10/20/2019 Bartholin Gland Marsupialization: Overview, Periprocedural Care, Overview of Technique

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Bartholin Gland Marsupialization

Updated: Nov 18, 2015
Author: Tabitha F Perry, MD; Chief Editor: Christine Isaacs, MD more...

OVERVIEW

Periprocedural Care
Anesthesia
The typical anesthesia used for a Bartholin gland marsupialization is procedural sedation, a local
anesthetic alone, or a combination of the two.

A local anesthetic (eg, lidocaine, mepivacaine) should be administered and may minimize
postoperative discomfort. Including a vasoconstrictive agent, such as epinephrine, with the local
anesthetic may be beneficial. Although bleeding is usually minimal for the procedure, this step may
help during those few times when bleeding may otherwise cloud the surgical field. For more
information, see Infiltrative Administration of Local Anesthetic Agents.

The anesthesiologist usually chooses the anesthetic. Depending on body habitus, airway
distortion, or prior history of adverse reactions to anesthesia, the anesthesiologist may decide that
general anesthesia, which requires intubation, may be the best method, and procedural sedation
may be forgone. Given that most marsupializations are relatively quick procedures, this happens
rarely.

Equipment

Equipment needed for the procedure consists of the following [10] :

Scalpel

Pickups/tissue forceps

Sponges (laparotomy or 4 x 4 gauze sponges)

Scissors (Mayo, Metzenbaum)

Allis clamps

Absorbable suture; options and acceptable sizes vary and include the following: Polysorb
(usually 2-0 or 3-0); Vicryl (usually 2-0 or 3-0); Chromic (usually 2-0 or 3-0); and Caprosyn
(usually 2-0 or 3-0).

Culture swab and tube - Optional

Povidone iodine (eg, Betadine) or alternative prep cleanser such as iodine

povacrylex/isopropyl alcohol (eg,DuraPrep)

Foley catheter or straight catheter - Optional

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10/20/2019 Bartholin Gland Marsupialization: Overview, Periprocedural Care, Overview of Technique

Bovie cautery - Optional

Small hemostatic clamps (Criles or Mosquitoes)

Local anesthetic - Optional

Positioning
To ensure proper positioning, care must be taken to place the patient carefully in the lithotomy
position. Stirrup choices include Yellow Fin, Allen, and Candy Cane. Proper positioning for any
type of gynecological procedure is key to prevent unwanted injury to pelvic, buttock, or groin
vasculature or nerve. See the image below.

Lithotomy position

Part of positioning the patient includes draping the patient appropriately. Sterile drapes or towels
must cover unwanted areas while allowing the surgeon adequate exposure to the operative site. A
sterile towel may be placed over the anal area to guard against anal and rectal bacteria.

Complication Prevention

The operative area should be prepared with an antimicrobial solution such as Betadine. Given that
the vulva and vagina are closely linked, a vaginal prep/cleansing should also be performed.
Avoidance of cross-contamination from the anal area is important, since those bacteria are
numerous and can be easily transferred to the vulvar area. If not careful, this can lead to a
postoperative wound infection in women who initially present for marsupialization of a known
uninfected cyst.

Depending on the timeframe between diagnosis and procedure, the patient may have already been
on broad spectrum antibiotics if cellulits was noted or an abscess was suspected. In the case of a
simple Bartholin gland cyst, antibiotics are usually not used.

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