Beyond the Pfannenstiel: Minimally Invasive Incisions for Maximum Exposure

802 Views | Sep 27, 2019

Authors: Elizabeth Miazga, Emma Skolnik, Andrew Zakhari, Emmy Cai, Cleve Ziegler, Ally Murji

Affliations: University of Toronto

Gynecologists are most familiar with the Pfannenstiel and midline incisions for laparotomy. The Cherney and Maylard are two alternative transverse incisions. These are both muscle splitting incisions that retain the advantages of a low transverse skin incision while providing greater exposure to the pelvis. The Cherney separates the tendinous attachment of the rectus muscles to the pubic bone and the Maylard transects the rectus muscle bellies. This video will review the relevant anatomy of the anterior abdominal wall for laparotomy and provide a comprehensive review of the Cherney and Maylard incisions including their detailed surgical steps and the decision making regarding the abdominal incision that is best suited for a given procedure. Finally, we compare their advantages and disadvantages to other laparotomy incisions used for gynecological surgery.