This is a timely updated edition of a valuable resource that covers all aspects in relation to vaginal surgery as the least invasive approach to restore normal anatomy and function when dealing with prolapse and incontinence. The aim is to promote the vaginal route through providing information.
Female pelvic anatomy is explored from a vaginal perspective as applied to clinical examination and operative dissection. Patient assessment is outlined with suggested examination techniques tailored to detect specific defects. Neuropathy and neurological assessment are also included. Teaching trainees is explored in a mixture of personal experience and educational theory. Attention is given to cognitive knowledge as well as dealing with problems. Prevention and management of various types of infections, both in the surgical site and beyond, are covered. Classical as well as modern instruments are described in detail. A chapter is dedicated to complications of surgical mesh (described as bolster implantation) and their management.
Various techniques of vaginal hysterectomy, including simple, laparoscopic assisted, subtotal, and radical, as well as myomectomy and salpingo-oophorectomy, even for adnexal masses, are described in detail. Special attention is given to enlarged uterus and difficult vaginal hysterectomy.
All surgical procedures are described in meticulous detail with a variety of techniques evaluated and ample information provided based on published literature as well as personal author experience. The theoretical consideration behind various techniques are outlined to enable the reader to understand the rationale behind techniques and the reason for their variation. Special attention is given to the prevention, diagnosis and management of various operative and postoperative complications, especially those involving the bowel and urinary tract. The book comes with internet access to full text, an image bank, as well as surgical videos for easy access to the text and good quality images and videos.
The book is written primarily by American authors, which is reflected in the terms used and techniques described, as well as writing style. This helps broaden the reader's horizon, but must to be borne in mind when considering new ideas. The book extends beyond reconstructive surgery, to consider subtotal vaginal hysterectomy, vaginal myomectomy, laparoscopic assisted vaginal hysterectomy and radical vaginal hysterectomy with laparoscopic lymph node dissection, which are part of general gynaecological and gynaecological oncological surgery. The book covers vulval and vaginal infections, which are part of general gynaecology and may not necessarily require surgery, although they can at times pose real challenges for general gynaecologists as well as urogynaecologists. Some of the views expressed in relation to the use of mesh in anterior compartment reconstruction and posterior intravaginal slingoplasty represent personal opinion, rather than firm scientific evidence. A chapter is dedicated to vaginal cerclage, which is not a recognised surgical technique for pelvic organ prolapse, whilst colposuspension is not described. Nonetheless, this comprehensive book is a valuable resource for those with experience in vaginal reconstructive surgery to gain insight in different views and learn additional skills to improve and advance their practice.