Arri Coomarasamy, MBChB, MD, FRCOG. Professor of Gynaecology, Institute of Metabolism and System Research, University of Birmingham. Consultant Gynaecologist and Sub-specialist in Reproductive Medicine and Surgery, Birmingham Women's Hospital, Birmingham, United Kingdom. Mahmood I. Shafi, MBBCh, MD, DA, FRCOG. Consultant Gynecological Surgeon and Oncologist, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. G. Willy Davila, MD, FACOG. Center Director, Women's Health Institute (Florida), Chairman, Department of Gynecology, Head, Section of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston/Fort Lauderdale, Florida, United States. K. K. Chan, MBBS, FRCS, FRCOG. Emeritus Consultant Gynecological Oncologist, Pan-Birmingham Gynecological Cancer Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust. Birmingham, United Kingdom.

• Contributors, xPreface, xvList of Abbreviations, xviPart I: General Preoperative, Intraoperative, and Postoperative ChallengesSection 1: Preoperative CareEditors: Phil Moore and Arri Coomarasamy1 Patient with Poor ASA Score, 3Phil Moore2 Patient on Medication, 6Arri Coomarasamy3 Patient with Ischemic Heart Disease, 9Sohail Q. Khan and Jonathan N. Townend4 Patient with Arrhythmias, 13Sanoj Chacko and Joseph de Bono5 Patient with a Pacemaker or Implantable Defibrillator, 17Howard Marshall6 Patient with Complex Congenital Heart Disease (Fontan Circulation), 20Yaso Emmanuel and Sara A. Thorne7 Hypertensive Patient, 22Aarthi R. Mohan and Catherine Nelson-Piercy8 Patient with Respiratory Disease, 25Heinke Kunst9 Patient with Diabetes, 28Arri Coomarasamy and Dukaydah van der Berg10 Patient with Thyroid Disease, 30Ramy Labib and Shiao-yng Chan11 Patient with Renal Disease, 33Khalid Hasan12 Patient with Liver Disease, 35Joanna K. Dowman and Philip N. Newsome13 Patient with Rheumatologic Diseases, 38Amita A. Mahendru and Justin Chu14 Patient with Hematologic Disorders, 41Chieh Lin Fu15 Patient at High Risk of Venous Thrombosis, 44Ian A. Greer16 Patient on Anticoagulant Therapy, 47Sophie Lee and Will Lester17 Patient on Steroid Therapy, 50Shaista Nazir and John Ayuk18 Patient with Epilepsy, 54Danita Jones and Virgilio Salanga19 Patient with a Psychiatric Condition, 56Idnan Yunas20 Patient with Organ Transplant, 59Sarah Winfield21 Patient with Hepatitis B or C, 61Firas Al-Rshoud and Arri Coomarasamy22 Patient with HIV, 64Firas Al-Rshoud and Arri Coomarasamy23 Obese Patient, 67Phil Moore24 Patient with Poor Nutritional Status, 69Phil Moore25 Pregnant Patient Requiring Non-obstetric Surgery, 71Arri CoomarasamySection 2: Intraoperative CareEditors: Arri Coomarasamy and Mahmood I. Shafi26 Transverse Incision on the Abdomen Inadequate for Surgery, 77Arri Coomarasamy27 Previous Multiple Abdominal Scars, 79Mohammed Khairy and Arri Coomarasamy28 Patient with Previous Mesh Incisional Hernia Repair Requiring a Laparotomy, 83Christopher Smart and Chris Keh29 Patient with Previous Mesh Incisional Hernia Repair Requiring a Laparoscopy, 86Emanuele Lo Menzo, Samuel Szomstein, and Raul J. Rosenthal30 Unexpected Pathology: Ovarian Cyst, 89Mohan Kumar31 Unexpected Pathology: Abnormal Appearance of the Uterus, 92Arri Coomarasamy32 Unexpected Pathology: Severe Pelvic Adhesions, 94Stephen E. Zimberg and Michael L. Sprague33 Unexpected Pathology: Abnormal Appearance of Bowel, 97Olivia Will and Justin Davies34 Unexpected Pathology: Retroperitoneal Mass, 100Mohamed Mehasseb35 Bladder Injury, 103Arri Coomarasamy and Richard Popert36 Ureteric Injury, 106Arri Coomarasamy and Richard Popert37 Small and Large Bowel Injury, 111Howard Joy38 Inferior Epigastric Vessel Injury, 116Manas Chakrabarti and Sudha Sundar39 Bleeding from Retracted Pedicular (Pelvic Sidewall) Vessels, 119Michael L. Sprague and Stephen E. Zimberg40 Massive Hemorrhage, 121Karen Louise Moores, William Parry-Smith, and Martyn Underwood41 Broken Needle, 125Joanne Kathleen Ritchie, Anuradha Radotra, and Martyn Underwood42 Lost Swab, Needle or Instrument, 127Joanne Kathleen Ritchie, Martyn Underwood, and William Parry-SmithSection 3: Postoperative CareEditors: Arri Coomarasamy and Janesh Gupta43 Postoperative Care, 131Janesh Gupta, Robbert Soeters, and Aaron Ndhluni44 Excessive Nausea and Vomiting after Surgery, 133Phil Moore45 Excessive Abdominal Pain after Surgery, 136Manjeet Shehmar46 Bowel Damage: Postoperative Presentation, 139Ketan Gajjar and Mahmood I. Shafi47 Wound Infection, 142Pallavi Latthe and James Gray48 Wound Dehiscence, 147T. Justin Clark49 Late Wound Failure: Incisional Hernia, 150Saloney Nazeer50 Necrotizing Fasciitis, 153Tariq Ahmad51 Management of Surgical Drains, 156Ahmed M. El-Sharkawy and Sherif Awad52 Shocked Patient, 159Manjeet Shehmar53 Breathless Patient: Postoperative Pulmonary Complications, 162Heinke Kunst54 Confused Postoperative Patient, 165Idnan Yunas55 Patient with Poor Urine Output, 167Amelia Davison and Jackie A. Ross56 Electrolyte Imbalance, 170Manjeet Shehmar and Arri Coomarasamy57 Swollen Leg, 174Edwin Stephen, Indrani Sen, and Tim Lees58 Cardiorespiratory Arrest, 177Jennie KerrPART II: Operations and ChallengesSection 4: General and Minimal Access GynecologyEditors: T. Justin Clark, Kiong K. Chan, and Arri Coomarasamy59 Difficulty in Dilating the Cervix: Cervical Stenosis and Cervical Closure, 183Arri Coomarasamy60 Uterine Perforation, 186Arri Coomarasamy61 Surgical Uterine Evacuation: Excessive Bleeding, 189Rajesh Varma62 Surgical Uterine Evacuation in a Woman with Multiple Fibroids, 191Rajesh Varma63 Use of Excessive Distension Media at Hysteroscopy, 194Arri Coomarasamy64 Hysteroscopy: Endometrial Resection and Ablation in the Abnormal Uterine Cavity, 197Alessandro Conforti and Adam Magos65 Laparoscopy in a Pediatric Patient, 199Suketu M. Mansuria, Cara R. King, and Arri Coomarasamy66 Safe Laparoscopic Entry in a Thin Patient, 202Janesh Gupta and Justin Chu67 Laparoscopy: Unable to Gain Entry, 205Mohamed Mehasseb68 Surgical Emphysema, 208Arri Coomarasamy69 Venous Air Embolism, 210Anneke Chu and Jennie Kerr70 Laparoscopy: Problems with Monopolar Diathermy, 213Thomas G. Lang and Resad Pasic71 Laparoscopy: Problems with Bipolar Diathermy, 216Thomas G. Lang and Resad Pasic72 Laparoscopy: Bladder Injury, 218Peter L. Rosenblatt73 Laparoscopy: Ureteric Injury, 221Peter L. Rosenblatt74 Bowel Injury During Laparoscopy: Intraoperative Presentation, 224Alan Lam75 Bowel Injury After Laparoscopy: Late Presentation, 227Alan Lam76 Blood Vessel Injury at Laparoscopy, 230Elizabeth Ball77 Laparoscopy for Large Ovarian Cyst, 233T. Justin Clark78 Laparoscopy for an Ovarian Cyst in Pregnancy, 235T. Justin Clark79 Laparoscopic Removal of Rectovaginal Endometriosis, 238Alan Lam80 Laparoscopic Myomectomy, 242Ertan Saridogan81 Total Laparoscopic Hysterectomy, 245Alan Farthing82 Laparoscopic Hysterectomy for a Large Fibroid Uterus, 247Alan Lam83 Laparoscopy: Difficulty in Tissue Retrieval, 250Su-Yen Khong and Alan Lam84 Surgery for Cornual or Interstitial Pregnancy, 253Ayesha Mahmud and Yousri Afifi85 Surgery for Cervical Ectopic Pregnancy, 256Bassel H. Al Wattar and Yousri Afifi86 Surgery for Cesarean Scar Pregnancy, 259T. Justin Clark87 Surgery for Adnexal Torsion, 262Mohamed Otify and Jackie A. Ross88 Laparoscopic Appendectomy, 264Edward Rawstorne, Christopher Smart, and Chris Keh89 Laparoscopic Surgery: When to Convert to Laparotomy?, 267Mohamed Mehasseb90 Laparoscopy: Port-site Herniation, 269Ayesha Mahmud and Yousri AfifiSection 5: Reproductive SurgeryEditors: Arri Coomarasamy and Mahmood I. Shafi91 Uterine Septum, 275Basim Abu-Rafea and Khaldoun Sharif92 Surgery for Intrauterine Adhesions, 278Mohan Kumar93 Myomectomy: Breach of the Endometrial Cavity, 280Masoud Afnan and Arri Coomarasamy94 Myomectomy: Multiple Large Fibroids, 282Justin Chu and Arri Coomarasamy95 Myomectomy: Massive Intraoperative Hemorrhage, 284Neelam Potdar and Arri Coomarasamy96 Vaginal Myomectomy, 287Adam Magos97 Surgery for Proximal Tubal Blockage, 289Spyros Papaioannou98 Surgery for Distal Tubal Disease, 292Lynne Robinson, Hemant N. Vakharia, and Yousri Afifi99 Reversal of Sterilization, 295Hemant N. Vakharia, Lynne Robinson, and Yousri Afifi100 Surgery for Congenital Abnormalities of the Genital Tract, 299Naomi S. Crouch101 Surgical Sperm Retrieval, 304David Muthuveloe and Y. Zaki AlmallahSection 6: Urogynecologic SurgeryEditors: Pallavi Latthe and G. Willy Davila102 Sling Procedures: Bladder Injury, 309Fidan Israfil-Bayli and Philip Toozs-Hobson103 Sling Procedures: Urethral Injury, 311Gamal M. Ghoniem104 Sling Procedures: Retropubic Hematoma, 314Fidan Israfil-Bayli and Philip Toozs-Hobson105 Sling Procedures: Bowel Injury, 316Fidan Israfil-Bayli and Philip Toozs-Hobson106 Sling Procedures: Voiding Dysfunction after Stress Urinary Incontinence Surgery, 318Margarita M. Aponte and Victor W. Nitti107 Sling Procedures: Tape Erosion into the Bladder, 321Samuel J.S. Grimsley and Y. Zaki Almallah108 Sling Procedures: Sexual Dysfunction, 323Swati Jha and Ranee Thakar109 Sling Procedures: Persistent Urine Leakage, 325Luis Manuel Espaillat-Rijo and G. Willy Davila110 Difficult Vaginal Hysterectomy, 329G. Willy Davila111 Vaginal Hysterectomy: Difficulty in Entering the Posterior Pouch, 332Alfredo Jijon and G. Willy Davila112 Salpingo-oophorectomy at the Time of Vaginal Hysterectomy, 335Alfredo Jijon and G. Willy Davila113 Bladder Injury During Anterior Vaginal Repair or Vaginal Hysterectomy, 338Pallavi Latthe, Suneetha Rachaneni, and Mohammed Belal114 Difficult Sacrocolpopexy, 341Orfhlaith E. O’Sullivan and Barry A. O’Reilly115 Difficult Sacrospinous Fixation, 345Smita Rajshekhar and Rohna Kearney116 Recurrent Pelvic Organ Prolapse, 348Monika Vij and Robert Freeman117 Colpocleisis, 351Kalaivani Ramalingam and Ash Monga118 Uterine Suspension Procedures: Laparoscopic Hysteropexy, 353Natalia Price and Simon Jackson119 Mesh Tape Exposure Following Tension-free Vaginal Tape, 356Helen Bolton and Mark Slack120 Vaginal Vault Evisceration, 360Swati Jha121 Complications in Laparoscopic Pelvic Floor Surgery, 362Nir Haya and Christopher Maher122 Robotic Urogynecology Procedures, 367Orfhlaith E. O’Sullivan and Barry A. O’Reilly123 Complications in Robotic Pelvic Floor Surgery, 370Amie Kawasaki124 Neovagina, 372Lynsey Hayward and G. Willy Davila125 Vaginal Stricture After Pelvic Organ Prolapse Surgery, 375Ted M. Roth, G. Rodney Meeks and G. Willy Davila126 Urethral Diverticula and Other Periurethral Masses, 378Bhavin Patel and Kathleen C. Kobashi127 Vesicovaginal Fistulae, 382Karolynn T. Echols,Tamara V. Toidze, and Edward Stanford128 Urethrovaginal Fistulae, 386Sohier Elneil129 Rectovaginal Fistulae, 389Claire Burton and Simon Radley130 Secondary Anal Sphincter Repair, 392Steven D. Wexner and Emanuela SilvaSection 7: Gynecologic OncologyEditors: Kavita Singh, Mahmood I. Shafi, and Kiong K. Chan131 Large Loop Excision of the Transformation Zone, 399Mahmood I. Shafi132 Knife Cone Biopsy, 401Najum Qureshi133 Staging Procedures: Examination Under Anesthesia, Cystoscopy, Sigmoidoscopy, and Biopsy Techniques, 403Mahmood I. Shafi134 Radicality of Surgery for Cervical Cancer, 406Mahmood I. Shafi135 Pelvic and Para-aortic Lymphadenectomy in Gynecologic Cancers, 408Kavita Singh and Rami Fares136 Trachelectomy for Treatment of Cervical Cancer, 412Kavita Singh and Janos Balega137 Laparoscopic Radical Surgery for Cervical Cancer, 414Mohamed Mehasseb138 Groin and Retroperitoneal Lymphocele, 416David M. Luesley139 Laparotomy for a Pelvic Mass of Uncertain Nature, 418Mahmood I. Shafi140 Gynecologic Cancer Extending to the Bowel, 420Kiong K. Chan141 Omental Procedures: Supracolic Omentectomy, Infracolic Omentectomy, and Omental Biopsy, 423Kiong K. Chan142 Diaphragmatic Surgery in Advanced Ovarian Cancer, 425Ariella Jakobson-Setton and Kavita Singh143 Fine-needle Aspiration Biopsy of Superficial Groin Lymph Node, 428Moji Balogun144 Vulval Surgery: Wide Local Excision and Vulvectomy, 431Mahmood I. Shafi145 Sentinel Node Biopsy in Gynecologic Cancer, 433Kavita Singh146 Groin Lymphadenectomy, 435Ketan Gajjar147 Plastic Surgical Techniques in Vulval or Perineal Procedures, 438Mahmood I. Shafi148 Vaginectomy, 441Janos Balega and Kavita Singh149 Urinary Diversion, 443John Parkin150 Pelvic Exenteration, 446Kavita Singh151 Gynecologic Cancer and Concurrent Pregnancy, 449Nirmala Rai Talapadi and Sudha SundarSection 8: Obstetric SurgeryEditors: Pallavi Latthe, Kiong K. Chan, and Arri Coomarasamy152 Ovarian Cyst Identified at Cesarean Section, 455Kiong K. Chan and Ioannis Gallos153 Laparoscopy in Pregnancy, 457Kevin J.E. Stepp and Anjana Nair154 Cervical Cerclage, 459Ayesha Mahmud and Yousri Afifi155 Cesarean Section in a Woman with Fibroids, 463Andrew Prentice156 Cesarean Section at the Limits of Viability, 465Catherine Aiken and Jeremy Brockelsby157 Difficult Delivery of the Fetal Head During Cesarean Section, 468Parveen Abedin158 Surgical Management of Massive Obstetric Hemorrhage from the Uterus, Cervix, or Vagina, 470Phil Steer159 Surgical Management of Placenta Praevia, 475Vibha Giri and Mohan Kumar160 Surgical Management of Placenta Accreta, 479Vibha Giri and Mohan Kumar161 Surgical Management Options for Shoulder Dystocia: Zavanelli Maneuver, Abdominal Rescue, Symphysiotomy, and Cleidotomy, 482Syeda Batool Mazhar and Asia Nazir162 Uterine Inversion, 485Phil Steer163 Episiotomy and Second-degree Tear, 488Khaled M.K. Ismail and Sara S. Webb164 Obstetric Anal Sphincter Tear, 490Natalie P. Nunes, Helen Stevenson, and Matthew Parsons165 Pregnancy and Female Genital Mutilation, 493Naomi Low-Beer and Gubby Ayida166 Destructive Operations on a Dead Fetus, 496Hany Abdel-Aleem167 Development of a Basic Obstetric Theater Facility in a Low-resource Setting, 499Zahida Qureshi and Alfred MurageSection 9: MiscellaneousEditors: Mahmood I. Shafi and Arri Coomarasamy168 Enhanced Recovery, 505Manjeet Shehmar169 Major Surgery in a Jehovah’s Witness Patient, 507Martyn Underwood and William Parry-Smith170 Termination of Pregnancy at Advanced Gestation, 509Rohan Chodankar and Janesh Gupta171 Cervical Fibroids: Techniques for Myomectomy and Hysterectomy, 511Deborah R. Karp172 Hysterectomy for Broad Ligament Fibroids, 514Kiong K. Chan173 Hysterectomy for a Double Uterus, 516Kiong K. Chan174 Cervical Stump Excision, 518Kiong K. Chan175 Surgery for Ovarian Remnant, 520Kiong K. Chan and Arri Coomarasamy176 Surgery for Missing Intrauterine Contraceptive Device, 522Toh Lick Tan177 Management of Imperforate Hymen, Transverse and other Vaginal Septa, 525Jane MacDougall178 Benign Lesions in the Groin and Vulva, 528Jennifer Byrom179 Cystic Structure in the Upper Vagina, 531Ted M. Roth and G. Rodney Meeks180 Adnexal Masses in Infants and Children, 533Rachel J. Miller and Kris Ann P. Schultz181 Nerve Injuries Associated with Gynecologic and Obstetric Surgery, 536Djavid Alleemudder182 Consent Challenges, 540William Parry-Smith and Martyn Underwood183 Dealing with Complaints, 542Mahmood I. Shafi184 Dealing with Litigation, 544Rebekah Ley and Mahmood I. ShafiIndex, 547

Arri Coomarasamy, MBChB, MD, FRCOG. Professor of Gynaecology, Institute of Metabolism and System Research, University of Birmingham. Consultant Gynaecologist and Sub-specialist in Reproductive Medicine and Surgery, Birmingham Women's Hospital, Birmingham, United Kingdom. Mahmood I. Shafi, MBBCh, MD, DA, FRCOG. Consultant Gynecological Surgeon and Oncologist, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. G. Willy Davila, MD, FACOG. Center Director, Women's Health Institute (Florida), Chairman, Department of Gynecology, Head, Section of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston/Fort Lauderdale, Florida, United States. K. K. Chan, MBBS, FRCS, FRCOG. Emeritus Consultant Gynecological Oncologist, Pan-Birmingham Gynecological Cancer Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust. Birmingham, United Kingdom.

• Contributors, xPreface, xvList of Abbreviations, xviPart I: General Preoperative, Intraoperative, and Postoperative ChallengesSection 1: Preoperative CareEditors: Phil Moore and Arri Coomarasamy1 Patient with Poor ASA Score, 3Phil Moore2 Patient on Medication, 6Arri Coomarasamy3 Patient with Ischemic Heart Disease, 9Sohail Q. Khan and Jonathan N. Townend4 Patient with Arrhythmias, 13Sanoj Chacko and Joseph de Bono5 Patient with a Pacemaker or Implantable Defibrillator, 17Howard Marshall6 Patient with Complex Congenital Heart Disease (Fontan Circulation), 20Yaso Emmanuel and Sara A. Thorne7 Hypertensive Patient, 22Aarthi R. Mohan and Catherine Nelson-Piercy8 Patient with Respiratory Disease, 25Heinke Kunst9 Patient with Diabetes, 28Arri Coomarasamy and Dukaydah van der Berg10 Patient with Thyroid Disease, 30Ramy Labib and Shiao-yng Chan11 Patient with Renal Disease, 33Khalid Hasan12 Patient with Liver Disease, 35Joanna K. Dowman and Philip N. Newsome13 Patient with Rheumatologic Diseases, 38Amita A. Mahendru and Justin Chu14 Patient with Hematologic Disorders, 41Chieh Lin Fu15 Patient at High Risk of Venous Thrombosis, 44Ian A. Greer16 Patient on Anticoagulant Therapy, 47Sophie Lee and Will Lester17 Patient on Steroid Therapy, 50Shaista Nazir and John Ayuk18 Patient with Epilepsy, 54Danita Jones and Virgilio Salanga19 Patient with a Psychiatric Condition, 56Idnan Yunas20 Patient with Organ Transplant, 59Sarah Winfield21 Patient with Hepatitis B or C, 61Firas Al-Rshoud and Arri Coomarasamy22 Patient with HIV, 64Firas Al-Rshoud and Arri Coomarasamy23 Obese Patient, 67Phil Moore24 Patient with Poor Nutritional Status, 69Phil Moore25 Pregnant Patient Requiring Non-obstetric Surgery, 71Arri CoomarasamySection 2: Intraoperative CareEditors: Arri Coomarasamy and Mahmood I. Shafi26 Transverse Incision on the Abdomen Inadequate for Surgery, 77Arri Coomarasamy27 Previous Multiple Abdominal Scars, 79Mohammed Khairy and Arri Coomarasamy28 Patient with Previous Mesh Incisional Hernia Repair Requiring a Laparotomy, 83Christopher Smart and Chris Keh29 Patient with Previous Mesh Incisional Hernia Repair Requiring a Laparoscopy, 86Emanuele Lo Menzo, Samuel Szomstein, and Raul J. Rosenthal30 Unexpected Pathology: Ovarian Cyst, 89Mohan Kumar31 Unexpected Pathology: Abnormal Appearance of the Uterus, 92Arri Coomarasamy32 Unexpected Pathology: Severe Pelvic Adhesions, 94Stephen E. Zimberg and Michael L. Sprague33 Unexpected Pathology: Abnormal Appearance of Bowel, 97Olivia Will and Justin Davies34 Unexpected Pathology: Retroperitoneal Mass, 100Mohamed Mehasseb35 Bladder Injury, 103Arri Coomarasamy and Richard Popert36 Ureteric Injury, 106Arri Coomarasamy and Richard Popert37 Small and Large Bowel Injury, 111Howard Joy38 Inferior Epigastric Vessel Injury, 116Manas Chakrabarti and Sudha Sundar39 Bleeding from Retracted Pedicular (Pelvic Sidewall) Vessels, 119Michael L. Sprague and Stephen E. Zimberg40 Massive Hemorrhage, 121Karen Louise Moores, William Parry-Smith, and Martyn Underwood41 Broken Needle, 125Joanne Kathleen Ritchie, Anuradha Radotra, and Martyn Underwood42 Lost Swab, Needle or Instrument, 127Joanne Kathleen Ritchie, Martyn Underwood, and William Parry-SmithSection 3: Postoperative CareEditors: Arri Coomarasamy and Janesh Gupta43 Postoperative Care, 131Janesh Gupta, Robbert Soeters, and Aaron Ndhluni44 Excessive Nausea and Vomiting after Surgery, 133Phil Moore45 Excessive Abdominal Pain after Surgery, 136Manjeet Shehmar46 Bowel Damage: Postoperative Presentation, 139Ketan Gajjar and Mahmood I. Shafi47 Wound Infection, 142Pallavi Latthe and James Gray48 Wound Dehiscence, 147T. Justin Clark49 Late Wound Failure: Incisional Hernia, 150Saloney Nazeer50 Necrotizing Fasciitis, 153Tariq Ahmad51 Management of Surgical Drains, 156Ahmed M. El-Sharkawy and Sherif Awad52 Shocked Patient, 159Manjeet Shehmar53 Breathless Patient: Postoperative Pulmonary Complications, 162Heinke Kunst54 Confused Postoperative Patient, 165Idnan Yunas55 Patient with Poor Urine Output, 167Amelia Davison and Jackie A. Ross56 Electrolyte Imbalance, 170Manjeet Shehmar and Arri Coomarasamy57 Swollen Leg, 174Edwin Stephen, Indrani Sen, and Tim Lees58 Cardiorespiratory Arrest, 177Jennie KerrPART II: Operations and ChallengesSection 4: General and Minimal Access GynecologyEditors: T. Justin Clark, Kiong K. Chan, and Arri Coomarasamy59 Difficulty in Dilating the Cervix: Cervical Stenosis and Cervical Closure, 183Arri Coomarasamy60 Uterine Perforation, 186Arri Coomarasamy61 Surgical Uterine Evacuation: Excessive Bleeding, 189Rajesh Varma62 Surgical Uterine Evacuation in a Woman with Multiple Fibroids, 191Rajesh Varma63 Use of Excessive Distension Media at Hysteroscopy, 194Arri Coomarasamy64 Hysteroscopy: Endometrial Resection and Ablation in the Abnormal Uterine Cavity, 197Alessandro Conforti and Adam Magos65 Laparoscopy in a Pediatric Patient, 199Suketu M. Mansuria, Cara R. King, and Arri Coomarasamy66 Safe Laparoscopic Entry in a Thin Patient, 202Janesh Gupta and Justin Chu67 Laparoscopy: Unable to Gain Entry, 205Mohamed Mehasseb68 Surgical Emphysema, 208Arri Coomarasamy69 Venous Air Embolism, 210Anneke Chu and Jennie Kerr70 Laparoscopy: Problems with Monopolar Diathermy, 213Thomas G. Lang and Resad Pasic71 Laparoscopy: Problems with Bipolar Diathermy, 216Thomas G. Lang and Resad Pasic72 Laparoscopy: Bladder Injury, 218Peter L. Rosenblatt73 Laparoscopy: Ureteric Injury, 221Peter L. Rosenblatt74 Bowel Injury During Laparoscopy: Intraoperative Presentation, 224Alan Lam75 Bowel Injury After Laparoscopy: Late Presentation, 227Alan Lam76 Blood Vessel Injury at Laparoscopy, 230Elizabeth Ball77 Laparoscopy for Large Ovarian Cyst, 233T. Justin Clark78 Laparoscopy for an Ovarian Cyst in Pregnancy, 235T. Justin Clark79 Laparoscopic Removal of Rectovaginal Endometriosis, 238Alan Lam80 Laparoscopic Myomectomy, 242Ertan Saridogan81 Total Laparoscopic Hysterectomy, 245Alan Farthing82 Laparoscopic Hysterectomy for a Large Fibroid Uterus, 247Alan Lam83 Laparoscopy: Difficulty in Tissue Retrieval, 250Su-Yen Khong and Alan Lam84 Surgery for Cornual or Interstitial Pregnancy, 253Ayesha Mahmud and Yousri Afifi85 Surgery for Cervical Ectopic Pregnancy, 256Bassel H. Al Wattar and Yousri Afifi86 Surgery for Cesarean Scar Pregnancy, 259T. Justin Clark87 Surgery for Adnexal Torsion, 262Mohamed Otify and Jackie A. Ross88 Laparoscopic Appendectomy, 264Edward Rawstorne, Christopher Smart, and Chris Keh89 Laparoscopic Surgery: When to Convert to Laparotomy?, 267Mohamed Mehasseb90 Laparoscopy: Port-site Herniation, 269Ayesha Mahmud and Yousri AfifiSection 5: Reproductive SurgeryEditors: Arri Coomarasamy and Mahmood I. Shafi91 Uterine Septum, 275Basim Abu-Rafea and Khaldoun Sharif92 Surgery for Intrauterine Adhesions, 278Mohan Kumar93 Myomectomy: Breach of the Endometrial Cavity, 280Masoud Afnan and Arri Coomarasamy94 Myomectomy: Multiple Large Fibroids, 282Justin Chu and Arri Coomarasamy95 Myomectomy: Massive Intraoperative Hemorrhage, 284Neelam Potdar and Arri Coomarasamy96 Vaginal Myomectomy, 287Adam Magos97 Surgery for Proximal Tubal Blockage, 289Spyros Papaioannou98 Surgery for Distal Tubal Disease, 292Lynne Robinson, Hemant N. Vakharia, and Yousri Afifi99 Reversal of Sterilization, 295Hemant N. Vakharia, Lynne Robinson, and Yousri Afifi100 Surgery for Congenital Abnormalities of the Genital Tract, 299Naomi S. Crouch101 Surgical Sperm Retrieval, 304David Muthuveloe and Y. Zaki AlmallahSection 6: Urogynecologic SurgeryEditors: Pallavi Latthe and G. Willy Davila102 Sling Procedures: Bladder Injury, 309Fidan Israfil-Bayli and Philip Toozs-Hobson103 Sling Procedures: Urethral Injury, 311Gamal M. Ghoniem104 Sling Procedures: Retropubic Hematoma, 314Fidan Israfil-Bayli and Philip Toozs-Hobson105 Sling Procedures: Bowel Injury, 316Fidan Israfil-Bayli and Philip Toozs-Hobson106 Sling Procedures: Voiding Dysfunction after Stress Urinary Incontinence Surgery, 318Margarita M. Aponte and Victor W. Nitti107 Sling Procedures: Tape Erosion into the Bladder, 321Samuel J.S. Grimsley and Y. Zaki Almallah108 Sling Procedures: Sexual Dysfunction, 323Swati Jha and Ranee Thakar109 Sling Procedures: Persistent Urine Leakage, 325Luis Manuel Espaillat-Rijo and G. Willy Davila110 Difficult Vaginal Hysterectomy, 329G. Willy Davila111 Vaginal Hysterectomy: Difficulty in Entering the Posterior Pouch, 332Alfredo Jijon and G. Willy Davila112 Salpingo-oophorectomy at the Time of Vaginal Hysterectomy, 335Alfredo Jijon and G. Willy Davila113 Bladder Injury During Anterior Vaginal Repair or Vaginal Hysterectomy, 338Pallavi Latthe, Suneetha Rachaneni, and Mohammed Belal114 Difficult Sacrocolpopexy, 341Orfhlaith E. O’Sullivan and Barry A. O’Reilly115 Difficult Sacrospinous Fixation, 345Smita Rajshekhar and Rohna Kearney116 Recurrent Pelvic Organ Prolapse, 348Monika Vij and Robert Freeman117 Colpocleisis, 351Kalaivani Ramalingam and Ash Monga118 Uterine Suspension Procedures: Laparoscopic Hysteropexy, 353Natalia Price and Simon Jackson119 Mesh Tape Exposure Following Tension-free Vaginal Tape, 356Helen Bolton and Mark Slack120 Vaginal Vault Evisceration, 360Swati Jha121 Complications in Laparoscopic Pelvic Floor Surgery, 362Nir Haya and Christopher Maher122 Robotic Urogynecology Procedures, 367Orfhlaith E. O’Sullivan and Barry A. O’Reilly123 Complications in Robotic Pelvic Floor Surgery, 370Amie Kawasaki124 Neovagina, 372Lynsey Hayward and G. Willy Davila125 Vaginal Stricture After Pelvic Organ Prolapse Surgery, 375Ted M. Roth, G. Rodney Meeks and G. Willy Davila126 Urethral Diverticula and Other Periurethral Masses, 378Bhavin Patel and Kathleen C. Kobashi127 Vesicovaginal Fistulae, 382Karolynn T. Echols,Tamara V. Toidze, and Edward Stanford128 Urethrovaginal Fistulae, 386Sohier Elneil129 Rectovaginal Fistulae, 389Claire Burton and Simon Radley130 Secondary Anal Sphincter Repair, 392Steven D. Wexner and Emanuela SilvaSection 7: Gynecologic OncologyEditors: Kavita Singh, Mahmood I. Shafi, and Kiong K. Chan131 Large Loop Excision of the Transformation Zone, 399Mahmood I. Shafi132 Knife Cone Biopsy, 401Najum Qureshi133 Staging Procedures: Examination Under Anesthesia, Cystoscopy, Sigmoidoscopy, and Biopsy Techniques, 403Mahmood I. Shafi134 Radicality of Surgery for Cervical Cancer, 406Mahmood I. Shafi135 Pelvic and Para-aortic Lymphadenectomy in Gynecologic Cancers, 408Kavita Singh and Rami Fares136 Trachelectomy for Treatment of Cervical Cancer, 412Kavita Singh and Janos Balega137 Laparoscopic Radical Surgery for Cervical Cancer, 414Mohamed Mehasseb138 Groin and Retroperitoneal Lymphocele, 416David M. Luesley139 Laparotomy for a Pelvic Mass of Uncertain Nature, 418Mahmood I. Shafi140 Gynecologic Cancer Extending to the Bowel, 420Kiong K. Chan141 Omental Procedures: Supracolic Omentectomy, Infracolic Omentectomy, and Omental Biopsy, 423Kiong K. Chan142 Diaphragmatic Surgery in Advanced Ovarian Cancer, 425Ariella Jakobson-Setton and Kavita Singh143 Fine-needle Aspiration Biopsy of Superficial Groin Lymph Node, 428Moji Balogun144 Vulval Surgery: Wide Local Excision and Vulvectomy, 431Mahmood I. Shafi145 Sentinel Node Biopsy in Gynecologic Cancer, 433Kavita Singh146 Groin Lymphadenectomy, 435Ketan Gajjar147 Plastic Surgical Techniques in Vulval or Perineal Procedures, 438Mahmood I. Shafi148 Vaginectomy, 441Janos Balega and Kavita Singh149 Urinary Diversion, 443John Parkin150 Pelvic Exenteration, 446Kavita Singh151 Gynecologic Cancer and Concurrent Pregnancy, 449Nirmala Rai Talapadi and Sudha SundarSection 8: Obstetric SurgeryEditors: Pallavi Latthe, Kiong K. Chan, and Arri Coomarasamy152 Ovarian Cyst Identified at Cesarean Section, 455Kiong K. Chan and Ioannis Gallos153 Laparoscopy in Pregnancy, 457Kevin J.E. Stepp and Anjana Nair154 Cervical Cerclage, 459Ayesha Mahmud and Yousri Afifi155 Cesarean Section in a Woman with Fibroids, 463Andrew Prentice156 Cesarean Section at the Limits of Viability, 465Catherine Aiken and Jeremy Brockelsby157 Difficult Delivery of the Fetal Head During Cesarean Section, 468Parveen Abedin158 Surgical Management of Massive Obstetric Hemorrhage from the Uterus, Cervix, or Vagina, 470Phil Steer159 Surgical Management of Placenta Praevia, 475Vibha Giri and Mohan Kumar160 Surgical Management of Placenta Accreta, 479Vibha Giri and Mohan Kumar161 Surgical Management Options for Shoulder Dystocia: Zavanelli Maneuver, Abdominal Rescue, Symphysiotomy, and Cleidotomy, 482Syeda Batool Mazhar and Asia Nazir162 Uterine Inversion, 485Phil Steer163 Episiotomy and Second-degree Tear, 488Khaled M.K. Ismail and Sara S. Webb164 Obstetric Anal Sphincter Tear, 490Natalie P. Nunes, Helen Stevenson, and Matthew Parsons165 Pregnancy and Female Genital Mutilation, 493Naomi Low-Beer and Gubby Ayida166 Destructive Operations on a Dead Fetus, 496Hany Abdel-Aleem167 Development of a Basic Obstetric Theater Facility in a Low-resource Setting, 499Zahida Qureshi and Alfred MurageSection 9: MiscellaneousEditors: Mahmood I. Shafi and Arri Coomarasamy168 Enhanced Recovery, 505Manjeet Shehmar169 Major Surgery in a Jehovah’s Witness Patient, 507Martyn Underwood and William Parry-Smith170 Termination of Pregnancy at Advanced Gestation, 509Rohan Chodankar and Janesh Gupta171 Cervical Fibroids: Techniques for Myomectomy and Hysterectomy, 511Deborah R. Karp172 Hysterectomy for Broad Ligament Fibroids, 514Kiong K. Chan173 Hysterectomy for a Double Uterus, 516Kiong K. Chan174 Cervical Stump Excision, 518Kiong K. Chan175 Surgery for Ovarian Remnant, 520Kiong K. Chan and Arri Coomarasamy176 Surgery for Missing Intrauterine Contraceptive Device, 522Toh Lick Tan177 Management of Imperforate Hymen, Transverse and other Vaginal Septa, 525Jane MacDougall178 Benign Lesions in the Groin and Vulva, 528Jennifer Byrom179 Cystic Structure in the Upper Vagina, 531Ted M. Roth and G. Rodney Meeks180 Adnexal Masses in Infants and Children, 533Rachel J. Miller and Kris Ann P. Schultz181 Nerve Injuries Associated with Gynecologic and Obstetric Surgery, 536Djavid Alleemudder182 Consent Challenges, 540William Parry-Smith and Martyn Underwood183 Dealing with Complaints, 542Mahmood I. Shafi184 Dealing with Litigation, 544Rebekah Ley and Mahmood I. ShafiIndex, 547

Arri Coomarasamy, MBChB, MD, FRCOG. Professor of Gynaecology, Institute of Metabolism and System Research, University of Birmingham. Consultant Gynaecologist and Sub-specialist in Reproductive Medicine and Surgery, Birmingham Women's Hospital, Birmingham, United Kingdom. Mahmood I. Shafi, MBBCh, MD, DA, FRCOG. Consultant Gynecological Surgeon and Oncologist, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. G. Willy Davila, MD, FACOG. Center Director, Women's Health Institute (Florida), Chairman, Department of Gynecology, Head, Section of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston/Fort Lauderdale, Florida, United States. K. K. Chan, MBBS, FRCS, FRCOG. Emeritus Consultant Gynecological Oncologist, Pan-Birmingham Gynecological Cancer Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust. Birmingham, United Kingdom.

• Contributors, xPreface, xvList of Abbreviations, xviPart I: General Preoperative, Intraoperative, and Postoperative ChallengesSection 1: Preoperative CareEditors: Phil Moore and Arri Coomarasamy1 Patient with Poor ASA Score, 3Phil Moore2 Patient on Medication, 6Arri Coomarasamy3 Patient with Ischemic Heart Disease, 9Sohail Q. Khan and Jonathan N. Townend4 Patient with Arrhythmias, 13Sanoj Chacko and Joseph de Bono5 Patient with a Pacemaker or Implantable Defibrillator, 17Howard Marshall6 Patient with Complex Congenital Heart Disease (Fontan Circulation), 20Yaso Emmanuel and Sara A. Thorne7 Hypertensive Patient, 22Aarthi R. Mohan and Catherine Nelson-Piercy8 Patient with Respiratory Disease, 25Heinke Kunst9 Patient with Diabetes, 28Arri Coomarasamy and Dukaydah van der Berg10 Patient with Thyroid Disease, 30Ramy Labib and Shiao-yng Chan11 Patient with Renal Disease, 33Khalid Hasan12 Patient with Liver Disease, 35Joanna K. Dowman and Philip N. Newsome13 Patient with Rheumatologic Diseases, 38Amita A. Mahendru and Justin Chu14 Patient with Hematologic Disorders, 41Chieh Lin Fu15 Patient at High Risk of Venous Thrombosis, 44Ian A. Greer16 Patient on Anticoagulant Therapy, 47Sophie Lee and Will Lester17 Patient on Steroid Therapy, 50Shaista Nazir and John Ayuk18 Patient with Epilepsy, 54Danita Jones and Virgilio Salanga19 Patient with a Psychiatric Condition, 56Idnan Yunas20 Patient with Organ Transplant, 59Sarah Winfield21 Patient with Hepatitis B or C, 61Firas Al-Rshoud and Arri Coomarasamy22 Patient with HIV, 64Firas Al-Rshoud and Arri Coomarasamy23 Obese Patient, 67Phil Moore24 Patient with Poor Nutritional Status, 69Phil Moore25 Pregnant Patient Requiring Non-obstetric Surgery, 71Arri CoomarasamySection 2: Intraoperative CareEditors: Arri Coomarasamy and Mahmood I. Shafi26 Transverse Incision on the Abdomen Inadequate for Surgery, 77Arri Coomarasamy27 Previous Multiple Abdominal Scars, 79Mohammed Khairy and Arri Coomarasamy28 Patient with Previous Mesh Incisional Hernia Repair Requiring a Laparotomy, 83Christopher Smart and Chris Keh29 Patient with Previous Mesh Incisional Hernia Repair Requiring a Laparoscopy, 86Emanuele Lo Menzo, Samuel Szomstein, and Raul J. Rosenthal30 Unexpected Pathology: Ovarian Cyst, 89Mohan Kumar31 Unexpected Pathology: Abnormal Appearance of the Uterus, 92Arri Coomarasamy32 Unexpected Pathology: Severe Pelvic Adhesions, 94Stephen E. Zimberg and Michael L. Sprague33 Unexpected Pathology: Abnormal Appearance of Bowel, 97Olivia Will and Justin Davies34 Unexpected Pathology: Retroperitoneal Mass, 100Mohamed Mehasseb35 Bladder Injury, 103Arri Coomarasamy and Richard Popert36 Ureteric Injury, 106Arri Coomarasamy and Richard Popert37 Small and Large Bowel Injury, 111Howard Joy38 Inferior Epigastric Vessel Injury, 116Manas Chakrabarti and Sudha Sundar39 Bleeding from Retracted Pedicular (Pelvic Sidewall) Vessels, 119Michael L. Sprague and Stephen E. Zimberg40 Massive Hemorrhage, 121Karen Louise Moores, William Parry-Smith, and Martyn Underwood41 Broken Needle, 125Joanne Kathleen Ritchie, Anuradha Radotra, and Martyn Underwood42 Lost Swab, Needle or Instrument, 127Joanne Kathleen Ritchie, Martyn Underwood, and William Parry-SmithSection 3: Postoperative CareEditors: Arri Coomarasamy and Janesh Gupta43 Postoperative Care, 131Janesh Gupta, Robbert Soeters, and Aaron Ndhluni44 Excessive Nausea and Vomiting after Surgery, 133Phil Moore45 Excessive Abdominal Pain after Surgery, 136Manjeet Shehmar46 Bowel Damage: Postoperative Presentation, 139Ketan Gajjar and Mahmood I. Shafi47 Wound Infection, 142Pallavi Latthe and James Gray48 Wound Dehiscence, 147T. Justin Clark49 Late Wound Failure: Incisional Hernia, 150Saloney Nazeer50 Necrotizing Fasciitis, 153Tariq Ahmad51 Management of Surgical Drains, 156Ahmed M. El-Sharkawy and Sherif Awad52 Shocked Patient, 159Manjeet Shehmar53 Breathless Patient: Postoperative Pulmonary Complications, 162Heinke Kunst54 Confused Postoperative Patient, 165Idnan Yunas55 Patient with Poor Urine Output, 167Amelia Davison and Jackie A. Ross56 Electrolyte Imbalance, 170Manjeet Shehmar and Arri Coomarasamy57 Swollen Leg, 174Edwin Stephen, Indrani Sen, and Tim Lees58 Cardiorespiratory Arrest, 177Jennie KerrPART II: Operations and ChallengesSection 4: General and Minimal Access GynecologyEditors: T. Justin Clark, Kiong K. Chan, and Arri Coomarasamy59 Difficulty in Dilating the Cervix: Cervical Stenosis and Cervical Closure, 183Arri Coomarasamy60 Uterine Perforation, 186Arri Coomarasamy61 Surgical Uterine Evacuation: Excessive Bleeding, 189Rajesh Varma62 Surgical Uterine Evacuation in a Woman with Multiple Fibroids, 191Rajesh Varma63 Use of Excessive Distension Media at Hysteroscopy, 194Arri Coomarasamy64 Hysteroscopy: Endometrial Resection and Ablation in the Abnormal Uterine Cavity, 197Alessandro Conforti and Adam Magos65 Laparoscopy in a Pediatric Patient, 199Suketu M. Mansuria, Cara R. King, and Arri Coomarasamy66 Safe Laparoscopic Entry in a Thin Patient, 202Janesh Gupta and Justin Chu67 Laparoscopy: Unable to Gain Entry, 205Mohamed Mehasseb68 Surgical Emphysema, 208Arri Coomarasamy69 Venous Air Embolism, 210Anneke Chu and Jennie Kerr70 Laparoscopy: Problems with Monopolar Diathermy, 213Thomas G. Lang and Resad Pasic71 Laparoscopy: Problems with Bipolar Diathermy, 216Thomas G. Lang and Resad Pasic72 Laparoscopy: Bladder Injury, 218Peter L. Rosenblatt73 Laparoscopy: Ureteric Injury, 221Peter L. Rosenblatt74 Bowel Injury During Laparoscopy: Intraoperative Presentation, 224Alan Lam75 Bowel Injury After Laparoscopy: Late Presentation, 227Alan Lam76 Blood Vessel Injury at Laparoscopy, 230Elizabeth Ball77 Laparoscopy for Large Ovarian Cyst, 233T. Justin Clark78 Laparoscopy for an Ovarian Cyst in Pregnancy, 235T. Justin Clark79 Laparoscopic Removal of Rectovaginal Endometriosis, 238Alan Lam80 Laparoscopic Myomectomy, 242Ertan Saridogan81 Total Laparoscopic Hysterectomy, 245Alan Farthing82 Laparoscopic Hysterectomy for a Large Fibroid Uterus, 247Alan Lam83 Laparoscopy: Difficulty in Tissue Retrieval, 250Su-Yen Khong and Alan Lam84 Surgery for Cornual or Interstitial Pregnancy, 253Ayesha Mahmud and Yousri Afifi85 Surgery for Cervical Ectopic Pregnancy, 256Bassel H. Al Wattar and Yousri Afifi86 Surgery for Cesarean Scar Pregnancy, 259T. Justin Clark87 Surgery for Adnexal Torsion, 262Mohamed Otify and Jackie A. Ross88 Laparoscopic Appendectomy, 264Edward Rawstorne, Christopher Smart, and Chris Keh89 Laparoscopic Surgery: When to Convert to Laparotomy?, 267Mohamed Mehasseb90 Laparoscopy: Port-site Herniation, 269Ayesha Mahmud and Yousri AfifiSection 5: Reproductive SurgeryEditors: Arri Coomarasamy and Mahmood I. Shafi91 Uterine Septum, 275Basim Abu-Rafea and Khaldoun Sharif92 Surgery for Intrauterine Adhesions, 278Mohan Kumar93 Myomectomy: Breach of the Endometrial Cavity, 280Masoud Afnan and Arri Coomarasamy94 Myomectomy: Multiple Large Fibroids, 282Justin Chu and Arri Coomarasamy95 Myomectomy: Massive Intraoperative Hemorrhage, 284Neelam Potdar and Arri Coomarasamy96 Vaginal Myomectomy, 287Adam Magos97 Surgery for Proximal Tubal Blockage, 289Spyros Papaioannou98 Surgery for Distal Tubal Disease, 292Lynne Robinson, Hemant N. Vakharia, and Yousri Afifi99 Reversal of Sterilization, 295Hemant N. Vakharia, Lynne Robinson, and Yousri Afifi100 Surgery for Congenital Abnormalities of the Genital Tract, 299Naomi S. Crouch101 Surgical Sperm Retrieval, 304David Muthuveloe and Y. Zaki AlmallahSection 6: Urogynecologic SurgeryEditors: Pallavi Latthe and G. Willy Davila102 Sling Procedures: Bladder Injury, 309Fidan Israfil-Bayli and Philip Toozs-Hobson103 Sling Procedures: Urethral Injury, 311Gamal M. Ghoniem104 Sling Procedures: Retropubic Hematoma, 314Fidan Israfil-Bayli and Philip Toozs-Hobson105 Sling Procedures: Bowel Injury, 316Fidan Israfil-Bayli and Philip Toozs-Hobson106 Sling Procedures: Voiding Dysfunction after Stress Urinary Incontinence Surgery, 318Margarita M. Aponte and Victor W. Nitti107 Sling Procedures: Tape Erosion into the Bladder, 321Samuel J.S. Grimsley and Y. Zaki Almallah108 Sling Procedures: Sexual Dysfunction, 323Swati Jha and Ranee Thakar109 Sling Procedures: Persistent Urine Leakage, 325Luis Manuel Espaillat-Rijo and G. Willy Davila110 Difficult Vaginal Hysterectomy, 329G. Willy Davila111 Vaginal Hysterectomy: Difficulty in Entering the Posterior Pouch, 332Alfredo Jijon and G. Willy Davila112 Salpingo-oophorectomy at the Time of Vaginal Hysterectomy, 335Alfredo Jijon and G. Willy Davila113 Bladder Injury During Anterior Vaginal Repair or Vaginal Hysterectomy, 338Pallavi Latthe, Suneetha Rachaneni, and Mohammed Belal114 Difficult Sacrocolpopexy, 341Orfhlaith E. O’Sullivan and Barry A. O’Reilly115 Difficult Sacrospinous Fixation, 345Smita Rajshekhar and Rohna Kearney116 Recurrent Pelvic Organ Prolapse, 348Monika Vij and Robert Freeman117 Colpocleisis, 351Kalaivani Ramalingam and Ash Monga118 Uterine Suspension Procedures: Laparoscopic Hysteropexy, 353Natalia Price and Simon Jackson119 Mesh Tape Exposure Following Tension-free Vaginal Tape, 356Helen Bolton and Mark Slack120 Vaginal Vault Evisceration, 360Swati Jha121 Complications in Laparoscopic Pelvic Floor Surgery, 362Nir Haya and Christopher Maher122 Robotic Urogynecology Procedures, 367Orfhlaith E. O’Sullivan and Barry A. O’Reilly123 Complications in Robotic Pelvic Floor Surgery, 370Amie Kawasaki124 Neovagina, 372Lynsey Hayward and G. Willy Davila125 Vaginal Stricture After Pelvic Organ Prolapse Surgery, 375Ted M. Roth, G. Rodney Meeks and G. Willy Davila126 Urethral Diverticula and Other Periurethral Masses, 378Bhavin Patel and Kathleen C. Kobashi127 Vesicovaginal Fistulae, 382Karolynn T. Echols,Tamara V. Toidze, and Edward Stanford128 Urethrovaginal Fistulae, 386Sohier Elneil129 Rectovaginal Fistulae, 389Claire Burton and Simon Radley130 Secondary Anal Sphincter Repair, 392Steven D. Wexner and Emanuela SilvaSection 7: Gynecologic OncologyEditors: Kavita Singh, Mahmood I. Shafi, and Kiong K. Chan131 Large Loop Excision of the Transformation Zone, 399Mahmood I. Shafi132 Knife Cone Biopsy, 401Najum Qureshi133 Staging Procedures: Examination Under Anesthesia, Cystoscopy, Sigmoidoscopy, and Biopsy Techniques, 403Mahmood I. Shafi134 Radicality of Surgery for Cervical Cancer, 406Mahmood I. Shafi135 Pelvic and Para-aortic Lymphadenectomy in Gynecologic Cancers, 408Kavita Singh and Rami Fares136 Trachelectomy for Treatment of Cervical Cancer, 412Kavita Singh and Janos Balega137 Laparoscopic Radical Surgery for Cervical Cancer, 414Mohamed Mehasseb138 Groin and Retroperitoneal Lymphocele, 416David M. Luesley139 Laparotomy for a Pelvic Mass of Uncertain Nature, 418Mahmood I. Shafi140 Gynecologic Cancer Extending to the Bowel, 420Kiong K. Chan141 Omental Procedures: Supracolic Omentectomy, Infracolic Omentectomy, and Omental Biopsy, 423Kiong K. Chan142 Diaphragmatic Surgery in Advanced Ovarian Cancer, 425Ariella Jakobson-Setton and Kavita Singh143 Fine-needle Aspiration Biopsy of Superficial Groin Lymph Node, 428Moji Balogun144 Vulval Surgery: Wide Local Excision and Vulvectomy, 431Mahmood I. Shafi145 Sentinel Node Biopsy in Gynecologic Cancer, 433Kavita Singh146 Groin Lymphadenectomy, 435Ketan Gajjar147 Plastic Surgical Techniques in Vulval or Perineal Procedures, 438Mahmood I. Shafi148 Vaginectomy, 441Janos Balega and Kavita Singh149 Urinary Diversion, 443John Parkin150 Pelvic Exenteration, 446Kavita Singh151 Gynecologic Cancer and Concurrent Pregnancy, 449Nirmala Rai Talapadi and Sudha SundarSection 8: Obstetric SurgeryEditors: Pallavi Latthe, Kiong K. Chan, and Arri Coomarasamy152 Ovarian Cyst Identified at Cesarean Section, 455Kiong K. Chan and Ioannis Gallos153 Laparoscopy in Pregnancy, 457Kevin J.E. Stepp and Anjana Nair154 Cervical Cerclage, 459Ayesha Mahmud and Yousri Afifi155 Cesarean Section in a Woman with Fibroids, 463Andrew Prentice156 Cesarean Section at the Limits of Viability, 465Catherine Aiken and Jeremy Brockelsby157 Difficult Delivery of the Fetal Head During Cesarean Section, 468Parveen Abedin158 Surgical Management of Massive Obstetric Hemorrhage from the Uterus, Cervix, or Vagina, 470Phil Steer159 Surgical Management of Placenta Praevia, 475Vibha Giri and Mohan Kumar160 Surgical Management of Placenta Accreta, 479Vibha Giri and Mohan Kumar161 Surgical Management Options for Shoulder Dystocia: Zavanelli Maneuver, Abdominal Rescue, Symphysiotomy, and Cleidotomy, 482Syeda Batool Mazhar and Asia Nazir162 Uterine Inversion, 485Phil Steer163 Episiotomy and Second-degree Tear, 488Khaled M.K. Ismail and Sara S. Webb164 Obstetric Anal Sphincter Tear, 490Natalie P. Nunes, Helen Stevenson, and Matthew Parsons165 Pregnancy and Female Genital Mutilation, 493Naomi Low-Beer and Gubby Ayida166 Destructive Operations on a Dead Fetus, 496Hany Abdel-Aleem167 Development of a Basic Obstetric Theater Facility in a Low-resource Setting, 499Zahida Qureshi and Alfred MurageSection 9: MiscellaneousEditors: Mahmood I. Shafi and Arri Coomarasamy168 Enhanced Recovery, 505Manjeet Shehmar169 Major Surgery in a Jehovah’s Witness Patient, 507Martyn Underwood and William Parry-Smith170 Termination of Pregnancy at Advanced Gestation, 509Rohan Chodankar and Janesh Gupta171 Cervical Fibroids: Techniques for Myomectomy and Hysterectomy, 511Deborah R. Karp172 Hysterectomy for Broad Ligament Fibroids, 514Kiong K. Chan173 Hysterectomy for a Double Uterus, 516Kiong K. Chan174 Cervical Stump Excision, 518Kiong K. Chan175 Surgery for Ovarian Remnant, 520Kiong K. Chan and Arri Coomarasamy176 Surgery for Missing Intrauterine Contraceptive Device, 522Toh Lick Tan177 Management of Imperforate Hymen, Transverse and other Vaginal Septa, 525Jane MacDougall178 Benign Lesions in the Groin and Vulva, 528Jennifer Byrom179 Cystic Structure in the Upper Vagina, 531Ted M. Roth and G. Rodney Meeks180 Adnexal Masses in Infants and Children, 533Rachel J. Miller and Kris Ann P. Schultz181 Nerve Injuries Associated with Gynecologic and Obstetric Surgery, 536Djavid Alleemudder182 Consent Challenges, 540William Parry-Smith and Martyn Underwood183 Dealing with Complaints, 542Mahmood I. Shafi184 Dealing with Litigation, 544Rebekah Ley and Mahmood I. ShafiIndex, 547