presumed to Be a Dermoid Tumor

Case 66 A 24-Year-Old G2P1 Woman with an Eight-Week Interstitial Ectopic Pregnancy

Case 67 A 16-Year-Old G0 Adolescent with Acute Psychosis and 3 cm Ovarian Dermoid Cyst

Case 68 A 23-Year-Old Woman with Cyclic Pelvic Pain and Suspected Obstructed Rudimentary Uterine Hor

Case 69 A 31-Year-Old Woman with Cesarean Scar Pregnancy

Case 70 A 35-Year-Old Woman with Bleeding from a Right Lower Abdominal Trocar Site

Case 71 A 21-Year-Old Woman with an Intra-abdominal IUD

Case 72 A 32-Year-Old G2P1 Woman with Ovarian Pregnancy Noted at Time of Surgery for Presumed Tubal

Case 73 A 32-Year-Old P0 Woman with Persistent Pain after LAVH/BSO for Endometriosis

Case 74 A 50-Year-Old Woman with Bleeding with Intercourse Four Weeks after Robotic Hysterectomy

Case 75 A 42-Year-Old Woman Who Desires Minimally Invasive Surgery for a 20-Week-Sized Uterus

Case 76 A 40-Year-Old Woman with No Spill from Her Left Ureter on Postoperative Cystoscopy after Tot

Case 77 A 40-Year-Old G1P1 Woman with Endometriosis Desiring Definitive Management

Case 78 A 40-Year-Old G4P4 Woman with 16-Week-Size Fibroid Uterus and Abnormal Uterine Bleeding Desi

Case 79 A 45-Year-Old Woman with Vaginal Bleeding and Fever to 38.3°C after Hysterectomy

Case 80 A 45-Year-Old Woman with Decreased Urine Output on POD#1 after Robotic-Assisted Total Laparo

Case 81 A 38-Year-Old G0 Woman with a 4 Cm Umbilical Mass

Case 82 A 26-Year-Old G0 Woman with Large Multifibroid Uterus Desiring Myomectomy

Case 83 A 45-Year-Old Woman with a Foul-Smelling Pfannenstiel Incision on POD 7

Case 84 A 45-Year-Old Woman with Watery Vaginal Discharge Six Weeks after Hysterectomy

Case 85 A 34-Year-Old G0 Jehovah’s Witness Undergoing Myomectomy

Case 86 A 50-Year-Old G0 Woman with Class III Obesity Undergoing Abdominal Hysterectomy

Case 87 A 60-Year-Old G2P2 Woman with Nausea and Abdominal Distension Following Abdominal Hysterecto

Case 88 A 15-Year-Old Adolescent with Severe Abdominal Pain and Hemoperitoneum

Case 89 A 24-Year-Old Woman Presents with Evidence of a Ruptured Ectopic Pregnancy and Is Reporting

Case 90 A 26-Year-Old Female Presents for Nexplanon Removal with a Non-palpable Device

Index