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1. Surgical Methods of Treatment in Gynecology Features of Preoperative Preparation and Postoperative Management Prevention of

Complications
Obstetrician-Gynecologist
Smerthina N.A.

2.

Despite significant advancements in medical science and the
development of innovative treatments for diseases of the female
reproductive system, surgical intervention remains the most
effective approach for certain conditions. Modern techniques,
such as laparoscopy, allow for minimally invasive procedures that
minimize
scarring
and
promote
faster
recovery.
Gynecological surgeries not only aim to treat pathological
conditions but also strive to preserve reproductive function.
Today, these procedures are utilized for both diagnostic and
therapeutic purposes.

3.

Types of Gynecological Surgeries
Minor Surgeries
Separate diagnostic curettage;
Vacuum aspiration of the uterine
cavity;
Hysteroresectoscopy;
Cervical biopsy;
Surgeries on external genitalia.
Major Surgeries
Laparotomy;
Laparoscopy.

4.

Separate Diagnostic Curettage and Hysteroscopy
Hysteroscopy is a diagnostic tool
used to identify conditions such
as endometriosis, endometrial
hyperplasia, and oncological
pathologies. A hysteroscope - an
optical instrument - is inserted
into the uterine cavity, allowing
the surgeon to visualize and
evaluate pathological changes in
the cervical canal and uterine
lining.

5.

Separate Diagnostic Curettage serves the following purposes:
Diagnostic Sampling: Tissue samples are collected separately from the
cervical canal and uterine cavity to investigate the causes of abnormal
bleeding, pelvic pain, or pathological discharge.
Therapeutic Intervention: Polyps, fibroids, and other neoplasms are
surgically removed. The excised tissue is sent for histological analysis to
confirm the diagnosis and rule out malignancy.

6.

Cervical Biopsy
A cervical biopsy is performed to diagnose suspected tumors or
precancerous conditions of the cervix. During the procedure, a small tissue
sample is extracted using specialized forceps and sent for pathological
examination.
The results guide the physician in formulating an accurate diagnosis and
treatment plan. In some cases, the biopsy itself may remove all affected
tissue, eliminating the need for further intervention. The procedure is typically
performed without anesthesia, though local anesthesia may be used if
necessary.
Important Note: A tampon is placed in the vagina
post-procedure to control bleeding and
should be removed by the patient after 5-6 hours.

7.

Surgeries on External Genitalia
These procedures address conditions resulting from multiple or
traumatic childbirth, such as perineal tears or genital prolapse. They are also
indicated for the treatment of neoplasms or inflammatory conditions, such as
Bartholin’s gland abscesses.
Common Procedures:
Labiaplasty: Corrects congenital or acquired
deformities of the labia, improving both
function and aesthetics.

8.

Major Gynecological Surgeries
This term refers to surgeries involving a large volume of intervention.
Most major gynecological surgeries are performed laparoscopically. However,
some pathologies can only be treated with traditional surgical methods. The
following types of incisions are used:
Longitudinal
Transverse

9.

Longitudinal Incision
The advantages of this incision include simplicity,
speed of execution, and faster healing. Tissues cut this
way are less traumatized and bleed less. A longitudinal
incision provides the surgeon with good access to the
surgical field without additional instrumental control.
For major gynecological surgeries, a longitudinal
incision is made from the pubis to the navel. If tissue
damage extends beyond the navel, the incision can be
easily
extended.

10.

Transverse Incision
This type of incision, also known as a "suprapubic" incision, is
made just above the pubis and is used for minor gynecological
surgeries.
It
is
more
complex
to
perform.
A suprapubic incision is used when the affected area is near the
pubis. It limits access to internal organs and cannot be extended.
The advantages of this incision include its cosmetic effect (almost
no
scar)
and
the
strength
of
the
suture.
Although surgeons now prefer methods with better cosmetic
outcomes, advanced pelvic organ diseases can only be treated
with open surgery. This method ensures complete removal of
altered
tissues.

11.

Laparoscopic Method
Gynecological surgeries without incisions are performed using laparoscopy.
Recovery takes a few days, and only barely noticeable wounds remain on the
body. This procedure requires a specially equipped operating room and a
surgeon skilled in this technique.
To access the pelvic organs, three tiny incisions (up to 1 cm long) are made. A
special instrument called a laparoscope is inserted through these openings. It is
equipped with microscopic tools (clamps, scissors, knives) and a micro-video
camera. The image from the camera is displayed on a screen, helping the
surgeon monitor all manipulations.
First, the surgeon examines the damaged tissues using the laparoscope, then
proceeds to remove them. This method can remove cysts, tumors, fallopian
tubes, nodes, and even the uterus. To remove these formations, the surgeon
crushes them with micro-tools, places them in small sterile bags, and evacuates
them.

12.

Indications for Laparoscopy
The laparoscopic method was first tested in gynecology. About 95% of
gynecological surgeries are performed using laparoscopy.
It is used in the following cases:
Removal of ovarian tumors and cysts;
Removal of the uterus (complete or partial);
Treatment of fallopian tube obstruction;
Removal of fibroids;
Treatment of endometriosis;
Restoration of the anatomical position of pelvic organs.

13.

Preoperative Preparation for Elective Surgery
Preparation for gynecological surgery is a complex, multi-step process that
requires careful organization and strict adherence to the gynecologist's
recommendations.
The success of the surgery largely depends on proper preoperative
preparation. This includes not only physical preparation but also
psychological readiness, which minimizes risks and speeds up recovery.

14.

Health assessment (consultation with a therapist and, if
necessary, other specialists for comorbid conditions);
Clarification of the diagnosis and surgical plan;
Sedatives the night before the surgery;
Cleansing enema the night before and on the morning of the
surgery;
Psychological preparation of the patient;
Hygienic shower on the morning of the surgery;
Antibiotic prophylaxis 30 or 60 minutes before the surgery.

15.

Preparation for Emergency Surgery
Patients with gynecological diseases admitted with symptoms of an acute
abdomen are not fed until the nature of the disease is clarified due to the
possibility of surgery. Postoperative nutrition depends on the type of surgery
and the course of the postoperative period.
To achieve a certain therapeutic effect, bed rest is necessary, with specifics
determined individually by the doctor and implemented by the nursing staff.

16.

Postoperative Period
The postoperative period is the time from the surgery
until recovery or transfer to disability. The patient's
condition during this period is influenced by the
preceding disease, the surgical intervention, and the
effects of anesthesia.

17.

3 Phases of the Postoperative Period
A) Catabolic Phase - observed in all patients for 3-5 days; a protective reaction of
the body aimed at rapid delivery of metabolic substrates and plastic components.
The main process is increased protein breakdown (primarily liver, plasma, and
gastrointestinal proteins).
B) Transition Phase - begins 3-5 days after surgery and lasts 4-5 days. In the
absence of complications, pain disappears, temperature normalizes, and appetite
returns by day 4-5. Skin color improves, breathing becomes deeper, and heart rate
and blood pressure normalize. Intestinal function activates, and patients become
more active. Diuresis increases. Patients become more active, demonstrating an
improved ability to assess their condition and interact appropriately with their
surroundings
C) Anabolic Phase - characterized by activation of metabolic processes, including
protein, glycogen, and fat synthesis. Patients feel better, and their appetite
improves. Patients are usually discharged during this phase. This phase lasts up to
3-5 weeks.

18.

Postoperative management is carried out in stages:
1.
2.
3.
Transfer of the patient after surgery to the intensive care unit, where they
are monitored with constant supervision of their general condition and
well-being, skin color, and the functional state of organs and systems.
Treatment and prevention of postoperative complications:
Antibacterial therapy - to prescribe it, indications should be determined,
medications and their routes of administration selected, the necessity for
combination therapy and its duration established, its effectiveness
assessed, the possibility of changing antibiotics considered, and potential
side effects kept in mind. Along with antibacterial therapy, antifungal
agents are prescribed to prevent candidiasis.

19.

4. Monitoring the condition of the surgical wound stitches with daily inspection
and dressing changes.
5. Regulation of endocrine organ function.
6. Patient nutrition - during the first two days, a surgical diet is prescribed,
followed by a gentle diet, with a transition to a regular diet within 4–5 days if
there are no contraindications. The main conditions for transitioning to a
regular diet are the absence of intestinal paresis and the presence of bowel
movements after an enema (on the 2nd–3rd day after surgery).
7. Physiotherapy - physiotherapy procedures are prescribed starting from the
second day after surgery in the intensive care unit and then continued in the
physiotherapy room.
8. Therapeutic physical exercise - plays an important role in preventing certain
complications (e.g., thromboembolic events); early patient mobilization
contributes to a more favorable postoperative recovery.

20. Thank you for your attention. You may now take a 15-minute break.