By Tito Lopes, Nick Spirtos, Raj Naik, John M. Monaghan
Enterprise favorite for gynaecological surgical perform for the reason that 1911, greatly revised through best gynaecological surgeonsProviding info on reconstructive surgical procedure, anaesthesia, details know-how and audit, issues and qualityFocusing at the most typically played strategies with emphasis on evidence-based determination making and the expanding use of laparoscopy in diagnostic and surgeries
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Additional resources for Bonney's Gynaecological Surgery, 11th Edition
Transverse incisions There are several transverse abdominal incisions available to the gynaecologist, and this is the preferred incision for the obstetrician and gynaecologist dealing with benign pathology. 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.
He or she should remember that the feet can be moved to obtain a more comfortable operating position and, if a part of the procedure is more easily performed from the opposite side of the table, the surgeon and his or her assistant should not hesitate in changing places. The table should be adjusted for the surgeon’s requirements to provide a comfortable operating 31 BONNEY’S GYNAECOLOGICAL SURGERY position and the very best access to the operative field. The editors’ use varying degrees of head-down tilt for most abdominal procedures; this allows the bowel to be easily packed out of the pelvic field and ensures minimal blood pooling in the lower limbs.
An absorbable monofilament suture material such as polydioxanone (PDS) is superior to non-absorbable monofilament sutures as there is less wound pain, sinus formation and buttonhole hernias (a hernia that develops lateral to the main incision in association with progressive enlargement of the needle hole through which the permanent suture material passes). The senior editor’s preference is to use a no. 1 looped PDS suture, thus avoiding the need for a knot at the start of the closure. The suture length–wound length ratio should not be less than 4:1 and excessive tension should not be applied.