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Mayo Clinic Manual of Pelvic Surgery, 2nd edition
Book Reviews
Book Review
Mayo Clinic Manual of Pelvic Surgery, 2nd edition Edited by Maurice J. Webb Lippincott Williams & Wilkins, Philadelphia, PA, 224 pages, $89.95, 2000
most practicing clinicians would disagree with is “Hysterectomies that can be performed through Pfannenstiel incisions probably should be done vaginally.” The author recommends lower midline incisions for all but the most minor procedures such as ovarian cystectomy, ectopic pregnancy, and cesarean section. The chapter on postoperative care is clear, comprehensive, and well written. It has good practical hints on suprapubic catheter insertion, catheter management, and self-catheterization techniques that could easily be incorporated into nursing protocols. The discussion of nutrition and diabetes management in this chapter were excellent, and perhaps the authors should consider including sample postoperative order sheets in the next edition. Specific descriptions of various surgical techniques are, for the most part, excellent. The reader always has a tendency to think “my way is better,” but the principles elaborated are quite safe and sound. However, I can’t resist suggesting that they try using a Steiner-Auvard long weighted speculum and BreiskyNavratil retractors for vaginal hysterectomies. Sections on indications for surgery are not up to date. This is especially true for the chapter on surgery of the uterus. Of eight indications for D&C listed (including persistent vaginal discharge and investigation of infertility and pelvic pain), the only one I agree with is “when office sampling is not possible.” I especially object to the author’s indications for total abdominal hysterectomy, which include asymptomatic myomas larger than 12 weeks gestational size and benign adnexal masses in postmenopausal women.
This easy-to-read manual is well organized in outline format covering each of the pelvic organs separately. Each chapter is subdivided into clear, concise sections on indications, preoperative investigations, preoperative preparation, surgical technique, postoperative management, and postoperative complications. Also included are detailed chapters on general preoperative and postoperative care, intraoperative and postoperative complications, and an extensive chapter on principles of surgical nutrition. The 156 high-quality gray-scale illustrations unfortunately are not always well labeled. Whereas illustrations in the chapter on abdominal hysterectomy are well sequenced, the very detailed chapter on retroperitoneal surgery has no illustrations. This chapter would especially lend itself to carefully labeled sequential anatomic drawings with accompanying references to steps outlined in the text. Corresponding color plates would also enhance the book. Some illustrations are confusing; for example, Figure 5 on page 11 showing Smead-Jones closure would benefit from the addition of directional arrows tracing the suture path. The first two chapters on preoperative and intraoperative care are, at times, very dogmatic. The author lists preoperative laboratory studies that he states are “the minimum required,” including serum creatinine and glucose levels on all patients over age 40 years, and also suggests blood type and screening for women undergoing D&C and tubal ligation. I personally believe that this is an unnecessary waste of resources and is certainly not the standard of practice in our institution. Another dogmatic statement that I think
Reprinted from the JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS, November 2000, Vol. 7 No. 4 © 2000 The American Association of Gynecologic Laparoscopists. All rights reserved. This work may not be reproduced in any form or by any means without written permission from the AAGL. This includes but is not limited to, the posting of electronic files on the Internet, transferring electronic files to other persons, distributing printed output, and photocopying. To order multiple reprints of an individual article or request authorization to make photocopies, please contact the AAGL.
580
November 2000, Vol. 7, No. 4
The Journal of the American Association of Gynecologic Laparoscopists
weighted toward Mayo Clinic faculty and include very few up-to-date references from other institutions. I had difficulty determining which audience would find this book most clinically useful. Whereas some good basic sections are applicable to residents and general gynecologists in practice, extensive sections are dedicated to procedures that should be performed only by gynecologic oncologists. Only 11 pages at the end of the book address hysteroscopy and laparoscopy— much like an afterthought—yet these topics appear prominently on the cover advertising. The book would be vastly improved if it had a section on laparoscopic or hysteroscopic alternatives in each chapter, with a brief discussion of the specific minimally invasive technique that applies. Laparoscopic hysterectomy is not even mentioned, neither in praise nor damnation. Far more practicing gynecologists are performing laparoscopy and hysteroscopy than are doing bowel anastomoses or plastic reconstruction after radical vulvectomy, both of which are covered extensively. I think this book may have a place in resident instruction and I do recommend it as a good quick reference guide since it contains many practical clinical tips. However, chapters on gynecologic endoscopy are weak, and for it to be useful in resident education, it must be in conjunction with modern manuals on hysteroscopic and laparoscopic surgery.
Also, dysfunctional uterine bleeding should not be listed as an indication for vaginal hysterectomy unless it includes statements indicating that the patient has failed hormone management and is not a candidate for endometrial ablation. The author also lists cervical intraepithelial neoplasia as an indication for vaginal hysterectomy, and in the section on conization of the cervix does not mention loop electrosurgical excision procedure as an alternative. The indications as listed do not reflect American College of Obstetricians and Gynecologists criteria set for these procedures and I suggest they be included in future editions. The chapter on urinary incontinence is weak, with only anterior colporrhaphy, Marshall-MarchettiKrantz (MMK) and paravaginal defect repair discussed. Burch procedure, various sling procedures, and use of tension-free vaginal tape are not even mentioned. The technique described for MMK includes making a 3-cm incision in the dome of the bladder, which is not the widely accepted standard. There is also no discussion of minimally invasive approaches to any of these operations. I think any chapter on stress incontinence should include an extensive discussion of preoperative work-up necessary to determine which procedure is appropriate for the patient. Also inclusion of failure rates of different operations based on current literature is necessary. Of the 16 references, 15 are from the author’s own institution. This list should be updated for future editions to include a broad spectrum of the modern literature. In fact most suggested readings throughout the text are heavily
Mark H. Glasser, M.D. San Rafael, CA
581
Book Review
Mayo Clinic Manual of Pelvic Surgery, 2nd edition Edited by Maurice J. Webb Lippincott Williams & Wilkins, Philadelphia, PA, 224 pages, $89.95, 2000
most practicing clinicians would disagree with is “Hysterectomies that can be performed through Pfannenstiel incisions probably should be done vaginally.” The author recommends lower midline incisions for all but the most minor procedures such as ovarian cystectomy, ectopic pregnancy, and cesarean section. The chapter on postoperative care is clear, comprehensive, and well written. It has good practical hints on suprapubic catheter insertion, catheter management, and self-catheterization techniques that could easily be incorporated into nursing protocols. The discussion of nutrition and diabetes management in this chapter were excellent, and perhaps the authors should consider including sample postoperative order sheets in the next edition. Specific descriptions of various surgical techniques are, for the most part, excellent. The reader always has a tendency to think “my way is better,” but the principles elaborated are quite safe and sound. However, I can’t resist suggesting that they try using a Steiner-Auvard long weighted speculum and BreiskyNavratil retractors for vaginal hysterectomies. Sections on indications for surgery are not up to date. This is especially true for the chapter on surgery of the uterus. Of eight indications for D&C listed (including persistent vaginal discharge and investigation of infertility and pelvic pain), the only one I agree with is “when office sampling is not possible.” I especially object to the author’s indications for total abdominal hysterectomy, which include asymptomatic myomas larger than 12 weeks gestational size and benign adnexal masses in postmenopausal women.
This easy-to-read manual is well organized in outline format covering each of the pelvic organs separately. Each chapter is subdivided into clear, concise sections on indications, preoperative investigations, preoperative preparation, surgical technique, postoperative management, and postoperative complications. Also included are detailed chapters on general preoperative and postoperative care, intraoperative and postoperative complications, and an extensive chapter on principles of surgical nutrition. The 156 high-quality gray-scale illustrations unfortunately are not always well labeled. Whereas illustrations in the chapter on abdominal hysterectomy are well sequenced, the very detailed chapter on retroperitoneal surgery has no illustrations. This chapter would especially lend itself to carefully labeled sequential anatomic drawings with accompanying references to steps outlined in the text. Corresponding color plates would also enhance the book. Some illustrations are confusing; for example, Figure 5 on page 11 showing Smead-Jones closure would benefit from the addition of directional arrows tracing the suture path. The first two chapters on preoperative and intraoperative care are, at times, very dogmatic. The author lists preoperative laboratory studies that he states are “the minimum required,” including serum creatinine and glucose levels on all patients over age 40 years, and also suggests blood type and screening for women undergoing D&C and tubal ligation. I personally believe that this is an unnecessary waste of resources and is certainly not the standard of practice in our institution. Another dogmatic statement that I think
Reprinted from the JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS, November 2000, Vol. 7 No. 4 © 2000 The American Association of Gynecologic Laparoscopists. All rights reserved. This work may not be reproduced in any form or by any means without written permission from the AAGL. This includes but is not limited to, the posting of electronic files on the Internet, transferring electronic files to other persons, distributing printed output, and photocopying. To order multiple reprints of an individual article or request authorization to make photocopies, please contact the AAGL.
580
November 2000, Vol. 7, No. 4
The Journal of the American Association of Gynecologic Laparoscopists
weighted toward Mayo Clinic faculty and include very few up-to-date references from other institutions. I had difficulty determining which audience would find this book most clinically useful. Whereas some good basic sections are applicable to residents and general gynecologists in practice, extensive sections are dedicated to procedures that should be performed only by gynecologic oncologists. Only 11 pages at the end of the book address hysteroscopy and laparoscopy— much like an afterthought—yet these topics appear prominently on the cover advertising. The book would be vastly improved if it had a section on laparoscopic or hysteroscopic alternatives in each chapter, with a brief discussion of the specific minimally invasive technique that applies. Laparoscopic hysterectomy is not even mentioned, neither in praise nor damnation. Far more practicing gynecologists are performing laparoscopy and hysteroscopy than are doing bowel anastomoses or plastic reconstruction after radical vulvectomy, both of which are covered extensively. I think this book may have a place in resident instruction and I do recommend it as a good quick reference guide since it contains many practical clinical tips. However, chapters on gynecologic endoscopy are weak, and for it to be useful in resident education, it must be in conjunction with modern manuals on hysteroscopic and laparoscopic surgery.
Also, dysfunctional uterine bleeding should not be listed as an indication for vaginal hysterectomy unless it includes statements indicating that the patient has failed hormone management and is not a candidate for endometrial ablation. The author also lists cervical intraepithelial neoplasia as an indication for vaginal hysterectomy, and in the section on conization of the cervix does not mention loop electrosurgical excision procedure as an alternative. The indications as listed do not reflect American College of Obstetricians and Gynecologists criteria set for these procedures and I suggest they be included in future editions. The chapter on urinary incontinence is weak, with only anterior colporrhaphy, Marshall-MarchettiKrantz (MMK) and paravaginal defect repair discussed. Burch procedure, various sling procedures, and use of tension-free vaginal tape are not even mentioned. The technique described for MMK includes making a 3-cm incision in the dome of the bladder, which is not the widely accepted standard. There is also no discussion of minimally invasive approaches to any of these operations. I think any chapter on stress incontinence should include an extensive discussion of preoperative work-up necessary to determine which procedure is appropriate for the patient. Also inclusion of failure rates of different operations based on current literature is necessary. Of the 16 references, 15 are from the author’s own institution. This list should be updated for future editions to include a broad spectrum of the modern literature. In fact most suggested readings throughout the text are heavily
Mark H. Glasser, M.D. San Rafael, CA
581