Table Of ContentBonney’s Gynaecological Surgery
Bonney’s Gynaecological Surgery, Eleventh Edition
Tito Lopes, Nick M. Spirtos, Raj Naik and John M. Monaghan
© 2011 Tito Lopes, Nick M. Spirtos, Raj Naik, John M. Monaghan
ISBN: 978-1-405-19565-2
This book is dedicated to the memory of Victor Bonney.
It is also dedicated to Jane, Vicki, Roopal and Maggie for their support, understanding,
patience and love, which they have shown us in our lives together .
Bonney’s Gynaecological
Surgery
Tito Lopes
MBChB, FRCOG
Consultant Gynaecological Oncologist
Royal Cornwall Hospital
Truro
UK
Nick M. Spirtos
MD
Professor and Vice-Chairman, Department of Obstetrics and Gynecology
Director, Division of Gynecologic Oncology, University of Nevada School of
Medicine, Reno, and the Women’s Cancer Center of Nevada, Las Vegas
NV, USA
Raj Naik
MD, FRCOG
Consultant Gynaecological Oncologist and Surgeon
Clinical Director of the Northern Gynaecological Oncology Centre
Queen Elizabeth Hospital
Gateshead
UK
John M. Monaghan
MB, FRCS (Ed), FRCOG
Retired Senior Lecturer in Gynaecological Oncology, University
of Newcastle Upon Tyne
Retired Gynaecological Oncologist, Regional Department of
Gynaecological Oncology
Queen Elizabeth Hospital
Gateshead
UK
ELEVENTH EDITION
A John Wiley & Sons, Ltd., Publication
This edition fi rst published 2011 © 1911, 1974, 1986, 2004, 2011 by Tito Lopes, Nick M. Spirtos, Raj Naik, John M. Monaghan
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Library of Congress Cataloging-in-Publication Data
Bonney’s gynaecological surgery. – 11th ed. / Tito Lopes ... [et al.].
p. ; cm.
Other title: Gynaecological surgery
Includes bibliographical references and index.
ISBN 978-1-4051-9565-2
1. Generative organs, Female–Surgery. I. Lopes, Tito. II. Bonney, Victor, 1872–1953. Gynaecological
surgery. III. Title: Gynaecological surgery.
[DNLM: 1. Gynecologic Surgical Procedures. 2. Genitalia, Female–surgery. WP 660 B7171 2010]
RG104.B65 2010
618.1–dc22
2010015117
ISBN: 9781405195652
A catalogue record for this book is available from the British Library.
This book is published in the following electronic format: ePDF 9781444325232; Wiley Online Library 9781444325225
Set in 9/11.5 pt Sabon by Toppan Best-set Premedia Limited
01 2011
Contents
Preface to the eleventh edition, vii
Preface to the ninth edition, ix
Part 1: General
1 Introduction and prologue, 3
2 Preparation for surgery, 7
3 Instruments, operative materials and basic surgical techniques, 15
4 Opening and closing the abdominal cavity, 31
5 The laparoscopic approach in gynaecology, 42
6 Postoperative care and complications, 52
Part 2: Anatomical
For the general gynaecologist and gynaecologist in training
7 Operations on the vulva, 59
8 Operations on the vagina, 66
9 Operations on the cervix, 81
10 Operations on the uterine cavity, 99
11 Operations on the uterus, 105
12 Uterine fi broids, 121
13 Operations on the fallopian tubes, 125
14 Operations on the ovaries, 131
15 Caesarean section, 136
Part 3: Condition
Recognition of surgical special interest and subspecialties
Urinary/pelvic fl oor
16 Operations for pelvic organ prolapse, 149
Gillian E. Fowler and David H. Richmond
17 Operations for urinary incontinence, 161
David H. Richmond
18 Operations for the correction of urinary fi stulae, 175
David H. Richmond
v
CONTENTS
Oncology
19 Surgery for carcinoma of the vulva, 181
20 Vaginal cancer surgery, 190
21 Cervical cancer, 192
22 Uterine cancer, 216
23 Ovarian cancer, 219
24 Exenterative surgery, 222
Operations on other organs
25 Vascular surgery: applications in gynaecology and
gynaecological oncology, 231
26 Urinary tract, 235
27 Operations on the intestinal tract for the gynaecologist, 250
28 Reconstructive procedures, 260
Index, 263
vi
Preface to the e leventh e dition
Next year, Bonney ’ s Gynaecological Surgery cele- last section recognizes the two surgical subspecialties
brates its 100th birthday, the fi rst edition having been of urogynaecology and gynaecological oncology.
published in 1911 by Comyns Berkeley and Victor Although several of the procedures described are cur-
Bonney. In those 100 years, major advances in anaes- rently undertaken by the experienced generalist as
thetics, transfusion services, antibiotics and instru- well as the specialist, this is becoming less common,
ment development have not only resulted in safer especially in cancer surgery. This section also covers
surgery for the patient but also have allowed increas- surgery for other sites that may arise during gynaeco-
ing innovation in surgical procedures. logical surgery, either as a planned procedure or as
In gynaecology this is exemplifi ed by the almost the result of an unexpected fi nding or complication.
routine use of minimal access techniques in everyday Although rarely encountered in general gynaecology,
practice, as well as the increasing surgical options in and usually within the remit of one ’ s surgical col-
the urological and oncological subspecialties. leagues, it is important to understand the principles
Despite these advances, many of the basic surgical of the procedures involved.
principles remain unchanged, and this is highlighted As the senior editor I am indebted to John Monaghan
by the retention in this edition of some of Bonney ’ s and Raj Naik for their continued support and I am
original drawings 100 years on. extremely grateful to Nick Spirtos for agreeing to join
Three of the current editors have worked in the us in editing this current edition. His skills in both
department of gynaecological oncology in Gateshead laparoscopic and radical open surgery are recognized
started by Stanley Way in 1948. It is therefore not internationally and his methodical approach to these
surprising that this 11th edition refl ects an evolution procedures is refl ected in his contributions to the
rather than a revolution from the 9th edition edited book. I also wish to thank David Richmond and
by John Monaghan in 1986, the preface of which Gillian Fowler for their contributions to the section
follows this current preface. on urogynaecology.
As with previous editors, I have taken the liberty Lastly, my thanks to Wiley- Blackwell and espe-
of removing elements from the last edition which are cially to publisher Martin Sugden for inviting me to
no longer relevant to current practice. The format lead on this edition of Bonney ’ s Gynaecological
has also changed and the current edition is divided Surgery . The support and encouragement of their
into three sections. The fi rst section, covering general team along with that of Lindsey Williams has made
principles and basic techniques, lays the foundation the whole process a pleasure.
for any trainee wishing to develop into a competent
gynaecological surgeon. The second section, presented Tito Lopes
by anatomical site, covers the common procedures Truro, Cornwall
undertaken in day - to - day benign gynaecology. The September 2010
vii
Preface to the n inth e dition
The infl uence of Victor Bonney and his pupils upon Bonney ’ s Gynaecological Surgery some 2 years ago,
gynaecological surgery has developed from the pub- I replied that I thought that it was undoubtedly the
lication of the fi rst edition of A Textbook of leading textbook of gynaecological surgery in the
Gynaecological Surgery in 1911. The fi rst to the world, but would nevertheless benefi t from a major
fourth editions were the results of the collaboration revision. I also jokingly said ‘ Give me fi ve years and
of Bonney with Sir Comynus Berkeley. Following the I will do it for you ’ . The prompt rejoinder was ‘ We
death of the latter, Victor Bonney produced the fi fth will give you two years if you will take it on ’ . Little
and sixth editions alone. Bonney ’ s pupils Howkins did I know at the time that I had been ‘ set up ’ , as the
and Macleod then produced the seventh edition. The Americans say. I felt hesitant at the prospect of
death of Macleod signalled virtually the end of those making major changes to such a well- established
practising surgeons who had been trained by Victor book but realized that large- scale changes were neces-
Bonney. The very successful eighth edition was pre- sary and also that if modern materials and instru-
pared by John Howkins and Sir John Stallworthy. ments were to be incorporated, most of the drawings
These two great fi gures of Commonwealth would require reworking.
Gynaecology had worked together as junior col- It was also clear that no single surgeon could
leagues during the last years of Bonney ’ s clinical encompass all the skills of modern gynaecological
career. surgery and that I would need assistance with three
When the eighth edition was published in 1974 major sections. I have been delighted with the response
many changes were incorporated into the text. and the quality of the contributions from Sir Rustam
However, in the next 10 years, an enormous number Feroze, Stuart L. Stanton and Professor John R.
of new developments have occurred, possibly the Newton. I am indebted to them.
greatest being a resurgence of interest in gynaecologi- Victor Bonney had skills far beyond those of mere
cal surgery and the growth and establishment of mortals; to be able to operate to the highest level and
gynaecological oncology as a recognized subspecialty. then to be capable of transferring those ideas to paper
The present editor has only a tenuous link with Victor as the most clear and concise drawings was an
Bonney in that he has been greatly infl uenced in his amazing talent. I have been especially fortunate in
career by the late Dr A.F. Anderson of Edinburgh and obtaining the services of Mr Douglas Hammersley,
by Mr Stanley Way, both of whom spoke frequently once head of graphics at the University of Newcastle
with great affection and reverence of the master upon Tyne, to illustrate all the chapters which have
surgeon. Indeed it was Way who introduced me to been rewritten. Doug has now moved to Norfolk to
the Bonney scissors, which instruments the reader will be a little closer to his chief interest, that of observing
see referred to throughout this edition. and drawing butterfl ies. I am sure that the reader will
When asked by the medical editor of Bailliè re appreciate the outstanding quality of the drawings in
Tindall for my opinion of the eighth edition of this new edition, in particular the way in which they
ix
PREFACE TO THE NINTH EDITION
have captured the movement and dynamism of cations sections, which although historically interest-
surgery. I am totally indebted to Doug for bringing ing are not relevant to modern- day practice except as
to life my attempts at surgery. records of the past. Their repetition would simply
This book is very much my own; the philosophy of occupy space.
the surgery is entirely mine and the responsibility for This ninth edition hopefully refl ects the most
making such drastic alterations to this classic text are modern aspects of gynaecological surgery as well as
also mine. I do not make apologies as I feel that retaining all that is still valuable and relevant from
Bonney would have approved because I have past editions. It also emphasizes the continuing role
attempted to keep his beloved gynaecological surgery of gynaecological surgery in the management of a
moving forward. Indeed, even between the beginning multitude of gynaeco - logical conditions, particularly
and end of the 2 - year writing period, new develop- highlighting the place of surgery in cancer care and
ments have occurred which have had to be incorpo- the newer surgical technique relating to the infertile
rated into the text. woman. The place of new tools such as the laser and
I have attempted to show that by adopting an staples has been added to the more standard
economy of movement in surgery as well as in the instrumentation.
text, operations can be performed cleanly and neatly, I would like to thank Bailliè re Tindall and in par-
without ritual. Operations should fl ow with a style ticular Dr Geoffrey Smaldon for his constant support.
and a natural pace, rather like a well- choreographed To all those who have assisted, guided and encour-
dance. There should be no great crises and the pro- aged me during my career, occasionally allowing this
cedure should not be performed to the point of total stubborn, single - minded Yorkshireman to have his
exhaustion for the surgeon and his staff. I have tried way, I am grateful.
to show the enormous enthusiasm which I have for Very special thanks must go to Mr Alan Evans
gynaecological surgery and the way in which I feel who, as my senior registrar, painstakingly read all my
that it can become a source of great satisfaction and fi rst drafts and attempted to bring a Welsh view of
pride. I hope that a little of this enthusiasm is trans- the English language to bear upon my efforts.
mitted to the reader and that this book will bring I stand in great awe at the end of a long line of
forth new energies for the development of our fasci- illustrious names in gynaecological surgery. I hope
nating subject. that I have done them justice in this the ninth edition
The updating of this text has been for me an enor- of Bonney ’ s Gynaecological Surgery .
mous honour and a great pleasure. I have had to
clarify my thoughts on many aspects of surgery and John M. Monaghan
take bold decisions to cut out large quantities of the Newcastle upon Tyne
previous edition, particularly the results and compli- April 1986
xx
Part 1: General
Bonney’s Gynaecological Surgery, Eleventh Edition
Tito Lopes, Nick M. Spirtos, Raj Naik and John M. Monaghan
© 2011 Tito Lopes, Nick M. Spirtos, Raj Naik, John M. Monaghan
ISBN: 978-1-405-19565-2
