Atlas of Gynecologic Surgery

2014·67.97 MB·English

by  Hirsch

Atlas of Gynecologic Surgery
Diethelm Wallwiener
Sven Becker
Matthias W. Beckmann
Sara Y. Brucker
Klaus Friese
Keith B. Isaacson
Walter Jonat
Arnaud Wattiez
With contributions by
H. Abele,C. Bachmann, K.Gardanis,E.-M.Grischke,R. Hornung,B. Krämer,
M. Oehler,C. Reisenauer,R.Rothmund, E. F.Solomayer,C. Wallwiener,
M. Wallwiener,W.Zubke
With the collaboration of
ErnstH. Schmidt
RudyL.De Wilde
4th edition
1138 illustrations
23tables
Thieme
Stuttgart· NewYork
LibraryofCongressCataloging-in-PublicationDataisavailablefromthepublisher. Importantnote:Medicineisanever-changingscienceundergoingcontinualdevelopment.Re-
search and clinical experience are continually expanding our knowledge, in particular our
Thisbookisanauthorizedtranslationofthe7thGermaneditionpublishedand knowledgeofpropertreatmentanddrugtherapy.Insofarasthisbookmentionsanydosageor
copyrighted2009byGeorgThiemeVerlag,Stuttgart.TitleoftheGermanedition: application,readersmayrestassuredthattheauthors,editors,andpublishershavemadeevery
AtlasdergynäkologischenOperationen. efforttoensurethatsuchreferencesareinaccordancewiththestateofknowledgeatthetime
ofproductionofthebook.
Translators: Nevertheless,thisdoesnotinvolve,imply,orexpressanyguaranteeorresponsibilityonthe
GertrudChampe,Surry,Maine,USA partofthepublishersinrespecttoanydosageinstructionsandformsofapplicationsstatedin
GeraldineOʼSullivan,Dublin,Ireland thebook.Everyuserisrequestedtoexaminecarefullythemanufacturersʼleafletsaccompany-
ingeachdrugandtocheck,ifnecessaryinconsultationwithaphysicianorspecialist,whether
Illustrators: thedosageschedulesmentionedthereinorthecontraindicationsstatedbythemanufacturers
ReinholdHenkel,Heidelberg,Germany differfromthestatementsmadeinthepresentbook.Suchexaminationisparticularlyimpor-
Karl-HeinzSeeber,Tübingen,Germany tantwithdrugsthatareeitherrarelyusedorhavebeennewlyreleasedonthemarket.Every
AndreaSchnitzler,Innsbruck,Austria dosagescheduleoreveryformofapplicationusedisentirelyattheuserʼsownriskandrespon-
MarianneLück,Hamburg,Germany sibility.Theauthorsandpublishersrequesteveryusertoreporttothepublishersanydiscrep-
anciesorinaccuraciesnoticed.Iferrorsinthisworkarefoundafterpublication,erratawillbe
postedatwww.thieme.comontheproductdescriptionpage.
©2014GeorgThiemeVerlagKG, Someoftheproductnames,patents,andregistereddesignsreferredtointhisbookareinfact
Rüdigerstrasse14,70469Stuttgart,Germany registeredtrademarksorproprietarynameseventhoughspecificreferencetothisfactisnot
http://www.thieme.de alwaysmadeinthetext.Therefore,theappearanceofanamewithoutdesignationaspropriet-
ThiemeMedicalPublishers,Inc.,333SeventhAvenue, aryisnottobeconstruedasarepresentationbythepublisherthatitisinthepublicdomain.
NewYork,NY10001,USA Thisbook,includingallpartsthereof,islegallyprotectedbycopyright.Anyuse,exploitation,
http://www.thieme.com orcommercializationoutsidethenarrowlimitssetbycopyrightlegislation,withoutthepub-
lisherʼsconsent,isillegalandliabletoprosecution.Thisappliesinparticulartophotostatrepro-
Coverdesign:ThiemePublishingGroup duction,copying,mimeographing,preparationofmicrofilms,andelectronicdataprocessing
TypesettingbyZiegler+Müller,Kirchentellinsfurt,Germany andstorage.
PrintedinChinabyEverbestPrintingLtd,HongKong
ISBN978-3-13-650704-9
EISBN 978-3-13-169684-7
P R E FAC E
TheAtlasofGynecologicSurgeryhasalongandrespectedhistory,goingbacktoits The result is a modern surgical authority with more than 1100 illustrations that
firstGermaneditionin1960.Sincethattime,gynecologyasascienceandthereper- givesacomprehensiveandcurrentpictureofoperativegynecologyandobstetrics.
tory of gynecologic operations have changed and developed in many significant Weareconvincedthatthispresentationwillprovidethereaderwithgreatpleasure
ways.Thetaskofconsolidatingthisconstantlygrowingknowledgeandtransform- andvisualenjoyment.
ingit,withtheapplicationofamultiplyingnumberoftechniques,intothebestpos-
sibleoperativetreatmentforpatientsisbecomingmoreandmorechallengingfor Theenormouschallengeofbringingoutthisinternationalworkinrejuvenatedform
physicians. whileretainingthetriedandtrustedcorewasmetthankstotheintensejointin-
volvementofthepublisher,authors,andgraphicartists.
Theprincipalgoalofthepresentworkwasandisastructuredpresentationofboth V
thescientist’sandthecraftsman’sviewofthevariousabdominal,vaginal,endoscop- Intheproductionofthisatlaswehavebeenhelpedbymanyandmanyneedtobe
icandsenologicoperationsinourfield,apresentationthatislucidandplacedinthe thanked.
rightcontext.
WewouldfirstliketothankThiemePublishersfortheircouragetotakeonthere-
Thischallenge,aswellasthemanychangesandparadigmshiftsoccurringinthe editionofsuchanoutstandingworkbothofscienceandofart.Thetremendoussuc-
yearssincethelastreworkingoftheEnglisheditionin1997,calledforafar-reaching cessoftheAtlas’neweditionintheGerman-speakingcountrieshasalreadyreward-
revisionofdesignandcontent.Thus,allaspectsofthiscurrenteditionhavebeen edthisinitiativeandtheconfidenceputintotraditionaldrawingsinthecontextof
changedandrenewed. surgicalteaching.
Theintroductorychaptersarefollowedbyatopographicalorganizationintosections Wewouldalsoliketothankourmedicalartist,ReinholdHenkel,forover10yearsof
treating theadnexa,uterus,vulva/vagina,andpelvicfloor.There,whereuseful,a closeandhighlycreativecollaboration.ReinholdHenkelpassedawaythisyear,and
distinctionismadebetweenabdominal(open),vaginal,andendoscopicapproaches. theworldofmedicalarthaslostanexceptionalartist.
Thechaptersonsurgicaltechniquesbeginwiththesimpleroperationsandmoveon
tothemoredifficulttechniques.Atthesametime,theOperationNavigator,newly CountlesshoursofexcitingworkwentintothisAtlas.Combinedwithourobliga-
developedespeciallyforthisbook,facilitatesaconvenientsearchfromthedisease tionsasdirectorsoflargeuniversitydepartments,wedevoteatremendousamount
totheindicationtotheoperationofchoice(seethegraphiconp.VI). ofourtimeintowhatweloveasgynecologicsurgeons:creatingamodernandlast-
ingschoolofbenignandgynecologicsurgery.
TheAtlasofGynecologicSurgeryisknownallovertheworldasaworkrichintradi-
tionthatlaysouttheentirefieldofoperativegynecologyindetailandatthehighest Itismorethanappropriateatthispointtoappreciatethesupportofbothofourfam-
level.Thecollectionofstill-applicableillustrationsfromearliereditionsandmore iliesovertheyears.WithaspecialthankstoGabriele,Markus,andChristian,aswell
than500newdrawingscontributetothenewcompositionofaworkofexcellentes- asGraziella,Nicholas,andCharlotte,wededicatethisbooktoourfamiliesandtoour
thetic and didactic quality. The conceptual reworking and the new textual and patients.
graphicconfigurationoftheworkmaturedforalmostadecade.Evenuntilshortly
beforethebookwenttopress,drawingswerestillbeingupdatedandrelevantinno- DiethelmWallwiener,Tübingen
vationswereworkedintotheappropriatechapters. SvenBecker,Frankfurt
FortheEnglishedition,twointernationaleditorshavebeeninvited.Theircollabora-
tionallowsforatrulyinternationalperspectiveofcurrentandclassicalgynecology.
Searching by body region
(e.g.adnexa,uterus,pelvicfloor)
Allpertinentinformationissummarizedinonechapter.
PreliminaryRemarksabouttheRegion
Page192–202
ConceptsforSurgicalTreatment—
ProcedureNavigator
Page203–220
SurgicalTechniques
VI
Page221–355
Abdominal Vaginal Endoscopic
Introduction to specific
characteristics of the body region
Topographyoftheapproach
(abdominal,vaginal,endoscopic)
Search for a selected operation
Orientationbasedonuniformlystructuredtables
IndicationsandContraindications
OperationRisksandInformedConsent
Guide to selecting a method OperationPlanning
Fromthediseasetotheindicationtotheintervention.
Procedure
Whataretheoptions?Theoperationofchoice!
Complications
ConcurrentandPostoperativeTreatment
LimitsoftheMethods
GR APHIC ARTWORK
Why watercolor drawings in the era of multimedia images? The detailed and This,togetherwiththeuniquequalityofthedrawingsintheatlas,suggestedcon-
uniqueillustrations,particularlythoseofthetwoillustratorsAndreaSchnitzlerand tinuing the work as a means of teaching operative surgery based on watercolor
Karl-HeinzSeeber,werealwaysthespecialtreasureofthetraditional“AtlasofGyne- drawings.
cologicSurgery”.Thehistoryofmedicineoverallandthatofsurgeryinparticularis
inconceivablewithoutattractiveandanatomicallyexactreproductionsoftheavail- Fornearlyadecade,drawingshadbeenselectedfromthewealthofexistingillustra-
ableknowledge.TheserangefromtheanatomicaldrawingsoftheRenaissanceand tions,andnewwatercolorswereproducedinminuteandtime-consumingdetail.
thescientificdiagramsofthe19thcenturytothegreatsurgicalatlasesoftheVien- Like the authors and draftsmen of previous editions, the authors of this edition
neseschoolandtheAmericantradition(Brödel,Netter)anduptothepresentday. workedcloselywithandwereinvolvedindetaileddiscussionswithReinholdHenkel
Many of the “classical” views have become the general property of the medical toobtainillustrationsofoptimalquality. VII
worldsothathardlyanyonenowknowswhofirstdrewthemandcreatedadidactic
workofart. Theeditors
Thieme,thepublisheroftheatlas,deliberatelycontinuedtheesthetictraditionof
theworkincommissioningReinholdHenkel,anoutstandingdraftsmanandartist,
toprovideillustrationsforthenewedition.
Inthedigitalworld,photographyhasoftenreplacedgraphicart,notleastbecauseit
iseasierandrequireslessefforttotakearepresentativephotothantodevelopan
illustration.Eventoday,however,acarefullyandartisticallyplanneddrawingwill
besuperiortoaphotoinmostcases.Onlyawell-consideredgraphicillustrationis
capableofcombiningperfectlytheexactanatomy,generalizedpathology,athree-
dimensionalview,anddidacticinformation.Inaworldpermeatedbydigitalinfor-
mationtechnology,thetraditionalpictureproducedbyhandexertsanimmediate
effectthroughitsinimitable“authenticity”andestheticexpression.