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Comprehensive Guide to Minilaparotomy for Female Sterilization

This session covers key differences in suprapubic and subumbilical procedures, instruments needed, surgery steps, and post-procedure care for female sterilization. Learn about teamwork, instrument trays, and specific steps for the surgery.

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Comprehensive Guide to Minilaparotomy for Female Sterilization

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  1. Tubal Ligation(Female Sterilization)Session IIIE: The Minilaparotomy Procedure

  2. Session Objectives By the end of this session, participants will be able to: • Discuss the key differences between suprapubic and subumbilical minilaparotomy procedures • Describe the tasks and steps of the suprapubic minilaparotomy approach • List the instruments, equipment, and supplies required for different kinds of minilaparotomy procedures • Describe the insertion of the uterine elevator and the skills necessary for its manipulation • Explain the use of the tubal hook to grasp the tubes • Describe the modified Pomeroy method of tubal occlusion • Describe the steps for closing the incision in the abdominal wall

  3. Female Sterilization At which times can a client have the female sterilization procedure? • Interval • Postpartum • Trans-caesarean • Postabortion

  4. Minilaparotomy: Surgical Approaches Source Engenderhealth 2015

  5. Teamwork • Minilaparotomy services require a surgical team that works in close coordination. • To achieve and maintain the needed level of coordinated function, it is important for everyone to be familiar with each member’s role. • The surgeon leads the surgery, opens the abdomen, manipulates the uterus, and accesses and occludes the tubes. • The surgical assistant helps the surgeon to perform the procedure. • The client monitor maintains ongoing assessment of and communication with the client. • The circulating nurse gets supplies as needed and assists in an emergency.

  6. Instrument Tray Used for Performing Minilaparotomy Source Engenderhalth 2003 Instrument tray used for performing minilaparotomy, with Richardson retractors

  7. Instruments Used for the Minilaparotomy Procedure (1) Allis forceps Source Engenderhealth 2017

  8. Instruments Used for the Minilaparotomy Procedure (2) Babcock forceps Toothed forceps Nontoothed forceps

  9. Instruments Used for the Minilaparotomy Procedure (3) Blade handle Mayo scissors Artery forceps, straight

  10. Instruments Used for the Minilaparotomy Procedure (4) Stitch scissors Needle holder

  11. Instruments Used to Insert the Uterine Elevator Sponge-holding forceps Tenaculum Source Engenderhealth 2017 Uterine elevator Gallipot

  12. Retractors Used in the Minilaparotomy Procedure Richardson-Eastman retractors Source: Adapted from Engenderhealth 2003 Army-Navy retractors Source Engenderhalth 2017

  13. Instruments Specific to Suprapubic Minilaparotomy Source: Engnederhealth 201

  14. Suprapubic Minilaparotomy Procedure—Steps and Tasks • Preprocedure assessment steps • Inserting the uterine elevator • Preparing the abdomen • Entering the abdomen • Accessing and delivering the tubes • Occluding the tubes • Closing the abdomen • Postprocedure tasks

  15. Preprocedure Assessment Steps In the preprocedure room: • Greet the client • Review relevant medical information • Verify informed consent • Verify the client’s understanding of the procedure • Check compliance with preoperative instructions • Provide sedative and analgesic • Take vital signs • Ask the client to empty her bladder just before entering the operating theater Source Engenderhealth 2015

  16. Assisting the Client onto the Operating Table Source Engenderhealth 2015

  17. Positioning the Client for Suprapubic Minilaparotomy (a) Dorsal lithotomy position (b) Dorsal supine position Source Engenderhealth 2015

  18. Insertion of the Uterine Elevator Bimanual pelvic examination of a normal anteverted uterus Instruments used for insertion of the uterine elevator

  19. Preferred Antiseptics for Preparing the Skin and Vagina • Iodophors, such as povidone iodine (e.g., Betadine) • Chlorhexidine gluconate (e.g., Hibiclens, Hibitane, or Hibiscrub)

  20. Insertion of the Uterine Elevator (cont.) (b)Passing the uterine elevator into the cervix without letting it touch the vaginal walls a)Using a Graves speculum to visualize the cervix Source Engenderhealth 2015

  21. Preparation of the Client’s Abdominal Wall a) Set up of instruments and related supplies b} Preparing the client’s abdominal wall Uterine elevator is not shown Source: EngenderHealth 2015

  22. Cleansing the Client’s Abdominal Wall

  23. Draping the Client Source Engenderhealth 2015

  24. The Sterile Field Positioning of the surgical team Establishing the sterile field Source Engendehealth 2015

  25. Infiltrating the Incision Site with Local Anesthesia b) Suprapubic minilaparotomy: the incision site a) Drawing local anesthetic from the vial (held by the circulating nurse) Source Engenderhealth 2015

  26. Infiltration with Local Anesthetic Field block using the diamond-shape technique Field block using the fan-shape technique OR

  27. Skin Infiltration with Local Anesthetic

  28. Entering the Abdomen a) Making the skin incision b) Grasping the fascia

  29. Entering the Abdomen(cont.) Opening the fascia Dissecting the fascia Note: While two Allis forceps are needed here, only one is shown in the figure, for clarity.

  30. Entering the Abdomen: Exposing the Rectus Abdominis and Pyramidalis Muscles

  31. Rectus Abdominis Muscle Exposed

  32. Entering the Abdomen: Opening the Rectus Muscles

  33. Repositioning the Retractors to Expose the Extraperitoneal Fat

  34. Entering the Abdomen: Exposing and Opening the Peritoneum

  35. Foot of the Operating Table Is Raised to Achieve a Head-Down Trendelenburg Position Source : EngenderHealth, 2014

  36. Accessing and Delivering the Tubes

  37. Viewing the Fundus and Anesthetizing the Fallopian Tubes (a) Viewing the uterine fundus through the incision (b) Dripping lidocaine over the tubes

  38. Client Monitoring

  39. Accessing the Tubes a) Rotating the uterus to position the tube at the incision site b) Grasping the tube with a baby Babcock forceps

  40. Visualizing the Fimbriated End of the Tube

  41. Use of the Tubal Hook to Retrieve the Tubes (a) The tubal hook is inserted behind the fundus and is swept around one side of the uterus. (b) The tubal hook is pulled horizontally and out through the incision.

  42. Use of the Tubal Hook to Retrieve the Tubes (2) (a) The fallopian tube is brought to the incision

  43. Holding the Tube with the Baby Babcock Forceps

  44. Confirming the Identity of the Tube • Hold the tube while releasing the uterine elevator. (b) Pull the tube further out of the incision.

  45. Confirming the Identity of the Tube (cont.)

  46. Tubal Occlusion Modified Pomeroy technique: After transfixing a suture in the mesosalpinx, tie a side of the tube, and then the other side of the looped tube with a square knot and cut the upper portion of the loop above the ligature

  47. Steps in the Modified Pomeroy Technique (b) Tying a square knot around the proximal side (a) Transfixing the suture

  48. Steps in the Modified Pomeroy Technique (cont.) (d) Loop of the fallopian tube with both sides of the tube ligated (c) Tying the distal side

  49. Ligation of the Fallopian Tube

  50. Excision of the Tube (a) Excision of the proximal side of the tube (b) Excision of the distal side of the tube

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