Gynecological surgery refers to surgery on the female reproductive system. Gynecological surgery is usually performed by gynecologists. It includes procedures for benign conditions, cancer, infertility, and incontinence. Gynecological surgery may occasionally be performed for elective or cosmetic purposes.

1. SURGERIES IN GYNAECOLOGY
&
PHYSIOTHERAPY

2. INTRODUCTION
• Surgical procedures in Gynaecology requires
when there is emergency of labour,
Complications in labour, Underlying pathologies
of pelvic or abdominal organs.
• Basic principles of surgery are also applied for
the Gynaecological Surgery.

3. BASIC PRINCIPLES
• Preservation of Childbearing Potential
• Conservation of Ovarian Function
• Avoid Damage to Other Important
Structures

4. 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.

5. COMMON SURGICAL PROCEDURES
PERFORMED IN GYNAECOLOGY
• Dilatation & Curettage : Under anesthesia, 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

6. • 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
• In small ectopic pregnancies (2-3cm. In diameter)
most commonly used is the ‘Linear salpingostomy.’
COMMON SURGICAL PROCEDURES
PERFORMED IN GYNAECOLOGY

7. • Oophorectomy : When ovarian torsion is
encountered, the ovary and all affected tissue
should be simply removed.
• Ovarian Cystectomy : Emergency removal of
an ovarian cyst is usually necessitated because
of either severe pain or hemorrhage.
• In either case, the cyst can often be "shelled out“
from the ovary allowing ovarian conservation.
COMMON SURGICAL PROCEDURES
PERFORMED IN GYNAECOLOGY

8. • Hysterectomy : A surgical procedure whereby the
uterus is removed. Performed for uterine fibroids,
cervical dysplasia, endometriosis.
• Types of incision- 1. Abdominal hysterectomy
2. vaginal hysterectomy
• A. Total Abdominal Hysterectomy: uterus with cervix
is removed
• B. LAVH (Laparoscopy assisted vaginal
hysterectomy)
COMMON SURGICAL PROCEDURES
PERFORMED IN GYNAECOLOGY

9. • C. Supracervical hysterectomy: removal of uterus
without cervix
• 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

10. • Episiotomy: Aim of this surgery is to avoid irregular
tearing of vagina which could be difficult to stich –
up than straight cut.
• Two types i) Midline
ii) 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

11. • Anterior Colporhaphy: In Cystocele or Urethrocele
• Posterior Colporhaphy: In Rectocele
• Manchester Repair: Uterine Prolapse
COMMON SURGICAL PROCEDURES
PERFORMED IN GYNAECOLOGY

12. • Caesarian Section: Surgical procedure where
delivery of fetus at the end of 28th 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

13. • Incisions:
• Low horizontal incision: (LSCS / bikini line incision or
pfamenstein incision) 5 inches long and over the pubis
near top line of pubic hairs.
• Adv:
• Better cosmetic results
• Less painful healing
• Less post-operative complications
COMMON SURGICAL PROCEDURES
PERFORMED IN GYNAECOLOGY

14. • Disadv:
• Less exposure
• More potential bleeding
• More time consuming
• Poor upper abdominal exposure
COMMON SURGICAL PROCEDURES
PERFORMED IN GYNAECOLOGY

15. • Vertical Incision: (Upper Uterine Segment CS)
Extends from below navel or umbilicus to the top of
pubic hair line.
• Adv:
• Optimal exposure of abdomen
• Less potential blood loss
• Comparatively less infectious
• More expedient in opening
COMMON SURGICAL PROCEDURES
PERFORMED IN GYNAECOLOGY

16. • Disadv:
• Less cosmetic
• More chance of herniation
• More painful
• More post operative complications
with respiration
COMMON SURGICAL PROCEDURES
PERFORMED IN GYNAECOLOGY

17. 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.

18. • Pre-operative Management:
• Can be given individually or in group
• Assess for risk factors
• Educate as what to expect post-operatively
• Teach immediate post-operative skills
• Overview of recovery course
PHYSIOTHERAPY IN GYNAECOLOGICAL
SURGERY

19. • Pre-operative Programme:
• History and Subjective assessment
• Respiratory PT-
• ACBT
• Peak Expiratory Pressure Mask (PEP)
• Incentive spirometry
PHYSIOTHERAPY IN GYNAECOLOGICAL
SURGERY

20. • Cardio PT-
• breathing exersices
• Coughing-Huffing techniques
• Ankle-toe movements
• Mobility Ex.-
• Bed mobility
• Matt Ex.
• Transfers from Bed to Chair and vice versa.
PHYSIOTHERAPY IN GYNAECOLOGICAL
SURGERY

21. • Strengthening Ex.
• PFM strength. Ex.
• Core Strengthening
• Abdominal drawing in diff. positions
• Pelvic rocking ex.
• Instruction in defecation and urination
dynamics.
PHYSIOTHERAPY IN GYNAECOLOGICAL
SURGERY

22. • Post-operative Physiotherapy:
• Day 1-
• Reading operative notes
• Assessing state of consciousness
• Pain Level
• Wound site if permissable
• Attachments (IV/IDC/ECG-BP Monitoring)
• Position
PHYSIOTHERAPY IN GYNAECOLOGICAL
SURGERY

23. • Day 1-
• Sitting with legs out of bed for 10 min.
• Thoracic expansion ex.
• UL full ROM ex.
PHYSIOTHERAPY IN GYNAECOLOGICAL
SURGERY

24. • 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

25. • Longer sitting period
• Abd. drawing in in standing
• 5 repetitions In 5 sec for PFM ex.
PHYSIOTHERAPY IN GYNAECOLOGICAL
SURGERY

26. THANK YOU!