Anatomy of O&G Surgical Incisions

Question 1

What are the common surgical incisions in O&G

Answer 1

Lower segment caesarean section Laparotomy Abdominal (and vaginal) hysterectomy Laparoscopy

Question 2

What lines should be used to guide incision if possible?

Answer 2

Langer lines

Question 3

The external obliques attach between lower ____ and ____ _____, ____ tubercle and ____ ____.

Answer 3

The external obliques attach between lower ribs and iliac crest, pubic tubercle and linea alba.

Question 4

What is the linea alba

Answer 4

Midline blending of aponeuroses Runs from the xiphoid process to the pubic symphysis

Question 5

In which direction to external oblique fibres run in?

Answer 5

Same direction as intercostals

Question 6

Where do the intercostals attach?

Answer 6

Between lower ribs, thoracolumbar fascia, iliac crest and linea alba

Question 7

Where does the transverses abdomens attach?

Answer 7

Between lower ribs, thoracolumbar fascia, iliac crest and linea alba

Question 8

Describe the structure of the rectus abdominis

Answer 8

Has tendinous intersections which divide each rectus abdominis into 3 or 4 smaller muscles Improved mechanical efficiency

Question 9

Where does the rectus sheath lie?

Answer 9

Immediately deep to the superficial fascia

Question 10

What is the rectus sheath?

Answer 10

Combined aponeurosis of anterolateral abdominal wall muscles

Question 11

What does the rectus sheath surround?

Answer 11

Rectus abdominis muscles

Question 12

When undertaking a suprapubic incision e.g. for LCSC, only the ______ rectus sheath will be cut

Answer 12

When undertaking a suprapubic incision e.g. for LCSC, only the anterior rectus sheath will be cut

Question 13

Why is the rectus sheath stitched closed?

Answer 13

After operation to increase the strength of the wound and reduce the risk of wound complications

Question 14

In what direction does the nerve supply to anterolateral abdominal wall enters from?

Answer 14

Lateral direction

Question 15

What do the 7th to the 11th intercostal nerves become?

Answer 15

Thoracoabdominal nerves

Question 16

What nerve is subcostal nerve

Answer 16

T12

Question 17

What nerve is the iliohypogastric nerve?

Answer 17

L1

Question 18

What nerve is the ilioinguinal nerve?

Answer 18

L1

Question 19

In what plane do the thoracoabdominal nerves travel in?

Answer 19

Between internal oblique and transversus abdominus

Question 20

What is the blood supply to anterior abdominal wall?

Answer 20

Superior epigastric arteries Inferior epigastric arteries

Question 21

The superior epigastric arteries are a continuation of the ______ ______. They emerge at _______ aspect of abdominal wall and lie _______ to the rectus abdominis.

Answer 21

The superior epigastric arteries are a continuation of the internal thoracic. They emerge at superior aspect of abdominal wall and lie posterior to the rectus abdominis.

Question 22

The inferior epigastric arteries are a branch of the ______ _____ _____. They emerge at _______ aspect of the abdominal wall and lie _______ to the rectus abdominis.

Answer 22

The inferior epigastric arteries are a branch of the external iliac artery. They emerge at inferior aspect of the abdominal wall and lie posterior to the rectus abdominis.

Question 23

What is the blood supply to the lateral abdominal wall?

Answer 23

Intercostal and subcostal arteries

Question 24

What are the internal and subcostal arteries continuations of?

Answer 24

Posterior intercostal arteries

Question 25

Where do the internal and subcostal arteries emerge

Answer 25

Lateral aspect of abdominal wall

Question 26

How can damage be minimised when incising muscle?

Answer 26

Incise in the same direction as muscle fibre Avoid damaging nerves and interrupting blood supply

Question 27

In a LSCS incision the rectus muscles are ___ \_\_\_, instead they are _____ from each other in a ______ direction. Moving them towards their _____ \_\_\_\_.

Answer 27

In a LCSC incision the rectus muscles are not cut, instead they are separated from each other in a lateral direction. Moving them towards their nerve supply.

Question 28

What layers are seen when opening in LSCS?

Answer 28

* Skin and fascia (anterior) * Rectus sheath * Rectus abdominis – separate the muscles laterally * Fascia and peritoneum * Retract bladder (a urinary catheter is usually already inserted) * Uterine wall * Amniotic sac

Question 29

What layers are stitched closed after LSCS incision?

Answer 29

Uterine wall with visceral peritoneum Rectus sheath Fascial layer if increased BMI Skin

Question 30

What are the layers when opening for laparotomy?

Answer 30

Skin and fascia Linea alba peritoneum

Question 31

What layers are stitched closed after laparotomy?

Answer 31

Peritoneum and linea alba fascia (if increased BMI) skin

Question 32

What is a laparotomy?

Answer 32

Vertical midline incision

Question 33

Why is healing of a laparotomy not as good?

Answer 33

Relatively bloodless Can mean that healing is not as good Increases the chance of wound complications *e.g. dehiscence, incisional hernia*

Question 34

If a lateral port is required in a laparoscopy what must be ensured?

Answer 34

that the inferior epigastric artery is avoided

Question 35

How can position of uterus be manipulated in laparoscopy?

Answer 35

Grasping the cervix with forceps

Question 36

Where is the inferior epigastric artery?

Answer 36

Emerges just medial to the deep inguinal ring - deep inguinal ring located halfway between the ASIS and pubic tubercle Then passes in a superomedial direction, posterior to the rectus abdominis

Question 37

How can the ureter be differentiated from the uterine artery?

Answer 37

The ureter passes inferior to the artery- water under the bridge The ureter will vermiculate when touched