By Tito Lopes, Nick Spirtos, Raj Naik, John M. Monaghan
Company favorite for gynaecological surgical perform on account that 1911, broadly revised through best gynaecological surgeonsProviding details on reconstructive surgical procedure, anaesthesia, info expertise and audit, issues and qualityFocusing at the most typically played techniques with emphasis on evidence-based determination making and the expanding use of laparoscopy in diagnostic and surgeries
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Additional info for Bonney's Gynaecological Surgery, 11th Edition
It has the advantage that the first hitch is easily held tight while the second is being made and that should the first tie slip the second will tighten it up again. This applies only to monofilament suture materials which slide. If surgeons use multifilament sutures, they must learn to tie all knots as they wish them to end up – the tension on the first knot must be exactly as it is wished to be, as there is no possibility of ‘snugging’ down the second throw. Granny knots are not recommended as they have a tendency to slip when subjected to increased stress.
The Pfannenstiel incision is the transverse incision of choice, but the Cherney and Maylard incisions provide excellent exposure to the pelvic sidewall. The advantages include better cosmesis and less pain. However, they limit access to the upper abdomen and are associated with greater blood loss and haematoma formation. Nerve injury resulting in paraesthesia of the overlying skin is also more frequent. Pfannenstiel incision The single most important value of this incision is cosmetic. It is important for many women that their abdomens should remain apparently untouched by the surgeon’s knife, and, using this technique, the illusion can be maintained.
As air enters the cavity of the abdomen the bowel falls away from the abdominal wall and the surgeon can now lengthen the incision under direct vision. If it is clear that there are extensive adhesions beneath the peritoneum then it is prudent to move to another part of the incision and enter the abdominal cavity away from the adhesions. Alternatively, the surgeon and assistant can lift up the anterior abdominal wall by firmly grasping each side of the incision and then cutting the peritoneal layer using the scalpel with the underlying tissues under tension as entry into the peritoneal cavity is achieved.