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Bonney's Gynaecological Surgery Bonney’s Gynaecological Surgery John M. Monaghan MB ChB, FRCS(Ed), FRCOG Consultant Surgeon Whitton Grange Whitton Northumberland England Alberto (Tito) de Barros Lopes Consultant Gynaecological Oncologist Northern Gynaecological Oncology Centre Queen Elizabeth Hospital Sheriff Hill Gateshead Raj Naik Consultant Gynaecological Oncologist Northern Gynaecological Oncology Centre Queen Elizabeth Hospital Sheriff Hill Gateshead TENTH EDITION Blackwell Science Bonney’s Gynaecological Surgery This book is dedicated to the memory of Victor Bonney. It is also dedicated to our wives Maggie, Jane and Rupal for their support, understanding, patience and love which they have shown us in our lives together Bonney’s Gynaecological Surgery John M. Monaghan MB ChB, FRCS(Ed), FRCOG Consultant Surgeon Whitton Grange Whitton Northumberland England Alberto (Tito) de Barros Lopes Consultant Gynaecological Oncologist Northern Gynaecological Oncology Centre Queen Elizabeth Hospital Sheriff Hill Gateshead Raj Naik Consultant Gynaecological Oncologist Northern Gynaecological Oncology Centre Queen Elizabeth Hospital Sheriff Hill Gateshead TENTH EDITION Blackwell Science © 2004 by Blackwell Science Ltd a Blackwell Publishing Company Blackwell Science, Inc., 350 Main Street, Malden, MA 02148-5020, USA Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK Blackwell Science Asia Pty, 550 Swanson Street, Carlton, Victoria 3053, Australia The right of the Author to be identified as the Author of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. First published 1911 Eighth edition 1974 (Baillière Tindall) Ninth edition 1986 (Baillière Tindall) Tenth edition 2004 Blackwell Science Ltd Library of Congress Cataloging-in-Publication Data Monaghan, John M. Bonney’s gynaecological surgery. — 10th ed. / John M. Monaghan, Tito Lopes, Raj Naik. p. ; cm. Includes bibliographical references and index. ISBN 0-632-05419-0 1. Generative organs, Female — Surgery. [DNLM: 1. Gynaecologic Surgical Procedures. 2. Genitalia, Female — surgery. WP 660 M734b 2004] I. Title: Gynaecological surgery. II. Lopes, Tito. III. Naik, Raj. IV. Bonney, Victor, 1872–1953. Gynaecological surgery. V. Title. RG104.B65 2004 618.1¢059 — dc22 2004020780 ISBN 0-632-05419-0 A catalogue record for this title is available from the British Library Set in 9 on 11.5 Sabon by SNP Best-set Typesetter Ltd., Hong Kong Printed and bound in India by Gopsons Papers Ltd, New Delhi Production Editor: Rebecca Huxley Commissioning Editor: Stuart Taylor Editorial Assistant: Katrina Chandler Production Controller: Mirjana Misina For further information on Blackwell Publishing, visit our website: http://www.blackwellpublishing.com Contents Preface to the tenth edition, vii Preface to the ninth edition, ix 1 Introduction and prologue, 1 2 Instruments, operative materials and basic surgical techniques, 5 3 Patient assessment, consent and preparation for surgery, 19 4 Operations on the cervix, 27 5 Operations on the uterine cavity, 47 6 Opening and closing the abdominal cavity, 54 7 Total abdominal hysterectomy, 66 8 Total hysterectomy for cervical and broad ligament fibroids, 74 9 Myomectomy and the management of fibroids in pregnancy, 87 10 Vaginal hysterectomy and radical vaginal hysterectomy (Schauta and Coelio-Schauta procedures), 95 11 Radical hysterectomy and pelvic node dissection, 110 12 Pelvic exenteration, 123 13 Operations on the vulva, 133 14 Operations on the vagina, 146 15 Operations for the correction of urinary fistulae, 162 16 Operations for the correction of infertility, 168 John R. Newton 17 Laparoscopy and other minimal access surgery, 187 18 Management of extrauterine gestation and sterilization procedures, 196 19 Operations for benign ovarian disease, 202 20 Operations for malignant ovarian disease, 207 21 Operations for urinary incontinence, 216 Stuart L. Stanton 22 Operations for prolapse of the uterus and vagina, 238 23 Operative procedures for therapeutic abortion, 253 24 Caesarean section, 257 25 The management of cancers complicating pregnancy, 266 26 Operations on the intestinal tract for the gynaecologist, 272 27 Presacral neurectomy, 283 28 The formation of a urinary diversion, 286 29 The management of injuries to the urinary tract, 294 Index, 301 v Preface to the tenth edition Unfortunately the tenth edition of this famous text has However in spite of all these setbacks, some of which been a little slow in arriving. The pressures on a surgeon are almost medieval in their arbitrariness, surgeons in modern clinical practice have reduced markedly the around the world continue to innovate, inspire and de- time available for ‘extra’ work. As the senior editor I am velop this exciting field for the benefit of their patients. extremely grateful for the contributions made to this Much of the change reflected in the tenth edition is edition by my colleagues Tito Lopes and Raj Naik, a combination of innovation from surgeons working without their assistance this edition would have been closely with the surgical instrument industry. This com- even longer in the gestation. bination has encouraged change and advancement and Surgery remains an art form with a tinge of science out of the difficulties identified above have developed to leaven the advances. Even though we have seen new method of teaching with live demonstrations, ani- enormous advances in the medical treatment of a num- mal work where possible and the use of simulators of ber of conditions previously diagnosed or treated by increasing sophistication. The surgeon continues to surgical means, the role of surgery remains vitally demonstrate that eternal desire to improve. Like all art, important. In many circumstances, particularly in surgery is going through another diffiult phase which gynaecological oncology, gynaecological urology, the we hope can be alleviated by the production of this management of the disordered pelvic floor and of tenth edition which continues to extol the virtues of advanced endometriosis, surgery continues to be the simple minimalistic surgery. mainstay of treatment. I am also grateful for the contribution from Stuart The need to teach surgery remains a high priority but Stanton and John Newton. My thanks to Jane Fallows with a significant reduction in working hours, an in- and Roger Hulley for their contribution to the artwork. crease in the numbers of junior doctors and pressures Rebecca Huxley has kept my nose firmly to the grind- from patients not to be treated as ‘guinea pigs’; gaining stone once we started to move, she certainly has made a weight of surgical experience has become increasing- the difficult phases of this book much easier to negoti- ly difficult. There are now very few countries where the ate; many thanks. teacher can utilise live animals for training. Cadaver experience is also becoming increasingly complex to John M. Monaghan access due to changes in consent rules and personal Whitton Grange privacy laws. 2004 vii Preface to the ninth edition The influence of Victor Bonney and his pupils upon I thought that it was undoubtedly the leading textbook gynaecological surgery has developed from the of gynaecological surgery in the world, but would publication of the first edition of A Textbook of nevertheless benefit from a major revision. I also jok- Gynaecological Surgery in 1911. The first to the fourth ingly said ‘Give me five years and I will do it for you’. editions were the results of the collaboration of Bonney The prompt rejoinder was ‘We will give you two years if with Sir Comynus Berkeley. Following the death of the you will take it on’. Little did I know at the time that I latter, Victor Bonney produced the fifth and sixth had been ‘set up’, as the Americans say. I felt hesitant at editions alone. Bonney’s pupils Howkins and Macleod the prospect of making major changes to such a well- then produced the seventh edition. The death of established book but realized that large-scale changes Macleod signalled virtually the end of those practising were necessary and also that if modern materials and surgeons who had been trained by Victor Bonney. The instruments were to be incorporated, most of the very successful eighth edition was prepared by John drawings would require reworking. Howkins and Sir John Stallworthy. These two great It was also clear that no single surgeon could encom- figures of Commonwealth Gynaecology had worked pass all the skills of modern gynaecological surgery and together as junior colleagues during the last years of that I would need assistance with three major sections. Bonney’s clinical career. I have been delighted with the response and the quality When the eighth edition was published in 1974 many of the contributions from Sir Rustam Feroze, Stuart L. changes were incorporated into the text. However, in Stanton and Professor John R. Newton. I am indebted the next 10 years, an enormous number of new devel- to them. opments have occurred, possibly the greatest being a Victor Bonney had skills far beyond those of mere resurgence of interest in gynaecological surgery and the mortals; to be able to operate to the highest level and then growth and establishment of gynaecological oncology to be capable of transferring those ideas to paper as the as a recognized subspecialty. The present editor has most clear and concise drawings was an amazing talent. only a tenuous link with Victor Bonney in that he has I have been especially fortunate in obtaining the services been greatly influenced in his career by the late Dr A.F. of Mr Douglas Hammersley, once head of graphics at the Anderson of Edinburgh and by Mr Stanley Way, both University of Newcastle upon Tyne, to illustrate all the of whom spoke frequently with great affection and chapters which have been rewritten. Doug has now reverence of the master surgeon.
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