1 / 16

Vaginal Hysterectomy

Vaginal Hysterectomy. Kaidy Waterman & Emily Beacham. Anatomy and Physiology. Removal of uterus Possible removal of fallopian tubes and ovaries Ligature of uterosacral ligaments Ligature of cardinal ligaments Ligature of uterine arteries

gerodi
Download Presentation

Vaginal Hysterectomy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Vaginal Hysterectomy Kaidy Waterman & Emily Beacham

  2. Anatomy and Physiology • Removal of uterus • Possible removal of fallopian tubes and ovaries • Ligature of uterosacral ligaments • Ligature of cardinal ligaments • Ligature of uterine arteries • Possible ligature of round ligament, ovarian ligament and fallopian tubes

  3. Reasons for Procedure • Sterilization • Endometriosis • Fibroids • Cancer • Adhesions • Uterine prolapse • About 1/3 of all hysterectomies are done vaginally • Doctors prefer vaginal because it is less invasive • Laparoscopically assisted vaginal hysterectomies are becoming much more common

  4. General Details Anesthesia and Positioning Skin Prep and Draping Vaginal prep Lithotomy drape • Anesthesia is general • Patient is in lithotomy position • Candy cane stirrups

  5. Supplies, Equipment and Instruments • Auvard weighted speculum • Heaney/Deaverretracters • Tenaculum/Laheyvulsellum • #15 blade • #7 knife handle • 4X4 sponges • Peri-Pad • Heaney clamps • Mayo scissors • Long mayo • Kelly clamps • Schnidt • Pean • Jacob’s vulsellum • Foley catheter • Vag packing

  6. Special Considerations • Careful with catheterization after the procedure • Care must be taken not to damage the fallopian tubes or ovaries if they are going to remain in the body

  7. The Procedure

  8. TIME OUT • Auvard weighted speculum is placed in the posterior vaginal wall • Heaney or Deavers retract the lateral vaginal walls • Tenaculum/Lahey placed at the edge of cervix to permit traction and movement. • D&C may be performed here

  9. #15 blade on #7 handle, incise vaginal wall anteriorly around cervix • Blunt dissection, index and middle finger with 4X4, free bladder from anterior surface of the cervix • Deaver is placed anteriorly to elevate the bladder • Protects bladder • Visualization of peritoneum and anterior cul-de-sac

  10. Use #15 knife blade, opening is made in the cul-de-sac • Peritoneum of posterior cul-de-sac is identified and incised with #15 • Uterosacral ligaments are doubly clamped with Heaney clamps, cut with Mayo and ligated. • Ligatures are not cut-left long and tagged with kelly

  11. Manipulate uterus posteriorly, cardinal ligaments on each side are doubly clamped and cut with Mayos and ligated • Same is done with uterine arteries except the clamps are Kelly, Schnidt, or Pean • Fundus is put into the vaginal canal with previously placed tenaculum/Jacob’s vulsellum

  12. If ovaries are preserved: • Round ligament • Ovarian ligament • Fallopian are doubly clamped with Heaney clamps, cut with mayo • Uterus is removed • Pedicles of the ligaments are ligated

  13. Peritoneum between rectum and vagina is approximated with a continuous absorbable suture • Cul-de-sac is closed by placing sutures from vaginal wall through infundibulopelvic and round ligaments and back out through the vaginal wall, tied down on the vaginal portion of the vault • Round, uterosacral, and cardinal ligaments are individually approximated and reattached to the angle of the vagina • Foley catheter is placed, vagina is packed, perineal pad is placed.

  14. Postoperative Care Complications Care and Prognosis Transport to PACU Return to normal activities • Bowel obstruction or damage • Bladder injury • Wound infection of dehiscence • Ureteral injuries • Hemorrhage

  15. Pearl of Wisdom Some surgeons complete actions on one side of the uterus then move to the other side; some alternate sides as they move caudally. The STSR must adjust to the pattern and be sure to have an adequate supply of homeostasis.

  16. http://www.lumitex.com/gynecology.html

More Related