Total Abdominal Hysterectomy
Objective
In case of :
• Tumor
or bleeding
• Removal
of the entire uterus through an abdominal incision.
Position
Supine.
Anesthesia
General.
Procedure
1. A Pfannenstiel, vertical, midline, or
paramedian incision is employed.
2. The peritoneal cavity is entered, and a
self-retaining retractor is placed.
3. The patient is placed in Trendelenburg
position.
4. Intestines are protected with warm moist
packs.
5. Sutured and tagged with hemostat after
indentifying the ureters.
6. Broad ligaments are incised.
7. Bladder is reflected from the anterior
aspect of the cervix.
8. Infundibulopelvic ligaments are ligated
and divided.
9. Vagina is incised circumferentially and
the uterine specimen removed.
10. Hemostasis is secured.
11. Vaginal cut is closed; a drain may be used.
12. The pelvic peritoneum is approximated, and
the wound is closed.
Instrument
• General
set
• Laparotomy
set
• Balfour
self-retaining retractor with Doyen blades (Fig. 8.100)
• Suprapubic
retractor Doyen (Fig. 10.15)
• Long
heavy scissors (10 in) (Fig. 10.6)
• Vulsellum
(Teale) (Figs 10.3 and 10.4)
• Utrine
dressing forceps (Fig. 10.24)
• Artery
forcep curved (8 in) Mayo 10
• Osehner
or Kocher Artery forcep
curved
(8 in) Mayo 6 (Fig. 8.32)
• Osehner
or Kocher
Any questions be sent to drmmkapur@gmail.com
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