{"paper_id":"aa4b2651-0286-401a-a6da-fc8b6ac8d63c","body_text":"Abstract\nGiven the anatomic proximity of the female reproductive system to other abdominal and pelvic structures, surgeons commonly find themselves faced with a decision regarding these organs. Similarly, the overlap of signs and symptoms in gynecological and surgical diseases commonly leads to the inclusion of a gynecological disease in a differential diagnosis.1 Thus, it is imperative that the surgeon has a general understanding of operative and nonoperative gynecology.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nPreview\nUnable to display preview. Download preview PDF.\nSimilar content being viewed by others\nReferences\nCurtis KM, Hillis SD, Kieke BA Jr, Brett KM, Marchbanks PA, Peterson HB. Visits to emergency departments for gynecologic disorders in the United States, 1992–1994. Obstet Gynecol 1998;91:1007–1012.\nVisco AG, Del Priore G. Postmenopausal Bartholin gland enlargement: a hospital-based cancer risk assessment. Obstet Gynecol 1996;87:286–290.\nSperoff L, Glass RH, Kase NG. Clinical Gynecologic Endocrinology and Infertility, 5th ed. Baltimore: Williams & Wilkins, 1994.\nRossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 2002;288(3):321–333.\nAnderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA 2004;291(14):1701–1712.\nWarren MP. A comparative review of the risks and benefits of hormone replacement therapy regimens. Am J Obstet Gynecol 2004;190(4):1141–1167.\nBeigi RH, Wiesenfeld HC. Pelvic inflammatory disease: new diagnostic criteria and treatment. Obstet Gynecol Clin N Am 2003;30(4):777–793.\nYeh JM, Hook EW 3rd, Goldie SJ. A refined estimate of the average lifetime cost of pelvic inflammatory disease. Sex Transm Dis 2003;30(5):369–378.\nCenters for Disease Control and Prevention. 2002 Guidelines for treatment of sexually transmitted diseases. MMWR (Morb Mortal Wkly Rep) 2002;51(RR-6]:48–51.\nFarley TM, Rosenberg MJ, Rowe PJ, Chen JH, Meirik O. Intrauterine devices and pelvic inflammatory disease: an international perspective. Lancet 1992;339:785–788.\nScholes D, Stergachis A, Ichikawa LE, Heidrich FE, Holmes KK, Stamm WE. Vaginal douching as a risk factor for cervical Chlamydia trachomatis infection. Obstet Gynecol 1998;91:993–997.\nJacobson L. Differential diagnosis of acute pelvic inflammatory disease. Am J Obstet Gynecol 1980;138:1006–1011.\nPatten RM, Vincent LM, Wolner-Hanssen P, Thorpe E Jr. Pelvic inflammatory disease. Endovaginal sonography with laparoscopic correlation. J Ultrasound Med 1990;9:681–689.\nCacciatore B, Leminen A, Ingman-Friberg S, Ylostalo P, Paavonen J. Transvaginal sonographic findings in ambulatory patients with suspected pelvic inflammatory disease. Obstet Gynecol 1992;80:912–916.\nBoardman LA, Peipert JF, Brody JM, Cooper AS, Sung J. Endovaginal sonography for the diagnosis of upper genital tract infection. Obstet Gynecol 1997;90:54–57.\nNess RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol. 2003;188(2):598–600.\nPerez-Medina T, Huertas MA, Bajo JM. Early ultrasound-guided transvaginal drainage of tubo-ovarian abscesses: a randomized study. Ultrasound Obstet Gynecol 1996;7:435–438.\nAboulghar MA, Mansour RT, Serour GI. Ultrasonographically guided transvaginal aspiration of tuboovarian abscesses and pyosalpinges: an optional treatment for acute pelvic inflammatory disease. Am J Obstet Gynecol 1995;172:1501–1503.\nNelson AL, Sinow RM, Renslo R, Renslo J, Atamdede F. Endovaginal ultrasonographically guided transvaginal drainage for treatment of pelvic abscesses. Am J Obstet Gynecol 1995;172:1926–1932.\nFeld R, Eschelman DJ, Sagerman JE, Segal S, Hovsepian DM, Sullivan KL. Treatment of pelvic abscesses and other fluid collections: efficacy of transvaginal sonographically guided aspiration and drainage. AJR Am J Roentgenol 1994;163:1141–1145.\nvanSonnenberg E, D’Agostino HB, Casola G, Goodacre BW, Sanchez RB, Taylor B. US-guided transvaginal drainage of pelvic abscesses and fluid collections. Radiology 1991;181:53–56.\nBreen JL. A 21 year survey of 654 ectopic pregnancies. Am J Obstet Gynecol 1970;106:1004–1019.\nCenters for Disease Control and Prevention. Advanced report of final mortality statistics. Mon Vital Stat Rep 1995;43:11–13.\nCenters for Disease Control and Prevention. Ectopic pregnancy-United States 1990–1992. MMWR (Morb Mortal Wkly Rep) 1995;44:46–48.\nZane SB, Kieke BA Jr, Kendrick JS, Bruce C. Surveillance in a time of changing health care practices: estimating ectopic pregnancy incidence in the United States. Matern Child Health J 2002;6(4):227–236.\nChow WH, Daling JR, Cates W Jr, Greenberg RS. Epidemiology of ectopic pregnancy. Epidemiol Rev 1987;9:70–94.\nPeterson HB, Xia Z, Hughes JM, Wilcox LS, Tylor LR, Trussell J. The risk of ectopic pregnancy after tubal sterilization. U.S. Collaborative Review of Sterilization Working Group. N Engl J Med 1997;336:762–767.\nSulak, PJ. Intrauterine device practice guidelines: patient types. Contraception 1998;58(3 suppl):55S–58S.\nAmerican Society for Reproductive Medicine. Assisted Reproductive Technology in the United States: 2000 results generated from the ASRM/SART Registry. Fertil Steril 2004;81(5):1207–1215.\nKadar N, Bohrer M, Kemmann E, Shelden R. The discriminatory human chorionic gonadotropin zone for endovaginal sonography: a prospective, randomized study. Fertil Steril 1994;61:1016–1020.\nKadar N, Caldwell BV, Romero R. A method of screening for ectopic pregnancy and its indications. Obstet Gynecol 1981;58:162–166.\nBarnhart KT, Sammel MD, Rinaudo PF, Zhou L, Hummel AC, Guo W. Symptomatic patients with an early viable intrauterine pregnancy: HCG curves redefined. Obstet Gynecol 2004;104(1):50–55.\nMurphy AA, Nager CW, Wujek JJ, Kettel LM, Torp VA, Chin HG. Operative laparoscopy versus laparotomy for the management of ectopic pregnancy: a prospective trial. Fertil Steril 1992;57:1180–1185.\nVermesh M, Silva PD, Rosen GF, Stein AL, Fossum GT, Sauer MV. Management of unruptured ectopic gestation by linear salpingostomy: a prospective, randomized clinical trial of laparoscopy versus laparotomy. Obstet Gynecol 1989;73:400–404.\nLundorff P, Thorburn J, Lindblom B. Fertility outcome after conservative surgical treatment of ectopic pregnancy evaluated in a randomized trial. Fertil Steril 1992;57:998–1002.\nTulandi T, Guralnick M. Treatment of tubal ectopic pregnancy by salpingotomy with or without tubal suturing and salpingectomy. Fertil Steril 1991;55:53–55.\nKorell M, Albrich W, Hepp H. Fertility after organ-preserving surgery of ectopic pregnancy: results of a multicenter study. Fertil Steril 1997;68:220–223.\nSilva PD, Schaper AM, Rooney B. Reproductive outcome after 143 laparoscopic procedures for ectopic pregnancy. Obstet Gynecol 1993;81:710–715.\nde la Cruz A, Cumming DC. Factors determining fertility after conservative or radical surgical treatment for ectopic pregnancy. Fertil Steril 1997;68:871–874.\nHajenius PJ, Engelsbel S, Mol BW, et al. Randomised trial of systemic methotrexate versus laparoscopic salpingostomy in tubal pregnancy. Lancet 1997;350:774–779.\nStovall TG, Ling FW. Single-dose methotrexate: an expanded clinical trial. Am J Obstet Gynecol 1993;168:1759–1762.\nLipscomb GH, Bran D, McCord ML, Portera JC, Ling FW. Analysis of three hundred fifteen ectopic pregnancies treated with single-dose methotrexate. Am J Obstet Gynecol 1998;178:1354–1358.\nStika CS, Anderson L, Frederiksen MC. Single-dose methotrexate for the treatment of ectopic pregnancy: Northwestern Memorial Hospital three-year experience. Am J Obstet Gynecol 1996;174:1840–1846.\nGlock JL, Johnson JV, Brumsted JR. Efficacy and safety of single-dose systemic methotrexate in the treatment of ectopic pregnancy. Fertil Steril 1994;62:716–721.\nAlexander JM, Rouse DJ, Varner E, Austin JM Jr. Treatment of the small unruptured ectopic pregnancy: a cost analysis of methotrexate versus laparoscopy. Obstet Gynecol 1996;88:123–127.\nACOG Practice Bulletin. Medical Management of Tubal Pregnancy. Number 3, December 1998. Obstet Gynecol 1998;92(6):510–511.\nACOG Practice Bulletin. Prevention of Rh D Alloimmunization. Number 4, May 1999. Obstet Gynecol 1999;93(5):627–633.\nSommerville M, Grimes DA, Koonings PP, Campbell K. Ovarian neoplasms and the risk of adnexal torsion. Am J Obstet Gynecol 1991;164:577–578.\nMerritt DF. Torsion of the uterine adnexa: a review. Adolesc Pediatr Gynecol 1991;4:3–13.\nChang KH, Hwang KJ, Kwon HC, et al. Conservative therapy of adnexal torsion employing color Doppler sonography. J Am Assoc Gynecol Laparosc 1998;5:13–17.\nLee EJ, Kwon HC, Joo HJ, Suh JH, Fleischer AC. Diagnosis of ovarian torsion with color Doppler sonography: depiction of twisted vascular pedicle. J Ultrasound Med 1998;17:83–89.\nFleischer AC, Stein SM, Cullinan JA, Warner MA. Color Doppler sonography of adnexal torsion. J Ultrasound Med 1995;14:523–528.\nZweizig S, Perron J, Grubb D, Mishell DR Jr. Conservative management of adnexal torsion. Am J Obstet Gynecol 1993;168:1791–1795.\nChapron C, Capella-Allouc S, Dubuisson JB. Treatment of adnexal torsion using operative laparoscopy. Hum Reprod (Oxf) 1996;11:998–1103.\nMcHutchinson LL, Koonings PP, Ballard CA, d’Ablaing G III. Preservation of ovarian tissue in adnexal torsion with fluorescein. Am J Obstet Gynecol 1993;168:1386–1388.\nGoldstein SR, Subramanyam B, Snyder JR, Beller U, Raghavendra BN, Beckman EM. The postmenopausal cystic adnexal mass: the potential role of ultrasound in conservative management. Obstet Gynecol 1989;73:8–10.\nBailey CL, Ueland FR, Land GL, et al. The malignant potential of small cystic ovarian tumors in women over 50 years of age. Gynecol Oncol 1998;69:3–7.\nYuen PM, Yu KM, Yip SK, Lau WC, Rogers MS, Chang A. A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses. Am J Obstet Gynecol 1997;177:109–114.\nCanis M, Mage G, Pouly JL, Wattiez A, Manhes H, Bruhat MA. Laparoscopic diagnosis of adnexal cystic masses: a 12-year experience with long-term follow-up. Obstet Gynecol 1994;83(5 Pt 1):707–712.\nChilders JM, Nasseri A, Surwit EA. Laparoscopic management of suspicious adnexal masses. Am J Obstet Gynecol 1996;175(6):1451–1457; discussion 1457–1459.\nCanis M, Pouly JL, Wattiez A, Mage G, Manhes H, Bruhat MA. Laparoscopic management of adnexal masses suspicious at ultrasound. Obstet Gynecol 1997;89(5 Pt 1):679–683.\nDottino PR, Levine DA, Ripley DL, Cohen CJ. Laparoscopic management of adnexal masses in premenopausal and postmenopausal women. Obstet Gynecol 1999;93(2):223–228.\nMontz FJ, Schlareth JB, Morrow CP. The natural history of theca lutein cysts. Obstet Gynecol 1988;72:247–251.\nSandenbergh HA, Woodruff JD. Histogenesis of pseudomyxoma peritonei. Review of 9 cases. Obstet Gynecol 1977;49:339–345.\nWheeler JM. Epidemiology of endometriosis-associated infertility. J Reprod Med 1989;34(1):41–46.\nAmerican Society for Reproductive Medicine. Revised classification of endometriosis: 1996. Fertil Steril 1997;67(5):817–821.\nKoninckx PR, Martin DC. Deep endometriosis: a consequence of infiltration or retraction or possibly adenomyosis externa? Fertil Steril 1992;58(5):924–928.\nKoninckx PR, Oosterlynck D, D’Hooghe T, Meuleman C. Deeply infiltrating endometriosis is a disease whereas mild endometriosis could be considered a non-disease. Ann N Y Acad Sci 1994;734:333–341.\nAdamson D. Surgical management of endometriosis. Semin Reprod Med 2003;21(2):223–234.\nMol BW, Bayram N, Lijmer JG, et al. The performance of CA-125 measurement in the detection of endometriosis: a meta-analysis. Fertil Steril 1998;70(6):1101–1108.\nColacurci N, Fortunato N, De Franciscis P, et al. Serum and peritoneal CA-125 levels as diagnostic test for endometriosis. Eur J Obstet Gynecol Reprod Biol 1996;66(1):41–43.\nLing FW. Randomized controlled trial of depot leuprolide in patients with chronic pelvic pain and clinically suspected endometriosis. Pelvic Pain Study Group. Obstet Gynecol 1999;93(1):51–58.\nSutton CJG, Ewen SP, Whitelaw N, Haines P. Prospective, randomized, double-blind controls: trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild and moderate endometriosis. Fertile Steril 1994;62:696–700.\nJones KD, Haines P, Sutton CJG. Long-term follow-up of a controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild and moderate endometriosis. J Surg Laparosc Surg 2002;5:111–115.\nOlive DL, Shwartz LB. Endometriosis. N Engl J Med 1993;328:1759–1769.\nRies LAG, Eisner MP, Kosary CL, et al., eds. SEER Cancer Statistics Review, 1975–2001. National Cancer Institute, Bethesda, MD: http://seer.cancer.gov/csr/1975_2001/, 2004.\nJemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin 2007;57(1):43–66.\nEinhorn N, Sjovall K, Knapp RC, et al. Prospective evaluation of serum CA 125 levels for early detection of ovarian cancer. Obstet Gynecol 1992;80:14–18.\nColombo N, Chiari S, Maggioni A, Bocciolone L, Torri V, Man-gioni C. Controversial issues in the management of early epithelial ovarian cancer: conservative surgery and role of adjuvant therapy. Gynecol Oncol 1994;55:S47–S51.\nGriffiths CT. Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr 1975;42:101–104.\nHoskins WJ, McGuire WP, Brady MF, et al. The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. Am J Obstet Gynecol 1994;170:974–979.\nNIH Consensus Development Panel on Ovarian Cancer. Ovarian cancer: screening, treatment, andfollow-up. JAMA 1995;273:491–497.\nKurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long-term study of “untreated” hyperplasia in 170 patients. Cancer (Phila) 1985;56:403–412.\nFerenczy A, Gelfand M. The biologic significance of cytologic atypia in progestogen-treated endometrial hyperplasia. Am J Obstet Gynecol 1989;160:126–131.\nMaggino T, Romagnolo C, Landoni F, Sartori E, Zola P, Gad-ducci A. An analysis of approaches to the management of endometrial cancer in North America: a CTF study. Gynecol Oncol 1998;68:274–279.\nPeters WA III, Anderson WA, Thornton WN Jr, Morley GW. The selective use of vaginal hysterectomy in the management of adenocarcinoma of the endometrium. Am J Obstet Gynecol 1983;146:285–289.\nGreer BE, Cain JM, Figge DC, Shy KK, Tamimi HK. Supraumbilical upper abdominal midline incision for pelvic surgery in the morbidly obese patient. Obstet Gynecol 1990;76:471–473.\nGoff BA, Rice LW. Assessment of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol 1990;38:46–48.\nCreasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer: a Gynecologic Oncology Group study. Cancer (Phila) 1987;60:2035–2041.\nWilson TO, Podratz KC, Gaffey TA, Malkasian GD Jr, O’Brien PC, Naessens JM. Evaluation of unfavorable histologic subtypes in endometrial adenocarcinoma. Am J Obstet Gynecol 1990;162:418–423.\nSherman ME, Bitterman P, Rosenshein NB, Delgado G, Kurman RJ. Uterine serous carcinoma. A morphologically diverse neoplasm with unifying clinicopathologic features. Am J Surg Pathol 1992;16:600–610.\nSociety of Gynecologic Oncologists. Clinical practice guidelines: uterine corpus—endometrial cancer. Oncology 1998;12:122–126.\nFanning J, Evans MC, Peters AJ, Samuel M, Harmon ER, Bates JS. Adjuvant radiotherapy for stage I, grade 2 endometrial adenocarcinoma and adenoacanthoma with limited myometrial invasion. Obstet Gynecol 1987;70:920–922.\nKeys HM, Roberts JA, Brunetto VL, et al; Gynecologic Oncology Group. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 2004;92:744–751.\nThigpen JT, Blessing J, Holmsley HD, Lia S. Phase III trial of doxorubicin versus doxorubicin plus cisplatin in advanced or recurrent endometrial carcinoma. Proc Am Soc Clin Oncol 1993;12:261.\nBall HG, Blessing JA, Lentz SS, Mutch DG. A phase II trial of paclitaxel in patients with advanced or recurrent adenocarcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol 1996;62:278–281.\nFleming GF, Fowler JM, Waggoner SE, et al. Phase I trial of escalating doses of paclitaxel combined with fixed doses of cisplatin and doxorubicin in advanced endometrial cancer and other gynecologic malignancies: a Gynecologic Oncology Group study. J Clin Oncol 2001;19:1021–1029.\nParkin DM, Pisani P, Ferlay J. Global cancer statistics. CA Cancer J Clin 1999;49(1):33–64.\nSolomon D, Schiffman M, Tarone R; ALTS Study Group. Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: baseline results from a randomized trial. J Natl Cancer Inst 2001;93:293–299.\nBenedet J, Odicono F, Maisonneuve P, et al. FIGO annual report on the results of treatment in gynaecological cancer: carcinoma of the cervix uteri. J Epidemiol Biostat 1998;3:5–34.\nWhitney CW, Sause W, Bundy BN, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol 1999;17:1339–1348.\nMorris M, Eifel PJ, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med 1999;340:1137–1143.\nRose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999;340:1144–1153.\nPeters WA III, Liu PY, Barrett RJ II, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 2000;18:1606–1613.\nKeys HM, Bundy BN, Stehman FB, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 1999;340:1154–1161.\nKozak LJ, Owings MF, Hall MJ. National Hospital Discharge Survey: 2002 annual summary with detailed diagnosis and procedure data. Vital Health Stat 13 2005;(158):1–199.\nWilcox LS, Koonin LM, Pokras R, Strauss LT, Xia Z, Peterson HB. Hysterectomy in the United States, 1988–1990. Obstet Gynecol 1994;83:549–555.\nBeinfeld MT, Bosch JL, Isaacson KB, Gazelle GS. Cost-effectiveness of uterine artery embolization and hysterectomy for uterine fibroids. Radiology 2004;230(1):207–213.\nStewart EA, Gedroyc WM, Tempany CM, et al. Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive thermoablative technique. Am J Obstet Gynecol 2003;189(1):48–54.\nAuthor information\nAuthors and Affiliations\nEditor information\nEditors and Affiliations\nRights and permissions\nCopyright information\n© 2008 Springer Science+Business Media, LLC\nAbout this chapter\nCite this chapter\nBoswell, H.B., Rader, J.S., Cohn, D.E. (2008). Gynecology. In: Norton, J.A., et al. Surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-68113-9_106\nDownload citation\nDOI: https://doi.org/10.1007/978-0-387-68113-9_106\nPublisher Name: Springer, New York, NY\nPrint ISBN: 978-0-387-30800-5\nOnline ISBN: 978-0-387-68113-9\neBook Packages: MedicineMedicine (R0)\nKeywords\nThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.","source_license":"CC0","license_restricted":false}