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It is in the surgical aspect of their specialty that the gynecologists' work may be most frequently judged by their peers or by the litigious society that currently exists. Great and commendable progress has been made over the past 30 years in the basic scientific, endocrinologic and obstetric aspects of the specialty, but this has occurred with a commen surate de-emphasis of surgical procedures and surgical training, a decline in devotion to technical detail and perfection, and a tendency to take surgery for granted. Obstetric and gynecologic residency programs provide increasing numbers of specialists with average competence in the performance of the common, rather standardized gynecologic operations. In general, technical skill in the extirpative operations can be acquired far more readily than proficiency in the art of reconstructive surgery. At present, for a number of reasons, gynecologic surgical training is most deficient in regard to the surgical correction of severe forms of obstetrically damaged genital tract supports. The operations for pro lapse defy standardization and require great technical individualization; this must be based on the surgeon's judgment developed through expe rience, a thorough understanding of normal pelvic anatomy, and recog nition of the deficiency responsible for the prolapse in individual cases.
E-Book Content
Robert E Zacharin
Pelvic Floor Anatomy and the Surgery ofPulsion Enterocoele With a Foreword by
Richard E. Symmonds
Mayo Clinic
Springer- Verlag Wien GmbH
Robert F. Zacharin, M.G.O. (Melb.), F.R.C.S. (Eng.), F.R.C.O.G., F.R.A.C.S., F.R.A.C.O.G.
Gynecologist in Charge, Department of Gynecology, Alfred Hospital, Melbourne, Australia
The use of registered names, trademarks, etc. in the publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting pharmaceutical literature. This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re·use of illustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks.
© 1985 by Springer-Verlag Wien Originally published by Springer- Verlag Wien New York in 1985 Sof'tcover reprint of the hardcover 18t edition 1985
With 75 partly coloured Figures
Cover design: Joachim Boning, Vienna, Austria Frontispiece: Routes of dispersion of intraabdominal pressure in the erect human. The key role of the lumbo-sacral joint is emphasized, and also that of the bony pelvis and sacrum. Levator ani is indicated by the darkened triangular area in the pelvic floor.
Library of Congress Cataloging in Publication Data: Zacharin, Robert Fyfe. Pelvic floor anatomy and the surgery of pulsion enterocoele. l. Uterus-Prolapse-Surgery. 2. Generative organs, Female-Anatomy. 3. Gynecology, Operative. I. Title. [DNLM: l. Genitalia, Female-anatomy & histology. 2. Hernia-surgery. 3. Uterine Prolapse-surgery. 3. Uterine Prolapse-surgery. WP 250 ZI6pJ RG36l.Z33 1985.618.1'44.85-17268
ISBN 978-3-7091-4077-2 ISBN 978-3-7091-4075-8 (eBook) DOI 10.1007/978-3-7091-4075-8
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