Common

Gynaecological
Surgeries
Dr Smita Shinde(PT)
Introduction

 Surgical procedures in Gynaecology requires when

there is emergency of labour, Comlications in
Labour, underlying pathologies of pelvic or
abdominal organs.
 Basic principles of surgery are aalso applied for
the Gynaecological Surgery
Basic Principles

 Preservation of childbearing Potential

 Conservation of Ovarian Function
 Avoid damage to other Important Structure
Surgical Emergencies in Obstetrics &
Gynaecology
 Laceration;like Vaginal or Vulvar, Bladder
Lacerations, Rectal Lacerations, other Lacerations
 Vulvar Hematoma
 Bartholin’s Abscess
 Incomplete loss of Pregnancy / Abortion
 Ectopic pregnancy, ruptured or Un-ruptured.
 Ovarian torsion
 In the case of endometriosis
Common surgical procedures
performed in Gynaecology
 Dilation & Curettage: Under anaesthesia, the
bladder is catheterized Polyp forceps or ring
forceps are used to remove any tissue from uterus.
Then a curette is gently inserted and used to
scrape any remaining tissue off the uterine walls
Common surgical procedures performed
in Gynaecology
 Salpingectomy: Salpingectomy (removal of the
fallopian tube) is uniformly effective , safe, simple,
fast, and well within the capabilities of an
abdominal surgeon.
 Lower midline incision is fast and gives excellent
exposure
 Insmall ectopic pregnancies (2-3in diameter) most
commonly used is “ Linear salpingostomy”
Common surgical procedures performed
in Gynaecology
 Hysterectomy: A surgical procedure whereby the uterus is
removed. Performed for uterine fibroids, cervical dysplasia,
endometriosis.
 Types of incision-
 Abdominal hysterectomy
 Vaginal hysterectomy
A) Total Abdominal Hysterectomy: uterus with cervix is
removed
B) LAVH ( Laparoscopy assisted vaginal hysterectomy)
C) Supracervical hysterectomy: removal of removal of uterus
without cervix
Common surgical procedures
performed in Gynaecology
D) Radical hysterectomy: removal of uterus, cervix,
surrounding tissues and upper vagina.

E) Myomectomy: removal of portion of uterus with

embolization

F) Endometrial Ablation: surgical destruction of lining

tissues of uterus (endometrium)
Common surgical procedures performed
in Gynaecology
 Episiotomy : Aim of this surgery is to avoid
irregular tearing of vagina which could be difficult
to stich- up than straight cut.
 Two types-
 Midline
 Medio-lateral

 Midline is from vagina to perineum till anus and

Medio-lateral is from vagina to lateral to anus
Common surgical procedures performed
in Gynaecology

 Anterior Colporhaphy: In Cystocele or Urethrocele

 Posterior Colporhaphy: In Rectocele
 Manschester Repair: Uterine prolapse
Common surgical procedures performed
in Gynaecology
 Caesarean Section: Surgical procedure where
delivery of fetus at the end of 28 th week is achieved
by incision on abdominal and uterine wall.
 Causes: Multiple bodies, prolonged labour or
failure of labour, Breech presentation, fetal
abnormality, placenta previa, prolapse of umblical
cord
Common surgical procedures
performed in Gynaecology
Incisions:
 Low horizontal incision: ( LSCS/ Bikini line incision or
Pfannenstiel incision) 5 inches long and over the pubis near
top line of pubic hairs.

 Advantage:
 Better cosmetic results
 Less painful healing
 Less post- operative complications
Common surgical procedures performed
in Gynaecology
 Disadvantages:

 Less exposure
 More potential bleeding
 More time consuming
 Poor upper abdominal exposure
Common surgical procedures performed
in Gynaecology
 Vertical Incision: ( Upper Uterine Segment CS)
Extends from below navel or umbilicus to the top of
pubic hair line.
 Advantages:

 Optimal exposure of abdomen

 Less potential blood loss
 Comparatively less infectious
 More expedient in opening
Common surgical procedures performed
in Gynaecology
 Disadvantages:

Less cosmetic
More chance of herniation
More painful
More post operative complications with respiration
Physiotherapy in Gynaecological
Surgery
 Aspects covered in Physiotherapy:
 Prevention of respiratory and circulatory
complications
 Facilitation of mobilization
 Education about back care and ergonomics
 Abdominal and pelvic floor muscle strengthening
Physiotherapy in Gynaecological
Surgery
Pre-operative Management:
 Can be given individually or in group
 Assess for risks factors
 Educate as what to expect post- operatively
 Teach immediate post –operative skills
 Overview of recovery course
Physiotherapy in Gynaecological
Surgery
 Pre- operative Programme:
 History and Subjective assessment
 Respiratory PT-
 ACBT
 Peak Expiratory Pressure Mask(PEP)
 Incentive Spirometry
Physiotherapy in Gynaecological
Surgery
Cardio PT
o Breathing Exercise
o Coughing-Huffing techniques
o Ankle –toe movements
Mobility Exercise
o Bed mobility
o Matt Exercises
o Transfers from Bed to chair and vice versa
Physiotherapy in Gynaecological
Surgery
Strengthening Exercise:
 PFM Strengthing exercise
 Core Strengthening
 Abdominal drawing in different positions
 Pelvic rocking Exercises
 Instruction in defecation and urination dynamics.
Physiotherapy in Gynaecological
Surgery
Post- operative Physiotherapy:
 Day1-
 Reading operative notes
 Assessing state of consciousness
 Pain level
 Wound site if permissible
 Attachments ( IV/ IDC/ ECG-BP Monitoring)
 Position
Physiotherapy in Gynaecological
Surgery

 Day 1-
 Sitting with legs out of bed for 10 min.
 Thoracic expansion exercises
 Upper limb full range of motion
Physiotherapy in Gynaecological
Surgery
Day 2-
 Ambulate short distance
 Pelvic Rocking
 Abdominal drawing in
 Coughing with abdominal support
 Incentive spirometry
 In case of IM Narcotics very early ambulation should
be avoided.
Physiotherapy in Gynaecological
Surgery
 Long sitting period
 Abdominal drawing in standing
5 repetitions in 5 sec for PFM exercise.
Reference

D C Dutta
 Polden and Jill Mantle
THANK YOU